Inspection on 29/12/05 for The Firs Residential Care Home

This inspection was carried out on 29th December 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Firs Residential Care Home 07/08/07

The Firs Residential Care Home 20/10/06

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Firs Residential Care Home 2 Lickhill Road Calne Wiltshire SN11 9DD Lead Inspector Pauline Lintern Unannounced Inspection 29th July 2009 09:30 DS0000067611.V375493.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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 older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The 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. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Residential Care Home Address 2 Lickhill Road Calne Wiltshire SN11 9DD 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) 01249 812440 The Firs Care Home (Calne) Limited Vacant Care Home 20 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (19) of places The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th July 2008 Brief Description of the Service: The Firs is a residential care home registered to care for twenty older people, one of whom may have a diagnosis of dementia. Mrs Sehnaz Butt of the Firs Care Home (Calne) Limited, owns the home. Mrs Butt owns another care home within the Bristol area and spends her time between the two services. A new manager has recently been appointed to the home and is due to take up his post at the beginning of August 2009. The home is situated within a residential area on the outskirts of Calne town centre. There is a fair walk into the town although people would probably find a car journey more appropriate. There are two twin and sixteen single rooms. All are on the ground floor and have access to a call bell system. Communal areas consist of a dining room and two adjoining lounges. There is an enclosed garden to the rear of the property. Staffing levels are maintained at three members of staff throughout the waking day. At 5pm this reduces to two staff members. At night a member of staff undertakes a waking night. Another member of staff provides sleeping in cover and can be called upon, as required. Management on call support is available at all times. Nursing or intermediate care is not provided at the home. Any required nursing task would be referred to the Community Nursing Team. Fees range from £437.74 to £450 per week. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The unannounced key inspection took place on 29/07/2009. The inspection took place between 9.30 am and 4.40 pm. Our pharmacy inspector looked at the arrangements for managing medication within the home. There is currently an acting manager in post until the new manager takes up his position at the beginning of August 2009. The acting manager was available throughout the day to assist us. The owner of the home, Mrs Sehnaz Butt, was also present on the day of our visit. Both the acting manager and Mrs Butt were available to receive feedback at the end of the day. On 09/12/2008 a random inspection took place to discuss a safeguarding alert, which had been made about the care of one person, within the home. As a result of this inspection two further statutory requirements were made. These have both now been met. We met with people living at the home. We spoke to some people in private and others in groups in communal areas. We also observed interactions between staff and the people they support. We took the opportunity to meet with two members of staff to obtain their views. One was a recently recruited member of staff and the other person had worked at the home since November 2008. We reviewed the information that we had received about the home since the last inspection. We looked around the home and read a number of records, including care plans, risk assessments, health and safety procedures, staff files and training records. We requested that an Annual Quality Assurance Assessment (AQAA) be completed. This was the home’s own assessment of how well they are performing and it gave us information about their future plans. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys; to be distributed by the home to people using the service and staff members, care managers, GPs and The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 6 other health care professionals. Three people using the service responded. The feedback received, is reported upon within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documents gave evidence whether each standard had been met. The judgments contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: The home ensures that an assessment is carried out prior to moving into the home. This means that people can feel confident that their needs will be met. People told us that they are treated respectfully and their dignity is upheld. People have access to health care professionals when required. There is plenty of information available within the home on raising a concern or making a complaint. Mrs Butt personally audits any complaints or concerns received. Evidence demonstrates that the home know how to report any allegation of abuse. On the day of our visit we found the home to be clean and tidy and mostly odour free. Staff records indicated that staff are properly recruited and trained. Within our surveys we asked people living at the home what they felt the home did well. We received the following comments, they look after residents in their care to the best of their ability and staff are always available when needed, all staff are very kind and extremely helpful, friendly, caring atmosphere, including residents in conversations, attention to medical needs and problems, keeping me updated by phone and the staff at the Firs show care and compassion for all the residents, treating them with dignity and respect. They are always friendly and helpful; nothing is too much trouble for them. Catering is excellent and cleanliness is second to none. What has improved since the last inspection? At the previous inspection nine statutory requirements were made and twelve good practice recommendations. We noted during our visit that eight requirements have been met in full and one is in good progress of being met. Many of the good practice recommendations have also been addressed. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 7 There is evidence of using a person centred approach, within care plans. Care plans now contain risk assessments regarding falls, nutrition, skin integrity and manual handling. Many areas of the home have been decorated and new carpet and flooring fitted. The domestics hours have been increased to ensure the cleanliness of the home. All radiators have now been covered to ensure the safety of the people using the service. Building work is being completed to provide further accommodation for ten more people. The plans include easy level access from each room to the planned courtyard. Mrs Butt has also submitted an application to register two flats, which will provide assisted living accommodation. Staff are regularly receiving training and attending refresher courses as needed. Satisfaction surveys have been distributed to the people living at the home and their representatives. Accidents are now being reviewed by the registered provider on a monthly basis to monitor for any trends or patterns. What they could do better: Good progress has been made on further developing care plans, to ensure that they are person centred and cover all aspects of the persons care needs. However, there still needs to be greater clarity within care plans to inform the reader on how tasks are to be completed and by whom. Some risk assessments sampled, did not provide sufficient detail on the actions to be taken to minimise any potential risks. Risk assessments also need to be signed and dated by the person who completed them. Although training has been undertaken by staff members, a clearer training matrix would make monitoring training needs more effective. Contact details for CQC need to be updated in some documents. Within our surveys we asked how the home could improve. One person commented some entertainment in the home and day trips. This was the only response that we received to our question. Another person commented previously when the home had an activities co-ordinator, a good number of internal and some external activities for the residents (and on other occasions family members) took place. However, since she left, I am not aware she has been replaced (no name has been displayed on the white board in the lounge) and I have not seen any extra activities taking place or advertised. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 8 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. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this service. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective new people to the service have a full assessment of their needs carried out prior to being offered a service. EVIDENCE: Within the AQAA, it states that all prospective service users are encouraged to visit the home, stay for a meal and talk to existing residents. People are provided with the homes Statement of Purpose, service user guide and a copy of the last inspection report. Records show that a full needs assessment is completed prior to admission. This ensures that the home is able to meet each persons needs. The The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 11 assessment covers all aspects of the persons life such as mobility, dressing, washing, eating, communication, hearing, sight and medication etc. A pen sketch of each person is also completed. This may be with the assistance of a family member. The pen sketch provides information about their preferred times for rising and going to bed, personal hygiene requirements, meals and drinks, mobility, health and recreation. It also asks how people prefer to spend their day. One person we spoke to told us that they had visited the home prior to moving in. They told us that they had settled in well. Within our surveys three out of three people told us that they received enough information to help them decide if the home was the right place for them. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Progress has been made within the care plans to ensure that peoples needs are reflected. However, they should provide greater detail on specific tasks by identifying who takes responsibility and the frequency needed. People told us that they have access to health care professionals when required. People are supported to take their medicines in a safe way, however the use of medicines prescribed ‘as required’ must be clearly evidenced. People told us that their privacy and dignity is maintained. EVIDENCE: As part of the inspection process we sampled three care plans in detail. Good progress has been made within the care plans to ensure that all assessments are completed in relation to the risk of falls, mobility, and nutrition and skin integrity. However, there is still room for improvement with regard to providing greater clarity within the plans to ensure all aspects of a persons needs are met. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 13 For example we saw that within one care plan it states that the person wears hearing aids. We asked the manager who is responsible for cleaning the aids and ensuring the batteries are working. She reported that the evening staff complete this task. We asked that this be included within the persons care plan. We also noted that one persons care plan only briefly mentioned that they were diabetic and that this was managed by diet and medication. The plan failed to provide information about who was responsible for blood tests, suitable food to eat, what the safe parameters were for this person and who would be responsible for eye tests and foot care. Although the plans inform the reader that regular appointments must be made with the optician and chiropodist it does not detail frequency. We discussed the need for greater clarity with regard to nail care. The care plans do not stipulate that toe nail cutting should be the responsibility of the chiropodist. We discussed with Mrs Butt and the manager the need to not assume that all carers will know this information. People are supported to take