Inspection on 07/06/10 for The Firs Nursing Home

This inspection was carried out on 7th June 2010.

CQC 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 01/04/10

The Firs Nursing Home 09/02/10

The Firs Nursing Home 21/09/09

The Firs Nursing Home 02/09/08

The Firs Nursing Home 11/10/07

The Firs Nursing Home 13/07/06

The Firs Nursing Home 18/10/05

The Firs Nursing Home 05/07/05

The Firs Nursing Home 25/01/05

The Firs Nursing Home 07/06/04

The Firs Nursing Home 09/12/03

Similar services:

The Lodge Nursing Home

Bracken House

Sunnycroft

Field Farm House

Edgeview Nursing Home

Church Terrace Nursing & Residential Home

The Forbury

The Maples

Extracts from inspection reports are licensed from CQC, this page was updated on 03/09/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: The Firs Nursing Home 745 Alcester Road South Kings Heath Birmingham West Midlands B14 5EY     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kerry Coulter     Date: 0 7 0 6 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: The Firs Nursing Home 745 Alcester Road South Kings Heath Birmingham West Midlands B14 5EY 01214303990 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ms Janet Alice Murrell Name of registered manager (if applicable) Type of registration: Number of places registered: care home 25 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Age: Mental disorder, excluding learning disability or dementia (MD) - age 40 and above. The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home with Nursing (Code N) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Mental disorder, excluding learning disability or dementia (MD) 25 Date of last inspection Brief description of the care home The Firs is a care home, which provides nursing care and support to 25 adults with enduring mental ill health. The home is located close to the Maypole area of Kings Heath. It is close to local shops, post office, banks, and leisure facilities. It is located Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 25 0 9 0 2 2 0 1 0 Brief description of the care home on a major trunk road into Birmingham, which also has good motorway connections. A regular bus service passes the home enabling easy access to Kings Heath and the city centre. The home was first registered in 1987. The Firs consists of the original house, and a newer extension. The home offers accommodation over three floors and has both single and shared bedrooms. No rooms have en-suite facilities. The home has a passenger lift enabling access to all floors. The home has an attractive rear garden. Copies of previous inspection reports are available in the home for people to read if they wish to. The service user guide did not record the range of fees to live there, the home would therefore need to be contacted directly for up to date fee information. Care Homes for Adults (18-65 years) Page 5 of 34 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was carried out by one inspector over one day. The home did not know we were going to visit. This was the homes key inspection for the inspection year 2010. We were assisted by an Expert by Experience. This is someone with personal experience of using care services. Experts by Experience observe what happens in the home and talk to people to obtain their views about what it is like to live there. The expert produced a report based on their findings and details of this are included in this report. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Care Homes for Adults (18-65 years) Page 6 of 34 Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and the Annual Quality Assurance Assessment (AQAA). The AQAA provides information about the home and how they think it meets the needs of the people living there. We case tracked the care received by two people living there. This involved establishing individuals experience of living in the care home by meeting and talking with them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking peoples care helps us understand the experiences of people who use the service. We looked at parts of the home and a sample of care, staff and health and safety records. The people living there, the owner and staff were spoken with. Surveys were sent to some of the people living there, care professionals and staff. Their views stated in the surveys are reflected in this report. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: The service user guide should be updated so that people have more information about the home, to include how much it costs to live there. This will help people decide if they would like to live there. The home should ensure that in future a full assessment is completed prior to people moving there so that people can be confident the home can meet all of their needs. Care Homes for Adults (18-65 years) Page 8 of 34 Risk assessments need to be developed further so that the risks to the safety and well being of people can be reduced as much as possible. Staff should have more detailed information in care plans so they know how to support people to meet their individual needs. Continue to develop the activities on offer to people to help ensure people are doing the things they enjoy. Training records need to be improved so the home can effectively track what training has been done and make arrangements for training that remains outstanding. The system of staff supervision needs to improve so that staff get support to meet peoples needs meet . Staff must not start working in the home until all the necessary checks have been completed. To make sure unsuitable staff do not work with people. Management arrangements should be reviewed to make sure they are effective and the manager of the home has appropriate support so that the home can be well run. Develop the quality assurance systems in place so that the home is improved for the benefit of people living there. The home needs to make sure that where any alterations are made to the structure of the building appropriate fire precautions are put in place. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements do not always ensure that people can be confident their needs will be met on admission and people may not always receive the information they need about the home. Evidence: People who live at the home have a copy of the service user guide that tells them about the home. We looked at the guide at our last visit and found it did not tell people everything they needed to know about the home. At this visit we found that the guide had not been updated. It was quite brief in content and much of the information could have been about any home. There was very little information about how much it costs to live there and house rules. There were no photographs of the home so people thinking of moving there would not know what it looked like. Only five of the nine people who returned a survey to us said they had received enough information about the home. The owner told us that the home were in the process of updated the service user guide and producing a brochure so that people will have more information about the Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: home. We were told that photographs of the home have been taken and will be included in the new brochure. Two people had moved into the home since the last key inspection. Staff told us that people had visited the home several times to see if they liked it before they moved in. We looked at the admission procedures followed for one new person. The home had obtained information from other health care professionals about the persons needs prior to them moving in. The home had also completed their own preadmission assessment of the persons needs. The pre-admission assessment did not include the persons cultural, mobility or activity needs and did not include any information regarding their food preferences. There was also no information about the persons views regarding moving to the Firs. However the home had recognised these areas had not been assessed and had completed an additional assessment a few days after the person had moved in. The home should ensure that in future a full assessment is completed prior to people moving there so that people can be confident the home can meet all of their needs. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff do not always have the information they need to support people to meet their individual needs and keep them safe. Evidence: The records of two of the people who live there were looked at. These included individual care plans to give staff information about how to support the person to meet their needs. They covered areas such as health, personal care, nutrition, mobility, social and mental health needs. We found that some information in the care plans was very good and gave staff clear information about how to meet peoples needs. The expert by experience said I would think it unlikely that anyones needs would go unobserved in the Firs, and from what people had to say, their needs were being taken into consideration. Some areas of care planning needed to be improved. For example one persons plan regarding their mental health said they should have regular 1 to 1 sessions with staff but it was not clear how often staff were actually expected to do this. Another persons Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: plan said that staff needed to make sure the person was toileted. There was no information about the exact support the person needed or any information about what they could actually do for themselves. One persons plan directed staff to check on them two hourly at night time to make sure their pad was dry. There was no guidance on how this should be done, we were concerned that staff might be waking the person up to do this. We were assured by staff that this was not the practice and the person told us that staff do not wake them up during the night. We also saw that care plans had very little information about peoples personal preferences regarding their cultural needs, food likes and activity needs. Care plans had been reviewed on a regular basis but these were not always an accurate reflection of the persons needs. One persons review recorded that they had put on weight when they had actually lost weight. It is good that people are included in the care planning process. People are given the opportunity to comment on the plan and sign their agreement. One person told us I am included in care planning, I have seen my care plan. Records and discussions with staff indicate that people are encouraged to make choices and decisions about their lives. We observed people being given choices, for example about what to eat and drink at meal times and how they wanted to spend their time. Meetings are usually held monthly with people who live at the home. Areas for discussion include the activities people would like to do, satisfaction with meals and how they would like their bedroom decorated. The minutes of a recent meeting were on display in the home so that people were able to read about what had been discussed. At the last inspection it was identified that improvements were needed regarding the assessment of risks to people. Some improvements have taken place and assessments are generally more detailed. Assessments had been completed that included smoking, skin care, nutrition, manual handling, self harm and behaviours directed at other people. Some further improvement is still needed to make sure that where a risk has been identified there is detailed information in place about how the risk is managed. For example we saw that one person may be verbally abusive