Care Home: Firbank Private Nursing Home

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What the care home does well Detailed assessments were undertaken before people came to live at the home. This makes sure that the manager and staff know everything they need to know about what care the person needs and can reassure them that their needs can be met. Care plans had been written for each person to make sure staff knew what care they needed to provide and records were kept up to date with any changes to the person`s condition. People returning surveys to us all said they always or usually got the care and attention they needed and that staff generally listened to them and acted on what they said. Comments from the surveys included "Extremely helpful, friendly, welcoming and caring. Homely atmosphere", "Staff are thoughtful and sensitive to the needs of residents and relatives", "Nursing care is excellent with wide range of knowledge", "Nurses work hard", "Staff are very friendly" and "The care staff and the domestics are friendly and caring and most are quick to respond to requests. The nurses are readily available and listen carefully. The atmosphere is homely and friendly". Medicines were managed well and the systems in place ensured the safety of people living there. The manager had undertaken recent training about new legal processes in place to protect people who do not have the mental capacity to make decisions for themselves and the manager and provider had used the training to review everyone living at the home to make sure their rights were being protected. The home was clean and comfortable. In the AQAA the manager reported that 53% of the staff had successfully completed National Vocational Qualifications (NVQ). This qualification is obtained following training in providing personal care. This meant that staff had a good basic knowledge of the care they needed to provide and the reasons such care was needed. People living at the home were asked in a variety of ways to give their views about how the home was running. People could join a "residents forum" to meet with the manager on a regular basis and discuss plans for the home, were given surveys to complete with their views about the food provided at the home etc and were also involved in reviews of their care plans. What has improved since the last inspection? At the last key inspection we made no requirements and we made 3 recommendations, which the manager has looked at and taken action on. Since the last key inspection we have carried out a random inspection on 10th August 2008 after receiving a complaint about staffing levels and hygiene in the home. At that inspection we made an immediate requirement because there was a plumbing problem in the kitchen and this was dealt with straight away. At the last inspection we commented that mealtimes did not appear to be very social occasions because nobody sat at the dining table and everyone was served their meal on a bedside table where they sat in the lounge. Since then the dining table has been made more accessible and although only a small number of people can sit at it due to the size of the room, it does enable some people to chat and interact more with each other while they have their meals. Some redecoration had taken place. What the care home could do better: During the inspection we noticed that one carer did not follow the advice given in the care plan when they were feeding someone and this was potentially unsafe practice. It was reported that this carer was quite new to the home and had yet to start induction training. When new staff are employed induction training should be started as soon as practically possible and staff should be supervised until they are assessed as being competent to deliver care to an acceptable standard. There were mixed views about the quality of food provided at the home with some people saying the meals were sometimes bland or boring. People with special dietary needs appeared to have quite limited choices as well and it was recommended that further training was provided for the cook to ensure she had the knowledge to cater for special diets. Although systems were in place to gain the views of people living at the home the staff generally felt that they themselves did not have the opportunity to put forward their own opinions about how the home was running. There had been no recent staff meetings and this was recommended, as there were a number of issues that staff raised that needed discussion and some routines and working practices needed reviewing to ensure better cooperation and communication between staff. At the random inspection there was evidence that staffing levels were not always sufficient to fully meet the needs of people. Staffing was discussed again with the manager and provider during this visit. There were no staff employed in the kitchen after 2pm and one of the care staff has to serve up pre prepared meals at teatime and tidy the kitchen afterwards. Staff told us this meant that they had less time to spend with people living at the home. Staffing must be reviewed and take into account the high dependency of many of the people living at the home. Although efforts were made to provide some opportunities for social stimulation this was an area that needed to be developed. Some people said they were bored and staff said they did not always have time to undertake activities with people. A key worker system was being implemented and the expansion of this was discussed as a means of enabling staff to work more closely with people to identify individual interests. Key inspection report Care homes for older people Name: Address: Firbank Private Nursing Home 81 Fir Road Bramhall Stockport Cheshire