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Inspection on 24/01/07 for The Firs Nursing Home

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

This inspection was carried out on 24th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

What the care home does well

Service users are accommodated in a homely environment that is clean and warm. The staffing level is sufficient to meet the care needs of the service users. The personal and professional qualities of the nursing and care staff on duty gave service users comfort with a good standard of care delivery.

What has improved since the last inspection?

The registered provider has ensured the service user guide has been updated and is available to service users in the home. The complaints procedure has been reviewed and now meets the national minimum standard. The registered manager has developed and introduced two new staff posts. Two new carer mentors have been recruited into the home along with a senior carer. Staff have attended accredited training on person centred care however there was no direct evidence that this has been introduced.

What the care home could do better:

The whole process of care planning needs to be reviewed and improved. The care plans have become task orientated and do not reflect the current state of the service user or how their needs are being met.The overseas staff need to be encouraged to be more proactive and talk to the service users at all times. The registered manager should continue to look at ways of improving the service delivery through use of appropriate quality monitoring tools.

CARE HOMES FOR OLDER PEOPLE The Firs Nursing Home 251 Staplegrove Road Taunton Somerset TA2 6AQ Lead Inspector Stephen Humphreys Unannounced Inspection 24th January 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Nursing Home Address 251 Staplegrove Road Taunton Somerset TA2 6AQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 275927 01823 336463 Care West Country Limited Kathleen Anne Vound Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Elderly persons of either sex, not less than 60 years, who require general nursing care Up to six places for personal care. Date of last inspection 14/06/06 Brief Description of the Service: The Firs Nursing Home is located in a residential area approximately one mile from Taunton town centre. The home fronts onto the busy Staplegrove Road and is close to a local pub and Staplegrove Village Hall. Access to the home is via the large car park to the side of the property. The home is registered to take up to a maximum of 37 elderly persons (aged over 60years) who require general nursing care; six places are registered for persons who need personal care only. The registered provider is carrying out major refurbishment work of the home. The refurbishment includes upgrading bedrooms in the present home along with communal areas. The final phase will include building ten new bedrooms that will overlook the garden area. Once completed all the bedroom accommodation will have an ensuite facility including shower. Accommodation is over two floors with communal rooms on each floor. Bedrooms on the first floor are accessed by a 4-person/300Kg lift. A registered nurse supervises the staff team on duty twenty fours a day. The registered nurse’s are all experienced in nursing older persons. Care staff are experienced and receive appropriate training to deliver personal care to service users. The home also has catering, housekeeping and maintenance staff. A deputy and an administrator support the registered manager. The current fees charged are from £465 to £535 per week The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second key inspection carried out by an inspector from the Commission for Social Care Inspection using the Inspecting for Better Lives methodology. The site visit was carried out over one day from 09:15 – 13:00. The inspector has sent survey questionnaires to visiting health and social care professionals to get their views on the quality of care delivered in the home. Since the last key inspection two random inspections were carried out at The Firs. The triggers for the random inspections were to monitor the progress of the home in meeting the requirements of the Care Homes Regulations 2001. The outcomes of the two random inspections were positive although progress on meeting the requirements was slow and did not meet the agreed timescales. At the time of this inspection the registered manager Miss K. Vound was in the home and available during the day. A senior manager from Care West Country Ltd was also in the home assessing progress on the internal action plan outcomes. The Firs nursing home is registered for a total of 37 places for older persons, at the time of this inspection there were 17 residents being accommodated. The registered provider has started a complete refurbishment of the home to include larger bedrooms with en-suite facilities and bathroom / shower rooms for service users. The lounge and dining areas will be extended. The project is expected to take approximately six to nine months to complete. During this time the registered provider has taken the decision not to admit any new residents. During the site visit the inspector had discussions with service users, staff, the registered manager, did a tour of the environment and a review of all the statutory records. A least four of the service users were unable to communicate verbally, however the inspector spent time in the lounge observing staff interactions with the service users. The inspector concluded that the service users care needs were being met satisfactorily. The staff on duty in the home were mainly overseas staff. They were observed to communicate effectively with service users who could verbalise and were sensitive to the needs of service users who were not able to verbalise. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The whole process of care planning needs to be reviewed and improved. The care plans have become task orientated and do not reflect the current state of the service user or how their needs are being met. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 7 The overseas staff need to be encouraged to be more proactive and talk to the service users at all times. The registered manager should continue to look at ways of improving the service delivery through use of appropriate quality monitoring tools. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. No service users are admitted without a needs based assessment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the refurbishment programme the registered provider has decided not to accept any new service users into the home. Therefore no new service users have been admitted since before June 2006. The inspector has reviewed the pre-admission care need assessments at a previous visit. The assessments are detailed however the admission is process driven and not particularly person centred. It is hoped that the registered manager will review the needs based assessment model to reflect a person centred care model when new admissions take place. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 10 Staff have the experience and skill to care for the service user group admitted into the home. At the last random inspection the inspector was able to review the revised and updated service user guide. The document had been completed and is being produced in large print. The service user guide will now be distributed to all current service users and then to prospective service users. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. The variable practice regarding the planning and delivery of care means that all services users cannot be sure that their health and personal care needs will be fully met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each service user has a care plan however there was no evidence of involving the service user or their representative. The significant finding was that the care plans were not reflective of the current state of the service user and they were not working tools. The findings indicated that the care delivery was based on a task orientated philosophy and not person centred. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 12 The care plan documentation is specific and detailed. The care plan would be very comprehensive if completed correctly. None of the care plans reviewed were up to date or had been evaluated. The care needs had not been evaluated for six months in some cases. The daily report did not reflect the care delivery as recorded in the interventions. In the main the interventions did not provide a pathway to an outcome. Two care plans identified the service users as having a wound and one care plan recorded “to provide a healthy diet”. There was no record of progress or regress, however there was a brief description kept in a dressing book. It is good practice to keep all the information in one working plan. The inspector was disappointed with the standard of the care plans as advice on how to make them into a working tool was provided at the last random inspection. The registered manager is considering the introduction of new care planning documentation that will help to make them a working record. General issues about improving the care plans was discussed with the senior nurse and the registered manager at the feedback session. During a tour of the home the inspector observed appropriate monitoring charts in the service users room, and each time a care need had been carried out it was recorded. The monitoring charts recorded all food and fluid intake. A record of when the service user was turned was also being kept. The inspector was able to have discussions with two residents whose care plans were reviewed to verify the delivery of care. All the care plans reviewed contained a needs based assessment and other assessments included continence, nutrition, tissue viability and moving & handling. However these were not recent assessments therefore changes may have occurred to the service users that have not been recorded. Staff must ensure the care plan is reflective of current needs as reliance on awareness does not ensure the safety of the service user. Records of other professional’s visits were dated and the entry described the reason for the visit. A record of when the optician and chiropodist had visited was seen. The medication procedure including storage, receipt, disposal and administration was checked. The local pharmacist carried out a medicines inspection on 1st March 2006 and found no problems. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 13 The storage of the medicines is safe and receipt and disposal records completed. Staff were observed to treat service users with respect and dignity by the inspector. Service users said they were happy with the staff and the care in the home. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. A limited range of activities within the home and community mean the service users do not have a range of opportunities to participate in stimulating and motivating activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff are aware of the need to plan the routines of the day and activities that meets the wishes of the service users. However there was no visible evidence of this occurring. Service users were sitting in the lounges on the ground and first floor. Those on the first floor had a television on but were not really watching it. Service users in the ground floor lounge received stimulation during the activities but very little after. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 15 During the time spent on site the inspector spent a considerable length of time observing staff interaction with service users, speaking to service users, staff and management. When staff interacted with service users the majority was task orientated for example when someone needed the toilet or someone was given a cup of tea. There were long periods where service users were not spoken to however the carers were in the lounge offering and prompting service users to take a drink. The most interactions observed between service users and staff occurred during the serving of lunch. Staff carried out this interaction sensitively and respectfully. Two service users commented that the food was generally good. One service user said there is always a snack and drinks available. Service users rooms are personalised with small furnishings, photos and entertainment media. One service user attends a social club in the local community. Transport to and from the centre is arranged for them. All service users confirmed that their relatives visited and no restrictions were put on them. An activities co-ordinator is in post for two / three hours each afternoon and a carer is being employed to assist with activities five days per week. Activities are based on the individual’s capabilities however these were not evidenced in the service users care plan. The Firs is a small nursing home and staff feel that they get to know the individual service users likes and dislikes. This reflects the practices in the home and little importance placed on person centred care planning. . The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. The registered manager takes all complaints seriously. Service users can be assured that they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the complaints procedure at the last random inspection. The procedure is now robust and displayed in the home. No other improvements were noted at this visit. The staff on duty during this visit have been employed in the home for a considerable time and are aware of the whistle blowing procedure and the action to take if an incident of abuse occurred. The inspector spoke to one of the new members of staff whilst in the home. Staff said they had received a good induction training period and were aware of the vulnerable adults procedure. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. Service users accommodation is homely and equipment suitable to meet the nursing needs of all service users is available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A major refurbishment of all bedrooms and lounges is taking place that will include building ten new bedrooms. This programme is expected to take up to twelve months to complete. The contractors are working so that there is minimal disruption to current service users. Following a requirement at the last random inspection the contractors now ensure that the areas in which they are working are left safe. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 18 The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Service users can be assured that competent and skilled staff will meet their care needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The nurses and carers spoken to said there are usually four staff on duty during the day and three in the evening and three waking staff at night. Duty rotas received from the registered manager confirmed this. The registered manager has recruited new staff since the last random inspection, which has helped to reduce the level of agency staff, used. The recruitment procedure was reviewed at the last inspection and remains robust. Nurses and carers spoken to appeared to understand their individual roles and responsibilities. Generally staff felt they all work together as a team. Apart from the statutory training the registered manager is arranging for staff to receive appropriate training to meet the needs of the client group. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 20 The inspector saw the staff files of newly recruited staff at the last random inspection. Service users commented that they felt safe and were happy with the staff. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33,38 Quality in this outcome area is adequate. The home is generally run in the best interests of the service user however during the refurbishment of the home service users are restricted to the amount of flexibility available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager works to continuously improve services and quality for service users. Since the last inspection the registered manager has been supported by the organisations operations manager and now has a deputy manager in post. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 22 Service users can be assured that the homes management is effective and safe. There are formal processes for internal quality assurance that includes accident audits, however this could be improved by ensuring risk assessments are developed concurrent to the accident report. The issues of quality monitoring were discussed with the registered manager at the time of this visit. The quality assurance system will be reviewed at the next inspection. The frequency of staff supervision has fallen over recent months due to recruitment problems necessitating the registered manager and senior nurses to work more in a hands-on position. The registered manager confirmed that following the recruitment of the new formal staff supervision is taking place. Since the last inspection the registered manager and deputy have received appropriate guidance and training to carry out the formal supervision. Once established the above will contribute to the overall improvement of service delivery in the home and identify specific areas of personal development for staff members. Records examined during the inspection were stored appropriately in order to maintain resident confidentiality. Since the last inspection the bed rails in use are now numbered and checked weekly to ensure safe fitting, this is a good practice. Records checked included the fire logbook, gas boiler safety certificate, Portable appliance tests, passenger lift and hoist service records. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 3 The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 24 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 OP7 Regulation 15(1)(a)( b) (1) Timescale for action Unless it is impracticable to 25/03/07 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. Requirement (2) The registered person shall— (a) make the service user’s plan available to the service user; keep the service user’s plan under review; This refers to the need to ensure a detailed care plan that reflects the service users present care needs and evidences their involvement. The care plan must be reviewed monthly to record the care outcome. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 25 2 OP8 12 (1)(a) (1) The registered person shall ensure that the care home is conducted so as— 25/03/07 (a) to promote and make proper provision for the health and welfare of service users. This refers to the need to ensure all treatments such as wound care are recorded in the service user care plan and that specialist professional advice is requested to ensure appropriate treatment. 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 Refer to Standard OP3 OP7 Good Practice Recommendations The registered manager should review the needs based assessment to make it more person centred by identifying the strengths and weaknesses of the service user . The registered manager should review current practices when developing the service users care plan to ensure it becomes person focused to include social care needs to make it a working record. The registered manager should ensure the service users care plan is kept up to date with monthly reviews of care needs. The registered manager should carry out regular care plan audits as a measure of the ability of the care plan record to reflect the service users current state. 3. OP12 The registered manager should ensure that social care needs are included in the service users care plan. DS0000003297.V321416.R01.S.doc Version 5.2 Page 26 The Firs Nursing Home 4. OP33 The registered manager should continue to improve the quality assurance process and develop appropriate action plans to measure the service delivery. The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Firs Nursing Home DS0000003297.V321416.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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