towards people and may sometimes hit out. There was an up to date risk assessment in place about how this should be managed but this was very brief. However, two members of staff spoken with were able to describe in more detail the measures that are taken to protect people. It was good that both staff described the same actions, however these need to be recorded on the assessment to make sure that all staff are being consistent with how the risk is managed. Care Homes for Adults (18-65 years) Page 14 of 34 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Arrangements are in place to ensure that the people living there usually experience a meaningful lifestyle and have a healthy and varied diet so ensuring their well being. Evidence: At the last inspection it was evident that people had limited opportunities to maintain or develop new skills. The homes annual quality assurance assessment told us that things had now improved. We were told that life skills sessions had been started twice a week and people were now being given opportunities to do daily living tasks such as making drinks and sandwiches. When we visited we saw that some people were helping to clean up the dining room after lunch. A number of people also took part in a cake baking session that they told us they had enjoyed doing. Most of the people who returned a survey to us said they were happy with the activities on offer. Two people commented that they would like more outings / Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: holidays. People spoken with during our visit said they were happy with the activities provided. One person said I am happy with the activities, I recently started going to the library, I go every week, we also make cakes, we have a lovely garden we use, we play skittles when weather is good. Another person said Every week we go to the Community Centre, have a meal and watch a film, we have a lot of fun. People are asked about the activities that they would like to do as part of the residents meetings. Minutes showed that some people had requested to go to a football match, the cinema and the theatre. We asked staff if arrangements had been made for people to attend these. We were told that one person had been to a football match but that theatre and cinema trips had not happened as people often change their mind about what they want to do. We were told that instead people had gone to the circus. People have also been on a day trip to Stourport. We were told they were going again soon as they had enjoyed the previous trip and wanted to go again. A recent audit of the activities available to people was carried out by the home. This identified that some improvements were needed including the activity timetable being made available to people. When we visited the home had an activity time table on display. This is mainly for group activities and is not done on an individual basis. Staff usually maintain records of the activities that people have participated in. However, for two people who were new to the home records of activities were not available. During the visit we saw that people had a good level of interaction from staff. The expert by experience said I noticed staff interacting with people in two of the communal rooms, one was discussing the newspapers in one lounge and people were giving their views. It was good that the home has a choice of four daily newspapers for people to choose from. Staff spoken with told us that newspapers are delivered to the home everyday and made available to people. The expert by experience said The staff seemed lovely and were giving their people plenty of quality time, one to one interaction and taking them out on a regular basis. But I did feel there was a lack of activities and that the care at the Firs could be improved by the introduction of more activities. No one said they had gone to the leisure centre even though there was a large one just up the road, and I felt that more effort should be made to introduce activities. The service user guide says that the home has an open visiting policy. The expert by experience said one person said I have loads of visitors, they can come any time and go into my room but I usually go out with them. Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: At our last visit we saw that the home had some internal security cameras, pictures from these were relayed to a monitor in the office. One of the cameras was in the main lounge and so staff or visitors in the office could see people in the lounge. At this visit we saw that the cameras had been repositioned so that they were not invading peoples privacy. The home has a rotating four week menu that includes a choice of meal options. We saw that the options did not reflect the culture of all of the people living at the home. However, one person spoken with told us that meals appropriate to their cultural background are made available if requested. We saw that the menus are on display in the home and observed the chef consulting people about their choices. Minutes of a recent meeting with people show they have been consulted about what they want on the menu. The expert by experience said I talked to the chef who explained that he cooked fresh food every day making his own pastry and giving everyone a choice. One person told me that he been asked what he liked to eat when he came to the Firs. Surveys received from people indicated they were happy with the meals on offer. During the visit people told us: Food is good, get a choice, can have Caribbean food if you ask for it but it is not on the menu, I also like English foods, you can always ask for something else here. Foods lovely here. Food here is alright, we get a choice. You get good service here. Its lovely here and theyre all lovely to you, the foods marvellous, they have