Inspection on 07/08/07 for The Firs Residential Care Home

This inspection was carried out on 7th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Firs Residential Care Home 20/10/06

The Firs Residential Care Home 29/12/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Firs Residential Care Home (The) 2 Lickhill Road Calne Wiltshire SN11 9DD Lead Inspector Alison Duffy Key Unannounced Inspection 10:00 7th August 2007 X10015.doc Version 1.40 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 Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firs Residential Care Home (The) 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 Heike Sampson 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 Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2006 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 or associated illness. The home has recently seen a change in ownership. Mrs Sehnaz Butt of the Firs Care Home (Calne) Limited, now owns the home. Mrs Butt owns another care home within the Bristol area and spends her time between the two services. Mrs Heike Sampson continues to be the Registered Manager. The home is situated within a residential area on the outskirts of Calne town centre. There is a fair walk into the town although residents would probably find a car journey more appropriate. Private accommodation consists of 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. These areas are comfortable, homely and have recently been refurbished. An enclosed garden has been created to the rear of the property. Staffing levels are maintained at two members of staff throughout the waking day with an additional member undertaking a 9am – 12noon shift. At night a member of staff undertakes a waking night and there is also sleeping in provision. 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. The fees for living at the home range between £380.00 and £425.00 a week, depending on need. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place initially between the hours of 9.15am and 3.50pm on the 7th August 2007. It was concluded on the 9th August 2007 between 9.30am and 5pm. Mrs Sampson was available throughout the inspection and Mrs Butt was available for much of the time. Feedback was given to Mrs Butt and Mrs Sampson at the end of each day. Time was spent with residents in the privacy of their own rooms and the communal lounge. Discussions were held with staff and one visitor was spoken with. The morning activities and the serving of the lunchtime meal were observed. Care planning information, daily records and assessments were viewed. The medication systems were examined and a tour of the accommodation was made. Further discussions were held with residents and staffing information was viewed. This included recruitment and training documentation. Systems such as health and safety and quality assurance were also examined. As part of the inspection process, surveys were sent to the care home for residents to complete if they wanted to. Surveys for relatives, staff and health care professionals were also sent to the home to be distributed. A positive response was received and specific comments are included in the main text of this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements 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: There is a clear admission procedure that ensures residents needs, will be met within the home. Family contact is promoted and staff give residents support to write letters or use the telephone. Staff ensure relatives are kept informed of all matters, such as appointments or ill health. The medication systems are orderly managed, which minimises the risk of error. Residents are clear about who to speak to if they are unhappy. Many reported they would tell a member of staff, the manager or their family. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: While a new care plan format has been developed, not all documentation details the specific care needs of residents. Some information requires greater clarity and subjective terminology such as ‘needs assistance’ should be avoided. Greater formality with the management of health care conditions is required. This includes, in particular the management of diabetic care. Greater detail is required within the care plan. For the resident’s wellbeing, parameters of the resident’s blood sugar levels must be stated. Guidance must be available if the level is outside of these parameters. The care plan must also state the procedure for testing the resident’s blood sugar levels and who is responsible. The district nurse must train all staff in this procedure and assess and document their competency. The training must not be cascaded in the home to other staff. When a potential risk is identified within an assessment, strategies to minimise the risk must be addressed within the care plan. This must include the risk of falling and developing a pressure sore. Policies must be developed in relation to anticoagulant therapy, staff undertaking invasive treatments and the giving of intimate personal care. Any changes in anticoagulant therapy must be requested from the GP in written form. All these aspects of care provision must be documented with each resident’s care plan. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 7 While some basic activities are arranged in the home, further more meaningful opportunities must be available to residents. Activity plans, which have been devised according to individual wishes, should be applied in practice. Residents should have easier access to the garden and be given the support from staff to do so. While residents are satisfied with the food provided, a review into the level of frozen or packaged goods should be undertaken. All food removed from its original packaging or surplus to requirements after being cooked, must be sealed and dated. A review of the meal times, with particular attention to breakfast and teatime, may be of benefit to some residents. Although opportunities for training have increased, staff must receive training associated with their role. The cook therefore must be trained in food hygiene. Greater formality to the safekeeping of some residents’ monies is required. All informal receipts, for example from the hairdresser or the LINK transport scheme, must be signed and dated. A member of staff should countersign all transactions. Mrs Butt should also regularly audit the accounts. The current practice of staff using their own loyalty cards, when undertaking residents shopping must cease. Residents should be assisted to gain their own loyalty card. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 8 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 Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are assured their needs can be met within the home through an established assessment process. Greater accessibility and clarity within documentation would ensure more information is available to prospective residents. EVIDENCE: Mrs Sampson reported that there have been no changes to the admission procedures since the last inspection. All prospective residents are assessed in their own home. Assessments from placing authorities and discharge summaries from hospital are gained, as appropriate. Mrs Sampson confirmed that prospective residents and their families are encouraged to visit the home. During this time, they have the opportunity to view the home’s Statement of Purpose and the Service User’s Guide. Mrs Sampson reported that the documents are not sent out to enquirers, but discussed in the home during the initial visit. This enables any questions to be fully answered. When a placement Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 10 is offered, Mrs Sampson confirms in writing, that the home is able to meet the prospective resident’s needs. Within comment cards, seven residents reported that they received enough information about the home before making their decision. Four did not. Specific comments included ‘No but I’m very happy,’ ‘I’ve been here a long time now, I looked around the home’ and ‘the people told me, this is a nice home - that’s why I came here.’ Discussion took place with one resident who was new to the home. They reported ‘the home was recommended to me so I just believed what they said and moved in.’ They confirmed they had a visit from Mrs Sampson. The assessment documentation of this resident was viewed. The information was gained using a standard assessment format. The documentation addressed the resident’s basic care needs. However, Mrs Sampson appeared much more knowledgeable about the resident’s needs, than was documented. For example, within documentation, vision was stated as poor. Mrs Sampson was able to describe this in more detail. It was advised that this level of detail should be stipulated, so that staff are clear about the support the resident requires. The placing authority had also completed a detailed assessment. Within this, a difficulty with swallowing food and fluids was identified. This need however, had not been addressed within the home’s assessment or the resident’s care plan. The home’s Statement of Purpose has recently been reviewed. The level of fees and how these are determined, need to be added. It was also advised that exact staffing levels are documented. This would enable prospective residents to be clear of the level of provision provided. Meal times should also be stated. The document states that residents with a mental health need, can be accommodated within the home. Discussion took place with Mrs Butt regarding this, as the home is not registered for mental health. Mrs Butt said she believed The Firs could care for an older person with depression, for example. They could not however accommodate an older person with schizophrenia. It was recommended that the term ‘mental health’ should be removed. It was agreed it would be replaced with specific needs, which could be clearly met within the home. The Firs does not provide intermediate care and therefore Standard 6 is not applicable to this service. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ needs may not be fully addressed due to a number of short falls within care planning information. While residents have access to health care services, greater formality of the management of some conditions would minimise the risk of potential harm. EVIDENCE: Mrs Sampson has recently spent a large amount of time, introducing a new care planning format. In part, the format is much improved, as it is more person centred. The plan details what is essential and what is important to the individual. Specific information is identified. This includes one resident enjoying a specific woollen blanket and having alcohol in their coffee. However, the section of the plan detailing the support residents require, is limited. A brief summary or pen sketch gives a quick reference guide at the start of the care plan. Within one summary however, the section detailing recreation, rising and going to bed, were not completed. The summary stated ‘needs full assistance in all aspects of personal hygiene.’ Other subjective terms such as ‘needs prompting, with some assistance,’ ‘may get confused from time to time’ and Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 12 ‘likes to go to bed early – sometimes too early’ are stated. Mrs Sampson was advised to ensure recording is specific, to ensure staff have a clear understanding of what support is required. Under the heading foot care, chiropody was stated. There was no indication of the day-to day support the resident needed. This also applied to communication, whereby ‘not able to communicate all her needs’ was stated. All care plans contain a standard format addressing potential risks such as bathing. The bathing assessment highlighted the need for equipment and the numbers of staff required to assist. However, the risk of leaving the resident unattended in the bath, to promote privacy, was not identified. Mrs Sampson reported that all residents are accompanied at all times, as the risks have been assessed as too high. Residents’ wishes and this assessment should be identified within documentation. Within one care plan it was evident that a resident’s alcohol intake was being monitored. The resident had to ask staff for a drink when they wanted one. This practice was discussed with Mrs Butt and Mrs Sampson, as it appeared a restriction. Mrs Butt reported that she had advised staff to monitor the situation, as the resident appeared to be consuming more than was beneficial to them. Mrs Butt explained that she did not mean staff to withdraw the alcohol, from the resident. Mrs Butt was advised to discuss her concerns with the resident and their care manager. Management strategies should then be agreed and detailed within the care plan. Manual handling, tissue viability and nutritional assessments are in place. A number of assessments identified high or medium risks. Some plans detailed strategies for intervention, but many did not. In relation to the risk of developing a pressure sore, some documentation stated ‘ensure position is changed when sitting.’ It was not evident how this was being achieved. One resident had a ‘walking chart.’ Staff encouraged the resident to walk, a distance along the corridor, as a means to minimise tissue damage. Within one plan an entry stated ‘red area - keep clean and creamed. Monitor for skin breaks. Apply sudocreme.’ This information is insufficient. As good practice there was evidence that the District Nurse had been informed of one resident’s high risk of developing a pressure sore. The district nursing notes contained pictorial formats of the areas of the body prone to a pressure sore. Mrs Sampson was advised to view this information and adapt it accordingly to use in residents’ care plans. It was also suggested that the district nurse could be consulted to assist with pressure care management plans. Staff training would also be of benefit. There was evidence that Mrs Sampson reviews care plans on a monthly basis. A formal review facilitated by the resident’s care manager is undertaken annually. If the resident does not have a care manager, six monthly reviews are held. Mrs Sampson reported that the resident and their family are asked to participate. One relative confirmed their involvement by stating, ‘The Firs are happy to discuss any care plans, and happy to adapt/change new ideas should Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 13 the need arise. Care plans are always audited regularly and the care home manager is always willing to discuss XX’s care at anytime.’ Another relative stated ‘The Firs are always very good at keeping the family informed about changes and anything else relevant to the care of XX. They are also willing to share review documents and other official documents relevant to XX’s care and are always willing to answer any questions I may have.’ Another relative commented ‘I am informed of Dr visits etc but if bloods are taken etc I generally have to ask about results, it would be good to get a call from the manager, as I rarely see her due to me visiting at weekends.’ Further comments about care provision included ‘meets criteria for good care and attention in all respects’ and ‘the staff of The Firs treat my XX as an individual and give them personal attention. I, too am made welcome on my weekly visits.’ Discussion took place with Mrs Sampson regarding the need to move away from the standard care plan components, to greater individuality. For example within daily records, a number of issues were evident, which were not recorded in the care plan. This included a resident sometimes sleeping in their armchair, requiring a commode near their bed at night and various district nursing input. Residents are weighed regularly and a record is maintained. There is also documentation to record the monitoring of residents bowels. Discussion took place with Mrs Sampson regarding the need for bowel monitoring, unless there was a specific reason to do so. Mrs Sampson felt this aspect of care provision was required with all residents and was reluctant to change existing practice. Within comment cards nine residents said they always receive the care and support they need. Two said usually. Specific comments included ‘you can’t always’ and ‘the staff are very nice. They are helping me with everything. I think they are working hard.’ Within relative comment cards, five felt the home always meets the needs of their friend/relative. Four said usually. All reported that the home keeps them up to date with events. One relative stated ‘they even highlight changes in sleeping patterns, eating patterns and general dayto-day behaviour. We are also informed of Dr and Nurse visits and anything relevant to the visit, even though the home does maintain a good level of client confidentiality.’ Within discussion, all residents said they could see a doctor when they wanted to. One resident explained that they needed to change their doctor when they moved into the home. They said this caused anxiety yet they are happy with the service they now receive. A GP visited during the inspection. Staff gave the resident assistance to see the GP in their own room. Mrs Sampson reported that good support is received from health care professionals. Within comment cards eight residents said they always receive the medical support they need. Two said usually. One resident commented ‘the doctor’s always been very good.’ A relative stated that they had no concerns about the health care received. They felt staff were attentive and called the doctor as required. Care Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 14 plans demonstrated a range of visits including the GP, District Nurse, the chiropodist and the Consultant Psychiatrist. Within comment cards from health care personnel, two said the home always seeks advice and acts upon it to manage and improve individuals’ health care needs. Two said usually. Specific comments included ‘with the manager this usually happens but as D/Ns we have experienced some difficulties with some issues especially with diabetic care.’ Also ‘staff and management are always very prompt at seeking advice and are good at following my instructions for individual patients.’ Two health care professionals confirmed residents’ health care needs are always met. Two said usually. One professional stated ‘The Firs offers a restful atmosphere for patients who sometimes may be a challenge (physically or behaviourally.) The place is always clean and soft music is often played. All my patients have always appeared settled and happy with The Firs.’ While residents have regular access to health care provision, documentation demonstrated some shortfalls in the management of diabetes. It was evident that the district nurse administers insulin to one resident. However, written documentation in relation to this was minimal. There was a record of blood sugar levels, which were taken daily. There was no evidence of the parameters of the resident’s blood sugar level, to ensure wellbeing. An advice sheet detailing the symptoms of high and low levels had been placed in the care plan. This had not been related to the individual resident. There were also no guidelines for the procedure of testing the blood sugar level or who was responsible. Mrs Sampson confirmed that not all staff undertake the task. The district nurse has provided training for some staff. Mrs Sampson said she has cascaded the training to other staff. Discussion took place regarding the need for the district nurse to facilitate all training and ensure each member of staff’s competence. This must be documented and regularly reviewed. It was recommended that the district nurse should assist with the development of the resident’s diabetic care plan. Staff training is also required. One health care professional reported that ways, in which the home could improve, was to train staff to give insulin. Mrs Sampson explained that she had discussed this with the district nurse. However, Mrs Sampson or Mrs Butt are not happy with the responsibility, so will not proceed in this area. One care plan identified an ulcer on a resident’s toe. The action to be taken stated ‘chiropodist to take care of ulcer.’ Discussion took place with Mrs Sampson regarding this, as clearly the home has a responsibility to monitor the wound. They also have a responsibility to provide the support, the chiropodist or district nurse advises. Greater intervention and detail within the care plan is therefore required in this area. Residents do not administer their own medication as at this time, Mrs Sampson felt individual’s safety would be compromised. Staff therefore administer all medication. Staff reported that they have recently undertaken medication training. Names of those staff, who have been assessed as competent, are Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 15 highlighted within the administration record. All medication was securely stored and had been appropriately receipted on arrival. The medication records were satisfactorily completed. One resident was away on holiday and had taken their medication with them. Mrs Sampson was advised to record this and ensure the resident or their family signed to state they had taken the medication. One resident had been prescribed an invasive treatment, which staff were administering. Specific guidance must be in place with this. Another resident was prescribed an anticoagulant therapy, warfarin. This requires regular monitoring and possible changes in the medication’s dosage. Mrs Sampson reported that staff were accepting any change in dose, from the GP over the telephone. This practice must be formalised with written documentation requested from the GP, evidencing any changes. A formal written policy and procedure regarding anticoagulant therapy must be in place. Such details should also be documented within the resident’s care plan. One health care professional confirmed ‘medications are always administered properly and correct procedures followed at each of my visits. Storage is safe for medication.’ One health care professional confirmed that the home always respects individuals’ privacy and dignity. Two said usually and one said sometimes. One stated ‘they care for the residents very respectfully.’ Another said ‘I do feel at times that some dignity issues are not addressed well by some carers.’ Another said ‘privacy and dignity are usually respected in The Firs but this can sometimes be a difficult ideal to reach in a home with EMI beds.’ Within the inspection there was evidence of staff respecting residents personal space. They knocked on doors and waited to be asked in before entering. One resident entered the lounge and was dressed inappropriately. Staff immediately gave assistance and the resident’s dignity was promoted. Another resident however was sobbing and expressing their unhappiness with living. Staff did not respond straight away but then assisted the resident to sit in a chair, without any form of discussion or distraction from their distress. There are currently two male staff within the staff team. There was no evidence that residents had been asked if they would like their intimate personal care to be undertaken by a male or female carer. On the second day of the inspection, Mrs Sampson reported that she had asked all residents. Individual preferences must be addressed with the staff team and documented within the resident’s care plan. Mrs Butt was advised to develop a gender working policy. Firs Residential Care Home (The) DS0000067611.V337223.