Care Home: Firgrove Nursing Home

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What the care home does well Residents told us that they are well looked after by a caring team of staff. The home is clean and decorated and furnished in a homely fashion in the majority of areas. There is a nice pleasant atmosphere in the home and the staff are friendly, helpful and respectful. Residents told us that night staff always come quickly when summoned and are very patient. Medicines are given to residents as prescribed at the times they are meant to have them allowing for continuity of treatment. A number of residents told the Expert by Experience that staff make them feel comfortable and safe when bathing them. The surveys completed by the local GP was complimentary about the home and said communication was good and they thought residents were well cared for. Staff told us that they are given up to date information about residents and they thought there was enough staff employed with the right experience and knowledge to look after residents. What has improved since the last inspection? We are told that a new call bell system has been installed, a new dish washer purchased along with new washing machines and tumble driers. Life history books for residents have been started. We were told in the AQAA that many improvements had been made since the last inspection, but the only evidence we could find was that the care plans now had signatures of residents or their representative agreeing to the care planned and that complaints had been separated from compliments. In the AQAA we were told that improvements made in the last twelve months included the implementation of person centred care plans for residents. The implementation and an updated training matrix to ensure staff are all up to date with training. More person centred activities and no rigid routines in the home. We were unable to confirm any of these had occurred. What the care home could do better: Person centred care planning should be introduced to show individual needs and preferences of residents. Records keeping must be improved to show that resident`s health is being monitored and action taken when necessary and that residents are kept safe by the training procedures in the home. The specialist equipment provided such as pressure mattresses must be relevant to the resident`s risk assessments in order to protect them. Residents should have more choices in respect to how they want to spend their day and these should be recorded. Risk assessments should be completed for the garden furniture which is used as diningfurniture as there is a potential risk with frail unsteady residents. Residents should have the choice based on their abilities to choose to drink out of crockery/china cups and saucers or plastic mugs in oder to protect their dignity. Records in general and especially nutritional risk assessments and staff training records must be improved to protect both residents and staff. If chefs were to have specific nutritional training they would be more aware of the nutritional needs of the elderly which would improve outcomes for residents. The social needs of residents would be better met if an activity co-ordinator was employed a the home. Health and safety procedures in the home must be improved in relation to the storage and decanting of substances hazardous to health. Mrs Lollchand is advised to seek advice about the form the home is using for resuscitation wishes. The gardens should be satisfactorily maintained to allow residents and their visitors to walk around them safely. Mrs Lollchand told us that they plan to carry out some building work to improve the overall facilities in the home. The AQAA recorded that improvements planned for the next twelve months include: The implementation of person centred care plans. To promote the rights of residents to manage their own medication following a risk assessment. To introduce new documentation for pain assessments. To arrange more activities in the summer months. To devise an audio tape to help people with the complaint procedure. To have a CCTV camera installed to the outside of the building to ensure safety for residents and staff day and night. To carry out a self assessment of the service at six monthly intervals. To assess staff competencies every six months. To plan and provide more activities and care based on research based practice. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Firgrove Nursing Home Keymer Road Burgess Hill West Sussex RH15 0AL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Ann Peace     Date: 0 5 0 5 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 34 Information about the care home Name of care home: Address: Firgrove Nursing Home Keymer Road Burgess Hill West Sussex RH15 0AL 01444233843 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) : Firgrove Care Home Limited care home 35 Number of places (if applicable): Under 65 Over 65 35 0 old age, not falling within any other category physical disability Additional conditions: 0 35 The maximum number of service users to be accommodated is 35 The registered person may provide the following category of service: Care home with nursing (N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Physical disability (PD) Old age, not falling within any other category (OP) Date of last inspection Brief description of the care home The home is a two storey converted detached house in a residential area of Burgess Hill, West Sussex. Accommodation is provided in twenty-three single and six double rooms, which are located on the ground and first floors. Two vertical lifts provides access to each of these floors. Communal