nice kippers and we can tell them what we want and they cook it for you. Care Homes for Adults (18-65 years) Page 17 of 34 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements may not always ensure that the personal and health care needs of the people living there are met. Evidence: Care plans sampled information about the support people need with their personal care. Some of the plans would benefit from further development to make sure that people receive the support they need in the way they prefer. The people living there were dressed in individual styles that were appropriate to their age, gender, the weather and the activities they were doing. The expert by experience said All the residents appeared immaculately dressed. We saw that people received the support they needed from staff in a sensitive and respectful manner. One person at the home had recently had a bereavement. The expert by experience said I felt that the staff showed people a lot of respect, in particular I noticed how Xs bereavement was not being ignored. In fact, a staff broke away from her chat with me to hug X and get him out of the dining room where he was sitting alone saying this is not a good time to be alone. I found this really showed Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: the level of care to be high at The Firs. The health care provided to two people was case tracked. People had some good information in their care plans about their health needs, for example regarding diabetes. For one person who has diabetes we saw they had been supported to attend regular health checks regarding this. Assessments had been completed by the home on peoples nutritional needs and we saw that peoples weight is regularly monitored. Assessments had also been completed to make sure that people were not at risk of developing sore skin. Detailed records are kept of health appointments attended. Records showed that staff supported people to go to the dentist, opticians, and the GP when they are unwell and to have annual health checks. One person told us staff look after you, they take you to appointments if you are not well, have check ups. Following the last key inspection we had some concerns about medication practice in the home. A pharmacy inspector visited the home and found that medication practice was poor. As a result the home was issued with a Statutory Requirement Notice (SRN). We did not look at medication at this key inspection. The pharmacy inspector visited the home several days after the key inspection. They found that medication practice had improved and that the SRN had been met. However one medicine had not been ordered in time so was recorded as out of stock. This is of serious concern as they home did not have enough medicine for one person on the premise to administer for seven days. A requirement was made regarding this. Details of the pharmacy inspectors visit are recorded in the random inspection report dated 21st June 2010. Care Homes for Adults (18-65 years) Page 19 of 34 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are protected from abuse and harm but arrangements may not always ensure that the views of the people living there are listened to. Evidence: The home has a complaints procedure that is on display to people. We saw that this needed to be updated as it said people should complain to the registered manager. However the registered manager in no longer employed at the home. At the last inspection surveys returned to us showed that a low number of people were aware of how to make a complaint. At this inspection five out of nine surveys received from people said they know how to make a complaint and all said they knew who to speak to if they were unhappy. This indicates that more people know how to make a complaint. The expert by experience spoke with people about making a complaint during the visit to the home. People said: You have to write everything down and give it the manager,but I havent got anything I could complain about, its lovely here No I dont know what you do Yes I know, but I never have. We have not received any complaints about the home in the last twelve months. The homes annual quality assurance assessment told us that they had received three complaints directly but that these had not been upheld. We saw that the home had Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: kept a record of the complaints received and the action they had taken in response. We saw that people are actively asked if they have any complaints as part of the residents meetings. Some people had raised some minor grumbles and there was some evidence that action had been taken in response to these. When people have a grumble but do not wish to make a formal complaint there should be a recording system that shows what action the home has taken. Improved recording would help the home to track more effectively if any similar issues were re-occurring so that these could be put right. At the last inspection we found that the homes safeguarding procedures needed to improve. An allegation had been made and the home conducted their own investigations before notifying the appropriate authorities. Since the last inspection there have been two incidents of a safeguarding nature. The home acted appropriately in both instances and immediately informed the local authority. One of the incidents involved a person being left behind by staff following a trip out. This led to disciplinary action being taken by the home with the member of staff concerned. Since we visited the home we have received an anonymous allegation about one of the members of staff. We have passed this information to the local authority to investigate under their safeguarding of adults procedures. Staff at the home have received more training in safeguarding people from abuse. Staff