risks, although not all risks are fully reflected in the care plan. There was no risk assessment in place for a person who has a catheter fitted. Their care plan did not identify who would be responsible for managing the catheter. It did not inform staff of what to do if the catheter fell out. We sampled a risk assessment for a person with poor vision. The assessment did not mention the need to ensure there were no obstructions left around, or that if they moved furniture around it would disorientate them. It also did not mention that they used a Delta fame to mobilise with. We discussed this further with the manager who confirmed that she was still in the process of documenting their care needs as they had only recently moved into the home. We advised the manager to ensure that all risk assessments are signed and dated by the person who completed them. We saw two manual handling risk assessments that had not been signed. However there was good evidence that all care plans and risk assessments are kept under regular review. Each section of the care plan is supported by a review and evaluation sheet. This is good practice and ensures that consideration has been given to each area and notes are made to support any changes which may have taken place. We noted that where a person has experienced a number of falls this is recorded appropriately within the accident book. Advice is also sought from the falls clinic if necessary and medication may be reviewed. Mrs Butt confirmed that she audits the accident books on her visits to the home and ensures that all appropriate action is taken. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 14 The manager showed us the short term care plans and method of approach sheets which are used when there are significant changes to a persons care needs. This might include when a person needs to be monitored or intervention in the short term. We saw that daily records had improved and no longer recorded information, which should be within their care plan. We noted that during a recent staff meeting staff had been reminded about how to record information properly and not to use subjective terminology. At the last inspection we asked that consideration be given to the use of bowel monitoring within the home. The manager confirmed that this practice has now ceased, unless it is necessary for an individuals care. We also made a good practice recommendation which related to restricting a persons alcohol intake. Consent has now been sought form the service user and their family representatives. The manager reported that training in the Mental Capacity Act Deprivation of Liberties safeguards has been arranged for all staff to attend. We saw that peoples weights are regularly monitored and records are being kept. This ensures that people are maintaining a healthy weight or nutrition advice is sought. Each person had a record of healthcare intervention, including chiropodists, GP, district nurse and optician. The manager confirmed that the chiropodist visits the home every six weeks. People told us that if they need a doctor the home arranges it for them straight away. One person was due to attend a doctors appointment during our visit. We saw that a volunteer driver supported them to attend the surgery. During our visit one person was unwell and there were concerns for their well being. The emergency services were alerted and the person was admitted to hospital. We observed staff reassuring the person and comforting them while they awaited the ambulance. Our Pharmacist Inspector looked at arrangements for the handling of medicines. Medication is stored securely, including a controlled drug cupboard. The records of the controlled drugs had not been kept in a bound book but on separate sheets of paper which does not comply with current guidance. Staff who administer medication are all given training in the safe handling of medicines before they start. We saw medicines being given in a safe and appropriate manner, with the correct recording. People were seen to receive their medicine in a way that they chose and were supported by the staff. Some people were prescribed medication to be taken ‘as required’. Some of these medicines were being given regularly and no reasons for use were The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 15 recorded, even though the home’s policy requires this. The acting manager explained that they were in the process of having reviews from the prescriber to enable them to draw up protocols for the use of these medicines if they were to be given ‘as required’. A few creams had the instructions ‘as directed’, these were being used appropriately, but the prescriber’s full instructions should be on the label. We saw one occasion where a new medicine had been started and this was recorded on the medication administration record and signed and checked by two people, the information about this medicine and the doctor’s visit was documented in the records. We saw one care plan which had detailed instructions for the administration of a medicine during the night and records of visits and advice from healthcare professionals. As mentioned in the summary of this report, the home is developing a person centred approach. Each person has a personal fact file. This is used to gain further information on the person using the service. It asks for information about the earlier life, where they went to school, their parents, siblings, previous employment, favourite place they have lived, best holiday, favourite colours, songs, food and drink and what their biggest achievement was. This information can then be used in directing the persons care and ensuring that they are living their life in the way they would prefer. We discussed life books as an extension to personal fact file, by using photographs, mementos and postcards etc. All staff members are provided with training in dementia to raise their awareness. We asked people that we spoke to if they felt that their dignity and privacy is respected. People confirmed that they are treated with respect by carers and the management. One person we spoke to told us that they have plenty of baths and showers. They commented I have baths and showers until I am sick of them. They are always changing me, no sooner that they put something on me, they change it. It gets me down. Another person told us I get help with personal care if I want but I am quite independent really. This person added that the staff always treats them ‘nice and gentle’. Within our surveys three out of three people confirmed that they receive the care and support that they require. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to participate in social activities, which match their expectations and preferences. Links with families and friends are encouraged. People are supported to make choices and decisions about their lives. People told us that they enjoy the food provided by the home. EVIDENCE: Within the AQAA, it states although the activities co-ordinator has now left, the home have employed another member of staff all day so that they can offer the same amount of activities as they did before. This staff member is designated to only do activities, in the morning and afternoon. During the morning of our visit we saw seven people participating in music and movement and throwing and catching balls. The afternoon activities session involved playing quoits. People appeared to be enjoying the activities and the social interaction. We observed one person entering the lounge area, stating that they did not wish to join in. This decision was respected by staff member. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 17 During the day different music was being played. We saw one person turn up the sound and sing along. Staff asked if it was a favourite of the persons and if they knew all of the words. One person was playing draughts with a staff member during the afternoon. The manager told us that one person attends a local art club in Calne and has a facilitator visit them at the home for art sessions. We asked one person if they liked to participate in the activities. They told us I do join in the activities but its putting your legs in the air today so I let that go. They added that they enjoy going out for walks with the staff and like to be in the fresh air. This home benefits form having good sized communal areas at each end of the building. This provides people with the opportunity to sit and watch the television or sit alone if they choose to do so. One person we spoke to told us that they prefer to sit away from the activities as they like to be quiet. They commented I like to sit here quiet, I dont like to chat, I like to mind my own business. There is an activities programme on the notice board, which details activities taking place during the week. Activities listed included; communication/discussion, hymn singing, newspapers and sherry, team quizzes, board games, word association, dominoes, bingo, skittles, knitting, card making, sensory activity, cooking, flower arranging, pool, darts, arts and crafts, hand massage, and word games. A record is kept of who attends certain sessions and there is an evaluation of how they appeared to enjoy the activity. At the previous inspection we recommended that the activity programme might be more conducive to peoples needs if it was in larger print and brighter. In response the previous manager had commented that she felt that as the activity plan was discussed within monthly resident meetings; people were being well informed and had the opportunity to comment. Holy Communion takes place every week for one person. Other denominations also have the opportunity to participate in their religion. One persons care plan states that they enjoy going out for lunch with friends from the church. The hairdresser regularly visits the home. We noted that the home had recently arranged for a clothes shop to visit the home. The manager reported that this had been a success and people had enjoyed choosing and purchasing their items of clothing. As mentioned previously, information is gathered from residents and their families regarding their interests, previous hobbies and skills. This information is used to ensure that all individual interests are included. It was noted that in The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 18 the residents meeting minutes one person had said that they would like the school children to visit the home again. Another person requested more outside entertainers and singers such as the Pearlies to visit the home. Daily reports show that day trips take place. This has included visits to the Butterfly farm and Longleat. The home has a minibus for transporting people to different venues. The handyman is always on duty during the day and is the driver of the minibus. People told us that their visitors and friends are made welcome at the home. They told us that they can entertain their visitors in the privacy of their own room if they choose to do so. We saw within care plans that each section is broken down into what is essential to the person, what is important and other pleasures. One person had stated under what was essential I am quite independent and like to do things myself, but I like to know there is someone to help if I need it. Another person said it is essential that I look smart and that clothes are comfortable and fit well, not too jazzy. One plan states I dont like lying in bed so I get up when I wake. One persons plan states that they do not like to be disturbed at night with staff opening their door. We asked how this person is monitored to ensure their safety during the night hours. The manager explained that the night staff are careful not to open the door very wide so as to disturb the person. We noted that one person was in bed during the day. We asked if they were unwell. The manager confirmed that they were not ill but just liked to spend time in bed where they felt really warm. We noted within the care plan that the person had stipulated that they like to rest in bed during the day. We took the opportunity to meet with the cook on duty during our visit. They explained that they usually only worked part time but they were doing extra hours as the other cook was on sick leave. We looked at the menus, which are usually based on a four week