Inspection on 29/08/07 for The Firs Specialist Residential Home

This inspection was carried out on 29th August 2007.

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 Specialist Residential... 19/06/08

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 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Firs Specialist Residential Home Old Forewood Lane Crowhurst East Sussex TN33 9AE Lead Inspector Melanie Freeman Key Unannounced Inspection 10:30 29th August 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Firs Specialist Residential Home DS0000021243.V345599.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.V345599.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 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.V345599.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 23rd January 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 2006 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.V345599.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. The unannounced assessment visit was facilitated by a senior carer supported by Mr and Mrs Detheridge the registered homeowners. On the day of the home assessment the inspector was able to spend time meeting with staff, residents, their visitors and observing practice, and noting how residents needs are being met. Resident’s lifestyles within the care home were also looked at along with measures taken to promote resident’s individuality and health. A tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose, service users guide, care plans, medication records, and recruitment files. The care documentation pertaining to two residents were reviewed in depth along with the homes procedures relating to complaints and safeguarding vulnerable adults. The inspector was able to talk to residents during the midday meal and observe practice and how the food was received in both dining areas. Information provided by the home within the Annual Quality Assurance Assessment (AQAA) has also been included in this report. What the service does well: The home provides prospective residents and their families, with a good level of information about what services are provided at the home. The admission procedure allows for a comprehensive assessment process of any prospective resident. 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, this positive approach was commented on by all people spoken to about the service. Staff training is well promoted and supported and records are well maintained. The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 6 The registered manager is approachable and responds positively to issues raised and is able to deal with matters constructively. What has improved since the last inspection? What they could do better: The nutritional needs of residents need to be fully assessed and responded to with specialist advice and training. Residents clothing needs to be treated with respect and laundered appropriately to ensure residents are dressed in their own clothes that are well laundered and ironed as necessary. A programme for routine maintenance and upgrading still needs to be established to ensure a well maintained home. The standard of cleanliness needs to be improved and maintained throughout the home. The recruitment practice needs to be improved to ensure all the necessary checks are completed by the home before staff start to work in the home. This will ensure robust recruitment practice is followed and safe guard residents. The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 7 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.V345599.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.V345599.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 the service experience good 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 Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 10 the most recent inspection report. In addition the home has a brochure that can be taken by those wishing to retain some information on the home. Contact with relatives confirmed that they felt they had access to suitable information about the home that had informed the decision about permanent admission to the home. An assessment of the admission process included the review of the last three admissions to the home and the relating care documentation. This confirmed that pre-admission assessments are completed and this records where and who is present for these assessments. Records also confirmed that letters are sent to prospective residents confirming that the home is able to meet the assessed needs. Surveys received confirmed that relatives and representative received information about the home before a resident is admitted. It was also noted that comprehensive property lists are completed when a resident is admitted to the home. Intermediate or rehabilitative care is not provided at The Firs at Crowhurst Care Home. The Firs Specialist Residential Home DS0000021243.V345599.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 the service experience adequate 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 although further attention is required in respect residents nutritional needs. Residents are protected by the efficient and accurate administration and recording of medication. Although staff treat the residents with respect and as individuals, residents privacy and dignity with regard to their clothing needs further attention. EVIDENCE: The care documentation pertaining to two residents was reviewed as part of the inspection process and each of these residents were met with during the The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 12 inspection visit to the home. It was pleasing to note that the documentation recorded residents preferred term of address and that staff used this. Some of the documentation was very good providing individual guidance in relation to residents needs. There was evidence that the care documentation was being updated in response to changing needs and daily records are held for each resident. In addition there was evidence that risk assessments are completed in respect to pressure areas, moving and handling, hot water, outings and falls, although these need to be reviewed to ensure they are all accurate. It was also noted that the home discusses the care plan with resident’s representatives along with the use of bedrails and their safety issues taken into account. The second resident that was case tracked was a resident who was initially admitted to the home for respite care. The care plans relating to this resident were rather vague and did not provide specific guidelines. For example the care plan relating to personal hygiene care needs recorded ‘prompt and assist as necessary’ and ‘offer activities to meet her needs’ with reference to her social care. Her care plan did not record her nutritional care needs despite her low weight and small diet. Although resident’s weights are recorded nutritional screening or assessment is not completed even if there is evidence to suggest weight loss or residents being underweight. Discussion with staff confirmed that they had not received any training on nutrition for residents with a dementia and did not have an understanding of fortifying food. This was further underlined when it was noted that the milk delivered to the home was all semi-skimmed. This matter was discussed with the senior carer in charge along with the need for training and liaison with the community dietician. Records indicated that the home involves the local GP regularly with support from the District Nursing Team as necessary. Relatives spoken to said that they were kept informed of residents health care needs and one said ‘They make sure that she goes to all her appointments’. All feedback received from visiting relatives and residents were very positive about the standard of care delivered at The Firs at Crowhurst and complemented