SK7 2JF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Fiona Bryan     Date: 1 0 0 8 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 27 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Firbank Private Nursing Home 81 Fir Road Bramhall Stockport Cheshire SK7 2JF 01614408725 01614398828 smallwoodadmin@btconnect.com www.smallwoodcarehomes.co.uk Smallwood Homes Ltd care home 21 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The registered person may provide the following category of service only: Care home only - code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. Physical disability - Code PD. The maximum number of service users who can be accommodated is: 21. Date of last inspection Brief description of the care home Firbank Nursing Home is a care home that provides 24 hour nursing care and accommodation to 21 adult service users. Many of the residents accommodated at the home have high physical dependency needs. The home is privately owned by Smallwood Homes Ltd. Firbank Nursing Home is situated on a quiet, leafy, residential road in Bramhall. Care Homes for Older People Page 4 of 27 Over 65 21 0 0 21 Brief description of the care home Bramhall village, local shops, churches and Bramhall Park are close by. Local bus services are also available. A small driveway leads to a car park and the main entrance to the home. Outside, to the front and rear of the home, there are pleasant garden areas which are accessible to service users. The home is a two storey building, converted some years ago to a care home. Fifteen bedrooms are single rooms and three are shared rooms. Two single bedrooms and one shared room have en-suite facilities. Assisted bathing facilities are available on both floors. There is one lounge, which also provides a small dining table. A separate dining room is not available. Residents have a choice of spending time in their rooms or in the lounge. Well maintained enclosed gardens at the rear of the home are accessible from doors off the lounge. A variety of adaptations and aids are provided to assist in the nursing of the service users and this includes a passenger lift and hoists. The current weekly fees range from £485.00 to £720. Further details regarding fees are available from the manager. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key unannounced inspection, which included a visit to the home, started on Saturday 8th August 2009 and we returned on Monday 10th August 2009 to complete the inspection. The staff at the home did not know that this visit was going to take place. All the key standards were assessed at the site visit and information was taken from various sources, which included observing care practices and talking with people that live at the home, visitors, the manager and other members of the staff team. Key standards refers to those standards we feel are particularly important in ensuring the health, safety, welfare and quality of life of people living at the home. The care and services provided to two people were looked at in detail, looking at their experience of the home from their admission to the present day. Care Homes for Older People Page 6 of 27 A selection of staff and care records was examined, including medication records, training records and staff duty rotas. Before the inspection, we asked for surveys to be sent out to people living at the home and staff asking what they thought about care at the home. 7 people and 3 staff returned their surveys. Comments from these questionnaires are included in the report. We also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. The manager completed the form well and showed that she was able to identify most of the areas where the service could be developed. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? At the last key inspection we made no requirements and we made 3 recommendations, which the manager has looked at and taken action on. Since the last key inspection we have carried out a random inspection on 10th August 2008 after receiving a complaint about staffing levels and hygiene in the home. At that inspection we made an immediate requirement because there was a plumbing problem in the kitchen and this was dealt with straight away. At the last inspection we commented that mealtimes did not appear to be very social occasions because nobody sat at the dining table and everyone was served their meal on a bedside table where they sat in the lounge. Since then the dining table has been made more accessible and although only a small number of people can sit at it due to Care Homes for Older People Page 8 of 27 the size of the room, it does enable some people to chat and interact more with each other while they have their meals. Some redecoration had taken place. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed assessments are undertaken before people come into to the home so they can feel confident that their needs can be met. Evidence: The homes statement of purpose was updated in June 2009 and we were told that there were plans to improve the company website and develop further information to ensure it was reader friendly and useful. Of the 7 people living at the home that returned surveys 6 said they had received enough information to help them decide if they wanted to live there. In the AQAA the manager reported that a new pre admission assessment process had been started in January 2009. We looked in detail at the care given to 2 people. Thorough assessments had been undertaken for both of them prior to their admission to the home. Assessments and information from Stockport Primary Care Trust (PCT) had also been obtained where applicable. Risk assessments for falls, nutrition, moving Care Homes for Older People Page 11 of 27 Evidence: and handling and risk of pressure ulcers had been completed. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Promotion of health is taken seriously, peoples welfare is monitored and health needs are met. Evidence: We looked in detail at the care provided to two people. Each person had comprehensive care plans in place that highlighted their preferences, abilities and care needs. Risk assessments had been undertaken for nutrition, pressure areas, falls and moving and handling and where people had been identified as high risk, associated care plans had been developed to address this. Care plans and risk assessments had been reviewed at least every month and more often where peoples condition had changed. Records showed that people had seen GPs, opticians, chiropodists and dieticians. Of the 7 people that returned surveys 6 said they always or usually got the care and support they needed and all said they received appropriate medical attention when they needed it. Comments included Extremely helpful, friendly, welcoming and Care Homes for Older People Page 13 of 27 Evidence: caring. Homely atmosphere, Staff are thoughtful and sensitive to the needs of residents and relatives, Nursing care is excellent with a wide range of knowledge, Nurses work hard, Staff are very friendly and The care staff and the domestics are friendly and caring and most are quick to respond to requests. The nurses are readily available and listen carefully. The atmosphere is homely and friendly. One person that we spoke to during our inspection said, They do very well for me. Theyre very good. One visitor told us that her relative always looked well cared for, clean and dressed appropriately when she visited. We asked carers to describe the normal routine and care needs of some of the people living in the home. Staff were generally knowledgeable although there was some information in peoples care plans that they did not seem fully aware of. Staff told us that they no longer had a formal handover at the start of shifts but relied on reading comments that staff on the previous shift wrote in a communications book. Some of the staff felt this reduced the opportunity for discussion about the best ways to care for people and communication systems between staff were not as good as a result. We observed one carer carrying out care interventions for people without speaking to them or explaining what he was doing. One person was being fed without being placed in an upright position. The correct positioning of this person was highlighted in this persons care plan as they were at risk of choking. If less experienced staff had the benefit of a handover, senior staff could reiterate the procedures they must follow and increase staff awareness. This was discussed with the manager who reported that the staff member concerned was very new and needed further training and supervision, which we recommend as a priority. We looked at how medicines were managed for a small number of people and found safe systems in place that reduced the risk of errors being made. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities are limited so people do not have opportunities to participate in stimulating and meaningful activities of their choice. Evidence: The main entrance of the home had various information posters and leaflets displayed. Minutes from the Residents Forum meetings were displayed; the last meeting had been held on 5th August. The home does not have a designated activities organiser although we were told that a relative of one of the people living at the home came in on a voluntary basis several times a week and spent time with people engaging in social activities. Staff said they did not always have time to undertake activities that may have been planned but tried to organise activities such as quizzes and word searches when they could. Clergy visited the home every fortnight to offer Communion to people and professional entertainment was booked from time to time. Of the 7 people returning surveys 3 said there were always or usually activities whilst 3 said there were only sometimes activities. In answer to the question What could the home do better? comments included Arrange entertainment and other means for Care Homes for Older People Page 15 of 27 Evidence: interest and concentration and Only a small number of residents can actively participate in activities so entertainers however modest would be welcome more frequently. Staff that returned surveys also thought that the provision of social stimulation for people was an area that needed to be developed. Since the last inspection the amount of detail in peoples social care plans had improved and staff were making great efforts to obtain information about peoples previous occupations, family history and interests but this information could be used to better effect to meet their needs more individually. This was discussed with the manager and the development of the key worker system would help staff work more closely with people to extend their opportunities for social engagement. Peoples opinions about the meals provided at the home were varied. Some people said the food was excellent whilst others said the food was bland and uninteresting or boring. Of the 7 people that returned surveys 5 said they always or usually liked the food whilst 2 said they only sometimes liked the meals provided. Staff that returned surveys said they thought the variety of food provided for people with special dietary needs could be better. The main cook told us she had not had any training in catering for people on special diets although she was in the process of undertaking NVQ training in catering. It is recommended that when she completes this, further training is arranged so she has a greater knowledge of what foods can safely be offered for people with specific medical conditions. In the AQAA the manager said the menus had last been reviewed in June 2009 but said she would look at them again with the aim of incorporating any suggestions from people living at the home. Lunch on the first day of our inspection was chicken casserole or fish cakes. We tried the casserole and thought it was tasty and appetising. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the complaints and safeguarding procedures, which were understood by staff. Evidence: A copy of the complaints procedure was available in the home and the manager keeps a record of any complaints received. Of the 7 people that returned surveys 6 said they could speak informally to someone if they were unhappy and 5 said they knew how to make a complaint, although 2 said they didnt. In the AQAA the manager reported that there had been 7 complaints over the last year, all of which had been responded to within the timescales set in the procedure. Records showed that the complaints had been investigated where necessary and remedial action had been taken. Since the last inspection we have received two complaints and as a result of one of them carried out a random inspection on 10th August 2008. The complaint was about poor staffing levels and inadequate standards of hygiene. During the random inspection we found evidence that staffing levels were at times insufficient to meet the needs of people and made a requirement about this. Staffing at the home is discussed more fully in the Staffing section of this report. Hygiene standards in the home were Care Homes for Older People Page 17 of 27 Evidence: generally satisfactory at the random inspection although we made an immediate requirement as the pipework in the kitchen was blocked, causing flooding and a hazard to staff. The immediate requirement was complied with. The second complaint was passed to the provider to investigate and we were satisfied with the information we were given in response. Staff were aware of the procedures to follow if they suspected abuse and had access to the Stockport all agency policy for safeguarding adults. Since the last inspection the manager has attended training on the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (MCA DOLS) and some good work had taken place to ensure that everyone living at the home had been assessed to ensure they did not fall within the scope of these requirements. At the time of our inspection no one living at the home was subject to an application being made under these requirements. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A clean, pleasant and comfortable environment is provided. Evidence: A partial tour was conducted and the home was clean, tidy and generally free from odours. All 7 people that returned surveys said that the home was always or usually fresh and clean. Other comments included All areas kept very clean and tidy, laundry is excellent, homely feel, Nice garden - well maintained and The patio area is pleasant and useful in fine weather and staff are ready to help move the residents outside. Xs bedroom is small but usually clean and well aired and the bed is always clean. Firbank Private Nursing Home is not a purpose built care home and, as a result, there are areas within the home that are cramped. This means that space is limited in the home, especially when equipment such as hoists are used and, as a result, bathrooms double as storage areas for the hoists when they are not in use. Some people did also comment that because the lounge was quite small it felt crowded and there was no room for privacy unless people went to their own room. The lounge, although small, had a homely feel with lamps, mirrors, bookshelves and plants. There were a large number of armchairs but staff said they needed more recliner type chairs and could make more space by removing some of the ordinary Care Homes for Older People Page 19 of 27 Evidence: armchairs, which were not suitable for some people to sit in comfortably or safely. The provider said she had ordered some new recliner chairs recently and was awaiting delivery. The garden was very pleasant and provided a private area for people to enjoy sitting outside. Bird seed containers had been placed to attract birds and some vegetables were being grown. In the AQAA the manager confirmed that there was a programme of redecoration and maintenance. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Firbank receive care and support from a well trained staff team who have gone through a thorough recruitment process to safeguard their interests but fluctuating staffing levels may affect the ability of care staff to meet peoples care needs fully. Evidence: On the first day of our inspection there was 1 nurse and 4 carers on duty in the morning to care for 19 people. From 2pm the number of carers was reduced to 3 and it was reported that carers also had the task of serving the teatime meal and washing up/tidying away afterwards. In answer to the question What could the home do better several people responded in the surveys as follows: Employ more staff. Three carers are expected to give total nursing care to ambulant patients which takes time and patience. Then they cook the patients tea and do the washing, Extra staff at mealtimes would be helpful. So many residents need help that some have to wait a long time to be fed and it is difficult to find staff to help i.e with toileting, There always appears to be a staffing shortage and Employ more staff - present staff very busy but always pleasant and helpful. Staff that returned surveys said there was either never enough staff or only sometimes