rolling rota. The cook told us that they were currently not following the four week menu as one of the freezers had broken and they were waiting for the new one to be delivered. On the day of our visit the menu consisted of faggots or quiche served with boiled potatoes, vegetables and jelly and cream to follow. We noted that when dinner was served people were offered jelly but there was no cream available. The menu had stated there was also a choice of rice pudding but the cook reported that they did not have any. The tea time menu is usually a hot snack such as sardines or beans on toast or various sandwiches. People told us that generally they were happy with the food provided by the home. We spoke to the seven people in the lounge and everyone said that they were happy with the food and that they had plenty of drinks made available to The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 19 them throughout the day. One person told us ‘its ok here, food‘s good, plenty to eat but its not always hot During the day a delivery of food arrived from the supermarket. The cook explained that she provides a list of food that they require to the manager and she then makes the order. The cook confirmed that they have a sufficient food budget. We saw that fresh fruit was available. We asked the cook how she obtained feedback from people about the quality of the food. She reported that this was done during residents meetings. We saw within minutes that one person had requested not so many boiled potatoes and another person had asked for different sandwiches. We observed lunch being served and noted that one person remained in the lounge to take their meal. Staff supported them where necessary. We noted that the meal time appeared fairly functional, with people leaving the table as soon as they had finished their meal. This did not appear to be a time when people chose to remain seated and socialise with each other. We saw that some people had almost finished their meals, whilst others had not been served with theirs. We discussed training courses, which the cook had attended. She confirmed that she had passed her basic food hygiene course a few years ago. She added that she had recently attended another course but it had not been fully completed. We asked Mrs Butt to make arrangements for the cook to finish the course. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 20 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is good provision for the receipt of and response to complaints. Policies and procedures are in place to safeguard vulnerable people. EVIDENCE: Information is available throughout the home on the procedure for raising a concern or making a complaint. Each person has information relating to this within their rooms. We noted that the contact information for CQC needs to be updated. Mrs Butt told us that one person living at the home had recently raised a concern about their care. The manager immediately provided them with a complaints form to complete. Mrs Butt then met with the individual to tell them what action she had taken regarding their complaint. Mrs Butt confirmed that she always encourages people to speak up if they have any concerns as this is the only way the home can continue to improve their services to people. We sampled the homes complaints log and saw that complaints are dealt with appropriately. The home‘s complaints policy states that any complaints will be acknowledged within 72 hours and responded to within 21 days. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 21 People we spoke to confirmed that they know how to raise a concern. Some people said that they would talk to their relatives in the first instance. Within our surveys three out of three people confirmed that they knew how to make a formal complaint if they needed to. The home recently had an adult protection issue, which was dealt with appropriately, effectively and efficiently involving outside professionals and following safeguarding procedures. The manager confirmed that the investigation into the matter remains on going. Within the AQAA it states that all staff have attended training in the protection of vulnerable people. Copies of the local protocols No Secrets in Swindon and Wiltshire are displayed in the hallway. One member of staff told us that they had attended safeguarding training in Bristol. We discussed a possible scenario where the carer may find someone living at the home had unexplained bruising. The member of staff was able to explain the procedure they would follow. They were aware of the home‘s whistle blowing policy. We saw that safeguarding training is offered to staff. The last training took place on 14/04/2009. Mrs Butt confirmed that all of the staff, except the most recently appointed, have a National Vocational Qualification in health and social care level 2 or above. Safeguarding vulnerable people is included in the content of the qualification. There is a copy of the revised policy Safeguarding Vulnerable Adults in Swindon and Wiltshire in the home. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home are provided with a safe and well maintained environment, which is clean and hygienic. EVIDENCE: As part of the inspection process we toured the premises, including bedrooms, bathrooms and communal areas. We saw that bedrooms were personalised with photographs and ornaments. Carpets were clean and surfaces were dust free. The home has increased the working hours of the domestic to ensure that the cleanliness of the home is maintained. Mrs Butt explained that staffing levels have been increased to three people during the day and there are two staff on duty after 5pm. This means that as there are minimal cleaning needs during the weekend period care staff have more time to concentrate on peoples care needs. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 23 All rooms are on the ground level. There are two adjoining lounges connected by a spacious hall with seating. The dining room is situated at the end of one of the lounges. Mrs Butt reported that they are planning to build a conservatory and extend the kitchen as part of the building plans. Building work has commenced to extend the home. This will provide additional accommodation for ten people. All new bedrooms will have an en suite and level access to the planned feature courtyard. The courtyard will have shrubs and flowers and seating so that the people using the service can enjoy the safety of the grounds. Mrs Butt showed us the two new self contained flats, which are located on the first floor. Each flat has a kitchen area and a modern shower/toilet. Mrs Butt explained that she plans for the flats to be used as assisted living accommodation for more independent people. The office below the flats will be incorporated within the new building. This will enable the people in the flats to have their own front door access. Some rooms in the existing home have been decorated and new flooring/carpet has been fitted to certain areas. People told us that they are happy with their rooms. One person said I like my room as it is down the end where it is nice and quiet. Another person commented, my room is always clean and the bed is changed. The laundry is good also. During the last inspection we asked that some consideration be given to how the call bell system could be quieter and less intrusive. During this visit we did not notice the call bell being particularly loud. We discussed this with the manager who confirmed that it does not present a problem. We asked people if the staff attended to them quickly when they pulled the call bell. Most people confirmed that staff came as soon as they could. One person said I have a call bell but sometimes I have to wait as they (staff) are often busy. Bathrooms and toilets were found to be clean and hygienic. One unused shower cubicle was identified at the last inspection as being used as a storage area, which was in need of a clean. We noted that this cubicle was still being used for storage, however it was found to be clean on this visit. We asked Mrs Butt to attend to the chipped paintwork at the base of one toilet. Mrs Butt told us that she had already asked the maintenance man to paint the area. During our tour of the building only one bedroom was found to be odorous. We discussed this with the manager and Mrs Butt. They confirmed that they had already identified the need for the carpet to be replaced with more suitable flooring. One staff member told us that they are provided with protective clothing such as gloves and aprons. She added that there were extra supplies kept upstairs if The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 24 needed. All hand washing facilities had pump action antibacterial hand wash available. The laundry was well equipped with washing machines and driers. The laundry area was found to be clean and tidy. The manager told us that all toxic materials are securely stored outside of the building. Accompanying risk assessments were found to be in place. One staff member told us that they have covered infection control guidelines in their health and safety training. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing numbers have been increased to ensure that peoples needs can be fully met. Records show that staff are properly recruited, inducted and trained. A clearer training matrix would ensure that training needs can be more readily identified. EVIDENCE: As mentioned previously, staffing levels have been increased during the day. This enables more quality time for the people living at the home. We asked staff members if they felt they had sufficient time to spend quality time with the people they support. They confirmed that they did have time to sit with people. We observed one member of staff taking time to sit with one person and tell them all about what they had been doing. They enquired if the person had enjoyed their birthday and what gifts they had received. It was evident that the person really enjoyed the communication. Another staff member was seen to be chatting to someone with a vision loss. This ensured that the person did not feel isolated. One person commented that all the staff were wonderful and that everyone was very good to them. We saw the domestic exchanging a playful banter with people in the lounge. People appeared to enjoy and feel comfortable with the interaction. The The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 26 domestic ensured that before leaving the home she said good bye to people and told them when she was next on duty. During the night hours there is one waking staff on duty and one person sleeping in. One member of staff commented that they felt there was plenty of staff on duty during the days, however they felt that an extra waking staff on duty at night might be of benefit to the people living at the home. She added that sometimes nights can be busy if people want personal support. Staff members told us that they have time for a handover between shifts. One staff member commented we share information at handover and throughout the shift. Within surveys we asked if staff listen and act on what people say. Three out of three people said always. As part of the inspection process we looked at the staff recruitment files. We also met with the most recently recruited member of staff. They told us that they had worked at the home for just over one week. They explained that the first week was spent inducting them into the service. This included looking at files, being introduced to people living at the home and getting to know their likes and dislikes. Part of their induction was spent in Bristol where they undertook manual handling training. We observed the member of staff encouraging people to participate in the music and movement session in the morning. The member of staff told us its going very well, I like doing the activities and I like everyone to be happy. We looked at recruitment documentation of four staff. We saw that they had been checked against the Protection of Vulnerable Adults (POVA) list to ensure that they suitable to work with vulnerable people. Each file sampled had two satisfactory references, a health declaration and proof of identity. Mrs Butt showed us the staff training programme for the year. We saw that all mandatory training is provided and staff have the opportunity to attend training in dementia, pressure care, safeguarding, mental health, nutrition and diabetes. Mrs Butt told us that some training is provided by the district nurse. On 5th May 2009 staff attended an activity management training course. We noted that the training file contained duplicated information and it was not easy to identify when training had been completed and when refreshers were due. We said that files should be rationalised for easy access and to ensure that all training needs are recognised. Mrs Butt confirmed that she had already identified a need for developing a new training matrix. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs Butt is supporting the acting manager to ensure the home is run in the best interests of the people living there, until the new manager takes up their position. Systems for the management of peoples personal money have improved. Health and safety policies and procedures are in place to protect the people living at the home and staff members. EVIDENCE: Mrs Butt reported that the newly appointed manager is due to take up their position at the beginning of August. Mrs Butt told us that the person has many years experience of managing a care home and working with people with dementia. Mrs Butt told us that the new manager is planning to hold a cheese The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 28 and wine party when they are in post. He intends to invite families and external stakeholders to give them the opportunity to get to know him and enable him to discuss his plans for the home. In the interim period the home has been managed by a senior member of staff in an acting up position. Mrs Butt told us that she intends to restructure the management team. This will consist of one manager, two deputies and two team leaders. This will ensure that there is always a responsible person available if needed to make decisions etc. Mrs Butt confirmed that she visits The Firs two or three times a week, when she carries out quality assurance audits, within the home. At the last inspection a requirement was made, which related to developing a quality assurance system, which involves the people living at the home and their representatives. This has now been addressed. We saw that satisfaction questionnaires had been returned directly to Mrs Butt, which enabled her to address any concerns raised directly. We asked how the feedback from the questionnaires would be filtered back to the people living at the home. Mrs Butt reported that if any issues were raised within the surveys she would ring the person to discuss it with them. She added that feedback from surveys would be discussed within residents meetings. As part of the inspection process we looked at the arrangements for holding peoples personal monies within the home. At the previous inspection we recommended that two members of staff signed all transactions. We noted that this is now being done. We sampled three records of transactions and checked the cash held on behalf of the person. We saw that records and cash balanced. We looked at health and safety within the home. Mrs Butt told us that they had recently had a visit from the fire officer, who made a couple of recommendations. Mrs Butt reported that the fire officer was calling back to confirm that their recommendations had been actioned. They were also planning to look at the two new flats to ensure compliance. We noted that the home has a fire risk assessment in place dated 24/03/2009. We saw that equipment is regularly serviced, this includes small electrical appliances, which were last checked 5/10/2008. Weekly checks are carried out on the call bell system to ensure all are working properly. We saw that environmental risk assessments are in place and kept under review. At the last random inspection two new requirements were made. One related to the need to cover the radiators in the lounge and dining room. The other requirement related to reviewing the accident book and ensuring that any falls are fully investigated. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 29 We saw that the radiators are now guarded. Mrs Butt confirmed that she now audits the accidents books. Any reoccurrences are investigated fully by Mrs Butt and the appropriate action is taken. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 13(4)(c) Requirement You must ensure greater clarity within care plans where people have specific needs such as diabetes and catheter care. They must also be supported by an assessment of potential risks. The records of controlled drugs must be kept in a bound book with numbered pages. This will ensure that the records cannot be altered or mislaid. Timescale for action 29/09/09 2. OP9 13(2) 29/09/09 3. OP9 13(2) All medicines must be given in 29/09/09 accordance with the prescriber’s instructions which must be clearly recorded. Records of medicines prescribed ‘as required’ must be clear, including the reasons for use. This will ensure that all people receive the medication they need at the appropriate time. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 32 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. 5. 6. 7. Refer to Standard OP7 OP8 OP8 OP16 OP30 OP30 OP30 Good Practice Recommendations Care plans must contain sufficient detail, to ensure staff are fully aware of who is responsible for certain tasks such as maintenance of hearing aids and glasses. Risk assessments should provide the reader with sufficient information regarding actions to be taken. All risk assessments should be signed and dated by the person who completed them. The complaints policy and procedure should contain current contact details for CQC. The cook should complete their recent basic food hygiene training course. A new training matrix should be developed to ensure training needs are easily identified. A written record of hoist training should be maintained. This recommendation was not explored at this visit. The Firs Residential Care Home DS0000067611.V375493.R01.S.doc Version 5.2 Page 33 Care Quality Commission London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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