Inspection on 04/01/06 for The Firs Specialist Residential Home

This inspection was carried out on 4th January 2006.

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... 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 At Crowhurst Old Forewood Lane Crowhurst East Sussex TN33 9AE Lead Inspector James Houston Unannounced Inspection 4th January 2006 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 At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 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 At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Firs At Crowhurst 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 Miyano Care Services Limited Mrs Tracy Helen Stevens Care Home 30 Category(ies) of Dementia (30) registration, with number of places The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 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 12th September 2005 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 Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place during the morning and early afternoon of the fourth of January 2006. Before the inspection papers held by the Commission for Social Care Inspection were read, including a Pre Inspection Questionnaire returned by the home and eight feedback forms returned by relatives of residents. The inspector spoke with seven residents, two relatives, two members of staff and the manager. A variety of records including four care plans were read. Twenty-nine 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 DS0000021243.V274899.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3 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 and undertakes full assessments of residents prior to their admission. 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. The home gives a contract of residence to each resident’s representative, with an acknowledgement section to be returned for the home’s records. Records inspected showed that these are in place. Care records inspected showed that a full initial assessment is carried out before admission. The manager said that this is done by her and a colleague, or in her absence by two other senior staff. Records inspected showed that Care Management assessments and care plans are obtained where these are available. Intermediate care is not offered in the home. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 8 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 the following standard(s): 7,8 and 11. Care plans are well kept. Arrangements to meet healthcare needs are thorough. Plans to care for dying residents and to meet their wishes re arrangements to be made after their death are good. EVIDENCE: Four care plans were read fully. They set out in detail the action to be taken by care staff. Records inspected showed that copies are sent to residents’ relatives, and that relatives are invited to sign to acknowledge content. Care plans were seen to be reviewed monthly. Daily recording is made for residents and these entries were up to date. Staff said that they had received guidance in report writing. The home has a key worker system. Records inspected showed that the home pays careful attention to meeting residents’ healthcare needs. A resident and a relative confirmed that this is the case. It is recommended that consideration be given to signing the entries made concerning treatment given etc. Risk assessments are completed and updated. The manager said that links with local healthcare professionals are good. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 9 The home has suitable policies for the care of ill/dying residents. The manager said the home attempts to keep ill residents in the home until the end of their lives, with the support of health staff. Care records inspected set out the action to be taken by staff in the event of the death of a resident and staff were familiar with what action to take. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 14 and 15. The home’s ethos is to give residents choice and control over their lives. Food provision is well managed and provides interest and variation for people living in the home. EVIDENCE: Residents are encouraged to make choices wherever possible, for example mealtime choices and whether or not to join in activities. Residents are encouraged to bring in personal items and an inventory of such items is kept. The manager said that the home has details of how relatives may contact external agents such as advocates in leaflets in the entrance area of the home. 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. The manager confirmed that special diets are catered for. Staff said that they have the time to offer discreet assistance at mealtimes to residents who need it. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 16. The home has suitable arrangements to deal with complaints made to it. EVIDENCE: The home has a suitable complaints policy, which is made available to residents and their relatives. A necessary minor modification to it was made during the inspection. Most but not all relatives said they were aware of the complaints policy. The home may wish to review whether to re-publicise it. No complaints have been made to the home or to the Commission for Social Care Inspection concerning the running of the home since the last inspection. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 19,21,22,23 and 25. The home provides safety and homely accommodation to a good standard. Items identified at the inspection require attention. EVIDENCE: The Firs is a large detached building set in its own grounds. The driveway to the home is currently being upgraded. The home has accommodation on two floors. The building is generally well maintained. Staff have a log in which to record items needing attention and said that this system works well. A fire door did not close onto its stops. An extractor fan in a communal toilet did not work. One window needs attention and the manager said it is about to be replaced. Areas of ceiling in two different locations need making good. The manager said that several bedroom carpets have been replaced since the last inspection and replacement of others is scheduled. Plans to extend the kitchen and laundry and provide a lift in the near future are in hand. The home has sufficient baths and toilets to meet residents’ needs. All bar three rooms have en suites. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 13 Specialist equipment is available to assist residents with mobility problems including assisted baths and hoists and grab rails. There is now a small ramp to assist residents wishing to access the garden through the patio doors. A chairlift gives level access to the first floor accommodation. The home is centrally heated and all radiators are guarded. Staff confirmed that radiators could be controlled in each room for the benefit of residents. Lighting in residents’ rooms is domestic in character. Emergency lighting is provided throughout the home. Water is delivered to areas used by residents at a safe temperature and records inspected showed that these temperatures are checked regularly. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28 and 30. The home places considerable emphasis on the training of staff. EVIDENCE: Two staff are currently completing NVQ level 3 in care. Four other staff hold NVQ level 2 in care and most other staff are expected to complete it shortly. The home had anticipated attaining the recommended level of 50 of care staff having NVQ level2 in care by 2005, but the manager said difficulties in securing consistent input from assessors had delayed completion for several staff. The home is developing a training matrix, and this is proving effective in identifying training patterns and training needed. A wide range of training is provided and the immediate goal is to build on existing training by offering staff a certificated course from an outside provider on dementia care /awareness. New staff receive full induction and foundation training. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,36,37 and 38. The home is well managed. The ethos is open and inclusive. Staff are regularly supervised. Record keeping is good. The health and safety of residents and staff is promoted. EVIDENCE: The home’s manager has substantial relevant experience. She has completed her registered manager’s award, and is now finishing her NVQ level 4 in care. She has a suitable job description. One minor alteration to this was made during the inspection. There are clear lines of accountability within the home. The atmosphere in the home on the day of the inspection was relaxed and friendly. Staff were knowledgeable about residents and committed to their work. Residents are consulted informally, and relatives who replied to the preinspection questionnaire all said that they are kept informed and involved in the care of their relative. Staff said that they are listened to and are able to put forward ideas as to how the service given to residents might be improved. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 16 Staff meetings are held and minuted and the minutes of these were made available to the inspector. The home does not currently hold monies or valuables for residents but the facility to do so exists. Staff said that they receive regular supervision and records inspected confirmed this. Records inspected and procedures read were well kept. Records of untoward incidents were reviewed with the manager. The inspector queried whether some incidents involving residents should have been reported to the Commission for Social Care Inspection under regulation 37 of the Care Homes Regulations. It is recommended that this aspect be reviewed over time. Records inspected showed that regular health and safety and fire safety checks are carried out. The home’s gas and electrical systems and portable electrical appliances are tested regularly. Staff said that they have received training in fire safety, first aid, moving and handling, food safety and infection control, and records inspected confirmed this. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 x 2 X 3 3 3 X 3 X STAFFING Standard No Score 27 X 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 3 3 3 The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 18 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 OP19 Regulation 23(2)(b)& (p) Requirement Attend to physical items identified at this inspection. Timescale for action 28/02/06 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. Refer to Standard OP28 OP37 Good Practice Recommendations Achieve the recommended level of 50 of care staff having NVQ Level 2 in care Review when to report any event affecting the well being or safety of any resident to the Commission. The Firs At Crowhurst DS0000021243.V274899.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex 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 DS0000021243.V274899.R01.S.doc Version 5.1 Page 20 - 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. 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