spoken with during our visit were aware of the need to report any suspicions of abuse to make sure people are protected. We were told that since the last inspection that staff had training on the Mental Capacity Act and Deprivation of Liberty Safeguards. The Act governs decision making on behalf of adults, and applies when people lose mental capacity at some point in their lives or where the incapacitating condition has been present since birth. It is important that staff know how to put the Act into every day practice and the procedure to follow when peoples freedom may need to be restricted. We were told that the home does not act as an appointee for peoples money but they do help people to look after their money. The finance records of one of the people living there were looked at. Receipts were kept of purchases and where money had been handed to the person they had signed their record to show it had been received. Care Homes for Adults (18-65 years) Page 21 of 34 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 environment was comfortable, clean and well maintained and generally meets the needs of the people living in the home. Evidence: We looked at most of the communal areas and some peoples bedrooms. Facilities include two lounges, a smoking room, large dining room, choice of bathroom or shower rooms and a large rear garden. The home has both single and double bedrooms, some of which are located on the first and second floor of the home. The home has a passenger lift so that people who have mobility difficulties can access the upper floors of the home. We saw that the home was well maintained and in good decorative order. At the last inspection we saw that some of the hallways were dimly lit and so were quite dark. At this visit the hallways were much brighter. The expert by experience said Inside, The Firs was immaculate, even though it was cramped in places with a warren of corridors and stairs leading to various floors, everywhere was very neat, clean and fresh smelling. The smoking room has recently been relocated to what used to be the office. The extractor fan from the old smoking room has been fitted. However the new smoking Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: room is smaller than the previous one. We saw that when lots of people were all smoking in the room it was extremely smokey. Consideration should be given to installing a larger extractor fan. The home is very well maintained and in recent years has undergone many improvements to make it more homely. Recently the dining room has been redecorated and now looks more welcoming making it a nicer place for people to eat their meals. However further improvements could be made. The expert by experience said The furnishings at the Firs are very institutional and plain and the home would really benefit from some personal touches, some art work on the walls, photographs and flowers about in the public places. Bathrooms and shower rooms were in good condition. The main bathroom has an adapted bath so it can be used by people who have mobility difficulties. Shower rooms are located on the first and second floors of the home. It is good that the shower cubilcles are a large size making them more comfortable for people to use. One of the shower rooms had a broken lock and this was repaired as soon as we brought it to the attention of the homes maintenance man. The home has a large rear garden that is very well maintained. The expert by experience said I was amazed at the garden, its stunning, with beautifully maintained beds, manicured lawns, shrubs and flowers and several sets of garden seats dotted around almost like a hotel. One seating area in the garden was designated for smokers. In the afternoon we saw several people using the garden and they could access it when they wanted to. One person told us We often go in the garden, play skittles out there. We looked at some peoples bedrooms and these were personal in style. People spoken to said they were happy with their bedroom. Minutes of residents meetings show that people have recently been consulted about what colour they would like their bedroom to be painted. The homes maintenance man is going to be doing a schedule for the repainting of bedrooms to meet peoples personal preferences. As recorded earlier in this report the home was seen to be very clean. We saw that the home has two dedicated domestic staff who obviously take pride in their work. In the morning we saw that in one bathroom there was some urine on the floor however this had soon be cleaned up before we had the chance to bring it to the owners attention. The home had an audit completed of their infection control procedures in August 2009. This was done by the local Primary Care Trust who awarded them an excellent score of 98 compliance. Care Homes for Adults (18-65 years) Page 23 of 34 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for staff recruitment, their support and development may not always ensure that the needs of the people living there are met. Evidence: The Annual Quality Assurance Assessment told us that over half of the care staff have a National Vocational Qualification in Care. Staff who do not have this have been enrolled to do this. This should ensure that staff have the qualifications and skills to meet the needs of the people living there. Staff turnover at the home is relatively low and some staff have worked there for a long time. This means that people are usually supported by staff who know them well. Observed staff interactions with people were good and discussions with people indicate staff are well liked. One person told us staff are nice. Surveys from people recorded that staff treat them well. The expert by experience said a high level of care from dedicated staff. During the day there are usually two nurses on