facilities, which are located on the ground floor, include a sun lounge, a lounge/dining area, which is roofed in glass and has tables with umbrellas to provide shade when needed and a small reception/sitting area. There is a large garden to the rear of the property, which is accessible to residents from a patio area outside the garden lounge. There is private parking to the front of the house. Care Homes for Older People Page 4 of 34 Brief description of the care home The current fees being charged by the home are from 600 pounds to 675 pounds per week. Care Homes for Older People Page 5 of 34 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: one star adequate 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: The quality rating for this service is 1 star. This means that the residents who use this service experience adequate quality outcomes. The inspection visit was carried out by Mrs Ann Peace on Tuesday 5th May 2009. An independent Expert by Experience also visited the home with the permission of Mrs Lollchand to observe what life was like in the home and to speak to residents who live in the home. She did ask residents some specific questions to build up a picture, these included: what was like to live in the home, did they feel happy, safe and able to express concerns? Did they think there was enough staff on duty to meet their needs and if they were given choices about how they liked to spend their day? Care Homes for Older People Page 6 of 34 In the main she noted that residents are well cared for and respected although she did identify areas where the management need to take action, these are recorded in the main body of the report. Planning for the visit took into account information received about the home since the last visit including information from outside agencies, and surveys returned to us from staff and one GP. No surveys were returned to the Commission from residents although we were told by Mrs Lollchand the Registered Manager that these had been returned to us. We were able to see in house surveys that had been completed by residents. On the day of the visit we met with the residents in the communal areas of the home and in their bedrooms with their permission, we spoke to residents, staff and the manager and looked at records relating to the residents and the general running of the home. We observed staff directly and indirectly in their interactions with the residents and noted that residents were at ease with the staff and staff were friendly, caring and respectful to residents. We sampled a number of residents care records including individual assessments care plans and medication records. Other records included recruitment and training records, complaints and records relating to health and safety in the home. We found that some of the care records were disorganised and in some cases contradictory which could put residents at risk. Staff training records were not clear so we could not tell who had and who had not been trained in keeping residents safe. Requirements have been made and are recorded in the report. Mrs Lollchand did complete the Annual Quality Assurance Assessment (AQAA) and returned this to the Commission in good time, however in some sections there was minimal evidence to support some of the claims made in it. This included the section for complaints and safeguarding. Since the site visit Mrs Lollchand has informed us that the requirements made have been met. What the care home does well: What has improved since the last inspection? What they could do better: Person centred care planning should be introduced to show individual needs and preferences of residents. Records keeping must be improved to show that residents health is being monitored and action taken when necessary and that residents are kept safe by the training procedures in the home. The specialist equipment provided such as pressure mattresses must be relevant to the residents risk assessments in order to protect them. Residents should have more choices in respect to how they want to spend their day and these should be recorded. Risk assessments should be completed for the garden furniture which is used as dining Care Homes for Older People Page 8 of 34 furniture as there is a potential risk with frail unsteady residents. Residents should have the choice based on their abilities to choose to drink out of crockery/china cups and saucers or plastic mugs in oder to protect their dignity. Records in general and especially nutritional risk assessments and staff training records must be improved to protect both residents and staff. If chefs were to have specific nutritional training they would be more aware of the nutritional needs of the elderly which would improve outcomes for residents. The social needs of residents would be better met if an activity co-ordinator was employed a the home. Health and safety procedures in the home must be improved in relation to the storage and decanting of substances hazardous to health. Mrs Lollchand is advised to seek advice about the form the home is using for resuscitation wishes. The gardens should be satisfactorily maintained to allow residents and their visitors to walk around them safely. Mrs Lollchand told us that they plan to carry out some building work to improve the overall facilities in the home. The AQAA recorded that improvements planned for the next twelve months include: The implementation of person centred care plans. To promote the rights of residents to manage their own medication following a risk assessment. To introduce new documentation for pain assessments. To arrange more activities in the summer months. To devise an audio tape to help people with the complaint procedure. To have a CCTV camera installed to the outside of the building to ensure safety for residents and staff day and night. To carry out a self assessment of the service at six monthly intervals. To assess staff competencies every six months. To plan and provide more activities and care based on research based practice. 