CARE HOME ADULTS 18-65
The Firs 60 Upper Manor Road Preston Paignton TQ3 2TJ Lead Inspector
Sam Sly Announced 16 June 2005
th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Firs Address 60 Upper Manor Road, Preston, Paignton, Devon, TQ3 2TJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 523191 01803 523191 Havencare (Plymouth) Mrs Patricia Clare Cronin Care Home 4 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 3rd December 2004 Brief Description of the Service: The Firs provides care for up to 4 adults with learning disabilities and/or additional physical disabilities. The home is a detached property with level access to local shops and amenities and public transport. Each resident has a separate flatlet with its own bedroom, lounge and en-suite facilities for maximum privacy, with an additional large communal lounge/dining area which has level access into the spacious enclosed garden. There is also an office, laundry and large kitchen, all of which are accessible to residents. The home has a ground and first floor with stairs to the first floor that may cause problems to a residents with mobility problems. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Inspection was announced and took place over an afternoon and early evening in June. Evidence was gathered from talking to each resident, the staff on duty, the registered manager, and a visiting relative. Records were examined, pre-inspection information was obtained, and a tour of the building was made. Comments were also received from two relative’s, via feedback cards. What the service does well: What has improved since the last inspection?
The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 6 There were no requirements or recommendations after the Commissions last visit to The Firs, and there continues to be no requirements. The registered manager and staff are continuing to develop and improve the quality of life for residents by giving them new experiences and opportunities. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Resident’s needs were fully understood and recorded, so staff could support them in meeting their aspirations. EVIDENCE: All the residents had been at The Firs for over three years, and many of the staff had also worked there for many years. Two resident’s files were examined, and staff and residents were spoken to about what they did at The Firs. It was found that staff and residents knew each other well, and residents changing needs were well understood, documented and met. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 and 9 Staff had clear guidance to work by and supported residents to reach their chosen goals, and enjoy independent, fulfilling lives. EVIDENCE: The care planning at The Firs should be commended for being person-centred. Two care plans were examined and found to be current and reflective of the goals and aspirations of the residents spoken to. Where possible, family and those people important to the residents were involved in developing their plans. Risks were well understood, and documented with responsible risktaking encouraged so that residents could be as independent as possible. Residents were fully consulted and participated in all aspects of life at The Firs and at the Inspection it was observed that staff efforts centred around residents needs and desires, with examples throughout the day of residents making choices about meals, activities, clothes and chores. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 10 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 and 17 Residents were given choices and supported to develop skills, and engage in new, but also valued experiences, making their lives meaningful and enjoyable. EVIDENCE: The Firs should be commended, as residents lead full, meaningful lives with activities and routines developed to meet each of their needs. One resident had a cleaning job, and used the community fairly independently; others chose what to do on a daily basis. All residents had long-term goals, and residents were constantly motivated by staff to develop skills and independence. Residents that wished to went on several holidays a year, which they chose and helped organise. Resident’s leisure needs were constantly reviewed, with staff encouraged to be innovative about developing new experiences for them. Resident’s families were encouraged to be involved in their lives. Relative’s feedback stated that they could visit when they liked, were kept well informed, and were very happy with the overall care at The Firs. The relative spoken to
The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 11 said the staff did ‘over and above what they were expected’, the food was ‘very good’, and that his son got taken out all the time, and staff took him to places that in the past other establishments would not have even considered. There were planned meals, however these plans could change if residents wanted something different, and residents were encouraged to help prepare, or what meals being prepared. One resident also cooked cakes and biscuits in the afternoons sometimes. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 12 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 and 20 The Firs provided good personal and health care, including the administration of medicines, so residents remained healthy and well. EVIDENCE: Staff provided personal and health care in sensitive and flexible ways, and this coupled with the fact that each person had their own bathroom, meant residents privacy and dignity was maintained at all times. Residents were supported to choose and buy their own clothes and were all dressed to reflect their personalities, age and the time of year. There was evidence in plans that professional input was accessed appropriately when necessary, and the medication administration procedures were being adhered to ensuring that medicines were given safely. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 13 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 The views of residents and their families were listened to and acted on promptly, and residents were protected from abuse. EVIDENCE: Neither The Firs nor the Commission had received any complaints since the last Inspection, and there was a clear complaints procedure available. It was clear from discussion with staff and a visiting relative that any queries, concerns or views were taken seriously by the registered manager and acted on promptly. All staff had received adult protection training, as well as training on how to work positively with challenging behaviour. Incidents and accidents were recorded appropriately and there was guidance on Whistle blowing for staff. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 14 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 The Firs offers residents a safe, comfortable, clean and hygienic environment where they can chose to be private, or mix with others. EVIDENCE: The Firs should be commended for offering residents very high standards of accommodation with each person having their own lounge, bedroom and bathroom as well as additional communal lounge/dining room, kitchen and laundry. The home was very clean, well furnished and decorated with resident’s bedrooms reflecting their hobbies and interests. The laundry was hygienic, and accessible to residents, enabling them to wash and dry their own clothes. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34 and 35 There were sufficient staff, who were experienced, trained and well supported, enabling them to maintain the care and safety of residents. EVIDENCE: The Company that owned The Firs had just received an award from ‘Investors in People’ for retaining its accreditation for ten years. Staff said they felt well supported by the registered manager, and the owning Company. Staff were encouraged to train, and most staff were doing NVQ levels 2, 3 or 4. There was appropriate induction and foundation training which was Learning Disability Award Framework accredited and staff had also attended training on autism, communication, first aid, health and safety, learning disability awareness, discrimination, risk assessment and more. The staff recruitment procedure protected residents and ensures the home has a competent and effective workforce. Some Agency staff were used, and the registered manager said the same staff were asked for, and there was an Agency induction to ensure continuity for residents. Staffing levels were high to reflect the complex needs of residents, and there was a good male/female ratio of staff reflective of the number of male residents. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 16 Staff spoken to were enthusiastic, interested and motivated, and said they enjoyed working at The Firs. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 17 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39 and 42 Residents benefit from the open, positive and inclusive atmosphere at The Firs, and can be confident that their views influence the development of the home. The Owner Company and registered manager ensure the safety and welfare of residents at The Firs are promoted and protected. EVIDENCE: The registered manager should be commended for the inclusive, open, positive atmosphere at The Firs. Staff spoken to, and the visiting relative commented on her strong leadership and approachable style. Residents were included in decision-making and development in the home, and staff were encouraged to use initiative to support residents. There were a number of quality monitoring tools in operation, and the Commission was receiving a monthly report from the Owners. Questionnaires were regularly sent to residents and relatives, and there was a regular
The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 18 newsletter for staff, and staff and resident meetings. The registered manager said the Owners held meetings for Managers, and were about to start a staff forum with representatives from each home. It was recommended that the Owners develop a system for pulling together all the quality monitoring information and producing an annual report for the Commission and other interested people to demonstrate the development of the home. Staff received training in health and safety areas including first aid, manual handling, food hygiene and fire safety. The fire book had been kept appropriately and accidents were recorded. The Environmental Health department had recently visited and had no issues. Gas, central heating and water checks for Legionella were being regularly carried out. The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23
ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 4 3 3 3 x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 4 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 4 4 4 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Firs Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 4 3 x x 3 x D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 39 Good Practice Recommendations The Owners are recommended to develop an annual quality report from all their quality monitoring systems, a copy of which should be made available to the Commission, and other interested people. Owners are recommended to fit self-closers, of a design agreed by the local Fire Service, to residents bedroom doors if they are likely to want them left open. 2. 42 The Firs D54-D07 S18442 The Firs V222613 160605 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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