enough staff. Staff that we spoke to during our inspection felt that having Care Homes for Older People Page 21 of 27 Evidence: to undertake kitchen duties in the afternoons affected the level of care they were able to give and described the afternoons, especially from 5pm onwards as mad and said they were rushed off our feet. It was noted that a significant proportion of the people living at the home were funded by the Primary Care Trust due to their high level of nursing needs. Staff also told us that it was expected that all the people living at the home were helped to go to bed by 8pm before the night staff came on duty in order to help them with their workload. The manager and provider said this was not the expectation but agreed to discuss this more fully with staff and look at routines and job responsibilities and roles within the home. it is recommended that whatever responsibilities of staff are decided they are flexible enough to ensure that people living at the home have choice in their own daily routines. Extra care staff in the afternoon or employing someone to work in the kitchen would enable staff to spend more time with people and would help them to develop the key worker system. We looked at the personnel records for two staff members. Each person had been recruited after all the necessary checks and information had been received to ensure they were suitable to work in a care home. Staff that returned surveys confirmed they had been asked to provide references and had had Criminal Record disclosures prior to starting work at the home. Since the last inspection the manager has implemented a new staff training matrix, which clearly identifies when refresher training is due. Staff also had individual training files in which certificates of attendance and proof of training were kept. Mandatory health and safety training was ongoing and some staff had undertaken training in other topics specific to the conditions of people living at the home, such as diabetes, Parkinsons disease and dementia care. In the AQAA the manager reported that the induction programme for new staff had been changed in June 2009 to cover the Common Induction Standards set by Skills for Care. One member of staff had started working at the home a few weeks previously but had not yet commenced induction training. This needs to be started as soon as possible to ensure the carer is competent to deliver basic care. Other training should also be arranged, for example for the cook in providing specialised diets. It was reported that 53 of care staff had successfully completed NVQ training. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Firbank is managed with systems, policies and procedures in place to ensure the health and safety of staff and people living there are promoted and protected. Evidence: The manager is registered with us and has completed the Registered Managers Award. Further evidence was also available that the manager attends training to maintain her knowledge and skills. A good system of quality assurance was in place with the manager undertaking regular checks to ensure that staff were following the correct procedures, for example in managing medicines and record keeping. Systems were also in place to enable people living at the home to give their views about how the home was run. Firbank Forum consists of people living at the home, sometimes supported by relatives, who meet with the manager for updates about the home. Care plan reviews were also used as an opportunity for staff to ask people Care Homes for Older People Page 23 of 27 Evidence: being cared for and their relatives what they thought about the care they received and feedback from these was condensed into a short report and displayed on the noticeboard for everyone to read. Systems were not as good in respect of communicating with staff and a number of staff told us they could not remember the last time they had a staff meeting. This was discussed with the manager and provider and before we finished the inspection we were told a staff meeting had been arranged for later in August. This would be beneficial as there were a number of areas where staff did not feel the current systems worked especially well and encouraging staff to put forward their views and look for solutions may help achieve better collaboration between staff. We looked at the systems for keeping peoples money safe and they were satisfactory. Staff were observed using safe working practices and they told us they had all the equipment they needed to carry out their jobs safely. It was reported that regular checks of the building and equipment were carried out and recorded to ensure the health and safety of staff, people living at the home and visitors. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 27 18 Staffing levels must be 15/08/2008 sufficient at all times to meet the needs of the residents. Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 12 The manager should consider developing the key worker system so the staff have the opportunity to work more closely with individuals in identifying their interests and goals and planning to meet them. The menus should be reviewed to ensure that meals for people with specific dietary needs are varied and to ensure they take into account peoples preferences and suggestions. New staff should commence induction training as early as possible after starting work at the home to make sure they are competent to carry out basic care tasks and work unsupervised. Other training should be arranged for other staff to ensure they have all the knowledge to carry out their role. 2 15 3 30 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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