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 set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get Care Homes for Older People Page 9 of 34 printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 34 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 11 of 34 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. Residents who live at Firgrove Nursing home and their families have the information they need to make an informed choice about where they want to live and prospective residents needs are assessed before admission to ensure the home will be able to look after them. Once admitted basic assessments, care plans and in the majority of cases risk assessments are completed. Firgrove does not provide intermediate care but respite care is available. Evidence: Firgrove Nursing home has a statement of purpose and service users guide and people spoken to said they had been given enough information about the home to be able to make an informed choice. Information provided by Mrs Lollchand the registered manager reports that all residents are pre assessed to ensure the home will be able to meet their needs and once a resident is admitted a fuller assessment is carried out. Care Homes for Older People Page 12 of 34 Evidence: Five sets of care records were examined and basic pre assessments, basic assessments had been carried out and care plans were up to date. However not all of the nutritional risk assessments were up to standard because they did not reflect the changes to some of the residents weight and did not record if any action needed to be taken where residents had lost weight. In one case a resident had been identified as being at risk but their nutritional risk assessment had not been filled in so would not alert staff of action to take in the event of weight loss. Firgrove nursing home does not provide intermediate care but does offer respite care. Care Homes for Older People Page 13 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents told us that they are well looked after by friendly and caring staff and all residents have an up to date care plan. The medication procedures in the home are safe and residents receive their medication as prescribed. Some of the care records do not reflect the good care we are told is given and nutritional risk assessments could be improved. Residents are assured that at the time of death staff will treat them and their family with care sensitivity and respect. Evidence: We tracked residents care records to find out if the care planned was being given and that their health and welfare was being monitored. Some nutritional records and weight records were looked for residents who had air flow mattresses. Four of the mattresses were set at the incorrect inflation for the residents weight. Also one residents care plan and risk assessment were contradictory about the risks for pressure sores and nutrition. Another residents mattress had been changed from a Care Homes for Older People Page 14 of 34 Evidence: high risk one to a lower risk one although the risk assessment for pressure area damage had not changed, their assessments showed they were also at risk nutritionally because of circumstances and yet a nutritional risk assessment had not been completed. When we asked Mrs Lollchand about this she was not aware of the change of mattress but said it may have been because the resident had improved, yet records did not reflect any change good or otherwise. Mrs Lollchand was reminded that air flow mattresses must be inflated to the residents weight as skin damage can occur if the mattress is incorrectly inflated. Records showed that eight residents had lost weight between April and May 2009. For one resident there had been a care plan to say that this resident was a risk for weight loss, but this had been cancelled in March 09 and the nutritional risk assessment said all satisfactory, however this had not been updated to the reflect the loss of weight in May. There was nothing in the records to say staff had noted the weight losses or that any action was being taken. Mrs Lollchand said she was unaware of the weight losses as she had been off the weekend they were recorded however there were senior nurses onn duty so this does indicate that communication should be improved to safeguard residents. The way the weights are recorded do not give an instant overall view of weights over the months which may be why no action had been taken to check if the weights were correct. In the daily records for one resident, staff had written that a relative had expressed concern about this residents loss of weight. However there were no further records to indicate that staff had passed on the message to senior staff or that any action had been taken. The nutritional risk assessment did not show any changes. The home uses lots of different books and records to monitor residents health and welfare which does not lend itself to individual person centred care. In the Annual Quality Assurance Assessment completed by Mrs Lollchand it was recorded that improvements in the last twelve months included The care plans are person centred and address many references to the fundamental principles that underpin social and health care such as independence, privacy, dignity and choice, however there was no evidence that the care plans had changed to person