the way staff responded and supported residents. Comments included ‘They give Auntie every support and care that she needs’ ‘Very happy with the home no concerns or problems’. During the inspection visit the way medicines are administered was seen and good practice was observed. The individual as required medicines guidelines were seen to be very personalised and to provide clear guidelines. It was also noted that a community pharmacist working for a supplying pharmacy visits the home to review the systems and provide advice. Records relating to The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 13 medicine administration were seen to be accurate and clear and the registered manager is completing regular audits to ensure these are maintained. Observation confirmed that staff treated residents correctly and with respect spending time with them and giving them time. It was however noted that privacy locks are not fitted to all communal bathroom and toilets to ensure resident privacy. In addition it was noted that residents clothing is not ironed and contact with relatives and residents confirmed that laundry is not dealt with correctly leading to discoloration, shrinking and clothes being returned to the wrong resident. This poor service could lead to residents wearing each other’s clothes and one relative highlighted that on one occasion their relatives under wear was all missing. This matter was raised with the registered manager following the inspection who confirmed that further resources are to be provided to address this problem. The Firs Specialist Residential Home DS0000021243.V345599.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 the service experience good 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 although further attention is needed to reflect the specific dietary needs of residents with dementia. There are opportunities for stimulation through leisure and recreational activities for residents although individual needs and preferences could be further developed. EVIDENCE: During the inspection visit a motivational entertainer visited the home, all residents attended and joined in as they wished, and they danced and sang and played some simple games like throwing beanbags. This entertainment was appropriate and enjoyed by most of the residents. The co-ordinator was The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 15 able to engage with the residents and the staff facilitated this session by joining in. This entertainer visits the home fortnightly and a further musical entertainer visits on a fortnightly basis. It was noted that staff engage with residents spending time talking and walking in the garden with some residents. This along with visitor contact is clearly very important to the residents. The management of the home need to ensure that as the occupancy and dependency of residents has increased that time available for this interaction is maintained and that staff receive specific training on the provision of therapeutic activities. The AQAA returned confirmed that further improvements are planned to promote activity and social entertainment in the home. Mrs Detheridge explained that she is available in the home most days and does take residents out of the home on shopping trips and also engages them with household activity if they want to. She also confirmed that the home provides social events including a summer BBQ that are well attended and enjoyed by residents and relatives. Residents and relatives commented on these events and said how good they were ‘The events they hold for residents friends and family such as Christmas and Easter make everyone feel that it is one big family occasion’. During the inspection it was seen that residents were able to move around the home freely spending time in different areas of the home including an attractive outside terraced patio area. Visiting is well promoted and encouraged with no restrictions and it was noted that visitors coming in to the home were all offered a drink. One confirmed ‘They always make visitors welcome whatever time of the day’. The local vicar visits the home once a fortnight none of the residents attend the church. The home provides a home cooked menu that includes the use of fresh vegetables. On the day of this assessment visit the main meal was a beef casserole with an alternative of pork if preferred. The meal was attractive and residents were able to eat their meals in separate dining areas. The beef however was rather tough some residents complained about this and others left it. Those that complained were given pork as an alternative. Staff need to be more mindful of residents dietary needs and eating difficulties to ensure an appropriate nutritional diet is provided at all times. Feedback about the food provided at the home on the whole was positive with two relatives saying that their relative is eating much better since they had moved into the Firs care home. Staff were seen to be attentive to residents during the meal and assisted with feeding when needed. The Firs Specialist Residential Home DS0000021243.V345599.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 the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has suitable arrangements to deal with complaints made to it. Procedures available in the home ensure that adult protection issues when raised would be responded to appropriately. 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 complaints records seen indicated that there had not been any complaint received over the past year. Discussion took place around the recording of any issues/concerns raised with the home this would provide evidence that the home responds to matters raised effectively. Relatives spoken to said that they would feel comfortable speaking to the manager about any complaint and felt that she would deal with any problem. During the inspection it was confirmed that the home has sourced the new local procedures on Safeguarding Vulnerable Adults. The homes own procedure clearly identifies Social Services as the lead authority and that they would be notified directly of any allegation or suspicion of abuse. The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 17 The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 18 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 the service experience adequate 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.V345599.R01.S.doc Version 5.2 Page 19 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. The environment is satisfactory and the individual bedrooms are mostly attractive although there are still a number of areas in need of general maintenance and upgrading. This includes the replacement of broken and worn furniture, the replacement of worn and torn carpets and the improvement of the decoration. The communal areas are attractive and provide flexible accommodation and space for residents to move around, including separate areas for dining. There is still no planned programme for redecoration and refurbishment that accurately records the condition of the home and the areas to be addressed and this was again discussed with the registered homeowner. A tour of the home that included looking at some resident bedrooms and this identified that areas of the home are in need of more thorough cleaning and this was particularly noticeable in toilet and bathroom areas. This was discussed with the senior carer I charge of the home and the registered homeowner. Who said that the problem had been compounded by the absence of the full time cleaner. The planned improvements to the kitchen and laundry are still on hold until finances allow for this work to be progressed. The laundry room was found to be suitably equipped and care staff confirmed that they complete all laundry duties, although ‘the care of residents always came first’. As mentioned earlier in the report