Inspection on 27/11/08 for The Firs Nursing Home

This inspection was carried out on 27th November 2008.

CSCI found this care home to be providing an Good 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 17/12/07

The Firs Nursing Home 24/01/07

The Firs Nursing Home 14/06/06

The Firs Nursing Home 04/10/05

The Firs Nursing Home 13/04/05

The Firs Nursing Home 15/10/04

The Firs Nursing Home 18/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Firs Nursing Home 251 Staplegrove Road Taunton Somerset TA2 6AQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Barbara Ludlow     Date: 2 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Firs Nursing Home 251 Staplegrove Road Taunton Somerset TA2 6AQ 01823275927 01823336463 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Care West Country Limited Name of registered manager (if applicable) Kathleen Anne Vound Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 37 The registered person may provide the following category of service only: Care home with nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home 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 car park to the side of the property. The home is registered to take up to a maximum of 37 older people who require general nursing care; eight places are registered for persons who need personal care Care Homes for Older People Page 4 of 31 care home 37 Over 65 37 0 Brief description of the care home only. The registered provider has carried major refurbishment work at 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. 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 four hours a day. The registered nurses 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 £390.00 to £602.80p per week (£499.00 plus the Free Nursing Care payment). The fees do not include extras such as hairdressing. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was undertaken by one inspector for the Commission for Social Care Inspection (CSCI) and an Expert by Experience from Help the Aged. The inspection was well received and staff and management welcomed the inspector and the expert by experience into the home. There were twenty five people in residence and a registered nurse and four care staff were on duty. The manager was also on duty and the company group coordinator made a visit to the home. The inspector toured the premises, spoke with staff and people living at the home. Records were sampled and people were case tracked for inspection purposes, this Care Homes for Older People Page 6 of 31 includes looking at care plans and the pre admission assessment processes and the outcomes for people coming to live at the home. The expert by experience also looked around the home and met with people living at here. They spent time chatting with people and staff and observed daily life at the home. The lunchtime experience was also observed. The home manager had completed an Annual Quality Assurance Assessment (AQAA) for the commission and this had been received by the inspector and examined prior to the inspection visit. Questionnaires were sent from the commission to the home for people living at the home and for staff to complete for their views on aspects of care and of working at the home. Seven questionnaires were returned by people living at the home, four people had received help from their families with the completion of their forms. Feedback was given after lunch by the expert by experience and at the close of the visit by the inspector. The experts report is quoted directly in the body of the report. Extracts and figures from the comments received on the questionnaires are also included in the report. The inspector would like to thank the people living at the home, the staff and the management team for the time and input given towards the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. Care Homes for Older People Page 8 of 31 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this 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 home offers a good range of information to help people make an informed decision when choosing this home. People are issued with a contract. The breakdown of costs for private nursing care could be clearer. Pre admission assessment is thorough. Evidence: The service has a range of information available to prospective people to inform them about the service available at The Firs Nursing Home. The home has a Statement of purpose, a Service User Guide and brochures which would be sufficient to enable people to make an informed choice of care home. These documents were seen to be available in the homes entrance hall for visitors. On display in the hall is the care homes CSCI certificate of registration. Care Homes for Older People Page 11 of 31 Evidence: Contracts were sampled for the whole range of residential services offered. These included residential care, continuing health care and nursing care. The contracts for people who are privately funded should be clearer about the free nursing care funding which is paid by the primary care trust (PCT) to the home. This money is kept by the home and is added to the fee rate charged at 499 pounds per week, the actual cost of care is then 602 pounds 80 pence per week. There are charges made at cost for extras such as hairdressing. A Pre admission assessment would be undertaken by the registered manager or a senior nurse from the home to ensure care needs can be met. Four care plans were sampled at the inspection these included more recent admissions to the home. There was information from the hospital regarding care and discharge information and there was a copy of the Single Assessment Process document (SAP) on each file. The manager had undertaken the assessments and all relevant information had been collected and recorded to inform the persons care planning on their admission to the home. People completed questionnaires for the commission, seven were returned and these indicated that all had received a contract , six said they received enough information before coming into the home to decide it was the right place for them, one said no. Seven people responded that they always receive the care and support they need. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are treated with respectfully by all staff. Everyone has a detailed care plan, these could be more person centered in style. The personal and nursing care is delivered to a good standard by trained and experienced registered nurses and care staff. Medications are safely administered. The monitoring and maintenance of the medications fridge requires attention. Evidence: At this inspection there were twenty five people in residence. Fourteen people receiving nursing care and eleven people receiving personal care only. Four care plans were sampled, these care plans were selected as part of the case Care Homes for Older People Page 13 of 31 Evidence: tracking part of the inspection process. One recent admissions file was selected for examination of the admission process. The care plans had photographic identification and personal details records including the name of the next of kin and some social history. All pre admission information was seen this included hospital discharge information and the Single Assessment Process (SAP) documents from the community care manager. An inventory was recorded from the time of admission to monitor all personal belongings. Social activities are recorded and the level of involvement or non involvement was recorded. The care plans demonstrated choices being offered in daily life such as preference for a bath or shower and choice of clothes. Risk assessments were in place for manual handling and the equipment being used. Information about pressure sores and their treatment and preventative measures were documented. Pressure relieving equipment where used was recorded. There were no recorded settings or evidence of calculation for the air pressure settings for the pressure relieving mattresses in the care plans. These calculations should be made for the individual person and be recorded in their care plan. One care plan did not have a risk assessment for the use of bed rails. Falls risk assessments had been made and regular monthly reviews had been made. The care planning could be more person centered in the way the care plans are written, they should be inclusive and reflect the involvement of the person they are written for. One person said that their relative was involved in their care planning when there are changes to be made. Three care plans had risk assessments for bed rails and bumpers, dependency, moving and handling, and Waterlow pressure sore risk assessment. Continence management was recorded and the level of night care input was determined in the care plan. The care plans had all been reviewed on a regular basis. One nurse was spoken with and she confirmed that the registered nurses are the allocated as the named nurse to six people and they would undertake the reviews of care plans for them. Nursing staff confirmed having particular training and skills such as phelebotomy, syringe driver medication administration and percutaneous endoscopic gastric tube feeding (PEG), wound and catheter care. Care Homes for Older People Page 14 of 31 Evidence: A visiting GP was spoken seen and spoken with, they said they were satisfied with the care given and the contact they have with the service. Out of hours all calls made to the doctors have been appropriate. Nutritional assessment had been made using the MUST assessment tool, weight observation was made on admission and was regularly recorded thereafter. Detailed nutritional care plans were seen, these indicated appetite and dietary requirements. Health care and input from the local G.P was evident and medications are reviewed. Daily care records are kept with the person in their room or safely in the lounge. Care plans are otherwise safely held in the nurse and care staff office. The treatment room and equipment was all satisfactory. The capillary blood sampling methods and equipment was confirmed as sharp safe and best practice. The management of medications was reviewed. The medications fridge was found to be too cold and to be in need of adjustment up to a safe storage temperature. The temperature had been recorded as minimum maximum wrongly and the temperature had been negative or minus one but had not been recorded as a negative or minus figure. This was explained to the group coordinator and nursing staff for correction. Controlled drug storage, records and quantity was all correct when checked. The Medication Administration Records (MAR) charts were seen, these have photographic identification. All the chart entries checked were complete. One medication change did not have a second signature but overall the charts were fully completed. Staff were heard to speak to people in residence in a kindly, caring and considerate manner throughout the inspection. The questionnaires completed by seven people living at the home indicated that they always receive the care and support they need, five people said they always receive the medical support they need and two forms were blank. One person commented on the degree of disability their relative has and said they are so lucky to have found a home with lovely staff to take care of my relative. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 home has dedicated activities staff. The home provides a range of activities, more trips out would be welcomed. People have choices in their daily lives and can spend their time as they wish. The catering is of a good standard, the food is nourishing and a good choice is available. Evidence: People were in the sitting rooms and dining area that looks onto the garden. Four people said they were waiting to go out. A small number of people that were having bed rest were seen by the inspector during a tour of the premises. The staff and people living at the home have good relationships, friendly banter was heard and caring interactions between staff and people living at the home. One person returning from an outing with their family was heard to laugh and joke with staff on Care Homes for Older People Page 16 of 31 Evidence: returning to the home. One person was asked about life at the home said they are satisfied with their care. They raised concerns about their hospital appointment and the manager addressed this problem which had not been routinely picked up. They also said they had to ask for drinks or a jug of water and often were told in a minute and then the staff forgot. This person said they did feel able to raise a complaint if they had to and said that staff always respond to the call bell. The inspector heard that they sometimes stay up late to watch television and have help to bed when they need it. We heard the beds are comfortable and personal care is delivered to suit individuals tastes and timings. We heard that more activities, outings and trips would be welcomed. People go out into the garden in warmer weather. The home has one activities staff who has sixteen hours per week for activities, there was also one other activities staff who was absent on the day of the inspection. The home has one regular student and there are three others who are applying to work with leisure activities at the home. An expert by experience accompanied the inspector at this inspection visit. The expert met with people and observed daily life at the home. The following observations were reported; Looking around the building, I found the usual range of notices displayed, fire instructions, floor plan, complaints procedures, etc and a list of activities which seemed a little sparse. In the hall there was also a suggestions and comments book which seemed a good idea but there were no entries. I didnt ask how long this had been there. I spoke to a number of people all of whom expressed their satisfaction with the facilities and with the care they received. The laundry service came in for particular approval and certainly everyone looked very clean with freshly laundered clothes. The weekly visits from a hairdresser were obviously much appreciated. I gathered there were no problems with regular bathing, and I noted in addition to standard bathrooms there was also a new shower room on the ground floor which seemed to me to be very practical for those who find bathing more difficult. I was able to speak at some length to a visiting lay minister from the local church who told me she comes in to sit and read with anyone who asks for her to do so. The food was rated as very good. The kitchen had recently been awarded a 5-star rating for hygiene. The food looked and smelled very appetising. There were two lounges,dining rooms, one on each floor, to which lunch was brought in a heated trolley and served either at dining tables or on individual trays. I watched one-to-one Care Homes for Older People Page 17 of 31 Evidence: help with feeding for two ladies who needed assistance, and this was carried out with great patience and kindness. On the day we visited there was a choice at lunchtime, gammon with parsley sauce or meat pie, followed by rice pudding or yogurt. I asked about breakfast, and was quite surprised to see the range of dishes on offer, everything from toast and cereals to what can best be described as a full English cooked breakfast. Questionnaires completed for the commission asked the question are there activities arranged by the home that you can take part in? two people said always, two said usually and one said sometimes. We heard that staff are extremely helpful, always there when you need them and always act on what you say. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 home has policies and procedures in place to provide protection for people from abuse and staff receive abuse awareness training. Complaints and concerns are taken seriously and are dealt with in a timely manner. Staff recruitment is thorough and all checks are made on newly recruited staff to ensure they are suitable to work with vulnerable people. Evidence: The Annual Quality Assurance Assessment (AQAA) completed for the commission indicated that there has been one complaint in the past twelve months. The commission were aware of this complaint which has been investigated and is now closed. The home has a complaints policy and procedure that is available for people to read in the homes entrance hall. The staff handbook contains the complaints policy. There is a whistle blowing policy for staff to bring concerns to the management team or to another agency, with confidence. Staff have received Protection of Vulnerable Adults (POVA) training during the past Care Homes for Older People Page 19 of 31 Evidence: twelve months and the AQAA indicates that this will be completed for all staff in the coming months. People at the home who were asked said they would be able to make a complaint and all those responding in writing indicated that they know how to raise a concern. Staff also said they would know how to raise a concern that was brought to their attention. The recruitment of staff was very thorough and demonstrated good recruitment practice. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 Firs is a well maintained and well equipped homely nursing home. The environment has been upgraded to provide a very pleasant standard of accommodation and is suitably adapted for the provision of nursing care. Infection control is well managed and staff have access to hand washing facilities and gloves and aprons. Waste control is safely managed. Evidence: The Firs Nursing Home has been extended and refurbished to provide a good level of nursing accommodation. The assisted bathing and toilet facilities have all been improved. The sluice facilities have been modernised with new equipment fitted. Corridors have hand rails for support and there is a small passenger lift between floors. The environment has been redecorated and refurbished to a high standard. The home was found to be clean and tidy and well maintained the new bedroom accommodation has en suite facilities. New carpets have been fitted to refurbished areas and where needed. People seen during the day seemed very settled and comfortable in the communal Care Homes for Older People Page 21 of 31 Evidence: rooms and in their own rooms. Infection control is well managed. There are hand washing facilities for staff to use and staff have access to personal protective clothing such as gloves and aprons. The home has a waste collection contract. The kitchen is well equipped and some repair work identified by the environmental health inspector has been completed. There was more work needed to stop a roof light leaking, CSCI heard that this has been attended to since the inspection visit. The expert by experience accompanying the inspector commented; this is a fairly old building, situated at the junction of two busy roads and with a small garden which was well maintained and must be very much enjoyed in the summer. My initial impression was of a welcoming atmosphere. Looking round the building, I found the usual range of notices displayed, fire instructions, floor plan, complaints procedures, etc and a list of activities which seemed a little sparse. In the hall there was also a suggestions/comments book which seemed a good idea but there were no entries. The furniture in the rooms was generally of a standard design, which made for a more co-ordinated look throughout, and the bedding and other furnishings were similarly coordinated for each room all of which helped to give an impression of quality. The standard of decoration throughout was very good, with clean carpets and generally a clean and fresh atmosphere. Questionnaires were sent to people living at the home. In answer to the question is the home fresh and clean? all respondents answered always. The home housekeeper organises the domestic staff team for all the cleaning and laundry tasks. There are dedicated maintenance staff who would undertake the routine fire alarm testing and environmental checks. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 home has an experienced and skill mixed staff team. Staff are regarded as helpful and available when needed. Staff are safely recruited and receive induction and on going training to retain their skills. Evidence: The manager Miss Kathy Vound was on duty.There were four care staff and a nurse in charge of care on duty at the start of the inspection. Staff were spoken with and we heard that staff love working at the home. We heard that staff receive induction and on going training. The care staff confirmed holding National Vocational Qualifications (NVQ) in care, the registered nurse confirmed having up to date nursing skills. The people living at the home said that staff always respond promptly to the nurse call bell when they are summoned help or assistance. They also said that staff are available when they need them. Staff working at the home said they have support in their roles and one questionnaire confirmed that there are alwaysenough staff on duty at all times to meet the needs of people they care for. Care Homes for Older People Page 23 of 31 Evidence: The expert by experience made the following observations; There were a good number of staff on duty, and all those to whom I spoke were very friendly and efficient and were obviously enthusiastic about their work at the Home and this enthusiasm translated into their attitude to residents who all described the staff as kind and attentive. It was very encouraging to hear from several of the staff their views on the importance of attaining NVQs which they saw as useful and relevant to their careers and their duties. The inspector examined two staff recruitment files for new starters since the last inspection. These staff had been safely recruited and all checks such as two satisfactory references, personal identification and Criminal Record Bureau (CRB) checks had been carried out. The home maintains a record of the checks undertaken with the Nursing and Midwifery Council (NMC) to verify the qualifications and current registration of trained nurses employed to work at the home. One staff questionnaire said that the home supports all staff in up to date training and assists with PREP ( registered nurse updating) requirements. Care Homes for Older People Page 24 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 homes Registered Manager is an experienced qualified nurse. There is supportive company management and the home has a deputy manager and an administrator. Quality Assurance is monitored. Finances and all records are safely managed. The home is well maintained. The expert by experience accompanying the inspector concluded I found this a very happy inspection of what I judged to be a well-run and caring Home. Evidence: The registered manager is an experienced registered nurse. Miss Vound has worked at the Firs for a number of years as the deputy, the acting manager and now the registered manager. Miss Vound is in touch with the day to day care and nursing as she works some