centred ones. We were then told during our visit that the home is planning to update their care records to a person centred approach in the near future. All residents had care plans which had been updated monthly although a number of incidences where the care plan did not reflect all of the care needs were discussed with Care Homes for Older People Page 15 of 34 Evidence: Mrs Lollchand. Mrs Lollchand was advised to seek clarification about whether the Not for Resuscitation forms used by the home and signed for by relatives are in line with the Human Rights Act. Staff keep daily records about the health and welfare of residents and night staff record care given at night and if there are any changes. These records are not kept with the care plans which may be why some changes are not always noted or appropriate action taken, we could see that they are put with the care plans at a later date. There were no social care plans for any resident, basic information is gathered at assessment but is not followed up with a care plan, this is discussed later in the report. .A small number of the bedrooms french windows open out on to the main communal area for ventilation as there are no outside windows in these bedrooms. This could be a potential problem when trying to maintain privacy and dignity for residents, however during our visit staff were noted to close doors and curtains when they were carrying out care. The Expert by Experience spoke to five residents at length she found that responses about the home were mixed, two of the residents told her about their routine which they were happy with although they had not chose it. Another resident said what can you do you have to put up with whats on offer. Another resident did relate some concerns about her health, when we asked Mrs Lollchand about this she assured us that the home was following this up. When the residents were asked by the Expert about staffing levels and the response was bland, the general response was I suppose so. One resident did say she calls the night staff a lot and they are always prompt giving their attention. Two residents told the Expert that day staff were gentle when bathing them and that they felt safe. The Expert did note that There was a lot of open doors which I felt showed lack of privacy even though the residents were not in all of the rooms. There did not seem to be enough social or emotional interaction between staff/residents and resident/residents. However the Experts overall opinion about the home was that residents are well cared for and respected. We were told by residents that some of the routines in the home are not as flexible as Care Homes for Older People Page 16 of 34 Evidence: residents would wish, such as times for getting up and washed and going to bed. They said they are not given the choice. Mrs Lollchand told us that if someone wanted to lie in they could although residents did not seem to know this. In the AQAA we were told in the last twelve months improvements had been made and that there were now no rigid routines in the home and that individual preferences about a range of matters concerned with their lifestyle are noted in their care plans. However in the care plans we examined the individual preferences of how residents want to spend their day and their individual preferences were not recorded. Residents have access to outside healthcare services and records of visits and treatment were in the residents care records, one GP who completed a survey was happy with the way the home run said communication was good and thought that residents were cared for well. One resident was very poorly on the day of our visit and we noted that all staff displayed a caring and compassionate attitude. There is a policy for control, storage, disposal, recording and administration of medicines we are told in the Annual Quality Assurance Assessment that this policy was updated in February 2009. We observed a new qualified nurse being supervised carrying out a drugs round and were satisfied that safe practices are followed. We carried out a random check of the drugs kept in the home including controlled drugs and found them to be correct. Medication administration charts had been completed appropriately and Mrs Lollchand told us that they have a contract for disposal of drugs that meets with legal requirements. Care Homes for Older People Page 17 of 34 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. Some activities are arranged in the home but are not designed around residents individual interests as social care plans are not completed. Visitors are encouraged and are made welcome. Residents are offered good home cooked food. Evidence: On the day of the visit the atmosphere in the home was pleasant and welcoming. There are two main communal sitting areas, one in the middle of the home, an atrium which is bright and airy and has a water feature. The other is a conservatory overlooking the garden. The majority of residents were sitting in the atrium although some were in their rooms through choice. The Expert noted that staff were pleasant, smiling and respectful to residents but said there was no significant interaction with residents, most of who were asleep or staring in to space, so was not sure if they were tired or bored, there were no activities planned for the morning session. In the afternoon when the bingo session was in progress there was a buzz and residents looked as if they were enjoying themselves. Care Homes for Older People Page 18 of 34 Evidence: Although basic information is gathered during assessment about social care needs this is not transferred to a care plan. The home does not have an activity co-ordinator