Inspection on 02/07/08 for The Firs Residential Home

This inspection was carried out on 2nd July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 Home 16/07/07

The Firs Residential Home 26/07/06

The Firs Residential Home 07/02/06

The Firs Residential Home 22/06/05

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Firs Residential Home 9 Stevens Lane Breaston Derby Derbyshire DE72 3BU Lead Inspector Steve Smith Unannounced Inspection 10:20 2nd July 2008 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 The Firs Residential Home DS0000063245.V367605.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. The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Residential Home Address 9 Stevens Lane Breaston Derby Derbyshire DE72 3BU 01332 872535 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) The Firs Care Home Ltd Yvonne Marie Pelosi Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th July 2007 Brief Description of the Service: The Firs Residential Care Home provides accommodation for 20 Older People. The building was originally a large Victorian family home that has been extended to its current size. The Home is situated in the village of Breaston, located almost midway between Derby and Nottingham. Two stair lifts, and three staircases, provide access to the first floor. The Home has two lounges, and a seating area in the large reception area of the Home. There is a front conservatory that exits on to a patio and garden area, which people staying in the Home regularly use. There is a call system, which operates in all areas of the Home. Relatives and visitors can call to visit Residents at any time. The Home is run by the two Registered Providers, one of which is also the Manager. The charge made for a room at The Firs Care Home ranged from £370.00 to £345.00 a week. The difference in fee relates to the size of room chosen by the potential new Resident, and whether it is a shared room. Details of previous inspection reports can be found in the Home, or on the Commission for Social Care Inspection’s website: www.csci.org.uk The Firs Residential Home DS0000063245.V367605.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 that people who use the service experience Good quality outcomes. The focus of inspections, undertaken by the Commission for Social Care Inspection (CSCI), is upon outcomes for people and their views of the service provided. This process considers the Home’s capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. This inspection visit was unannounced and took place over a period of nearly 7 hours. In order to prepare for this visit we looked at all of the information that we have received, or asked for, since the last key inspection of the Home, which took place on 16 July 2007. This included: The ‘Annual Quality Assurance Assessment’. This is a document completed by the Registered Providers of the Home that focuses on how well outcomes are being met for people using the service. What the service has told us about things that have happened in the service. These are called ‘notifications’ and are legal requirements. The previous ‘Key Inspection Report’, and the results of any Other Visits that we have made to the service in the last 12 months. Relevant information from Other Organisations, and what Other People have told us about the service. Surveys returned to us by people using the service, from the relatives of those staying in the Home, and from the staff working in the Home. For this inspection of the service the Commission’s Residents questionnaire (a ‘survey’ mentioned above) was sent to ten people staying in the Home, and nine were returned. Ten questionnaires were also sent to relatives of those staying in the Home, and seven were returned. Ten questionnaires were also sent to staff, and four were returned. During this visit to the Home ‘case tracking’ was used as a system to look at the quality of the care provided. This involved the sampling of a total of three peoples records, being a cross-section of people staying in the Home. Discussions were held with those people, if they were able, together with a The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 6 number of others, about the care and services the Home provided. Their care plans and care records were also examined, and their private bedrooms and communal facilities were seen. Discussions were also held with any relatives that were visiting during this visit to the Home. In addition, discussions were held with the Manager of the Home about its general operation. Discussions were also held with staff about the arrangements for peoples care, and also about the staffs recruitment, induction, deployment, training and supervision. What the service does well: What has improved since the last inspection? What they could do better: The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 7 Staff must sign the Medication Administration Record (MAR) sheets after distributing medication to people staying in the Home. Staff also needed to record more accurately when additional medication was stated as needed by Doctors for those staying in the Home. Additional activities must be provided for those staying in the Home. Staff needed to receive training in Safeguarding Adults and Whistleblowing. The exterior of the Home needed to be decorated and seating needed to be provided in one of the bedrooms of the Home. One bedroom also needed a light shade. When appointing new staff, the Registered Provider/Manager needed to follow proper recruitment procedures to ensure that only appropriate people were appointed to work with people staying in the Home. New staff also needed to be provided with information from the General Social Care Council concerning the code of conduct and practice they needed to maintain. The Registered Provider/Manager needed to provide an annual development plan for the Home. 