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents would benefit from greater opportunities to meaningful social activities both inside and outside of the home. Important relationships are promoted and visitors are welcomed at any time. Residents are able to follow their preferred routines, yet those who require assistance, rely on staff guidance and routines. Residents enjoy their meals although more emphasis on home cooking may improve the nutritional value of some foods. EVIDENCE: At the last inspection, engagement between staff and residents was minimal. However, an improvement was noted during this inspection. When supervising residents with mobility, discussion was taking place. One member of staff was involved in looking at the newspaper with a resident. The cook also discussed the menu with another resident while writing the day’s menu on the menu board. A positive relationship was evidenced with one member of staff and a resident with limited communication skills. The member of staff was able to interpret what the resident wanted. The member of staff assisted the resident, to show the inspector family photographs. The resident confirmed that the member of staff assisted them to write letters and use the telephone. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 17 Those residents spoken with said they generally spent their day, quietly in the lounge. One said they sometimes go out to lunch with their family. Another resident said ‘there’s nothing to do,’ while another said ‘they do things down there [in the lounge] but its’ not my cup of tea. I don’t join in.’ Another resident said they liked the quizzes. The staff confirmed that they undertake two activities a day, when all the general tasks have been completed. Such activities include spelling games, quizzes, catching the ball, hoopla, cards and board games. On the first morning of the inspection, staff were playing cards with four residents. In the afternoon, three residents were playing with the ball. One resident went out to an art class. There were however, two residents in particular who spent time walking up and down. They were not engaged in any activity but spent time looking out of the windows. Despite being a hot, sunny day residents were not able to walk freely into the garden. Staff did not ask if anyone wanted to go outside. Within comment cards, four residents said there were always activities arranged by the home they could take part in. Four said usually, two said sometimes and one said never. Specific comments included ‘Yes, I enjoy them very much,’ ‘I don’t like to play cards or ball. I enjoy outings and musical programmes’ and ‘I can’t do much with my body.’ Relatives raised some shortfalls within their comment cards. Specific comments included ‘in general the needs of residents are met, however I think activities need to be more structured and a wider/more frequent choice of activities available to residents who would like to participate’ and ‘most of the time XX is contented but sometimes says he/she is bored. I think a walk up and down may help this at times.’ As a means to improve the service, one relative stated ‘to spend more time with individual people.’ Another comment stated ‘I am very pleased they now go on outings, would like to see more trips, may be a mystery tour ride out on the bus.’ All residents had been asked what activities were important to them and these had been recorded on an activity planner. There was no evidence however, that these preferences were applied in practice. For example, one plan stated ‘is looking forward to the better weather so he/she can get outside.’ As stated above, this had not been addressed, through restricted access to the garden and staff not being aware. External trips, to places such as Weston-Super-Mare have been introduced and further trips to the local garden centre are planned. Mrs Sampson said trips into town are also undertaken. Discussion took place with Mrs Butt and Mrs Sampson regarding activities. While certain groups are taking place, the quality and variety of activities could be significantly improved upon. Mrs Butt and Mrs Sampson were advised to give additional consideration to the implementation of more meaningful and preferred activity, which will improve residents’ quality of life. Those residents spoken with explained that they could get up and go to bed when they wanted to. However, one said they needed to be up at a certain Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 18 time so that they would be ready for breakfast. One resident reported that they had their meals in their room. Another said ‘they like you to have your meals in the dining room unless you’re not very well.’ Another confirmed they always went to the dining room. When asked if they could stay in their room for meals, the resident said ‘I suppose you could but I like to go down.’ Some residents chose to spend their day in their room either reading or watching television. A number of residents had a rest on their bed in the afternoon. It appeared that those residents who were able to make their own decisions were able to follow their preferred routines. However, for those residents requiring assistance, staff made decisions on their behalf. These were linked to the general routines of the home. Within comment cards, two health care professionals said the home always supports individuals to live the life they choose. Two said usually. One explained ‘The Firs usually try to support my patients choice to live the way they choose, but this is not always easy when you sometimes are dealing with aggressive and confused patients.’ Three relatives felt the home always enables residents to live the life they choose. Three said usually. One relative reported ‘the only point to mention here, would be the lack of structured activities. However I have highlighted this to the care home manager and a day trip is planned in the near future and will hopefully become a regular event.’ Residents confirmed that they are able to have visitors at any time. A number confirmed the days their family visited. One explained that they often go out with their family. During the inspection, various relatives visited. Some spent time in the lounge while others used the resident’s bedroom. Within comment cards, seven relatives confirmed the home enables residents to keep in touch. Specific comments included ‘the care home are very keen to promote contact between residents and families. The home are more than happy to help residents write letters to relatives and make sure they are posted. They are equally happy to help maintain contact by phone or welcome visitors into the home with no restrictions on times or days people can visit.’ Another said ‘I am confident that if my mother needs me to call and see her, they will contact me.’ Also, ‘we are always made to feel very welcomed and offered tea/coffee. All in all, I’m very happy with the home and much more importantly XX is happy which is the main thing.’ All residents spoke favourably about the food. Within comment cards, seven residents said they always like the meals at the home. Three said usually and one said sometimes. One resident said ‘very nice meal, they are giving me everyday. I am enjoying my early morning tea as soon as getting up from the bed.’ There is a rolling four-week menu, which gives a choice at each meal. The cook reported that there are two residents who are vegetarian. A meat free meal is therefore prepared. This is often offered to all residents, so sometimes there is Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 19 a choice of three main dishes. This was not recorded on the menu. Breakfast is served at 9am and consists of cereals, porridge and toast. On a Sunday, a cooked breakfast is provided. The main meal of the day is served at approximately 12 – 12.30pm. This is always a full cooked meal with a pudding. Tea consists of sandwiches or a hot snack such as scrambled eggs on toast and cake. This takes place between 4.30 and 5pm. The menu describes supper as cheese and biscuits or sweet biscuits and a hot drink. Mrs Sampson reported that sandwiches are often provided. The cook said she believed sandwiches were served although she was not sure, as she did not make them. Supper is served at approximately 7 – 7.30pm. A number of residents said they did not have anything to eat at suppertime. One resident believed it to be a long time between suppertime and breakfast. One relative also commented ‘Although I am aware the residents of ‘The Firs’ may have a late evening sandwich if desired, I do feel that the timing of the last meal of the day is rather early – between 4 and 5pm.’ In response to this, Mrs Sampson said that some residents have an early breakfast of tea and toast at around 6am. Mrs Butt confirmed that consideration is currently being given to the meal times. She said residents would be consulted, but breakfast could probably be brought forward. Within the kitchen there was little evidence of fresh vegetables. There were potatoes and onions and mushrooms and tomatoes were in the fridge. The cook reported that a cabbage had been used for lunch. All other vegetables were frozen. This included carrots and mixed vegetables, which were served with the cottage pie. The cook explained that sometimes, fresh broccoli or swede was purchased. However the majority of vegetables were frozen. The cook reported that food such as quiches and pies were also purchased and not home made. On a Sunday teatime, soup is identified on the menu. The cook explained that this could not be homemade due to the quantities involved. Packet soups were therefore used, to give residents greater variety. Fresh fruit was reported to be available to residents. Mrs Sampson reported that these areas would be monitored and discussed with the cook accordingly. Fresh fruit salad was also offered as a regular pudding. Firs Residential Care Home (The) DS0000067611.V337223.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their families are clear about how to make a complaint and who to speak to if they are unhappy. Residents are further safeguarded from abuse following recent staff training in adult protection issues. EVIDENCE: Residents spoken with said they would generally tell a member of staff if they were unhappy. One resident felt complaining was not in their nature. They explained that if staff suggested something they wanted, they would go along with it. They would not however ask staff for anything. The resident was complimentary about the staff and felt they should fit in with everyone. The resident felt this was not a negative comment about the home, but a personal feeling. Within a tour of the accommodation it was noted that some residents had a reminder on their wardrobe, encouraging comments, to be given to Mrs Sampson. Mrs Samson explained that this had been undertaken, as a prompt for those residents, who may forget who they need to speak to, if they were unhappy. Within comment cards, eight residents said they knew who to speak to if they were unhappy. Three said usually. Specific comments included [I would speak to] ‘the staff,’ ‘my wife,’ ‘the one who sits at the table (Manager)’ and ‘I would ask Jan, carer.’ One resident said ‘I’m always quite happy.’ Eight residents knew how to make a complaint. Two said they did not know. Specific Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 21 comments included ‘I would just tell them,’ ‘too true but I’m quite satisfied,’ ‘I don’t make no complaint. I’m alright’ and ‘I am very well satisfied.’ Within comment cards, one health care personnel stated the home always responds appropriately to concerns about their care. Three said usually. One said ‘management and staff are always open to suggestions and approachable. They are keen to do a good job.’ Another said ‘all residents appear happy when I visit and I’ve never heard any complaints.’ All relatives who responded to comment cards were aware of how to make a complaint. One relative stated ‘any concerns are addressed immediately and resolved and the care home manager continues to monitor the situations and keep me updated.’ There have been no complaints reported to CSCI since the last inspection. At the last inspection, a number of negative comments were received in relation to some staff. In response, their practice has been monitored and additional training has been arranged. The majority of staff have undertaken adult abuse training by an external facilitator. Mrs Butt reported that local reporting procedures are addressed within this training. There was no evidence of the ‘No Secrets’ documentation on notice boards within the home. Mrs Sampson reported that it is discussed in supervision and within staff meetings. It was recommended that all staff have their own copy of the document. A record of this should be kept and all staff should sign to demonstrate their awareness of their responsibilities, within adult protection. Within the inspection, a number of staff were asked a hypothetical question about abuse. They reported that they would inform the manager or Mrs Butt immediately. When asked what they would do in the absence of management, they explained that a manager is always on call. They explained a manager could always be spoken to at any time of the day or night. Mrs Butt confirmed this. However she agreed ‘No Secrets’ would be more readily displayed. She also confirmed more discussions would be held with staff in terms of reporting incidents. Firs Residential Care Home (The) DS0000067611.V337223.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a comfortable, clean, well maintained environment, which is currently subject to full refurbishment. Some residents would enjoy easier access and greater use of the garden. EVIDENCE: Mrs Butt’s programme of refurbishment is progressing with residents’ bedrooms being the next stage. One resident said their bedroom had recently been redecorated. They said they had chosen the paint and the wallpaper and were really pleased with the result. The resident continued to explain that new furniture had been ordered. Another resident said they wanted to wait until the New Year before their room was decorated. An additional refurbished room was seen. The new furniture was of a good quality. Some rooms have had new flooring fitted. Mrs Sampson confirmed that all rooms would be addressed in time, as part of the ongoing programme. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 23 The environment was comfortable, homely and well maintained. One resident commented positively about the large television in the lounge. They said it was much better than the old one. Another resident confirmed they liked sitting in the lounge, as they could watch visitors’ come and go. Since taking over the home, Mrs Butt has replaced all the armchairs in the lounge and has purchased new furniture for the entrance hall. This has also improved the environment. Within the lounge however, all armchairs contained a small colour coordinated ‘kylie.’ This is a cover used as a continence aid. Discussion took place with Mrs Butt and Mrs Sampson regarding the need for these. Mrs Sampson explained they were used to minimise the potential of wet chairs through incontinence. Mrs Butt confirmed this and also reported that, if required they could be removed quickly and be washed without causing stains or odour to the chair. While this was acknowledged, it was suggested that the use of ‘kylies’ for each chair should be reconsidered. A keypad security system is in place on the front door. All visitors therefore need to see a member of staff, to enable them to leave the building. When Mrs Butt took over the home’s ownership, patio doors from the lounge were installed, to enable residents’ easier access to the rear garden. However, during both days of the inspection, furniture had been placed in front of the doors. This restricted residents’ ability to go outside, even though it was a warm, summers day. Mrs Butt reported that this had been identified although the furniture had not as yet been relocated. The laundry was not viewed on this occasion. Residents did not raise any negatives issues about their clothing. One relative commented favourably about the laundry, saying their relative was always nicely presented with clean, ironed clothes. The home was cleaned to a good standard throughout and there were no unpleasant odours. Protective clothing such as disposable aprons and gloves were readily accessible to staff. Within comment cards, ten residents said the home is always fresh and clean. One said usually. Specific comments included ‘brilliant,’ ‘spotless carpet and floor,’ ‘outside as well’ and ‘perfectly clean.’ One resident said ‘this is not posh but a really nice home and homely.’ A relative said ‘the care home is always clean and tidy and smells fresh. Whenever we go into XX’s room, it is always clean and tidy and the bed is always made and fresh. Care is taken with XX’s clothes and XX is always clean and tidy.’ A health care professional said ‘most of the rooms are lovely.’ Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While residents are satisfied with existing provision, staffing levels dictate the time and opportunities available to residents. Training is given priority and the introduction of topics related to the ageing process, would further enhance care provision. EVIDENCE: The staffing roster demonstrated that there are two members of care staff on duty at 8am. This increases to three at 9am. After approximately 12noon, the levels reduce back down to two. There are then, two care staff on duty for the remainder of the day. At night, a member of staff undertakes a waking night and another provides sleeping in provision. At the last inspection, a requirement was made to review staffing levels so that there are sufficient staff on duty at all times, to meet residents’ individual needs. In response to this, Mrs Butt has employed a domestic assistant between the hours of 9.30am and 2pm, on a Monday to Friday basis. This was intended to enable care staff to spend more time with residents. Mrs Butt also reported that as required, including times of a resident being unsettled or very unwell, staffing levels would be increased. While this was acknowledged, with twenty residents, staffing levels are only being maintained at a minimum level. There is also no domestic in the afternoon or at a weekend, so care staff remain responsible for these tasks during these times. Mrs Sampson explained that such tasks would be minimal and only involve the basics, such as cleaning toilets and hand Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 25 washbasins. Even so, it was recommended that domestic staff should also be employed at weekends. The majority of residents have breakfast in the dining room at 9am. Two members of staff therefore assist them with personal care routines before this time. Due to the number of residents receiving assistance identified in the care plans, this staffing level is minimal. With the third member of staff commencing duty at 9am, the majority of care provision has been undertaken. At the last inspection, Mrs Butt explained, that consideration was being given, to enable three staff to start at 8am. This would enable breakfast to be at an earlier time. At this inspection, Mrs Butt explained that a decision had not been finalised. Mrs Butt reported that training has been given priority and a number of new training providers have been found. The majority of staff are up to date with their mandatory training such as first aid and manual handling. However other topics related to older age and specific health conditions, have not been addressed. These include diabetic management, Parkinson’s disease, sensory loss and tissue viability. A number of staff have undertaken a two day dementia care course. Other topics covered have been challenging behaviour and adult abuse. Some of the more senior staff are currently undertaking a team building course. Discussion took place with Mrs Butt regarding giving consideration to an ongoing dementia care training programme. At the last inspection there were a number of issues, which involved poor engagement from staff. There were also a number of comments from relatives about poor attitudes of some staff. Mrs Butt has addressed this in supervision and through additional training. One relative reported that they believed, since Mrs Butt had taken over the home, staff were more attentive, caring and knowledgeable. They presumed this was due to additional training. Mrs Sampson was advised to ensure training provision is specifically related to individual roles. For example the cook has undertaken a basic food-handling course but does not hold a food hygiene certificate. The handyman and the domestic assistant have not received health and safety or manual handling training. Mrs Sampson reported that at present two members of staff have NVQ level 3. One member is doing level 2 and another is completing level 4. One member of staff is planning to start level 2. Within comment cards, one health care professional stated that the staff always have the right skills and experience to support individual’s social and health care needs. Three said usually. One stated ‘staff usually appear to be aware of all their clients individual needs. I do know that some of the staff in The Firs are qualified nurses and staff always appear to handle my patients in a caring and sensitive manner.’ Another health care professional stated ‘some carers need to enable service users to give their opinion and be given time to do so. Some carers do not speak English very well and this can cause problems.’ Difficulty in communication was evidenced with one resident. The Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 26 member of staff had a strong accent and was quietly spoken. This, combined with the resident’s poor hearing, made communication a challenge. Three relatives felt staff always have the right skills and experience to look after people properly. Four said usually. Specific comments included ‘I think so,’ ‘excellent’ and ‘I can only comment with regard to my XX and I am content with her care having regard to her health and mobility.’ One relative stated ‘the ability of care staff is second to none, however it does frustrate me when I hear care staff from an ethnic background talking in their native language… That said, I have mentioned it to the home manager and the problem now seems to have been attended to.’ Mrs Butt and Mrs Sampson confirmed that this had been an issue in the past, but not currently. Another relative stated ‘I think my XX is well looked after and generally happy in him/herself. The staff are very pleasant and always offer us coffee etc and generally I am pleased with the home manager etc.’ Further comments from relatives included ‘always very caring and mindful of residents needs. The home is bright, clean and cheery. All in all a job well done!’ and ‘they look after elderly residents very well and keep them clean and provide good food and are always kind and helpful to them.’ Within comment cards, ten residents said staff listen and act on what they say. One said staff did not listen. This resident was met with during the inspection but did not raise any concerns. Specific comments included ‘they’ve got lots of patience,’ ‘they are alright’ and ‘yes, they are extremely good.’ Seven residents said staff are always available when they need them. Four said usually. One resident commented ‘somebody’s always here’ and another said ‘at times they are with others, so I have to wait.’ During the inspection, a number of residents were asked about their call bell. All said they could use it to gain assistance from staff. One resident pulled the chord to evidence its use. Staff responded quickly. The recruitment documentation of the last two members of staff was examined. All contained the required information such as an application form, two written references, a POVAFirst check and a CRB disclosure. A medical questionnaire was in place, although these had been signed on the first day of employment. It was recommended that this should form part of the recruitment process and therefore be part of the application form. Mrs Sampson reported that all prospective candidates are asked to spend a day in the home before they are recruited. Mrs Sampson explained they are fully supervised. An assessment would then take place to see if they were suitable or if in fact, they enjoyed the work. On the day of the inspection, a prospective candidate was in the home. While they were with a member of staff in the morning, they appeared unsupported for times, in the afternoon. For example, they were expected to assist a distressed and unsettled resident and deliver meals to the table at lunchtime. This was difficult, as they were unfamiliar with the names of those residents, they were being directed to. In the afternoon, while staff were in the vicinity, they played ball with some residents. The Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 27 residents were not entirely engaged and one resident verbalised their comments, which were racially abusive. Staff did not intervene. This was discussed with Mrs Butt and Mrs Sampson who agreed the visit was poorly managed and did not go well. Mrs Sampson explained that she usually supervises the visit, although she was engaged with the inspection. In future, all introductory visits must be fully supervised. Documentation demonstrated that new staff undertake an induction programme. The format evidenced that various tasks had been demonstrated and the staff member had signed each area. The staff member’s competence had not been assessed. There were some aspects such as the use of bedpans, which were not relevant. The terminology of ‘feeding helpless residents’ would also benefit from review. It was evident that many topics had been covered in a short space of time. This included communicating with residents and care of pressure areas. Although perhaps adequate, it was advised that consideration should be given to a more in depth induction, which could be completed over a longer period of time. Mrs Sampson reported that she had various copies of induction programmes and would give consideration to one which would meet the needs of the home. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users benefit from management who are motivated to provide a good standard of care provision. Greater formalisation of the safekeeping systems of resident personal monies would ensure greater protection. Health and safety is given priority yet greater attention to food safety would minimise the risk of harm. EVIDENCE: Mrs Sampson has been the manager of the home since August 2003. She has completed her Registered Manager’s Award and is currently undertaking a distance learning, team-building course. Mrs Sampson works on a Monday to Friday basis and aims to speak with each resident on a daily basis. Mrs Butt spends two days a week in the home. She will also visit over the weekend period when Mrs Sampson is off duty. Mrs Butt explained that she was pleased Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 29 with the developments that had recently been made in the home. This included more resident focus and more staff training. Mrs Butt explained that she works well with Mrs Sampson and many of the shortfalls, identified within this inspection had already been discussed, although not implemented. Within a comment card, a health care professional reported ‘management is always keen to discuss with me patients’ individual needs (not only nursing medical ones, as they are keen to respond well to all wishes/needs.)’ The home does not have a formal quality assurance system. A number of questionnaires had been sent out to residents. However, these were not dated and were not in a format conducive to residents needs. They required a tick style response and contained many questions, covering a wide range of topics. Some were not particularly relevant. Mrs Sampson explained that she had acknowledged this so another format had been introduced. This was much improved, as it enabled comments. The questions were also in a more userfriendly style. A number of questionnaires had been sent out although the feedback had not been coordinated. Discussion took place with Mrs Butt and Mrs Sampson regarding quality audits. It was agreed that these could be linked to specific questionnaires. This would then provide feedback for future planning and developments within the home. Mrs Sampson explained that so far, she has been unable to find a system, which suits the needs of the home. Mrs Butt and Mrs Sampson agreed that they would give consideration to developing their own system. An Annual Quality Action Assessment was sent to the home to complete as part of this inspection. Mrs Sampson explained a great deal of time was spent on the document. However, as it was the first time she had completed it, she was unsure of some of its content. It was advised that in future, the assessment should be used as a quality review process. Therefore, rather than quoting National Minimum Standards, examples of good practice should be stated. Mrs Sampson reported that small amount of residents’ personal monies are securely stored for safekeeping. Each amount has a balance sheet, which details each transaction. A number were checked against the cash amounts and all corresponded. Mrs Sampson authorised each transaction. It was advised that a member of staff should also countersign. Mrs Butt was also advised of the need to regularly audit the accounts and document this on the record. Receipts were available for those expenditures checked. However, all receipts were kept separately and there was no order to their storage. It was recommended that all receipts should be numbered and then cross-referenced to the balance sheets. Some hand written receipts did not detail the reason for the expenditure or were not dated or signed. This included money used for the LINK transport scheme or the hairdresser. On a number of receipts, it was evident that when purchasing some goods for residents, staff had used their personal loyalty card. This practice must stop, as staff are benefiting from Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 30 undertaking residents shopping. Alternatively, residents could be given assistance to gain their own loyalty card, which could then be used. The environment is well maintained and no environmental hazards were evident during this inspection. Radiators are covered in toilets, bathrooms and bedrooms and all hand washbasins are fitted with thermostatic valves to maintain a safe temperature. Random testing of a selection of water outlets is also undertaken. Staff monitor and record the temperature of each bath that is run for residents. The