shifts as the nurse in charge. The company provides active support and regulation 26 visits from operations staff based in the homes in Wales. Care Homes for Older People Page 25 of 31 Evidence: One such visit had coincided with this inspection. The inspector had an opportunity to hear about the overall refurbishment programme which has reached the end of the first phase. The home owner also contacted the home and spoke to the management staff and the inspector during the visit. The proprietor takes an active interest in the management of the three homes in his company group and is committed to the provision of good quality care. The home has an administrator who shares the small office with the manager. Financial records were sampled for inspection. These included contracts for people in residence. The records seen indicated safe and up to date record keeping. The management of the free nursing care paid by the primary care trust was not as clear as it could be for privately funded people. The home has an established system for managing small amounts of money held on behalf of people in residence. People have lockable drawers in their rooms should they wish to hold money or valuables safely for themselves. The AQAA indicated that Quality Assurance questionnaires are issued annually and that the home listens to the views of people who use the service. The home has achieved Quality Rating with Somerset Social Services. The annual audit by the homes management was not inspected. People responding to CSCI were very satisfied with the quality of the care they or their relatives receives. Staff supervision for the care staff is delegated but for the nurses and heads of departments is the responsibility of the registered manager. The records sampled at this inspection did not evidence regular supervision by Miss Vound. This was brought to her attention and should be addressed. A requirement is made to ensure the supervision takes place for all staff. The home is well maintained. The AQAA indicated that staff receive fire training, manual handling training and that equipment for manual handling, fire detection and emergency use had been maintained during the previous twelve months. During the tour of the first floor of the premises two window restrictors were seen that were a type that can be easily disconnected. Some other window restrictors are of a screw and chain type. The integrity of these window restrictors should be checked and made safe to prevent anyone from accidentally falling from an unsecured first floor window. Care Homes for Older People Page 26 of 31 Evidence: Policies and procedures are in place and had been reviewed by the company policy manager in September 2007, the quality assurance policy was under review when the AQAA was completed in November 2008. Records were sampled for inspection purposes, these included accident records and the accident audit, this had not been completed for the third quarter of the year, July to September 2008. Hoist checks are made each week and were serviced in April 2008. Shower heads are disinfected each month as a preventative measure against Legionella colonisation. The homes Legionella risk assessment was completed on 22/09/08 and water tests were clear on 7/05/08. The hot water is regularly checked at all bedroom, toilet and bathroom outlets for delivery at a safe temperature. The homes electrical installation was checked in November 2007. Pressure relieving mattresses were checked in May 2008 and the patient weigh scales in February 2008. The passenger lift was serviced in June 2008. The call bell system in September 2008. PAT testing was up to date and two items, 17 and 86 were failed in April 2008. The fire alarm and extinguishers were serviced in July 2008. The fire alarm and emergency lighting were tested in November 2008. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The medication fridge 03/03/2009 minimum and maximum temperature recorded daily should be monitored and kept within the safe range of 2 to 8 degrees Celsius. Medication that has to be kept at a cool temperature must be stored in a medications fridge that is kept at the correct temperature and not too low as to risk freezing which would harm the integrity of the medication and make it unfit for safe use. 2 36 18 (2) Staff must receive regular supervision. Good staff development and management requires a commitment to regular workplace supervision. 04/04/2009 3 38 13 (4)(c) Two window restrictors were seen that were of a type that can be easily disconnected. Some 04/03/2009 Care Homes for Older People Page 29 of 31 other window restrictors are of a screw and chain type. The integrity of these window restrictors must be checked and made safe. In order to prevent anyone from accidentally falling from an unsecured first floor window the window restrictor must be sufficiently strong enough to prevent this and be tamper proof. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 Contracts for people who are privately funded did not clearly state that the fee includes the fee portion which comes from the Primary Care Trust as Free Nursing Care, and that this is inclusive and is kept by the home towards the overall cost of care. Care plans could be developed in style to present in a more person centered way and reflect the input of the person for and with whom the care is planned. Pressure relieving equipment that requires a pressure setting in line with a persons weight and build, should be calculated and recorded in the care plans. This will help to prevent maladjustment and lack of effective pressure relief being achieved. 2 8 3 8 Care Homes for Older People Page 30 of 31 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. 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