duty and three to four care staff. At night there is one nurse and two care staff. A chef, maintenance man and domestic staff are also employed so that other staff can concentrate on their nursing and caring duties. During our visit we did not see anyone having to wait for staff support. Eight Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: staff who returned a survey told us that there were always or usually enough staff on duty. However two staff did not think staffing levels were satisfactory. We looked at three staff recruitment records. One member of staff had started working in the home before their Independant Safeguarding Authority (ISA) check had been returned This check identifies if staff are on a list of people who are deemed unsuitable to work with vulnerable people. The owner told us that they had not been working with people but had been in the home on training and induction and had been supervised at all times. The home should however have waited the return of the ISA check. For part of the inspection the newly recruited manager was in the home. The owner told us he had been due to start work that day but would now not be doing so as his ISA First check had not been received. The home must review its procedures to make sure staff are not working in the home until all their checks have been completed to make sure people are protected. We looked at the references received for staff and found the format needed to be improved. The format does not make clear if references are from previous employers and does not indicate the designation of the person completing the form. A full review of the homes recruitment procedures should be completed to make sure they are robust. Surveys from staff indicated they were satisfied with the training they receive. One staff spoken with during our visit told us they had done lots of training recently. The home has a training matrix and this showed that most staff have had recent training in protecting people from abuse, manual handling, first aid, fire, infection control, managing agression and food safety. Where staff had not done this we were told this would be arranged. Discussions with staff, the annual quality assurance assessment and minutes of staff meetings indicate some staff have also had some training in tissue viability, Mental Capacity Act, mental health and epilepsy. However staff training records did not clearly show who had done this. Training records need to be improved so the home can effectively track what training has been done and make arrangements for training that remains outstanding. Staff meeting minutes sampled indicated that meetings are held regularly so that staff know how to meet the needs of the people living there and what is happening in the home. Records show that previously a system has been in place for staff supervision. The majority of staff who returned a survey to us said they had enough support from the manager. However since the surveys were completed the manager has left the Care Homes for Adults (18-65 years) Page 25 of 34 Evidence: home and records show staff have not had any formal supervision since March. We were concerned that one member of staff had not received recent supervision given that as a result of a disciplinary meeting the need for weekly supervision had been agreed. Staff need regular supervision to make sure they are supported in their role, their practice is discussed and any training needs are identified. Care Homes for Adults (18-65 years) Page 26 of 34 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems must be further developed and arrangements must be in place so that people living at the home can be confident that their health, safety and welfare are maintained whilst living at the home. Evidence: The registered manager ceased working at the home at the end of April 2010. During that time the home has had no manager in post. The home has been managed by the owner who has no experience of actually working in care other then owning a care home. We were told by staff the owner has looked after the administration side of things, for example recruitment and staff rotas. Whilst nursing staff have managed the actual care received by people on a day to day basis. Staff spoken with told us things have not fallen apart at the home since manager left, the nurses are good and owner is here all the time and things have not been too difficult but have been more stressful at times, however we can raise any problems with the owner, she is supportive, systems we have in place are still working. The management arrangements were not satisfactory as the home needs to be Care Homes for Adults (18-65 years) Page 27 of 34 Evidence: managed by a suitably experienced and qualified person. The owner has however taken steps to recruit a new manager and we have been told that they have now started working at the home. At the last inspection we identified that there was no deputy manager or senior nurse role in place. We commented that having a deputy in post would give the previous manager the support she needed to make more improvements at the home. The home still does not have a deputy or a senior nurse, had one been in place when the manager left the home there would have been more continuity in the management arrangements. We received the homes annual quality assurance assessment when we asked for it. This was completed by the homes previous manager and told us about the improvements the home had made and their plans for the future. Prior to the manager leaving the home the owner visited the home at least monthly and wrote a report of the visit. This helped to ensure the home was being well managed. Now that the manager has left we were told the owner is working there most days. Recently the owner arranged for a person external to the home to