Inspection on 07/06/06 for The Firs, Witheridge

This inspection was carried out on 7th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Firs, Witheridge The Firs 27 Fore Street Witheridge Tiverton Devon EX16 8AH Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 7 June 2006 08.45 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, Witheridge DS0000066437.V293582.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, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs, Witheridge Address The Firs 27 Fore Street Witheridge Tiverton Devon EX16 8AH 01884 860679 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) South West Care Homes Ltd Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A person meeting the criteria for registration as a manager under the Care Standards Act 2000, as described in Standard 31 of the National Minimum Standards for Care Homes for Older People, must be appointed and an application made for their registration within three months of the date of registration of South West Care Homes Limited as owners. Date of last inspection Brief Description of the Service: The Firs provides personal care and accommodation for up to 24 people over retirement age, who may have general personal care needs or mental health needs (including dementia). The home does not provide for nursing care other than that which the district nursing service can provide. It has recently been acquired by South West Care Homes Limited, who intend to register their newly employed manager with the Commission. Located in Witheridge, approximately 10 miles from Tiverton, the home is centrally situated close to a GP surgery, village shops and other local amenities. There is regular public transport to Tiverton, South Molton and Barnstaple. The home comprises of a two-storey building, built in the early 1900s, and a newer purpose-built ground floor extension. There are 20 single bedrooms and 2 double rooms, the majority having en suite facilities. There are 2 stair lifts, and a call bell system. The home is surrounded by attractive gardens, which are well maintained and accessible. At the time of the inspection, fees were £372 - £432.66 - some variation being due to which bedroom is to be occupied. Fees do not include hairdressing, chiropody, toiletries, newspapers/magazines, or hospital transport costs. The latest CSCI report on the home is on a notice board in the entrance hall, or the manager will send out a copy on request. Reports can also be obtained through the Commission’s website. In addition to the registered service detailed above, accommodation is available in a bungalow in the homes grounds. Those living there do not need help with personal care, but come to the home for activities and meals if they wish. Day care is also provided at the home. Neither of these services is regulated by the Commission. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector met most of the 22 residents during this unannounced inspection, either individually or in groups, around the home. A majority had dementia, which prevented them from giving their views in detail. Several residents were in day rooms; others moved between rooms, sitting where they chose to, and a few preferred to spend time in their bedrooms. There was a calm atmosphere. Seven hours of the inspection were spent on ‘case-tracking’ of three residents - looking in more detail into their care by meeting with them, checking their care records, talking with care staff, and observation of general care they receive; speaking with other residents (some of whom were outside enjoying the gardens); observing the day’s events; and reading documentation. The inspector then spoke with the newly appointed manager, Alan Johnston - who had only begun employment at the home two days earlier - and discussed her findings with him. A CSCI pre-inspection questionnaire had been returned by the home. Completed CSCI comment cards from two residents, three staff and four community-based health or social care professionals were also returned. This was a relatively small proportion of those sent out to residents and staff. Information gained from all these sources and from communication with the service since the last inspection is included in this report. The home does not offer intermediate care. What the service does well: When asked this question, a resident said, “You see how they (the staff) look after the others - they are always willing to help them”. Prospective residents’ needs are fully assessed, promoting the success of any admission to the home. Good systems in place to ensure residents’ health needs are met, with multidisciplinary input if necessary, helping to ensure their wellbeing. They can enjoy nutritious food of a good quality. Residents’ privacy is respected, with promotion of their dignity. And choice is generally encouraged well, so that residents can have control of their lives. They are enabled to maintain links with the community around the home as well as with family and friends, to add to the quality of their daily life. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 6 The home has an appropriate attitude towards concerns or complaints, using them to improve the quality of care for residents. Other quality assurance systems are also in place to help ensure the home is run in the best interests of residents. Residents enjoy pleasant accommodation, where there is good attention to maintenance and standards of cleanliness. A good proportion of staff have an accredited level of training, so residents receive a safe level of care. What has improved since the last inspection? What they could do better: Care plans include some very good practice, but inform staff less well about caring for residents with changing needs or dementia. Adequate medication policies are in place, but residents would be better protected from medication errors if two aspects of practice were improved. There could be better communication to ensure all residents get appropriate choices for meals. Residents’ expectations about their daily lifestyle are adequately met, but recreational opportunities should be improved, especially to ensure the longerterm wellbeing of residents with dementia or physical disability. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 7 Adequate measures have been taken to try to protect residents from abuse, but their effectiveness might be lessened because concerns may not be addressed correctly. Some residents would benefit from adaptations better suited to their individual needs, to enable them to be as independent as possible. Immediate attention to recruitment practices was required, so that the home gets full information about prospective staff before employing them, to ensure procedures protect residents as much as possible. Staffing numbers and skill mix are adequate but need improving to ensure residents’ mental health needs and social needs can be met. Staff receive an adequate level of training and support, but some would benefit from additional training to help them meet the needs of all residents well. The home is adequately run, although a manager is yet to be registered with the Commission, to establish a sound management base. Residents’ and staff welfare is promoted, although one aspect of safety must be addressed to help ensure their safety. 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, Witheridge DS0000066437.V293582.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, Witheridge DS0000066437.V293582.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Good systems are in place to ensure prospective residents’ needs are fully assessed, promoting the success of any admission to the home. The home does not offer intermediate care. EVIDENCE: Prospective residents are welcome to look around the home. Two new residents – who previously lived locally - said they had had sufficient information about the home before they moved in, had received terms and conditions of admission or contracts, and had settled in well. Comprehensive pre-admission assessment of their needs were seen, carried out by one or two of the home’s senior staff. There were also assessments from Social Services care managers where involved. Each resident is sent confirmation that the home can meet their needs on the basis of such assessments. Care plans were based on this information, with extra information added after admission to give a fuller description of preferences, etc. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 10 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 - 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Care plans are adequate, with some very good practice evident, but there is a risk that staff are less well informed about caring for residents with changing needs or dementia. There are good systems in place to ensure health needs are met, to promote residents’ wellbeing. Medication policies and procedures are adequate, but they could better protect residents from medication errors if two aspects were improved. There is good respect for residents’ privacy, with promotion of their dignity. EVIDENCE: Care plans were generally very ‘person-centred’ – reflecting residents’ individual life experiences and preferences – and had been recently reviewed. Residents who were asked said they had had their care plan discussed with them at some time. The template used was comprehensive, including how the The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 11 resident’s mental wellbeing could be increased, for example. However, some plans had less information than others – regarding social histories, etc. A recent mental health problem had not been reflected in one resident’s care plan. Staff said appropriate action was now being taken regarding one resident with particular needs that were difficult for them to meet, although care records did not inform about this. There was no photo of some residents - a photo being a way of clearly identifying them to new staff, or if the ‘missing person’ policy has to be used, for example; action has since been taken to remedy this. Two residents said their health needs were well attended to, and all residents looked cared for. Although all residents were able to eat independently, weights and intake are monitored. Contact with GPs was fully recorded. An optician visits regularly. One resident said staff understood her memory problem, and that they didn’t get frustrated with her. One felt some staff weren’t always sympathetic regarding their mobility problems; others felt well looked after, and care plans included mobility assessments and residents’ individual difficulties, so staff could be aware and mindful. Community professionals thought staff did not always understand residents’ needs, but were hopeful that under the new management this would be addressed. Incident report forms have recently been introduced, to help ensure behavioural needs, etc. are assessed and met appropriately. Those asked had no concerns regarding how the home managed their medications for them. Staff confirmed only senior carers dealt with medications, and they had had external training for this. Stocks and recording were generally well managed. However, handwritten entries had not been verified by two staff for their accuracy, and where a variable dose was prescribed, the dose given was not recorded. This could lead to unsafe administration or assessment of the medication’s effect. Residents said their privacy was respected. One resident has a kettle in their room, enabling them to make drinks independently as well as being able to easily offer visitors a drink. Another said staff knew they needed their food cut up, and they did this at mealtimes without the resident having to ask each time. There were locks on toilet, bathroom and bedroom doors, for privacy. One care plan detailed personal care the resident wanted to do for them self, and personal care that they would like help with. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 12 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): 12 - 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ expectations about the lifestyle of the home are adequately met, but recreational opportunities should be increased to promote residents’ quality of life, especially for those with dementia or physical disability. There is good support to enable residents to maintain links with the community around the home as well as with family and friends, to further enrich their lives. There is good promotion of choice generally, so that residents can have some control of their lives. Food provided is of good quality and nutritious, but there could be better communication to ensure all residents get appropriate choices. EVIDENCE: Surveys and conversations indicated outings and other activities were the main area residents and staff thought could be improved. The new manager had also identified this, and will be looking into it further. During the inspection, staff had little time for recreational time or social interaction with residents, The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 13 although a carer spent time with one resident applying nail polish for her. Several residents were thus dozing for much of the day; one said that’s what they usually did, although they felt cared for. A wheelchair-user said they’d like to go out more, even if they were just taken to the village shops. A carer said if they took a resident for a walk, it had to be much shorter now because they were needed at the home. Care records included some social events – a carer playing a board game with a resident, and an enjoyed Hawaiian party. A musician was coming at the weekend. A resident said church services are held at the home by different denominations. Bingo is held fortnightly, with people attending from the community around the home. Visitors are free to visit when they wish. Community professionals said they were able to see residents in private. Residents registered at the GP surgery nearby can go there to see their doctor, if they wish. Residents said they felt able to do as they wanted, describing the home as ‘relaxed’, ‘cheerful’. Staff described flexible routines – some residents staying up to watch favourite TV programmes on some nights, etc. At lunch, staff offered vegetables from a serving dish to each resident, enabling each to choose how much or little they would like. Wishes in the event of death, and associated arrangements, were included in individuals’ care records. A new resident - who intended to stay at the home only for a short while – spoke about agreed notice periods, etc. Surveys, conversations and observations during the inspection showed the staff are very concerned to ensure residents’ happiness and fulfilment, but two comments indicated protective rather than enabling attitudes. The manager hopes that planned training will help staff develop appropriate skills regarding this. Most residents’ views on meals ranged from ‘very good’ to ‘usually good’. Fresh fruit (sliced, etc. as necessary) is offered daily. One resident with particular dietary needs said they had little variety in meals given to them, although it had improved a bit since they had raised this with staff. Residents said choices were not offered unless a resident didn’t like the meal brought to them. Weekly menus provided to the inspector looked balanced, but did not include options for certain special diets. Thus it was not clear how these were monitored to ensure variety. The mealtime observed was well organised and relaxed, with dining tables set nicely with tablecloths, napkins, etc. and staff available to assist if needed. A few residents chose to eat in their own rooms. A staff said there was less wastage after meals, since a new cook had started. Some residents said they appreciated a weekly menu that used to be provided, but now the menu was only put out on a daily basis. The manager said this could be remedied, when this was later discussed with him. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 14 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good attitude towards concerns or complaints, using them to improve the quality of care for residents. Adequate measures have been taken to try to ensure residents are protected from abuse, but there is a risk that the effectiveness of these may be lessened because any concerns might not be addressed in the correct way. EVIDENCE: One resident said they had a good response to concerns they raised. Another said they felt able to make a complaint if they wanted to, that residents were listened to, with staff being willing to listen. The Quality Assurance policy includes that people are free to complain. Phone numbers for ‘on call’ senior staff were displayed in the entrance hall. Safeguarding is a subject included in a care qualification that half of the staff have obtained. Staff were clear that abuse must be reported, but not all knew whom to contact outside of the organisation if necessary; one said they were unfamiliar with whistleblowing policies and the Local Authority’s guidance on reporting concerns. The home’s training plan showed training