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. The Firs Residential Home DS0000063245.V367605.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 The Firs Residential Home DS0000063245.V367605.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): Standards 1, 2, 3 & 6. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. All new people moving to the Home were appropriately assessed prior to their admission, so that they were reassured that their needs would be met. EVIDENCE: The Registered Provider/Manager had provided a detailed statement of purpose for the Home together with a Resident’s Guide, which was seen in the bedrooms visited during this visit to the Home. The Guide was well completed, although it did not included information from people that had stayed in the Home on what life was like in the Home. The Residents Guide contained information on how contact could be made with the Commission, the local Social Services Dept and the local Health Authority. In the Annual Quality Assurance Assessment completed by the Registered Provider/Manager, prior to this visit to the Home, she wrote – ‘We provide a high quality service taking into account each residents health needs. The The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 10 statement of purpose has been reviewed and modified and has more details. Staff are attentive and supportive of the residents. Good levels of care staffing are provided above the Commission’s recommendation.’ People staying in the Home were very happy with the admission procedures, for example one said – I ‘consulted with my son and daughter’ before deciding to move here. My contract is now held by my daughter …’ Relatives, of people staying in the Home, were also happy with the admission procedures, saying – ‘… my relative (has very high) needs. However, the management and staff accommodated this sensitively and with the utmost care … the home needs a high degree of praise for the way the service (is) given…’ – and – ‘I think my mother is well looked after and her individual needs are always met’ – and – ‘Excellent care and facilities. Mother is very well looked after.’ Staff said that they were given good information about the care and support needs of people staying in the Home – ‘Management are always very good at giving up to date information’ – and – ‘Yes, I always have ‘hand over’ at the start of any shift.’ The records of three people were examined during this visit and a copy of the statement of terms and conditions of residency or a contract, if purchasing their care privately, was found in each file. When new people were admitted to the Home, the Registered Provider/Manager was provided with a summary of the needs of each person, completed by the Social Services Dept Care Manager supporting each person, copies of which were seen. The Registered Provider/Manager also assessed all people sponsored by Social Services Depts. If the person was self-funding from the outset, the Registered Provider/Manager completed her own summary of needs, which were also seen during this visit. Standard 6 does not apply to this Home. The Firs Residential Home DS0000063245.V367605.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): Standards 7, 8, 9 & 10. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Peoples health and personal care needs were being well met, as demonstrated within care plans and by comments made by those staying in the Home. Medication was also administered appropriately to meet peoples needs. EVIDENCE: Three records of people staying in the Home were examined, or case tracked, to ensure that suitable records were being maintained. Good initial assessment records were made by the Registered Provider/Manager, during her first visit to the potential new people to their own homes. This was found to be followed up by detailed Individual Plans of Care and risk assessments for each person in the Home. However, plans of care tended to be completed in general terms. For example, (the person) ‘needs the assistance of two staff to dress and undress’ and ‘Toileting – needs the assistance of 1 carer.’ This does not describe what staff should actually do for the person needing the assistance. The assistance needed was most likely to be very different for each person staying in the Home. The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 12 Six monthly reviews of care were seen, and were completed by the Registered Provider/Manager. Monthly reviews of the care plan were provided by the care staff, which were also seen in peoples files. Peoples care files were well organised with different sections, were regularly reviewed by the management of the Home, and were kept in a secure location. One care file seen had negative descriptions of a person’s behaviour used throughout the record. This was pointed out to the Registered Provider/Manager who undertook to immediately address the matter. Staff were observed talking and assisting those staying with meals in the dinning room and in the lounges. This was seen to be done very positively, with a relaxed atmosphere, which was enjoyed by the people staying in the Home. People staying in the Home had commented in the questionnaires that they received – ‘Excellent care at all times (and staff) always (listen and act on what I say)’ – and – ‘Yes the staff are very good and helpful, and treat me with respect.’ Relatives commented that staff were able to show that – ‘…every aspect of post-stroke support is available’ - and – ‘As far as I am aware, most staff have or are obtaining appropriate care qualifications.’ Staff said that they had been trained well in the Home – Yes, I have done my NVQ 2 and will soon be starting my NVQ 3.’ The records of peoples health needs were observed and a good record was found to be maintained. In the Annual Quality Assurance Assessment the Registered Provider/Manager wrote - ‘The (Registered Provider)Manager promotes and maintains (peoples) health and ensures access to health care services and the registered provider/manager escorts (people) to local surgeries and hospitals, so as not to compromise staffing levels. (Peoples) privacy and dignity is respected at all times.’ All medication and the method of distributing it to people was examined, and a good system was found to be in use. However, it was found that when a Doctor prescribed an additional medication, after the pharmacy had prepared the Medication Administration Record (MAR) sheets, that the additional medication was not documented correctly. Two people were not signing to indicate that the correct entry had been made on the MAR sheet, this entry was not dated with the date the medication was to start, and nor did it state the name of the Doctor who authorised the medication. The Home uses Medidose containers to hold medication for distributed to those staying in the Home. In three containers, for three people staying in the Home, a drug was found to have not been given to the people, but this drug had been signed for on the MAR sheet as though the drug had been given. The Annual Quality Assurance Assessment stated that – ‘The (Registered Provider)Manager ensures that there is a policy and staff adhere to procedures regarding The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 13 medication.’ All of these staying in the Home said in the questionnaire provided that they were always happy with the medical support they received. Discussion was held with people about life in the Home. They said that staff were very good at listening to their views on how they liked to be cared for and staff would carry out their wishes. They also said that their care needs were always met with dignity and respect. As a result, they felt very safe in the Home, and appeared to have a strong sense and appearance of well being. One person said, when asked if staff did things the way the person wanted – ‘As a rule, staff are all very good and do things my way’. Another person said that - ‘Staff help me my way.’ The Registered Provider/Manager’s Annual Quality Assurance Assessment stated that – ‘Relatives and residents have requested to stay at The Firs in their final stages of life whenever possible as they know the level of care is of a very high standard and local GPs have supported us in doing this. Evidence can be located in the families’ thank you letters and cards.’ The Annual Quality Assurance Assessment also stated – ‘With the help of GPs, district nurses and Macmillan nurses we have been able to improve our care where service users are able to spend their final days in the comfort of their own room and familiar surroundings. Staff administering medication have attended training and are appropriately trained. The training was accredited…’ All staff were observed to be very caring in their dealing with people, and spoke to them in a caring manner. The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 14 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): Standard 12, 13, 14 & 15. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Peoples preferred lifestyles were respected by the Home, and they were given a wholesome and appealing diet in pleasant surroundings, that enhanced their well being. EVIDENCE: People staying in the Home were asked about the activities provided. Those spoken with said that bingo was played, and that a physical exercise programme was provided that took place at least once a fortnight. They also said that there was a ‘singing session’ and occasional quizzes took place, about once a month. Aside from this no other activity was provided. One person did say, however, that a trip was being organised to Twycross zoo, in a few weeks time. In the questionnaire sent to people staying in the Home one person said that there were – ‘Motivation exercises, a visual impairment group is organised, a singer comes and we have quiz afternoons.’ Staff spoken to were not able to add any other additional activity. In the Annual Quality Assurance Assessment completed by the Registered Provider/Manager, she wrote that she would like to recruit an Activities Coordinator to boost the activities provided in the Home. However, she also The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 15 wrote that the activities provided had improved during the past 12 month period. People staying in the Home said that they decided when they got up and went to bed. They said - ‘I can get up whenever I want, and I also go to bed when I want’ – and – ‘I need a lot of staff help to do this, but I tell them what time I want to go to bed and get up.’ People also said that in the main they have one bath a week. One person said – ‘I can have one bath a week, but I would like two baths each week. People staying in the Home said that relatives and friends were able to visit at anytime, and could always be seen in private - ‘They come in here, in the conservatory, in private’ - and – ‘Oh yes, I can always see my relatives in private.’ The staff spoken with also said that relatives could visit at anytime. It was said that those staying could chose where they wanted to see their relatives, in the conservatory, or in the person’s bedroom. During this visit it was observed that people chose to see their relatives in the conservatory. One person said that – ‘I could go to the shops, if I wanted to go, but staff will get things for me that I want’ People were asked how staff respected the privacy of their bedrooms. One person said - ‘They knock and wait for my to say ‘come in’, always’ – while another said – ‘As a rule they knock on the door and walk in’. People staying in the Home were able to say that the Home provided good meals and that a choice was available at breakfast, dinnertime and teatime meals – ‘There is always a choice. I can choose what I want at all meals’ – and – ‘A choice at breakfast, two choices at dinner time and at tea time.’ Staff spoken with also confirmed this. People staying and staff said that drinks and snacks were always provided between meals, and that people could also ask for additional drinks at anytime. Mealtimes were never rushed, which was witnessed during this visit to the Home. The Annual Quality Assurance Assessment, provided by the Registered Provider/Manager, said that – ‘Mealtime menus are recorded and maintained. We offer a lot of choice at meal times. Visitors are able to have meals with residents. Residents are individually asked what they would like to eat at each mealtime and the cook spends a lot of time trying to cater for each individual. The food is homemade and cooked on the premises. We buy a lot of fresh food from the local farm shop and one of the residents enjoys choosing some of the food from local shops. Menus for meal times are recorded and the home has an open budget regarding food. Every Friday salmon fillets and battered fish is served. Our priority is to provide good quality meals high in nutrition and that the residents want.’ The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 16 Two staff were also asked, when people needed assistance to managed their meal, how many people they might help at the same time. Both staff were quite clear in saying that they would only assist one person at a time. However, they also said that it was not often that people needed this type of assistance in this residential care home. The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 17 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): Standards 17 & 18. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Complaints made to the Manager were addressed to meet peoples needs. The protection policies and procedures provided meant that people staying in the Home were well protected. EVIDENCE: People spoken with during this visit said that if they had a complaint to make – ‘I would tell the Assistant Manager, and she would tell me what she had found out.’ Another person said – ‘I would tell (the Manager), but I have never had to do this.’ Those who completed the questionnaire were clear that they would tell the Registered Provider/Manager of any complaint they had to make, however, some commented that they have not, so far, had to do this. One relative who completed the questionnaire sent to her wrote – ‘This information was given on admission … I did have one occasion to discuss (with the Manager) a serious issue around medication. … I can only praise the Manager in how she dealt with the issue.’ All other relatives, completing the questionnaire, were quite clear on how to make a complaint should the need arise. Staff were also clear about how to deal with complaints. One wrote – ‘(The Manager) has always been clear on how we are to handle (these) situations. In the Annual Quality Assurance Assessment completed by the Registered Provider/Manager she wrote – ‘All complaints are responded to by the Register Providers within 48 hours. Written and verbal complaints are logged and The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 18 maintained in the office. Complaint forms are available on the notice board in the main hall, we have an open door policy and the Manager is always available. Complaints are taken seriously and are acted on swiftly by the manager. The residents are confident to let staff know