although Mrs Lollchand told us that they are planning to recruit one. There are pleasant well established gardens with a pond feature although they are in need of some attention, one visitor did tell us that the gardens were neglected. We saw that some of the paths are overgrown and were quite slippy and one of the gates to the bridge over the pond was hanging off its hinges. We could see that there is garden furniture stored waiting for better weather. For the month of April only eleven activity sessions were recorded, these included sing a longs, book reading x 2, videos, nail cutting x 2 (although we did not agree this was an activity), dominoes, life history books, holy communion, snakes and ladders and music. For May a memory game occurred on the first of May and there was bingo on the day of our visit. Nothing else was recorded. No residents surveys were received by CQC although Mrs Lollchand said they had been posted to us. However we did see surveys that the home had distributed at the end of last year and although they were positive about the home there were some comments were about lack of activities and that residents would like more outings. We were told by Mrs Lollchand that two residents go out to attend clubs in the local community. Mrs Lollchand told us in the AQAA that suitable activities are devised according to the physical and psychological ability of the residents, but as there were no care plans and the activity book only showed group activities there was no evidence to back this statement up. We are told in the AQAA that there are plans to motivate residents to take part in outdoor activities which they plan to increase in the summer. One resident was sitting watching television in their room in a wheelchair, when we asked them about this they said they would rather be sitting in an armchair but that staff always put them in the wheelchair ready to go downstairs for lunch so they spent a long time in the wheelchair which is not that comfortable. Mrs Lollchand was told about this and said she would address this. All residents spoken to were not aware they could have a choice of when to get up, go Care Homes for Older People Page 19 of 34 Evidence: to bed and have a routine to suit them. When the home implement person centred care plans likes, dislikes and preferences of routines must be acknowledged. The majority of residents sit in the atrium at the fibre glass garden tables and chairs or in armchairs for meals. Due to the nature of the furniture which is fibre glass this is not substantial and could be unstable for frail elderly people Mrs Lollchand told us that they planned to change the furniture to something more substantial in the future. Mrs Lollchand was advised to carry out risk assessments until then. A full time chef and a part time chef are employed at the home and on the day of the visit the chef was seen talking to residents about what they would like to eat that day. We are told that cakes are made daily. The lunch menu on the day of our visit was pork or meat balls with potatoes and vegetables followed by sponge and custard. We sampled the lunch which was tasty, residents appeared to enjoy the meals and told us that they were generally happy with the food served. In the majority of cases staff helped residents who needed it sensitively, discreetly and with patience. However we saw one member of staff standing over a resident feeding them for a period of time. Mrs Lollchand was informed and agreed that this was not acceptable and would be dealt with. The chefs cook the main meal of the day and leaves the supper for staff to heat up and serve. We did note that on the drinks trolley all of the beakers and mugs were melamine there were no crockery cups and saucers available for service users. When asked, staff told us that this was always the case. When we asked residents they accepted this as there was no choice although those spoken to said they had always had proper cups and saucers or crockery mugs at home. Mrs Lollchand told us that the melamine mugs were light , so convenient for residents, but there should be evidence that residents have the choice of proper cups and saucers or melamine mugs. The AQAA records that the chefs and the majority of the care staff have attended training in safe food handling but we noted that none of the chefs have received any training in nutrition for the elderly which would improve outcomes for residents. Mrs Lollchand said that she would look into accessing nutritional training. When asked about individual food records for residents who are at risk Mrs Lollchand told us that food records for each resident are kept in the menu book. Special diets and individual needs are catered for. Care Homes for Older People Page 20 of 34 Evidence: Visitors to the home told us that they are always offered refreshments when they visit. Care Homes for Older People Page 21 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaint procedure in the home and people told us that they would feel able to complain. To protect the legal rights of residents Mrs Lollchand should seek advice about the use of Not for Resuscitation forms. We could not see any evidence to prove night staff are trained in how to safeguard residents and the AQAA did not give us an accurate account of safeguarding alerts and complaints. Evidence: Firgrove has a complaint procedure which is in the Statement of Purpose and on display in the home. A record of complaints with any action taken are kept. Residents and visitors told us that they would feel able to complain if they had any concerns. We were told in the AQAA that the home plans to devise an audio tape of the complaint procedure