records demonstrated a temperature of 36°C. Mrs Sampson was advised to check this, as it appeared low for a bath. Mrs Sampson has recently reviewed and further developed environmental risk assessments. COSHH assessments however were not dated and therefore it was not apparent if the information was relevant. A number of staff have received heath and safety training in the past. The domestic assistant and handyman have not received training specific to their role. The majority of staff had received manual handling training. Mrs Sampson reported that more sessions are planned. Within the fridge there were a number of food items, which had been covered but not dated. This included ham, cheese and a dish of salad cream. There were also some boiled potatoes and a small bowl of semolina, which had been left over from a mealtime, but not dated. The cook reported that she generally dates all such produce and had planned to throw the semolina out. The cook explained that the Food Safety documentation, recommended by the Environmental Health Department, was at her home. She said another book was used to record fridge and freezer temperature records. There was no recordings of cooked food temperatures or that of delivered goods. The cook reported that she took notice of the temperature of the delivery vehicle but did not record it. Mrs Butt explained, as the Food Safety documentation was only recommended, the home had developed its own recording formats. Mrs Butt was advised to reconsider using the recommended format, as it comprehensively covered all food safety practices. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 31 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 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 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4 Requirement Timescale for action 30/09/07 2 OP7 15 3 OP7 13(4)(c) The Statement of Purpose must be an accurate presentation of the services provided at the home. Information must therefore include fees, staffing levels and mealtimes. The term mental health must be removed and replaced with specific information, detailing needs that can be met within the home. 30/10/07 Care plans must demonstrate the management of health care conditions and how individual needs will be met and monitored. All plans must be kept up to date. This was identified at the last inspection. Some progress has been made with a new format and regular reviewing has taking place. However, some information lacks clarity and some conditions such as dementia, Parkinson’s disease and diabetes are insufficiently evidenced. Any potential risks identified 30/09/07 within assessments must be addressed with adequate control measures and clear intervention. This must be stated in care plans DS0000067611.V337223.R01.S.doc Version 5.2 Firs Residential Care Home (The) Page 33 4 OP8 12(1)(a) 5 OP8 12(1)(a) 6 OP9 13(2) 7 OP10 13(6) 8 OP12 16(2)(n) and address the risk of falling, developing a pressure sore and poor nutrition. The management of diabetes must be clearly detailed within the resident’s care plan. This must include the safe parameters of the resident’s blood sugar levels, the procedure to follow if the level is outside of the parameters and the procedure, frequency and responsibility of taking the blood sugar levels. All staff must receive training from the district nurse before they undertake the delegated responsibility of the testing of blood sugar levels. Written authorisation must be gained from a GP in relation to any changes in anticoagulant therapy. This medication must be detailed within the resident’ care plan and a policy be devised. A policy must be in place to ensure that individual residents’ wishes are known with regard to the giving of intimate personal care, for the protection of residents and male staff. A policy must also be developed in relation to invasive treatments. Individual wishes must be respected and fully documented within care plans. Residents must have greater opportunities for activity both in house and on an external basis. Such opportunities must be based on individual wishes. This was identified at the last inspection. Some progress has been made as external trips out have been undertaken. Further opportunities are required for meaningful activity. DS0000067611.V337223.R01.S.doc 30/08/07 30/09/07 09/08/07 30/08/07 30/09/07 Firs Residential Care Home (The) Version 5.2 Page 34 9 OP29 13(6) 10 OP30 18(1)(a) 11 OP33 24 12 OP35 13(6) 13 OP38 13(4)(c) If prospective staff members spend a day in the home before the recruitment process has been concluded, they must never be left alone with residents, at any time. Staff must have training in relation to their role. This must include tissue viability for care staff and food hygiene training for the cook. A quality assurance system that audits the home and involves residents and other stakeholders must be developed and implemented. Staff must not use their personal loyalty cards when undertaking shopping for residents. Recording systems to evidence transactions must be formalised with all receipts, dated and signed. All food that is not within its original packaging or has been cooked and surplus to requirements must be stored appropriately and dated. 09/08/07 30/10/07 30/10/07 09/08/07 09/08/07 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 Refer to Standard OP7 OP7 OP7 Good Practice Recommendations Care plans must contain sufficient detail, to ensure staff are fully aware of residents needs. Terms such as ‘needs prompting’ and ‘may get confused’ should be avoided. Consideration should be given to greater individuality within care plans including whether aspects such as bowel monitoring are required for all residents. Bathing risk assessments should document whether residents are able to be left alone while in the bath and for DS0000067611.V337223.R01.S.doc Version 5.2 Page 35 Firs Residential Care Home (The) 4 OP7 5 6 7 8 9 OP9 OP12 OP15 OP15 OP18 10 11 12 OP19 OP27 OP29 13 OP30 14 OP38 how long. If there is a need for any restriction, such as alcohol intake, this should be fully discussed with the resident and their care manager. The restriction should be fully documented with the care plan. When residents go out or go on holiday and take their medication with them, this should be documented within the medication administration records. Consideration should be given to ways in which residents can access the garden, as they wish. Consideration should be given to the review of mealtimes in order to make the time span between tea and breakfast shorter. A review of the level of frozen and packet foods should be undertaken and assessed in terms of nutritional value. ‘No Secrets’ documentation should be readily available for staff reference on the notice board. Alternatively staff should have their own copy and sign to demonstrate their knowledge. Consideration should be given as to whether all armchairs in the lounge require a ‘kylie’ sheet. Consideration should be given to employing domestic staff over the weekend period to enable care staff to concentrate on residents. Consideration should be given to attaching the medical questionnaire to the application form, so that health issues can be taken into account when making a decision about employment. Training related to specific health care conditions, should be undertaken. This should include sensory loss, Parkinson’s disease and a programme of on going dementia care training. Consideration should be given to implementing the Food Safety package, recommended by the Environmental Health Department. Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Firs Residential Care Home (The) DS0000067611.V337223.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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