if they are not happy and want changes. The manager has informed residents individually of the complaints form. The manager meets residents each morning and residents are aware that they can speak to the manager if they have any issues. Where service users lack capacity we call upon family members to help make choices on their behalf or would contact advocacy services. The Commission had not received any notice of complaint since the last visit to the Home, in July 2007. However, the Home had received 5 concerns since the last visit the Home. These were reviewed and found to have been addressed in a positive manner. Good procedures were seen for both written and verbal complaints. The Registered Providers complaints procedure detailed that all complaints would be responded to by the Registered Provider/Manager within 28 days. The Registered Providers had a Safeguarding Adults procedure that included a ‘Whistle Blowing’ policy, which staff knew about, but said that they had not received any training. This policy meant that a procedure was in place to allow staff to inform the Manager of any inappropriate actions by other staff. The Registered Provider/Manager had copies of the Public Interest Disclosure Act of 1998, and of the Dept of Health’s policy called ‘No Secrets’. The Registered Provider/Manager confirmed that all allegations and incidents of abuse would be promptly followed up and that all actions taken would be recorded. However, she said that she had never had to do this. Staff spoken with said that they understood that people staying in the Home might, on occasion, show anger and aggression, and were able to describe how they would deal with this sort of situation. The Manager said that a policy was available to staff stating that they could not benefit from Residents wills, which was also understood by the staff, with whom discussions were also held. The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 19 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): Standards 19, 20, 21, 22, 23, 24, 25 & 26. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. The Home was well maintained throughout, providing all people staying in the Home with a safe, comfortable environment in which to live. EVIDENCE: In the Annual Quality Assurance Assessment the Registered Provider/Manager wrote – ‘We have had a routine maintenance program, we have re-decorated most bedrooms, bought new furnishings, the grounds are kept tidy and attractive and we have encouraged residents who love gardening to keep up their hobbies. Residents have a choice of colour scheme in their bedrooms prior to entry. All emergency call lines are placed near to where the residents can reach. Additional emergency call lines have been fitted in the bathrooms. All call lines are red with red pendulums. The washbasin in bedroom 8 has been replaced with a full size basin. All bedroom doors are fitted with new locks which can be operated from both sides. Care and cleaning staff are provided with masterkeys. Door knockers are fitted to all bedroom doors. The The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 20 downstairs bathroom has been refurbished and a parker bath has been installed.’ A tour was made of the public areas of the Home, and included all of the bedrooms of those staying. The Home was most pleasantly decorated throughout, and the lounges and dining room was very pleasant to sit in. The bedrooms seen were provided with sufficient space and provision for each person staying in the Home. The Registered Providers had also provided appropriate furnishings in all locations seen during this visit. Toilets were easily available to everyone staying in the Home, were clearly marked, and were provided with handrails where necessary. A call system was also available throughout the Home. All bedroom doors were provided with locks, which Residents could choose to use. Almost all radiators were appropriately guarded, and could be controlled within each bedroom. The Home had appropriate sluicing facilities, and laundry was washed at appropriate temperatures. However, the following points needed attention: The paint work on the exterior of the Home was badly flaking and needed to be painted. Two radiators in the home needed to be assessed to ensure that people were not at risk, should they fall against them. If people were judged to be at risk covers must be provided. Bedroom 88 had no comfy chair within it all. Bedroom 4 was provided without a light shade. On the first floor, shelving had been provided for bed linen, but this appeared very untidy and needed to be enclosed within a cupboard. It was understood that the Fire Officer had also recommended that the shelving be enclosed in a cupboard to minimise the fire risk. The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 21 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): Standards 27, 28, 29 & 30. The quality in this outcome area was Adequate. This judgement was made using available evidence including a visit to this service. A good level of care staffing was provided to meet the needs of people staying in the Home. However, recruitment practices were not robust when recruiting new staff to the Home. EVIDENCE: Levels of care staffing were examined for the 2 weeks beginning 14 and 21 June 2008. This showed that a good level of staffing was being provided. The Registered Provider/Manager’s Annual Quality Assurance Assessment stated that – ‘High levels of staffing hours are provided to meet resident’s needs’ – and – ‘Additional staff are on duty at peak times.’ At the time of this visit to the Home it was found that over 50 of care staff had a qualification of at least NVQ level 2 in Care; 10 out of a total of 17 staff, 59 . A further 4 staff were currently undertaking the training at the time of this visit to the Home. This was confirmed by the Registered Provider/Manager’s Annual Quality Assurance Assessment, where she wrote – ‘More than 50 of staff have NVQ level 2 or 3.’ Two staff were spoken with during this visit to the Home. One said that she had an NVQ level 2 in Care , and was waiting it start her NVQ level 3. The second person had recently joined the staffing group and so did not have an NVQ level 2 in Care. The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 22 The records of two new staff employed during the past 12 months were examined to see whether the Registered Provider/Manager had obtained all relevant information about them. It was found that there were significant gaps in the information obtained. Criminal Record Bureau information had been sent for a considerable time after a member of staff had started work in the Home. References had been obtained for one member of staff, but for the second only a verbal reference was available. The history of employment of both staff had only been taken over the previous 10 years, and not back to when they had left school. This was needed to allow the Registered Provider/Manager to check whether the potential members of staff had worked in care in the past, to allow contact to be made with the care agency, to ensure the person had not been dismissed due to offences against those looked after. Details of each new member of staff’s physical and mental fitness for the job had been asked for, in general terms only, but no specific question was asked about their fitness to undertake the bending and lifting tasks required in this employment. All other information was found to be satisfactory. However, staff spoken with were also not able to confirm that they had been given copies of the General Social Care Council’s code of conduct and practice. The Registered Provider/Manager said that all new staff would be provided with induction and foundation training, which was confirmed by staff. She also said that all care staff were provided with at least three paid days training a year, which again was confirmed by staff spoken with; one said that she had had at least 4 days training during this past 12 months. In the Registered Provider/Manager’s Annual Quality Assurance Assessment she wrote - ‘Staff records are documented and maintained. Staff inductions are provided within 6 weeks of appointment and maintained within the employees files. Staff are paid for training. Staff have an individual training and development assessment and profile.’ This was also confirmed by a review of the information kept at the Home. One member of staff said in the questionnaire they completed – ‘Yes, I have completed my NVQ 2 and will soon be starting my NVQ 3.’ The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 23 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): Standards 31, 33, 35, 36 & 38. The quality in this outcome area was Good. This judgement was made using available evidence including a visit to this service. Management arrangements at the Home were in place to ensure that Residents care was maintained at a positive standard. EVIDENCE: The Registered Provider/Manager was appropriately qualified to manage the Home, having an NVQ level 4 qualification in Management and Care. The records of the monthly ‘inspections’ of the Home, carried out by the second Registered Provider, were examined and were found to be satisfactory. This was also confirmed in the Registered Provider/Manager Annual Quality Assurance Assessment. The Registered Provider/Manager was able to show that surveys had been undertaken of peoples opinions of the operation of the Home, and these had The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 24 been published. She also stated that she and the staff would be able to demonstrate the Home’s commitment to lifelong learning and development of each person in the Home. This was also confirmed by conversations held with staff during this visit. Staff said that they complete daily logs on each person staying in the Home, and complete a monthly review of each Resident, which was read to the Resident. The opinions of Residents families and friends, and of GPs and District Nurses were obtained on how well they all thought the Home was achieving goals for those staying. These were again published, and were posted on a notice board of the Home. However, the Registered Provider/Manager had not completed an annual development plan for the Home, covering such issues as the needs of those staying, the needs of staff and the needs for the development of the premises. It was seen that the personal money of people staying in the Home, and held by the Home, was maintained satisfactorily. However, the savings of some people were discussed with the Deputy Manager and an action plan recommended. A member of staff was asked about the supervision she received from the Registered Provider/Manager or other senior staff in the Home. She said that this was done on approximately a 2 or 3 monthly basis, when her own needs and the needs of the people staying in the Home were discussed. This was confirmed by the Deputy Manager. In the Registered Provider/Manager’s Annual Quality Assurance Assessment she wrote – ‘Staff receive formal supervision every 2 months and are aware that they can speak to the manager at any time. Supervision covers all aspects of practice, the philosophy of care and career development needs.’ Information was not totally available about the mandatory courses staff had attended within the last three years. The member of staff, with a number of years experience, spoken to said that she had attended mandatory courses on Moving and Handling, Fire Safety and First Aid, but not on Food Hygiene or Infection Control. The Deputy Manager was able to show that all accidents, injuries and incidents of illness or communicable disease were recorded and reported to the relevant government bodies. With the assistance of the Fire Service, fire safety notices were also posted in relevant places around the Home. The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 25 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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 26 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 OP9 Regulation Reg 13(2) Requirement When staff have to enter additional medication on to Medication Administration Record (MAR) sheets as a result of a Doctor’s visit, this must always be checked and signed by two staff, state the day on which the medication is to commence and state the Doctor authorising the additional medication. When distributing medication to people staying in the Home care staff must not sign the MAR sheet if a medication has not been given. One of the codes indicating the reason why the drug was not given must be used. 2. OP12 Reg 16(2)(m) & (n) People living in the home must be provided with a range of activities and social interests, to provide entertainment and to encourage mental and social activity. (This issue is outstanding from the inspection report dated 16 July 2007) DS0000063245.V367605.R01.S.doc Timescale for action 27/08/08 27/08/08 The Firs Residential Home Version 5.2 Page 27 3. OP18 Reg 13(6) All staff must be trained in Safeguarding Adults procedures and Whistleblowing procedures. This will enable staff to understand how their actions will protect people staying in the Home from abuse. The exterior of the Home must be decorated to prevent deterioration of the property and to present a pleasant appearance for people staying in the Home and their visitors. Bedroom 88 must be provided with at least one comfy armchair to all allow the person whose room it is comfortable seating. In bedroom 4 a light shade must be provided to ensure the bedroom is appropriately furnished. 30/11/08 4. OP19 Reg 23(2)(b) & (d) 31/10/08 Reg 16(2)(c) 5. OP29 Reg 19 & Sch 2 6. OP29 18(4) The Registered Provider/Manager must ensure, when appointing new staff, that all the requirements listed in Regulation 19 and Schedule 2 of the Care Homes Regulations 2001, as amended during 2004, are obtained. This is to ensure that people are appropriately assessed before they commence providing care. All new staff beginning to work in the Home should be given information about the General Social Care Council code of conduct and practice. The Registered Provider/Manager needs to complete an annual development plan for the Home to ensure that all future needs of the Home are documented and eventually addressed. DS0000063245.V367605.R01.S.doc 27/08/08 27/08/08 7. OP33 24 31/10/08 The Firs Residential Home Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP1 OP7 No. 1. 2. Good Practice Recommendations The Residents Guide should contain the views of people staying in the Home on what it is like to live in the Home. Peoples care plans should be very detailed, stating exactly what staff need to do for each person staying in the Home, in each aspect of the Care Plan. This will ensure that appropriate care is provided for each individual staying in the Home. Peoples behaviour should not be written up in negative ways. A non-judgement style needs to be developed by the care staff, and to achieve this training may be needed. 3. OP12 Every effort should be made to allow people to have more than one bath each week if that is their preference. Staff should be made aware of those people who should be encouraged, following staff knocking on their bedroom door, to invite staff into their bedrooms, and those people who can no longer do this. 4. OP19 The shelving, on the first floor landing area, provided for bed linen, should be boxed-in, to provide a cupboard for the linen. Arrangements should be put in place to allow the savings of the those people identified during the visit to the Home to be adjusted. 5. OP35 The Firs Residential Home DS0000063245.V367605.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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. 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