for residents who find it difficult to read. The AQAA reported that there had not been any formal complaints in the last twelve months but we CQC (then CSCI) had asked Mrs Lollchand to investigate a formal complaint we had received in July last year. Also The AQAA recorded that there had been no safeguarding referrals made and we knew of two that had been reported to Social Services. Care Homes for Older People Page 22 of 34 Evidence: Mrs Lollchand was reminded that the information given to the Commission in the AQAA must be an accurate account of how the home is run and managed and what has happened in the home. In the AQAA Mrs Lollchand told us that all staff receive training in safeguarding. During the visit day staff spoken to confirmed that they had received training in safeguarding and there was a flyer in the office advertising a training session that had been held in April 2009. When we looked at training records they were disorganized so it was difficult to see who had and who hadnt received training. When we looked to see if night staff had attended training, no evidence could be found despite the deputy manager looking for quite a while. The only record that could be found for one of the night staff having training was dated 2007. A requirement has been made that staff are to have training to protect residents. Subsequently to the visit Mrs Lollchand confirmed to us over the telephone that training was now taking place. Mrs Lollchand and the deputy manager told us that it was difficult to get night staff to attend training, but this is a management issue which must be addressed. Care Homes for Older People Page 23 of 34 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, homely and a maintenance programme is in place. The rear gardens need some attention to make them safe. Evidence: The home has a large car park to the front and gardens to the rear although parts of the garden need attention to make them safe for residents to walk around. The interior is decorated and furnished in a homely fashion and we are told that since the last inspection some new furnishings have been provided, new washing machines, tumble driers and a new dishwasher have been purchased. The carpet in the foyer is heavily stained which does not look very nice when you enter the home. Mrs Lollchand told us it was only purchased last year and it was the equipment the staff have to use that had marked it. They had tried to clean it but could not get rid of the stains. There is an ongoing repair and maintenance programme and we were told that there are building plans to improve the home. Service agreements were available that showed specialist equipment is maintained and Care Homes for Older People Page 24 of 34 Evidence: records are kept to show safety systems are checked on a regular basis. Accommodation is provided in twenty three single bedrooms and six double bedrooms. Shared rooms have screens to provide privacy. Residents are able to furnish their bedrooms with personal possessions to make them more homely. Rooms have locks on them if residents wish to lock them and self closing devices have been fitted to bedroom doors so they will close automatically in the event of a fire. Lifts provide access to bedrooms on the first floor. As stated earlier some bedrooms open out onto the atrium so do not have windows to the outside, some residents in these rooms were spoken to and told us that they were quite happy with their rooms. Communal areas consist of a lounge/diner with garden furniture for residents to sit at for meals, the room has a glass roof which makes it nice and bright, a conservatory that overlooks the garden and a small sitting area in the foyer of the home. All areas of the home visited were clean although one room did have an unpleasant odour in it, Mrs Lollchand said she was aware of this and they were trying to overcome the problem. Care Homes for Older People Page 25 of 34 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. We were told by residents that there is enough staff on duty to meet their needs and that staff are caring and attentive. The home operates a safe recruitment procedure. Records were not available to show that all staff have been trained in how to keep residents safe so requirements have been made. Evidence: On the day of the visit staff on duty were, the Registered Manager Mrs Lollchand, the deputy manager and a qualified nurse undergoing induction, also there were six care assistants, one chef, one laundry assistant and two cleaners. The night rota showed that there is one qualified nurse and two carers on every night. Managers are also on call 24 hours a day. Residents said they are satisfied with the care they receive and told us that they thought there was enough staff to meet their needs but they were always very busy. When the Expert by Experience spoke to a resident who was concerned about her visitor being late the Expert suggested she ask the staff in the office, but the resident was reluctant saying the staff were always very busy and she did not want to bother Care Homes for Older People Page 26 of 34 Evidence: them. Care staff were noted to kind, attentive and respectful to residents and residents seemed to have a good rapport with staff. The home has a safe recruitment procedure and records of new staff seen were satisfactory. One new member of staff was awaiting a criminal records bureau check (CRB)and although the protection of vulnerable adults list had been checked and was clear, Mrs Lollchand said that this member of staff would not work alone until the CRB had been received. The home has an induction process for new staff. Staff supervision records were seen in the staff