visit and complete an audit so that they know what needs to be improved. An action plan had been completed as a result of this visit. The home has recently developed some new surveys to give to health professionals who visit the home to seek their views on the service provided. These are currently in the process of being distributed. People who live at the home have the opportunity to complete surveys to say what they like and dont like about the home. Sampled surveys were generally positive about the home. It would be good if the outcome of the surveys could be produced into a short report so that people know their comments have been listened to. Information was provided within the annual quality assurance assessment to confirm servicing and maintenance of equipment is undertaken and policies and procedures are reviewed. We looked at a selection of maintenance and servicing records, all were up to date and demonstrate that systems are in place to ensure the equipment is safe. Records showed that the gas equipment, passenger lift and electrical installations were tested when required and that they were safe to use. The maintenance man tests the water temperatures regularly to ensure they are not too hot, which could put people at risk of being scalded. Records sampled showed that water was at a safe temperature. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: The fire procedure is on display in the home and staff spoken to understood what they had to do in the event of a fire. Records showed that the majority of staff were up to date with regards to training in fire procedures and first aid. Records show that the fire alarms and emergency lights are tested to make sure they are working. Fire drills are arranged on a regular basis so that staff and the people living can practice what to do if there was a fire. An engineer regularly services the fire equipment so it is well maintained and works well. The home has recently made some changes to the location of the office. This has been moved to the previous smoking room. A partition has been fitted with a door to split the room into two separate offices, one for the manager and the other for the staff. The managers office did not have a smoke alarm fitted. We brought this to the attention of the owner who has told us arrangements have now been made to have one installed. Care Homes for Adults (18-65 years) Page 29 of 34 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 Adults (18-65 years) Page 30 of 34 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 34 19 Staff must not start working in the home until a suitable ISA First / Criminal Records Bureau check has been received. To make sure people are not put at risk of having unsuitable staff working with them. 09/07/2010 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 1 The service user guide should be updated so that people have more information about the home, to include how much it costs to live there. This will help people decide if they would like to live at the home. The home should ensure that a full assessment is completed prior to people moving there so that people can be confident the home can meet all of their needs. Care plans should be reviewed more thoroughly to ensure they are still effective in meeting individuals needs. Care plans need to be further developed so that staff have Page 31 of 34 2 2 3 4 6 6 Care Homes for Adults (18-65 years) 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 all the information they need to enable them to support people in the way they require and prefer. 5 9 Improvements are needed to the homes written risk assessments. This will help make sure all staff are aware of the control measures in place and reduce the risk of harm to people. Continue to develop the activities on offer to people and review the systems in place for recording the activities that people participate in, to help ensure people are doing the things they enjoy. A recording system for peoples grumbles should be introduced where people do not wish to make a formal complaint. Improved recording would help the home to track more effectively if any similar issues were reoccurring so that these could be put right. The homes complaint procedure should be updated to make sure it is accurate regarding the name of the person that complaints can be made to. This will help people to know who they should make a complaint to. The format of the homes reference request forms for potential new staff should be improved and records kept of their interviews. This will help to make the homes recruitment procedure more robust. Training records need to be improved so the home can effectively track what training has been done and make arrangements for training that remains outstanding. Staff should have supervision at least every other month to make sure they are supported in their role, their practice is discussed and any training needs are identified. Management arrangements should be reviewed to make sure they are effective and the manager of the home has appropriate support so that the home can be well run. The results of the survey completed by people who live there should be produced in a report so that people can be confident their views have been listened to and taken into account in the way the home is run. The home needs to make sure that where any alterations are made to the structure of the building appropriate fire precautions are put in place. Where necessary the advice of Page 32 of 34 6 12 7 22 8 22 9 34 10 35 11 36 12 37 13 39 14 42 Care Homes for Adults (18-65 years) 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 the fire service should be obtained to help make sure people are protected from the risk of fire. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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