CARE HOME ADULTS 18-65
The Firs 60 Upper Manor Road Preston Paignton Devon TQ3 2TJ Lead Inspector
Sam Sly Unannounced Inspection 4th January 2006 1:30 The Firs DS0000018442.V252799.R01.S.doc Version 5.0 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 DS0000018442.V252799.R01.S.doc Version 5.0 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 DS0000018442.V252799.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Firs Address 60 Upper Manor Road Preston Paignton Devon TQ3 2TJ 01803 523191 01803 523191 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) 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 DS0000018442.V252799.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16th July 2005 Brief Description of the Service: The Firs provides care for up to four adults with learning disabilities and/or additional physical disabilities. The Home is a detached property with level access to local shops, amenities and public transport. Each resident has a separate flatlet with it’s own bedroom, lounge and en-suite bathroom facilities for maximum privacy. There is an additional large communal lounge/dining room, which has level access into a spacious enclosed garden. Also on the ground floor are an office, laundry and large kitchen, all of which is accessible to residents. The Firs has a ground and first floor with stairs leading to the first floor which could be a problem for a resident with mobility problems. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The Inspection was unannounced and took place during an afternoon in January. The registered manager was not present, however, two residents were spoken with, and staff interaction with another resident observed. All the staff on duty were interviewed and care, health, safety and recruitment records were examined. What the service does well: What has improved since the last inspection?
There were no requirements after the Commission’s last visit to The Firs, and there continues to be no requirements. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 Page 6 The registered manager and staff continue 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 DS0000018442.V252799.R01.S.doc Version 5.0 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 DS0000018442.V252799.R01.S.doc Version 5.0 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 the following standard(s): None. EVIDENCE: None of the standards were assessed, as those assessed at the last Inspection had been met, and there was no cause to investigate further at this visit. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 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 the following standard(s): 6 Staff have clear guidance to follow to ensure residents reach their chosen goals and enjoy independent, fulfilling lives. EVIDENCE: One resident’s care planning file was examined and discussed with staff. The care planning at The Firs should be commended for being person-centred and goal focussed. Records showed that plans were regularly reviewed and new goals developed. The resident, whose care plan was examined, had gained in confidence and skills and had tried new experiences. Where possible family and those people important to the resident were involved in care planning reviews. Discussion with staff, written records and observation of interaction between residents and staff proved that risks were well understood and action was taken to minimise risks, however this did not stop resident’s leading active lives. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 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 the following standard(s): 14 & 16 Residents enjoy a wide range of activities and the daily routines at The Firs promote independence and choice. EVIDENCE: The Firs should be commended on the range of leisure and activities developed, or made available to residents at The Firs or as part of the community. Staff said, and records proved that, if a resident wanted to do something or had a goal to meet financial and staffing support were always available to ensure it happened. Staff are encouraged to take the initiative and constantly think of new activities for residents to do. Residents choose and go on individual holidays if they want, and are involved in all the preparation and planning. One resident said they had been to Somerset last year with a staff member and enjoyed being ‘pampered’. Daily routines fitted around what residents were doing. As residents had their own bedrooms and lounges, they could chose whether to be alone or with other people, but wherever the are staff are on hand to support and ensure their safety at all times. Staff interacted with residents at all times in a relaxed and respectful way.
The Firs DS0000018442.V252799.R01.S.doc Version 5.0 Page 11 The Firs DS0000018442.V252799.R01.S.doc Version 5.0 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 the following standard(s): Medication procedures at The Firs protect residents. EVIDENCE: The medication procedures at The Firs were examined. Medication is administered by staff to all current residents, and is stored appropriately. Only senior staff were allowed to administer medication, and they had all received appropriate training. The administration records were examined as were filled in correctly, except for on one shift where the record was blank. Controlled drugs were stored, administered and handled appropriately too. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 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 the following standard(s): 23 Staff understand what to do to protect residents from abusive situations. EVIDENCE: All staff had either received or had dates in January or February to attend adult protection training. Staff spoken to were able to advise what constituted abuse and what they would do if they came across an incident of abuse, however there was some confusion amongst staff about where the adult protection procedures were kept at The Firs. Staff also receive training on managing behaviours that challenge in a positive way. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 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 the following standard(s): None. EVIDENCE: None of the standards were assessed, as those assessed at the last Inspection had been met, and there was no cause to investigate further at this visit. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 & 34 Residents are supported by competent, qualified staff and protected by the Home’s recruitment procedures. EVIDENCE: Several staff files for newly appointed staff were examined and found to contain sufficient identification documents, references, and fitness checks. In one file the interview record was missing, so it was unclear if discrepancies in the application documents had been discussed at interview. Criminal Record Bureau checks were carried out appropriately, but due to the registered manager not being present it was unclear whether Criminal Record Bureau checks were being destroyed, or whether the registered manager was fully up to date with the Commission’s Guidance on Criminal Record Bureau and Protection of Vulnerable Adult procedures. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 & 42 Resident’s benefit from a well run home where their safety and welfare in promoted. EVIDENCE: The Registered Manager was not present at the Inspection, but it is understood from previous Inspections that she is competent, qualified and has a lot of experience of managing care homes for people with a learning disability. Staff said she was supportive, and approachable. The Firs Quality Assurance system developments could not be assessed, as the staff on duty knew nothing about progress as the registered provider was in charge of this. Staff were receiving appropriate health and safety training including First Aid, manual handling, food hygiene and fire safety. The fire logbook and risk assessment were up to date and accidents were recorded and reviewed by the registered provider. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 Page 17 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 X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 X X X X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 4 14 4 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
The Firs Score X X 3 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000018442.V252799.R01.S.doc Version 5.0 Page 18 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. 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 2 3 4 Refer to Standard YA20 YA34 YA34 YA39 Good Practice Recommendations There should be no gaps in medication administration records. The Owners should familiarise themselves with the policy and guidance from the Commission on Criminal Record Bureau checks. A record should be made of decision-making concerning any anomalies found in the application information of prospective staff. The Owners should 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. The Firs DS0000018442.V252799.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection Ashburton Office 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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