Inspection on 04/12/08 for The Firs Nursing Home

This inspection was carried out on 4th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

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 23/06/05

The Firs Nursing Home 27/01/05

The Firs Nursing Home 01/09/04

The Firs Nursing Home 22/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

CARE HOME ADULTS 18-65 The Firs Nursing Home Kings Hill Great Cornard Sudbury Suffolk CO10 0EH Lead Inspector Tina Burns Unannounced Inspection 4th December 2008 10:00 The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 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 www.craegmoor.co.uk Speciality Care (REIT Homes) Ltd 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) Lin Block Care Home 21 Category(ies) of Learning disability (21) registration, with number of places The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service: Care Home with nursing - Code N to service users of the following gender: Either whose primary care need on admission to the home are within the following categories: Learning Disability - Code LD The maximum number of service users who can be accomodated is 21 2. Date of last inspection 26th November 2007 Brief Description of the Service: The Firs is a care home with nursing for adults with a learning disability run by the large organisation Craegmoor Healthcare. It is located in Gt Cornard close to the town centre of Sudbury. Although the home is registered to accommodate 21 residents the manager advised us that only 19 of the 21 places were available. This enabled them to provide all single bedrooms and more communal space. The home is on two floors with a shaft lift connecting the two. It has two interconnecting lounges and a separate dining room. The premises are set on a compact site that allows for parking of several cars to the front. There is a small garden area to the entrance of the home and an enclosed garden at the rear. The current base line accommodation fees are £967.97 per week but are variable according to service users needs. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection, which focused on the core standards relating to care homes for young adults. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included examination of a range of documents including staff records, service user’s care plans and health and safety records. We also carried out a tour of the premises, spoke with several service users and staff, and observed some of the daily routines. Other information has been obtained from the homes Annual Quality Assurance Assessment (AQQA) and a return of three staff surveys, four service user’s surveys and three relative’s surveys. The manager was present through out the day and fully contributed to the inspection process. What the service does well: What has improved since the last inspection? Since the previous key inspection residents care plans have continued to develop and reflect their individual needs, wishes and preferences and residents have more opportunities to participate in activities within the home and the wider community. The lift that had become unreliable has been replaced and the shower and bathrooms have been refurbished to create three assisted shower rooms and one assisted bathroom. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 6 Nursing staff now have the opportunity for one to one supervision with a manager who is a registered nurse. This should help to ensure that their practice remains safe, current and up to date. There is a record of meals provided so that it can be established whether individual diets are satisfactory in terms of nutrition or otherwise. After a lengthy period of temporary managers staff and residents are beginning to benefit from the consistent leadership of a manager that has been in post since February 2008 and is now registered with the Commission. 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 summary of this inspection report can be made available in other formats on request. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents can expect to have the information they need to help them decide whether the home will be suitable for them. EVIDENCE: The manager confirmed that there had been no new admissions to the home since the last key inspection. They also confirmed that the pre admission process had not changed and would include an assessment of need by the referring authority and a pre admission assessment undertaken by the home. Although we were unable to fully assess current admission procedures we had looked at the homes assessment procedures at the last inspection. At that time they covered areas such as maintaining a safe environment, communication, breathing, eating and drinking, elimination, personal hygiene and dressing, controlling body temperature, mobilising, social care/family involvement, sleeping and pain and included nutritional assessments, moving and handling assessments and pressure care assessments. The homes Annual Quality Assurance Assessment tells us that prospective service users are given the opportunity to visit the home and have a trial stay. It also tells us that since the last key inspection in November 2007 the homes Statement of Purpose has been updated to reflect the change in management The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 9 and all Service Users have been given a Service User Guide in a pictorial format. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a needs led person centred care plan. Further more they can expect to be involved in decisions about the home and their every day lives. EVIDENCE: Three residents care plans were examined. They had been completed in detail and in a person centred style with entries written in the first person as if they had been completed by the person concerned themselves. Areas covered included; Dates that are important to me, What I do now and what I’d like to do, Social interaction, Health and keeping safe, Finances, Personal Care, Communication, Independence and When I become sick or might die. Information provided in the homes AQAA tells us that three residents were assisted to attend a workshop on being your own advocate and making choices and as a direct result of the day are involved in greater decision making about The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 11 their own lives. One resident had the support of an independent advocate at their care review and others have assistance from their relatives or social care managers. Feedback from surveys told us that residents make decisions about their lives and what they do each day. Records confirmed that the home has monthly residents meetings. The agenda for the last meeting in November 2008 that was attended by nine residents and five staff included: What did we talk about at our last meeting and what has been done about it, questions, ideas and news, questions for the divisional managing director and agreed actions. The homes AQAA tells us that the home would like to better understand the choices of those residents who have limited communication skills. To achieve this they have been working closely with speech and language specialists and staff have had training in ‘Total Communication’. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 & 17. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to enjoy a range of community and leisure opportunities. They can also expect to maintain relationships with their friends and families. However, despite a healthy and well balanced menu they cannot be assured that they will always enjoy their meals. EVIDENCE: We carried out a random inspection at the home in August 2008 and found that the care plans examined were person centred and included peoples likes, hobbies, interests and preferences. However, although at the time some residents had recently enjoyed a summer holiday in Norfolk overall the range of activities on offer were limited due to staff shortages and this was an area that the home needed to address. The AQQA completed by the manager since the random inspection told us that “Service users have a community presence in the local area. They go into the The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 13 local town to shops, cafes and pubs”. It also told us that activities have included visits from PAT dogs, art and craft sessions, trips to the zoo, attending church services, shopping trips, picnics, meals out, local walks, karaoke, skittles, dancing, bingo and table top activities. Courses accessed at the local college include ‘Creativity’, ‘Using a Computer’, ‘Sound, Rhythm and Music’ and ‘Citizenship’. At this inspection evidence of these activities was seen in records examined and photographs displayed in the home. Further more, at this visit observations made, records seen and feedback from staff and residents confirmed that there were more opportunities for residents to take part in community based activities and activities within the home. On the day of inspection some residents were enjoying aromatherapy from a visiting practitioner and another resident was given assistance to attend a photography course at the local college. One resident said that they attended the local resource centre on some days and another enjoyed showing us their nails that had been painted at the local nail art studio. Others told us that they went to college to participate on the ASDAN course and one member of staff told us “Lin is trying to build relationships with families and the community; Sudbury Musical Society are coming tonight to do some singing”. Records seen and feedback received confirmed that people living at the Firs are assisted to maintain relationships with their friends and families and visitors are made welcome at the home. Staff were observed knocking on resident’s bedroom doors before entering and interacting positively and respectfully throughout the day. At our random inspection in August 2008 the lunch time meal looked and smelled appetising and residents looked as though they were enjoying their food. The cook told us that they planned the daily meal according to the needs, likes and preferences of the residents. However, there was no menu available and no records in place to tell us what meals had been provided or what choices had been available. We did see some work that the manager had started to do with one of the residents regarding developing a menu in a suitable format but there was not sufficient evidence in place to fully demonstrate that residents enjoy suitable options and a good well balanced diet. At this visit we were provided with records of meals taken by each resident and looked at the four week menu displayed in the entrance hall. The menu had a wide range of well balanced meals and although there was only one option for each meal time the cook advised that people could have an alternative if they did not like the set menu. Eleven out of the sixteen service user’s resident at the time of inspection had lunch in the dining room. We spoke with four of them who were seated together. While they were waiting for their lunch to be served they were asked what they would be having for lunch and they did not know and could not The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 14 remember being asked what they would like. Three of the four were able to eat their meals without full assistance and they were served first. The meal looked and smelled appetising but although one of the residents looked like they thoroughly enjoyed it another said that they didn’t like it and asked for a sandwich instead, this was provided. We asked another if they liked theirs and although they were eating it they said “no, I don’t like it there’s too much onion”. The fourth resident, who required assistance, had to wait until a member of staff was free to help them and most of the table had finished by the time they started their lunch. Further observations made during the meal time told us that the dining area was calm and relaxed and a good standard of food was provided for a range of dietary needs. However there were still some areas that could be improved to create a better experience for the residents. For example; People were provided with paper disposable ‘bibs’ rather than cloth napkins or protectors and tables were not set with table cloths, place mats, cutlery, glasses or condiments. Cutlery was provided when people were served their plate of food and drinks were not provided until the main course was completed. People needing full assistance were supported in an appropriate manner with staff sitting beside them, positively interacting and feeding them at a suitable pace. However, the four staff serving lunch and assisting with feeding could not assist everyone at once and this meant that five of the residents seated at the tables had to wait until others had finished their meal. The manager confirmed that the menu still needed to be developed in a suitable format for residents and recognised that this has been outstanding for sometime and needs to be a priority if real options and choices are to be offered. She also welcomed feedback about the meal time and agreed to introduce further improvements in consultation with staff and residents. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can expect to receive appropriate personal and health care support. EVIDENCE: Anonymous concerns about the personal and health care of three residents were explored in a random inspection that we carried out in August 2008. However, records examined and discussion with nursing staff and the local GP confirmed that there the concerns were unfounded and appropriate care had been provided for those residents. At this visit residents spoken with looked physically well cared for and indicated that they were happy with the support they received. Observations were that staff interacted positively with residents and were polite and respectful at all times. All personal care was given in the privacy of resident’s rooms. Feedback received, records examined and information provided in the AQAA confirms that the home continues to provide appropriate personal and The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 16 healthcare support. The home works in partnership with a wide range of professionals to meet the needs of residents including dieticians, speech and language therapists, occupational therapists, physiotherapists, chiropodists, GP’s, tissue viability specialists, dentists and a diabetic nurse. The home also has support from the company’s clinical governance team about nursing and health matters. The home had appropriate policies and procedures in place for the safe storage, administration and handling of medication. A monitored dosage system was being used and the Medication Administration Records (MAR charts) that were looked at had been appropriately completed. The MAR charts included photographs of each resident prescribed medication. The nurse on duty confirmed that medication is only administered by qualified nurses. There were no controlled drugs on the premises at the time of inspection. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to be protected from abuse. Furthermore, they can expect to have their complaints and concerns listened to and acted upon. EVIDENCE: The Commission has received concerns from three people since the last key inspection. Two of them were anonymous and we explored their concerns at a random inspection on 4th August 2008. The concerns were about the health and personal care provided to some residents, the cleanliness of the home, the condition of the environment, staff shortages, lack of activities for residents and the quality of food and choices available. Following the random inspection we were satisfied that the personal and healthcare needs of the residents concerned had been met and although we found some shortfalls in the other areas we were satisfied that the home was taking appropriate action to address them. Our full findings can be found in the relevant random inspection report. Concerns from a third person were dealt with by the homes area manager directly and within the framework of the company’s complaints procedure. Information provided to us confirms that they took the concerns raised seriously and responded appropriately. Discussion with the manager and information provided in the AQAA tells us that the home has received two complaints directly and records confirm that The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 18 they were handled by the manager appropriately and within the framework of the homes complaints policy. Four out of the four residents that completed surveys tells us that they know who to talk to if they are not happy. They also said that they know how to complain and carers listen to and act on what they say. Further more we found that the home actively seeks their views through reviews, advocacy services and residents meetings. Since the last key inspection the home has made one safeguarding adults referral. They full participated in the subsequent strategy meeting and investigation and demonstrated to us that they understand and work within agreed local protocols to protect vulnerable adults. Records examined and staff spoken with also confirmed that safeguarding adults training is provided as part of the homes staff induction training. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect the environment to be clean and comfortable but the physical design and layout of the home does not promote choice and independence. EVIDENCE: The Firs is a large property situated on a main road in the village of Great Cornard. It has parking to the front of the building with paved and bedding areas to the entrance of the home and a small but enclosed rear garden. During the inspection a tour of premises was undertaken and the home was found to be warm, safe and clean. Since the last inspection redecoration had occurred in some communal and private areas, a new lift had been fitted and the stairs had been replaced to both the front and back first floor fire escapes. Two downstairs bathrooms and one upstairs bathroom that had previously not been suitably equipped for resident’s needs had been replaced with showers and were due to have The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 20 overhead tracking and hoists fitted within the month. The upstairs shower room was also in the process of refurbishment and was due to have an assisted bath and tracking hoist fitted. The home had recently experienced serious problems with floods and leaks and this had caused damage to the communal lounge areas. The manager kept us informed of the ongoing problems and advised us about the action taken to minimise the impact on residents. At the time of our visit contractors were on site and in the process of replacing pipe work throughout the home. The manager was seen to be managing the process well and working with the contractors closely to minimise any disruption to residents. She advised us that on completion all areas affected by water damage or pipe work would be recarpeted and redecorated as appropriate. Since our last inspection a new maintenance worker had been appointed and we spoke with them during our visit. They told us that they had begun to fit footplates to all the doors to prevent chips and scuff marks and a programme of redecoration to bedrooms was due to start after the pipe work was finished. The manager advised us that the home is currently operating at a maximum occupancy level of nineteen although the home is registered to accommodate up to twenty one people. There were sixteen residents at the time of inspection and they each had their own bedroom and wash hand basin. The bedrooms seen were personalised and comfortable and reflected the individual’s needs, personalities and interests. However, the home is not unitised and the overall space and layout is not ideal for the number of residents that it is registered to care for. Residents continue to share communal areas that consist of two adjoining lounge areas and an adjacent dining room. At the last key inspection discussion with the previous manager about communal space and facilities demonstrated that they were clear that improvements could be made and they confirmed that they would work with the company to look at the development of a short and long term plan for improvement. At the time of this inspection progress had been made regarding the refurbishment of the lift and the bathrooms and the manager confirmed that they intended to submit proposals to the company for improvements to the available “day space”. There was hand washing facilities in each bathroom, toilet and laundry. The laundry was appropriately equipped with a commercial washing machine and a tumble dryer and there was a stock of disposable aprons and gloves for staff use. However, the home had lost its sluice facilities in the refurbishment of the bath and shower rooms and there was no disinfection unit in place. At our random inspection in August 2008 we looked around the premises and although most areas were clean there were some shortfalls. At this visit we found all areas clean and free of unpleasant odours. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to benefit from improvements in staff consistency. Further more, they can expect to be supported by suitably recruited and trained staff. EVIDENCE: Discussion with the manager, information provided in the AQAA and staff records examined confirmed that appropriate pre employment checks were undertaken. Documentation in place included photographs, evidence of ID, CRB checks, application forms, references and health checks. Feedback from staff, discussion with the manager, and records examined confirmed that staff receive appropriate induction and foundation training. Records examined included evidence of core training in Fire Safety, Manual Handling, Health and Safety, Control of Substances Hazardous to Health, Food Safety, First Aid, Protection of vulnerable adults, Infection Control and Equal Opportunities. The AQAA also confirmed that with the exception of qualified nursing staff over fifty percent of staff had achieved or were working towards NVQ level two in care or above. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 22 At the random inspection in August 2008 we found that the home had experienced some significant staffing issues and this had impacted on the staff rota. The manager was addressing the issue through recruitment and use of agency staff. The rota told us that there was a minimum of one qualified nurse and four support workers on duty each day and one qualified nurse and two support workers at night. There had also been a weekend cooks vacancy and care staff have been preparing and cooking the meals at the weekend, this has not been ideal but we were assured that the post was recruited to subject to confirmation that all the necessary recruitment checks have been done. Observations made during that inspection, discussion with the visiting GP and feedback from local authority care managers confirmed that people living at the home had their personal and health care needs met and there was no evidence that their needs had been compromised by staffing levels. Discussion with the manager and feedback from staff at this inspection confirmed that although there remained some staff vacancies the home had recruited additional permanent care staff and the need for over time and use of agency staff had decreased. At the previous key inspection it was concerning that nursing staff did not have the opportunity to have clinical supervision as the previous manager was not a qualified nurse. This matter has been resolved as the current manager is nurse qualified. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41 & 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are beginning to benefit from a more consistent management approach and overall they can expect their health, safety and welfare to be promoted and protected. EVIDENCE: The previous registered manager left the home in early 2006 and since then there has been four different managers in post. The current manager, Lin Block, has been in post since February 2008 and their application to become the registered manager was approved by the Commission on 1st October 2008. They have a nursing qualification and are registered with the Nursing and Midwifery Council. They also have several years experience as a manager and nurse. There is currently no deputy manager or administrative assistant at the The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 24 home but the manager advised that they intend to advertise these posts shortly. Up until now we have had concerns that the home has been without a permanent and stable manager in post and feedback from staff and relatives tells us that there has been an impact on the running of the home and in particular staff morale. However, staff spoken with during this visit had confidence in the manager and were positive about the changes that were being made. Comments included; “I’ve seen lots of changes and on the whole I think its getting better”, “Lin is approachable and helpful but she’ll tell you if you are doing something wrong”, “Lin has made big efforts to improve things, she is leading by example…, she is trying hard”, “Everything is moving forward, we are getting there, there is good leadership” and “Lin has lots of plans for this home”. The home continued to have appropriate quality assurance systems in place. These included health and safety audits, food safety audits, medication audits and infection control audits. Information provided in the homes AQAA and discussion with the manager demonstrated that they were able to identify what they do well and where they need to improve. Hot water temperatures were tested at five outlets and found to be close to 43 degrees centigrade. Discussion with the manager confirmed that hot water temperatures were thermostatically controlled and periodically tested however records of water temperatures had not been maintained. Immediate action was taken by the manager to ensure that appropriate risk assessments and water temperature records were in place and kept up to date. Bearing in mind that we have found that the homes hot water temperatures have exceeded safe temperatures in the past we will check that these records are maintained at our next visit. The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 2 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 X 2 2 X The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No 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 YA30 Regulation 13(3) Requirement The home must have suitable sluicing and disinfection facilities to prevent infection and/or the spread of infection. Timescale for action 28/02/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Firs Nursing Home DS0000031547.V373528.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000031547.V373528.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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