Inspection on 12/09/05 for The Firs Specialist Residential Home

This inspection was carried out on 12th September 2005.

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

Other inspections for this house

The Firs Specialist Residential... 19/06/08

The Firs Specialist Residential... 29/08/07

The Firs Specialist Residential... 16/08/06

The Firs Specialist Residential... 04/01/06

The Firs Specialist Residential... 12/10/04

The Firs Specialist Residential... 28/04/04

The Firs Specialist Residential... 24/06/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Firs at Crowhurst Old Forewood Lane Crowhurst East Sussex TN33 9AE Lead Inspector James Houston Unannounced 12th September 2005 08:30 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Firs at Crowhurst Address Old Forewood Lane Crowhurst East Sussex TN33 9AE 01424 830591 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miyano Care Services Limited Mrs Tracy Stevens Care Home 30 Category(ies) of Dementia (DE), 30 registration, with number of places The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. That only service users with a dementia type illness may be admitted 2. The maximum number of service users to be accommodated will be thirty 3. The service users accommodated will be aged sixty five years of age or over on admission Date of last inspection 12 October 2004 Brief Description of the Service: The Firs at Crowhurst is a detached extended and adapted building, situated in the village of Crowhurst. Both the towns of Battle and Hastings with their shops and access to bus and rail services are approximately three miles away. Accomodation is provided on two floors in six double and eighteen single rooms.A stair lift is fitted to assist those residents who have mobility problems to access first floor accomodation. The home is registered to accomodate 30 older people who have a dementia type illness. The registered provider is Miyano Care Services Ltd. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning and afternoon of the twelfth of September 2005. Before the inspection papers held by the Commission for Social Care Inspection were read, and those standards to be inspected prepared. The inspection took 6.1 hours. The inspector spoke with six residents, two relatives, four staff and the manager. A variety of records including three care plans were read. Twenty-eight residents were being accommodated on the day of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 6 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 Standards Statutory Requirements Identified During the Inspection The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4,5 and 6. The home gives full information to residents and their relatives to assist them in the decision as to whether or not they should enter the home. A copy of the most recent residents’ contract should be kept in the home. The home meets the needs of the current resident group. Residents and their representatives are encouraged to visit the home before admission to assist them in the decision about whether to enter the home or not. EVIDENCE: The home has a suitable service users guide/statement of purpose. A necessary minor amendment was made during the inspection. This document is available in the entrance area of the home. The home gives a contract of residence to each resident’s representative, with a section to be returned for the home’s records. It is recommended that a copy of the updated contract be available in the home. Discussion with residents, relatives, staff and the home’s manager and the reading of a range of records showed that staff, individually and collectively, have the skills to meet the needs of the current resident group. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 8 Residents and a relative said that they had visited the home prior to admission. The manager said that she always visits prospective residents in their own setting as part of assessment. A bed is kept for those in need of respite care. Admission is followed by a period of a month’s trial. Intermediate care is not offered in the home. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,9 and 10. Care plans are well kept. Medication administration systems are thorough. Residents are treated with respect. EVIDENCE: Three care plans were read fully. They set out in detail action to be taken by care staff. Records inspected showed that copies are sent to residents’ relatives and relatives are invited to sign to acknowledge content. Care plans were seen to be reviewed monthly. Risk assessments are drawn up. Daily recording is made for residents and these entries were found to be up to date. Staff said that they had received guidance in writing in such documents. The home has a key worker system. Medication records were inspected and found to be well kept. The home has suitable medication administration policies. Staff said that they had received suitable training from a local pharmacist. A local pharmacist visits the home regularly to check its systems. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 10 Staff said that they had had training as part of their induction about how to treat residents with dignity. They said that screens are provided so that care can be given without compromising privacy in shared rooms. There is a telephone which can be taken to residents receiving a telephone call. Private meetings can take place in residents’ own rooms or in a separate area in the sun lounge which can be screened off. Interactions seen by staff with residents were attentive and friendly. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 and 15. Social activities and food are well managed and provide interest and variation for people living in the home. Visitors are made welcome. EVIDENCE: Records of residents’ individual interests are kept within the care notes. All residents have freedom of movement around the house, and can go out with an escort or family member if they so wish. Relatives noted that a musician visits the home regularly and that an outside agency visits fortnightly to lead a range of activity sessions. The manager takes small groups of residents out regularly eg when going shopping or to a garden centre. Residents said that their relatives are made welcome when they visit and relatives confirmed this. Residents and their relatives said that the home provides good food for residents. Records inspected showed that full records of meals served and alternatives given are kept, and a relative confirmed that alternatives are offered. The manager confirmed that special diets are catered for. Staff said that they have time to offer discreet assistance at mealtimes to residents who need it. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 12 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. The home has suitable arrangements to deal with complaints made to it. The home’s procedures and processes were suitable and designed to protect residents in the event of any allegations of abuse. EVIDENCE: The home has a suitable complaints policy which is made available to residents and their representatives. The log where complaints made are recorded was inspected. This was found to be well kept. Since the last inspection a year ago there has been one complaint to the Commission of Social Care Inspection concerning the running of the home, namely some aspects of cleanliness. The home responded positively to the complaint and uses issues raised to review practice. The home has suitable policies on adult protection and managing challenging behaviour. The home has a copy of the local guidance on the protection of vulnerable adults. Staff said that they had had suitable training on these aspects, and records inspected confirmed this. Adult protection procedures have not had to be invoked in respect of any resident in the past year. Staff are aware of the home’s guidelines on not receiving gifts from relatives and their families. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20, 24 and 26. The home provides accommodation to a good standard. Fire doors must be attended to so as not to compromise fire safety. Items identified during the inspection need attention. Communal areas and bedrooms are well presented. The home’s laundry service is suitable. EVIDENCE: The Firs is a large detached building set in its own grounds. The home is on two floors. The garden is accessible to residents and they said that they enjoy using it. The building is generally well maintained. A fire door did not close onto its stops, and other corridor doors were held open but not connected to a magnetic closure so that they would shut in the event of an emergency. A communal toilet without natural ventilation must have an air extraction unit. Other minor matters brought to the attention of the manager during the inspection need attention. Some carpets need reviewing and the manager said that this is in hand. The home has been inspected by the fire officer and the environmental health officer since the last inspection, and evidence was produced that matters raised by these inspections have been dealt with. Plans to extend the kitchen and laundry and provide a lift next year are in hand. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 14 The home has a range of sitting and dining areas, and furnishing and lighting in these areas is domestic in character. Bedrooms are furnished to a satisfactory standard. Residents are enabled to bring in their own furniture and a record of these items is kept. Residents spoken to said that they do not lock their rooms. The manager said that the cleaner locks rooms after cleaning to lessen the incidence of residents entering the rooms of others, and two residents do choose to lock their doors. The home’s laundry is well sited away from food preparation areas. Relatives spoken with said that the laundry service works well for their relative and that they find the home to be kept clean and tidy. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29. A competent staff team meets residents’ needs. The home’s recruitment processes are robust. EVIDENCE: A staff rota was available for inspection. This showed that four carers are on duty in the home during the working day, and two waking staff are on duty in the home at night. There are in addition sufficient catering and cleaning staff. The owners assume responsibility for administration and maintenance. The manager is extra to the rota and is on call to her staff when not working in the home. Residents, relatives and staff confirmed that they consider there are sufficient numbers of staff to meet the needs of residents. Staff said that staff turnover is low and that agency staff are not used. A relative said that when an alarm call was rung it was answered “in a flash” by the home’s staff. Residents and relatives said that they find staff very helpful. The manager said that no staff under 21 are left in charge of the home. Records inspected showed that the home keeps the required records for members of staff recruited to work in the home. Staff photographs are held in the home and the manager agreed to incorporate a copy of these into the recruitment records. Staff said that they receive a contract of employment and records inspected confirmed this. Staff records showed that staff sign to acknowledge receipt of the General Social Care Council Code of Conduct. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35,36 and 37. Quality assurance systems are good. The home has suitable financial procedures. Residents’ financial interests are safeguarded. Supervision of staff needs some attention. Records are generally well kept. EVIDENCE: The home seeks the views of residents informally. Staff meetings are held regularly and are minuted. Satisfaction questionnaires are sent out to relatives regularly and the manager was able to provide concrete examples of how feedback received is used to improve the services for residents in the home. Views of visiting professionals are also sought formally. The home also produces a regular newsletter. The home’s owner also regularly undertakes and records visits which check on the home’s performance, in accordance with the Residential Care Homes Regulations. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 17 The home has an annual business plan, which was available for inspection. The home has adequate insurance and the certificate is on display in the home. The owners deal with finance issues. The home does not currently hold monies or valuables for residents but the facility to do so exists. Staff confirmed that they receive regular formal recorded supervision. Supervision records inspected did not show the recommended level of at least six times a year being attained. Records inspected and procedures read were generally well kept. Some attention to the keeping of the accident records is recommended. Records are securely held. Residents’ relatives are aware that they can see the records of their relative if they so wish but the manager said that to date this has not been requested. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 2 3 x The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 19 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 19 Regulation 23(2)(p) Requirement A communal toilet without natural ventilation must be provided with an effective air extraction unit. A fire door must close onto its stops and fire doors must not be propped open. Timescale for action 30 September 2005. 30 September 2005. 2. 19 23(4)(c) (1) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard 3 19 19 36 Good Practice Recommendations Have copies of the updated residents contract in the home. Review some carpets and replace as needed. Attend to minor physical items identified. Give care staff formal supervision at least six times a year. The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Susssex BN21 4QT National Enquiry Line: 0845 015 0120 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 The Firs at Crowhurst H59-H10 S21243 The Firs V245264 120905 Stage 4.doc Version 1.40 Page 21 - 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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