the laundry service does not ensure residents clothing is washed correctly or ironed and returned to the correct owner. The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 20 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 the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are not fully protected by the home’s recruitment practices. Staffing arrangements ensure that sufficient staff who are suitably trained are on duty to ensure that residents have their care needs attended to. EVIDENCE: At the time of this inspection visit there was 25 residents living in the home and the staffing arrangements were found to be satisfactory to meet their care needs although it was noted that the care staff were also undertaking the evening catering duties and all laundry duties. Staffing levels must be kept under constant review to ensure staff are available to meet all residents care needs including their social care needs. The duty rota was available although this did not clearly record what role staff were undertaking in the home and this needs to be clarified. The senior carer confirmed that there was always one senior carer working in the home with four carers over the day with two waking staff on duty in the home at night. The homeowners assume responsibility for administration and maintenance. The registered manager confirmed that she is extra to the rota and is on call to her staff when not working in the home and readily available. The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 21 All feedback received from residents, visitors and social/health professionals confirmed that the staff and the registered manager are well thought of and comments received included ‘All of the staff are very helpful and seem to enjoy their jobs. They all have the right attitude to the residents and we feel that they treat them as though they were their family’ ‘Staff are always friendly’ ‘the home’s staff is reassuringly helpful’. 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. Most care staff have achieved a National Vocational qualification in care. The recruitment files pertaining to the three staff were reviewed as part of the inspection process and identified that the recruitment practice still needs to be improved to ensure robust procedures are followed, and the following shortfalls were identified. • • Two files did not have a record of the carer’s identity. One carer working in the home did not have a Criminal Records Bureau check or POVA completed by the home. Once the serious shortfall in respect to the carers CRB and POVA was raised with the senior carer and the registered homeowner they confirmed that they would progress these checks as soon as possible and that the carer would not be working in the home until her POVA first was received and then she would work under supervision until the CRB is returned. The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 22 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 the service experience good 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, 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.V345599.R01.S.doc Version 5.2 Page 23 The home’s manager has substantial relevant experience and has completed relevant care and management qualifications. There are clear lines of accountability within the home. All feedback received in respect to the manager was positive and confirmed that staff felt very well supported by her and that residents and relatives felt she was very approachable and kept good lines of communication open. Comments from a visiting professional included ‘The management of the home appears to be good and the manager provides good leadership and responds to any health problems’. The home is using questionnaires on a six monthly basis to gain residents and their representatives views on the home and service it provides. Once these are returned they are discussed at a management meeting and if individual issues have been identified the manager responds to these on a personal basis. The audit of the responses and action taken by the home still needs to be documented and made available to interested people. The home would also benefit from implementing an audit system that correlates with the National Minimum Standards to identify shortfalls that can be addressed as part of the quality monitoring process. The homeowner confirmed that the home has no dealings with resident’s monies and that any extras costs incurred are paid by the home and then individually invoiced on a monthly basis. Although the home has varied policies and procedures these need to be reviewed and updated on an annual basis. Discussion with the registered manager following the inspection confirmed that she intends to review all policies and ensure all relevant and reflective of current legislation. Mr Detheridge the homeowner deals with all maintenance and health and safety issues in the home. A selection of safety certificates were seen and included a current electrical installation safety certificate. Records relating to accidents in the home were reviewed and found to be thorough although it was recommended that the registered manager indicates on each report that she has seen it and agrees with action taken in response. It was noted that on occasions residents get up at night and they may be unsteady on their feet. The use of pressure alarm mats was discussed with the senior carer which can be used to make staff aware that residents at risk are getting out of bed. The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 24 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 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 3 The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 25 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 OP8 Regulation 12 (1)(a) Requirement Nutritional assessments/screening to be completed for all residents linked to the care plan with appropriate referral for specialist advice as necessary. That staff receive training on the nutritional needs of residents with dementia and how to meet them. Timescale for action 01/11/07 2. OP10 12 (4) That staff ensure that the 01/11/07 privacy of residents is promoted at all times and that privacy locks are fitted to all toilets and bathrooms. That all residents have their clothes laundered appropriately and returned to them in an appropriate condition to be worn. That a programme of routine 01/11/07 maintenance and renewal of the fabric and redecoration is produced and implemented. (Outstanding from last inspection with a completion date of 01/10/06) 3. OP19 23 The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 26 4. OP26 23(2) 5. OP29 19 That the standard of cleanliness in the home is improved to ensure all areas in the home are clean. That the registered person operates a thorough recruitment procedure that includes obtaining all the necessary checks before a member of staff starts working in the home. 01/11/07 01/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP15 OP27 OP27 OP33 OP38 Good Practice Recommendations That all catering staff receive training on nutrition in the care of residents with a dementia. That staffing levels are kept under review to ensure staff are maintained to meet all the care needs of residents in the home. That the duty rota clearly records who is working and in what capacity. That an auditing system is established in order to measure how the National Minimum Standards are being met in the home. That all accidents and incidents are reviewed by the manager and signed to demonstrate that she is aware of the incident accident and agree with the action put in place in response. The Firs Specialist Residential Home DS0000021243.V345599.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local 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.V345599.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!