Inspection on 19/06/08 for The Firs Specialist Residential Home

This inspection was carried out on 19th June 2008.

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

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

Other inspections for this house

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

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

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

The Firs Specialist Residential... 12/09/05

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE The Firs Specialist Residential Home Old Forewood Lane Crowhurst East Sussex TN33 9AE Lead Inspector Melanie Freeman Unannounced Inspection 19th June 2008 09:30 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 Specialist Residential Home DS0000021243.V365329.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 Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Specialist Residential Home Address Old Forewood Lane Crowhurst East Sussex TN33 9AE 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) 01424 830591 01424 830346 thefirs.crowhurst@hotmail.co.uk Miyano Care Services Limited Mrs Tracy Helen Stevens Care Home 30 Category(ies) of Dementia (30) registration, with number of places The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. That only service users with a dementia type illness may be admitted The maximum number of service users to be accommodated will be thirty The service users accommodated will be aged sixty five years of age or over on admission 29th August 2007 Date of last inspection 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. Accommodation 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 accommodation. The home is registered to accommodate 30 older people who have a dementia type illness. The registered provider is Miyano Care Services Ltd. The home provides personal care and support to residents who are both privately funded and those who are funded by Social Services. The home’s fees as from 01 April 2008 range from what is funded by the placing county council to £450.00 per person per week for those funded privately. Additional costs are charged for hairdressing, chiropody at £12, newspapers, toiletries and activities charged at £12 and £6 per month. The homes literature states that one of its main aims is to provide a home where all members of ‘our family’ can be relaxed and happy; be encouraged to be as independent as possible and retain their dignity. The Firs Specialist Residential Home DS0000021243.V365329.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 1 star. This means the people who use this service experience adequate quality outcomes. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at The Firs at Crowhurst care home will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and follow up contact with visiting health/ social care professionals and visiting relatives. This unannounced assessment visit was facilitated by the registered manager who made herself available although not working on that day. During the assessment visits the inspector was able to spend time meeting with the staff, visitors residents and observing practice in the home. A tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose and service users guide, pre-admission assessment procedures, the systems in place for handling complaints and protecting residents from harm, staff recruitment files, quality assurance systems and some health and safety records. The care documentation pertaining to three residents were reviewed in depth and the inspector ate a midday meal with the residents in the dining room. . Resident’s lifestyles within the care home were also looked at along with measures taken to promote resident’s individuality and health. The required Annual Quality Assurance Assessment (AQAA) was completed by the registered manager and returned when requested and was used to inform this inspection report. What the service does well: The home provides prospective residents and their families, with a good level of information about what services that are provided at the home. The admission procedure allows for a comprehensive assessment process of any prospective resident along with assessment visits to the home. The atmosphere at the home is relaxed, with communication between staff and residents open and friendly. The staff and management of the home are welcoming to all visitors and staff were found to be very helpful. One relative The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 6 likened the home to one big happy family and felt her mother was treated as a loved person. Staff training is well promoted and supported, and records are well maintained. The registered manager is approachable and responds to issues raised in a positive way. What has improved since the last inspection? What they could do better: Although the care documentation provides an assessment of need the plans of care do not explore the individuality of residents with a focus on person centred care. People’s preferences, choices abilities and rights are not well documented and when there have been restrictions made in these areas the documentation does not reflect the reasons for this. The medicine storage facilities in the home on the whole have been improved although staff need to monitor the temperature that medicines are stored at and the arrangements for the storage and recording of controlled drugs need to be improved. Routine practices in the home that includes locking residents rooms and providing toiletries from a central store do not enable residents to maintain the maximum possible level of independence, choice and control over their lives. Although the home does not intend to restrict and control residents the blanket use of these practices must be reviewed. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 7 Further attention needs to be given to the way residents clothing is laundered to ensure it is dealt with appropriately and returned to them in a good condition to be worn. The hand washing facilities in all toilet area need to be improved to ensure suitable facilities. In all communal areas this should be liquid soap and paper towels. Although the standard of cleanliness has improved in the home there are still areas in the home that need to be improved. This includes the communal toilet and bathing areas and equipment in the home. The system used to monitor quality in the home needs to include a way of recording action taken in response to feedback received, and a sharing of the information with interested parties. 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 Specialist Residential Home DS0000021243.V365329.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 Specialist Residential Home DS0000021243.V365329.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, 3 and 6 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are provided with information about the home to inform their choice of home. The admission procedures ensures prospective residents are suitably assessed prior to their admission by a competent person, who ensures that the home admits only those residents who’s needs can be met by the home. Intermediate care is not provided at The Firs Residential Care Home. EVIDENCE: The home has a suitable service users guide/statement of purpose. This document is available in the entrance area of the home, and includes a copy of the most recent inspection report. A review of this document indicated that it The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 10 needed to be updated slightly to reflect more fully all the information that it should contain. For example it should record the number and size of rooms in the home, and the number of staff and their qualifications. The registered manager confirmed that she would review and update this document as necessary. An assessment of the admission process included a review of the documentation used in respect of the last two admissions to the home. This demonstrated that all prospective residents are fully assessed prior to admission although it was noted that it did not always record when and where the assessment took place. The registered manager said that this would be addressed and confirmed that she was involved in any decision to admit anyone to the home. The assessments are completed by her and often include a day visit to the home for the prospective resident. Intermediate or rehabilitative care is not provided at The Firs at Crowhurst Care Home. The Firs Specialist Residential Home DS0000021243.V365329.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 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was found to be meeting resident’s health and general needs with assessed additional community support when needed however residents choices are not well reflected in the provision of care. Residents are protected by the efficient and accurate administration and recording of medication. Although staff were seen to treat residents with respect further attention needs to be paid to individual rights and dignity. EVIDENCE: The care documentation pertaining to three residents were reviewed as part of the inspection process and each of these residents were met with during the inspection visit to the home. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 12 It was seen as good practice that the documentation recorded residents preferred term of address and that staff used this. The care documentation has been reviewed and updated in a number of areas including the screening tool used for nutritional status of residents since the last inspection. All residents had a plan of care that set out a framework for the care needs of that individual. These however did not reflect a person centred approach to care, as they were not specific or individualised. For example the plan of care in place for two resident in respect of promoting independence were the same and did not provide information on what people can do for themselves. Choices and preferences are not well recorded in the care documentation and this would promote a more person centred approach to care, and ensure the care is delivered based around the resident and not routines. There was evidence that risk assessments are completed in respect to pressure areas, moving and handling, the use of bed rails, hot water, outings/activities and falls. A behavioural assessment is also completed. The care documentation is reviewed and on the whole is updated in response to changing needs, daily records are held for each resident and evidenced regular contact with the community health care professionals. Residents or their representative’s views are not recorded on the care documentation although the manager explained that they are involved and sent a copy of the plan of care. Relatives spoken to had a good level of knowledge and understanding in respect of the care and services provided at the home. Further ways of recording resident and their representative’s consultation were discussed. During the inspection visit it was noted that on the whole residents toiletries are held centrally, including toothbrushes and toothpaste, and are transported around the home on a trolley for individual use at washing times. A fee of £12 a month is contributed for all toiletries used in this way and stock items are purchased. This practice does not promote an individual approach to resident choices and could be seen as restricting resident’s autonomy. Relatives spoken to about this practice were happy with the arrangements and the manager said that it ensured resident safety and promoted a good standard of care. All feedback received from residents and visiting relatives were very positive about the standard of care delivered at The Firs Residential Care Home and complemented the way staff responded and supported residents. Comments included ‘I feel fortunate that my mother is in this home. Its like a big happy family’ ‘I am very pleased with the service and do not have any concerns’. Visiting professionals were also positive one saying ‘the home is very good’. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 13 Practice observed confirmed that medicines were being administered in a safe way and the records examined were found to be accurate. The individual ‘as required’ medicines guidelines were seen to be very personalised and to provide clear guidelines. Some residents have their medicines crushed and this is clearly recorded with the necessary consultation with the General Practitioner. The home has recently purchased a trolley for the storage and transportation of medicines. This has improved the storage facilities however the area that it is placed needs to have its temperature monitored to ensure all medicines are stored correctly. The registered manager had noted this as an issue and confirmed that a system to monitor the temperature around the trolley would be implemented. The current controlled drug storage facility is a locked metal box attached to the inside of the trolley by a chain and does not meet current legislation and needs to be improved. In addition the controlled drug register needs to have numbered pages. Further information on this matter is available on the CSCI Intranet with a guidance document ‘The safe management of controlled drugs in care homes’. Throughout the inspection residents were seen to be spoken to in a positive and inclusive way. Staff spent time with them and the interaction was enjoyed by the residents. Although the management of laundry has improved with an allocated laundry worker who ensures residents have the correct clothing returned to them. It was again noted at this inspection that some clothing that residents were wearing was not ironed. One relative confirmed that the condition of her mothers clothing had been a problem but this had been resolved recently. A visiting professional also commented on the ‘crumpled’ state of clothing. Further attention must be paid to ensuring all residents have well laundered clothing to wear. Whilst being shown around the home it was noted that most bedrooms are locked. This raised the question of resident’s freedom to move around the home and spend time in his or her own rooms without being restricted. The registered manager said that rooms were locked to protect its contents from wandering residents. This blanket approach in restricting access to most rooms needs to be reviewed to ensure individual choices and equality is respected for all. Any decision to lock a door needs to be supported with clear documentation that takes into account the individuals rights and evidence that this has been discussed within a multi-disciplinary team. The Firs Specialist Residential Home DS0000021243.V365329.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): 12, 13, 14 and 15 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to keep in contact with their family and friends. The meals at the home are satisfactory offering variety and choice and catering for dietary needs if required. There are opportunities for stimulation through leisure and recreational activities for residents although individual needs and preferences could be further developed. EVIDENCE: A motivational entertainer visits the home fortnightly and a further musical entertainer visits on a fortnightly basis, both these activities are enjoyed by residents and are well attended. Contact with staff and visitors is a very important part of residents life. During the inspection visit staff were seen walking in the garden with residents engaging in conversation and sitting The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 15 participating in a small knitting group. This contact was positive and staffing arrangements need to be maintained to provide for this important interaction. The hairdresser visit on a weekly basis and the ladies enjoy sitting together while they have their hair done. Two relatives indicated that outings were not provided and ways of promoting activity outside of the home need to be developed. The AQAA indicated that a programme of activities need to be provided along with further training for staff to promote meaningful and therapeutic activity in the home. Social events are still held at the home that includes a summer BBQ. The local vicar visits the home once a fortnight however none of the residents attend the church. The Firs has an attractive garden area that is well used in the summer months. Visiting is not restricted and visitors spoken to said that they felt comfortable when visiting and were warmly welcomed by staff. They commented on having space to see their partners in different areas in the home and that they were offered beverages and meals if they wanted. Resident’s rooms seen were personalised with many possessions including photographs being displayed. These possessions were clean and well cared for. A meal was eaten with residents and a choice was given to residents who said this was always available. The home focuses on supplying a home cooked menu with the use of fresh vegetables. The meal eaten with the residents was satisfactory and included a choice of either a pork curry or a chicken casserole with vegetables. The pudding was either a fruit crumble or cherry pie with custard. The registered manager confirmed that all staff had received training on the dietary needs of people with a dementia and have better understanding of their nutritional needs that are related to the nutritional screening tool now used routinely in the home on all residents. There are two separate dining rooms, which allow different areas for residents to use. The dining experience was a social one where staff and residents interacted. Direct observation indicated that one resident did not like her curry and an alternative was not offered she did however eat her pudding. Records relating to what each resident eats need to be fuller and more accurate. This was raised with the manager who said that she would review the records to ensure a better tool is used. Comments received by residents about the food were positive with one saying ‘I enjoy the food’. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 16 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 18 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are confident that any complaint would be listened to and responded to appropriately. Staff training and information in the home ensures that any Safeguarding Vulnerable Adult issue would be responded to appropriately when identified. EVIDENCE: The home has a suitable complaints policy and procedure, which is made available to residents and their representatives in the front entrance area with forms available to record any concerns. The home has a central record of complaints made and the action taken in response to them. Two complaints have been recorded in this way one was resolved by the home and the other was investigated by social services in accordance with Safeguarding Vulnerable Adults Policies and procedures. This complaint was not up held. All feedback from people spoken to said that they would be comfortable and confident in raising any concern with the homes manager who they felt would deal with any issue effectively. The home has policies and procedures on Safeguarding Vulnerable Adults along with a whistle blowing procedure. Staff training is provided on a rolling programme and the manager confirmed that staff were due an update and would ensure that this was progressed within the next two months. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 17 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 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst the physical environment is suitable to meet the needs of the residents parts of the home are in need of general maintenance, redecoration and an improved standard of cleanliness to ensure a safe and pleasant environment throughout. EVIDENCE: The Firs at Crowhurst is a large detached building set in its own grounds in a rural location. The outside of the home presents an attractive environment and location with good car parking facilities. There is a door entry system in operation, to enable staff to be aware when people are entering or leaving the building for security reasons. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 18 The home has accommodation on two floors and is not designated to provide a service to people with physical disabilities as the stairs and other access arrangements would make it unsuitable for residents with a permanent restricted mobility. A tour of the home confirmed that the standard of cleanliness in the bedroom areas had been improved since the last inspection along with an improvement to the general maintenance and furnishings. Some areas however were still in need of further improvement in respect to cleanliness. All these areas were identified to the manager and included the communal toilet/bathing areas, some bedrails and commodes in the bedrooms. She immediately raised these cleaning requirements with the cleaner to address and acknowledged the need for commode replacement. All areas apart from the communal areas had been audited to ensure any maintenance and decoration issues have been identified so that a plan for improvement could be progressed accordingly. The manager said that the communal areas would be audited in this way within the next month. She was also able to confirm that all bedrooms are being upgraded on a rolling programme and the plan is to have high quality rooms decorated and furnished to a high standard. One room in the home was being completed to the planned standard and was seen to be very attractive with en suite facilities. During the tour of the premises it was noted that one communal toilet was still without a privacy lock and the manager said that she would ensure that a suitable lock is fitted by the end of the week. The home was found to be fresh with clear evidence of the steps that the home are taking to address the ongoing redecoration and upgrading issues. The laundry room has been re-organised and systems for the management of laundry have been improved ensuring residents have all their own clothing. The bed linen in the home has also been replaced. The tour of the home also highlighted that the communal hand washing areas need to be improved to include suitable hand drying facilities. The conservatory area in the home was found to be rather hot and this needs to be monitored with suitable temperature control measure being provided to ensure residents are comfortable throughout the summer months. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 19 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 People who use this service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. There is sufficient staff that are suitably trained on duty to ensure that residents receive the level of care they need. Residents are protected by the recruitment practice followed. EVIDENCE: At the time of this inspection visit there was 21 residents living in the home and the staffing arrangements were found to be satisfactory at the time of the inspection visit. Staffing levels must be kept under constant review to ensure staff are available to meet all residents care needs including their social care needs. A duty rota is maintained and this confirmed that staffing levels are maintained throughout the week and include 3 care staff throughout the waking day and 2 care staff at night. In addition domestic and catering staff are employed. All feedback received about staff working in the home was very positive and commented on the amount of ‘patience’ the staff have and how ‘kind’ they are. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 20 The recruitment practice in respect of three staff members was reviewed and were found on the whole to be full, records checked included an application form, two references and the necessary Protection Of Vulnerable Adults and Criminal Records Bureau checks had also been obtained. Recruitment practice could be further improved with greater attention to ensuring a full employment history is supplied and those people who supply references confirm in what capacity they know to the applicant. The AQAA confirmed that all care staff have either attained a National Vocational Qualification in care at level 2 or are working towards this qualification. Staff training is well organised and the manager uses a matrix to organise and record the training provided and attended. The staff training is supplied and organised with a training consortium that provides all the mandatory training. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 21 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 People who use this service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home was found to be managed in an open and friendly manner although it needs to develop an ethos that promotes person centred care. Systems are being developed to monitor the quality of care provided. Resident’s financial interests are safeguarded. The health, safety and welfare of residents and staff are generally promoted and protected. EVIDENCE: The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 22 The home’s manager has substantial relevant experience and has completed relevant care and management qualifications. She has responded positively to environment issues identified at the last inspection and all visiting professionals who have known the home for some time commented on the improvements made. She would however benefit from specific training on person centred care to promote an ethos in the home that enables residents to maintain the maximum possible level of independence, choice and control over their lives. All feedback received in respect to the manager was complementary one relative saying ‘she is brilliant’. Relatives felt that they were kept well informed of any incidents and that she was approachable and kept lines of communication open. The home is using questionnaires on a six monthly basis to gain residents and their representatives views on the home and service it provides. These have not been discussed at a management meeting yet this year and the registered manager said that this would be arranged for the near future. This meeting will review the responses and arrange suitable responses. An audit of responses still needs to be recorded along with the action taken by the home. Once complied this needs to be made available to all interested people. The audit of the responses and action taken by the home still needs to be An AQAA has been completed and records the improvements made in the home and planned improvements for the future. The registered homeowner completes a visit with a report on a bi-monthly basis this needs to be completed on a monthly basis to meet the requirements. A review of the policies and procedures manual indicated that these had not been subject to regular review. This was raised with the manager who advised that she did review them annually and would record this ain the future. The AQAA recorded that all equipment in the home is being maintained appropriately and that relevant policies and procedures are in place to ensure the health and safety of residents and staff. Mr Detheridge the registered homeowner deals with all maintenance and health and safety issues in the home and visits the home regularly. Records relating to accidents in the home were reviewed and found to be thorough and include confirmation that they are reviewed by the manager who ensures they are responded to appropriately. New pressure mats have been purchased so that staff can be alerted to residents getting out of bed if they are unsafe to be alone. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 3 The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement That individual care plans providing specific guidance on person centred care that take into account residents choices, preferences and capabilities are devised for staff to follow for each resident in consultation with the resident or their representative The registered person must ensure that all controlled drugs are stored and handled appropriately in accordance with Misuse of Drugs (safe custody) regulations 1973. That practices that restrict resident choices, control and autonomy are reviewed and not used routinely. All such restrictions must be clearly documented evidencing a multi disciplinary team approach to such decisions. That all residents have their clothes laundered appropriately and returned to them in an DS0000021243.V365329.R01.S.doc Timescale for action 01/10/08 2 OP9 13(2) 01/10/08 3 OP10 OP14 12(2) (3) (4) 01/08/08 4 OP10 12(4) 01/08/08 The Firs Specialist Residential Home Version 5.2 Page 25 appropriate condition to be worn. 5 OP26 13(3) Suitable hand washing facilities need to be provided in all communal hand washing areas that include liquid soap and paper towels to promoted good infection control practice. 01/09/08 6 OP26 23(2) 7 OP33 24(1)(2) That the standard of cleanliness 01/08/08 in the home is improved to ensure all areas and equipment in the home are kept clean and hygienic. That a suitable quality 01/09/08 monitoring system is maintained to ensure residents and their representatives views are taken into account and demonstrates ongoing review and improvement to the quality of care and services in the home. The results of formal feedback from the residents, their relatives and stakeholders, about the services provided by the home, must be published and made available to current and prospective users, and the Commission. 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. Refer to Standard OP9 Good Practice Recommendations That the book used for the recording of controlled drugs has all its pages numbers prior to use. The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 26 The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 The Firs Specialist Residential Home DS0000021243.V365329.R01.S.doc Version 5.2 Page 28 - 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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