due to be given in July 2006, and the manager said all these areas would be included. Inventories were kept of residents’ property, as a clear record of what they owned (as opposed to what had been provided by the home, etc.). The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 15 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, 22 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy pleasant accommodation, where there is good attention to maintenance and standards of cleanliness. Some residents would benefit from adaptations better suited to their individual needs, to enable them to be as independent as possible. EVIDENCE: Residents liked their accommodation, although one noted the décor was ‘tired’ in places. There were new carpets in some bedrooms, and the new owner plans to refurbish the entire property over time. Residents said minor maintenance matters were addressed promptly. Some particularly appreciated the garden - those who liked walking the pathways, or using the benches placed around the gardens (both in sunny and shady spots). A resident who enjoyed reading confirmed lighting was adequate in the evenings. Staff said an issue with low water pressure had recently been resolved. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 16 There is a specialist bath, and toilet frames to promote independence. A frame was quite low for one resident, and the manager said he would look at this. A resident in their room didn’t have easy access to a call bell, since they sat away from the wall point and had mobility problems. A resident with memory problems had difficulty locating their bedroom, it being on a corridor with several similar doorways. The home looked clean and was odour-free. Residents said it was usually like this. Staff said there were always sufficient supplies of disposable gloves, aprons, etc. for them to use, as seen when lunch was being served. The washing machine seen had recommended programmes, and a staff described appropriate use of these. The manager is obtaining special bags to make handling of soiled laundry safer. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 17 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): 27 - 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers and skill mix are adequate, but need improving to ensure residents’ mental health needs and social needs can be met. A good proportion of staff have an accredited level of training, so residents receive a safe level of care. Recruitment systems are in place but they have been poorly managed, thus reducing the level of protection for residents. Staff receive an adequate level of training and support, but some would benefit from additional training to help them meet the needs of all residents well. EVIDENCE: When the inspector arrived, there were three care assistants on duty for 22 residents; the manager arrived soon after, and there were domestic staff and a cook on duty until after lunch. During the afternoon there were two carers with the manager; three carers on duty in the evening; and two staff on duty overnight. A resident said there were staff shortages (- some staff having left in recent months), but that the residents were ‘no worse off’ – they did not have to wait any longer than usual for assistance. Others said there was always someone around. Staff said they were working extra hours to cover the vacancies; two said there was little or no time for one-to-one activities. Little The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 18 social interaction was noted between residents and staff during the inspection, other than when staff were giving direct care, because staff were otherwise occupied. Where staff were seen with residents during the visit, they were kind and patient; residents confirmed staff were usually like this, including towards the frailer or more confused residents. Senior staff are currently assessing residents’ dependency needs, so that this can inform admission policies and help ensure appropriate staffing levels. It was good to see that half of the staff have a Care NVQ2 or higher. Some staff have professional healthcare-related qualifications obtained in their country of origin. Residents asked said staff generally appeared to know what they were doing, and what help they, the resident, needed. And they understood each other well when English was not the first language of some staff. A resident said recently appointed new staff were very nice. Of four staff files checked, three did not have all required information; for the fourth, some required information had been obtained after starting employment. Completed CRB forms were seen, waiting to be posted. The owner has since evidenced that a high priority is given to residents’ welfare when recruiting staff, and that this matter is now being addressed fully by the new manager, to ensure correct information is held at the home. Induction records had been commenced for new staff. Staff had been notified that the manager would be holding individual supervision sessions soon. Surveys and observation indicated staff were very compassionate, but a small number would benefit from developing enabling skills to ensure that they give more mentally or physically frail residents similar opportunities as given to others. The new manager intends to work on all these areas, to ensure staff get appropriate support and training. This year’s training programme includes the topics of dementia (by an external trainer) and communication. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 19 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, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New developments are promoting good management of the home, although the manager is yet to be registered with the Commission to confirm they are fit to be in charge of this particular home. Good systems are in place to help ensure the home is run in the best interests of residents. Good practices regarding residents’ financial affairs safeguard their monies. There is adequate promotion of residents’ and staff welfare, although this would be further improved by attention to one aspect of safety. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager, Alan Johnston, is yet to be registered with the Commission having just been appointed by the new provider. He was a registered manager for another care home previously, having 10 years’ experience in managing care services for people with dementia. He also has the Registered Managers Award. Residents said they had met the new manager, and that he seemed approachable. Staff felt well supported by senior staff. Alan is keen to familiarise himself with the home, and then identify where and how best the service can be developed and improved. He took action during the inspection to address some of the issues that were raised with him. Residents said there has been a meeting with Mr Beale, when they were asked about the food, etc. During the inspection, the manager was heard also seeking views from people about the home. The policy on quality assurance indicates surveys are carried out yearly, as well as holding monthly meetings with residents. Mr Beale has also held a meeting with community professionals who provide a service to the residents, so that their views can also inform service development. Staff are not appointees for any residents – residents or their families retain responsibility for their finances. A lockable facility is supplied for individual use, if requested by a resident. Some residents’ personal monies were held by the home for safekeeping. Cash balances tallied with records kept for each resident, receipts being kept when the home did shopping for residents or a service such as hairdressing was received. It was discussed with the manager that these could be made more easily auditable. Staff confirmed they have had various training in relation to health and safety in their work; they also said lifting aids (hoists, etc.) have been recently obtained. Fridge and freezer temperatures are recorded, and within recommended levels. A new fire risk assessment is in place. A resident confirmed the fire alarms were tested regularly, and said they had taken part in a fire drill recently. The manager is going to review these drills, to ensure their usefulness. Appropriate door retainers have been fitted recently, promoting independent mobility but with regard to fire safety considerations. A confused resident left the home during the inspection without staff being aware of their departure. Measures were taken immediately to reduce the risk of this happening again. Two windows upstairs were found to be unrestricted, the catch on one having been undone. The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 05/07/06 arrangements for the recording & safe administration of medicines. This refers to the need to ensure that where a variable dose is prescribed, the actual dose given is recorded. The registered person shall not 05/07/06 employ a person to work at the care home unless they are fit to work at the care home, which includes that there is full and satisfactory information available about them as specified in Schedule 2. The registered person shall 05/07/06 ensure that, as far as is reasonably practicable, parts of the home that service users access are free from hazards to their safety, and unnecessary risks are identified and so far as possible eliminated. This refers to any risk of falling from windows. Requirement 2 OP29 19 3 OP38 13(4) The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 23 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 OP7 OP9 Good Practice Recommendations You should ensure each care plan has sufficient detail and is updated to reflect the resident’s changing needs, to ensure all aspects of needs are met. You should ensure - for the safe administration of medicines - that for all hand written entries on the Medication Administration Record (MAR) Charts, the person making the entry dates & signs it and this is then checked and signed by a second person. You should ensure leisure & recreational activities suit individuals’ preferences and capacities, with particular consideration given to those with dementia, other cognitive impairments & physical disabilities, to promote their wellbeing. You should ensure residents receive timely information or choice to enable them to have a varied, appealing diet. You should ensure robust procedures are in place for responding to suspected abuse, by improving staff knowledge of local reporting procedures, to safeguard residents. You should ensure residents have aids and environmental adaptations they need to maximise their independence, including those with dementia. You should ensure staffing numbers and skill mix are appropriate to meet the needs of the residents and purpose of the home. You should ensure the staff training & development programme ensures staff fulfil the aims of the home regarding care of those with dementia, etc. You should ensure you submit an application to register a manager with the Commission without delay, to help ensure the home is run by a person who is fit to be in charge. 3 OP12 4 5 OP15 OP18 6 7 8 9 OP22 OP27 OP30 OP31 The Firs, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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, Witheridge DS0000066437.V293582.R01.S.doc Version 5.2 Page 25 - 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!