files examined. In the AQAA it is recorded that there are 20 care staff employed at the home and that over 60 have achieved NVQ level 2 or above. However elsewhere in the AQAA it is recorded that only 7 care staff have NVQ level 2 or above which does not meet the standard. The training records seen were disorganised, in the AQAA Mrs Lollchand told us: that improvements in the last twelve months were that training records are more structured and that a training matrix has been developed and is updated regularly. On the day of our visit there was no training matrix updated or otherwise. There was a very old one dated 2006, but nothing since. There was a training file which was very disorganised and we were not clearly able to see which staff had received mandatory training and which staff had not. There were no records available to indicate night staff had received any training mandatory or otherwise although the deputy manager spent quite a while looking for them. An requirement has been made that staff have training in keeping residents safe. Care Homes for Older People Page 27 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs Lollchand is the registered manager and people told us that that they were happy with the way the home is run. There is a quality assurance system in the home but the monitoring of the audits needs to be completed so an action plan can be developed. There is a staff supervision system in place although lack of safety training for some staff had not been identified during supervision sessions. Record keeping must be improved to show for those residents at risk their health is being monitored and residents are kept safe by well trained staff. Substances hazardous to health are not being stored or prepared safely. Evidence: The Registered Manager Mrs Lollchand is a qualified nurse and is registered with the Commission. Mrs Lollchand has the required qualifications and experience to run the home. Care Homes for Older People Page 28 of 34 Evidence: Residents and visitors were complimentary about the home and the staff. Satisfaction surveys for residents and staff have been circulated by the home and these were available and the majority were positive. Mrs Lollchand told us that they had not yet been able to look at the responses and formulate any action plan that may be needed. The home has audit processes and Regulation 26 visits are undertaken by the Responsible Individual. Mrs Lollchand was advised to bring all of the different audit processes and outcomes together to form a quality circle to evidence how they are improving life in the home for residents. The AQAA which Mrs Lollchand completed was in parts incorrect and improvements were said to have been made when they had not happened, such as the implementation of person centred care plans and the training matrix. This does not give an accurate view of the home and how it is operating. Mrs Lollchand told us that the home does not look after any money for residents, the home pays for additional services such as hairdressing and then residents advocates are invoiced for these additional services. There is a staff induction process in the home. We saw that cleaning substances (COSHH) that could be dangerous to residents were stored on the floor in an unlocked sluice, Mrs Lollchand was told about this, she responded that this should not have happened and would ensure all cleaning materials would be kept out of reach of vulnerable residents, for example in a locked cupboard when not in use. Some cleaning fluids were also seen to be decanted into bottles with handwritten labels on them. This is could be dangerous as information about the substance is found on the original label and is not transferred to the homes own labels. The Health and Safety Executives publication Health and safety in care homes states where health and safety information is contained on the label, the contents should not be decanted into smaller containers unless fully labelled in line with the original bottle. As stated earlier in the report we could not tell if all staff had received mandatory training in keeping people safe, for this outcome area in fire safety training. In general the record keeping in the home must be improved to show that residents best interests are safeguarded. Requirements have been made related to staff training and regarding COSHH safety. Care Homes for Older People Page 29 of 34 Care Homes for Older People Page 30 of 34 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 31 of 34 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 1 8 13 All residents health must be 31/05/2009 monitored, records kept up to date and equipment maintained to protect residents. To ensure residents health care needs are met. 2 18 13 All staff must have training 19/05/2009 in safeguarding procedures and records kept to evidence this. To protect residents 3 37 17 Accurate records must be kept in the home to show residents who are at risk health is being monitored. Residents best interests are safeguarded by the homes record keeping. 31/05/2009 4 38 23 All staff must have regular training in fire safety procedures. To keep residents and staff safe in the event of a fire. 19/05/2009 Care Homes for Older People Page 32 of 34 5 38 13 Substances hazardous to health must be locked away when not in use and cleaning procedures must comply with health and safety requirements. To keep residents safe. 19/05/2009 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 19 Risk assessments should be available to safeguard residents from potential accidents with the unsubstantial garden furniture used in the dining room. 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