Care Home: Firstlings

Similar services:

• Claremont House
• Oak Ridge
• Sun Court Nursing Home
• Ashville House
• Bilney Hall
• Hill Barn
• Mabbs Hall Nursing Home
• Henrietta House

What the care home does well The vast majority of the feedback received about Firstlings has been positive. People made favourable comments such as, "There is nothing the home could do better for me," and, "They look after us very well which makes for a happy environment." Firstlings provides a very comfortable home for people which is well furnished, decorated and maintained. There is pleasant outdoor space for people to enjoy. A good level of equipment is provided to help people to maintain their independence. When people are considering moving into Firstlings they are given good information, and encouraged to visit the home to see what it is like. People living at Firstlings are able to welcome their visitors at any time so that they can maintain contact with friends and family. The home provides good opportunities for people to be occupied and take part in different activities. A regular newsletter is produced to keep people up to date with things happening in the home. Most people said that they enjoyed the food provided by the home. They are offered choice and their individual needs and preferences are understood and respected. The kitchen has been recognised as providing excellent standards of organisation and hygiene. People said that they liked the staff at the home and found them friendly and helpful. We saw that all designations of staff worked well as a team, and had a good awareness of individual residents. What has improved since the last inspection? It has been three years since we carried out a site visit at Firstlings. Since that time the home has continued to develop procedures and practices. The premises have continued to be pleasant and well maintained. Since the previous inspection a large pavilion has been erected which provides a different space for activities and other events. Activities at the home have continued to develop and recent forays into gardening and vegetable growing have provided residents with interest. What the care home could do better: Firstlings continues to provide service that people are happy with, and provides a home where people enjoy living. Firstlings has experienced a recent change in manager. The new manager has been in post for about six months. Although the new manager is competent, hard working and knows what they need to do, this inspection identified some areas where improvements can be made. Although people are happy with the care they receive, planing people`s care so that all of their needs are identified and catered for could be better. Care planning needs to be more consistent so that it provides a clear and detailed basis for staff to work in a person centered way with residents. The way people`s medication is managed needs to be reviewed so that it shows best practice in all respects. Staff training needs to be kept up to date so that staffs` knowledge and skills are current. Although staff have received basic training in dementia care, they would benefit from having more in depth training in this area for which which the home is registered. Following the inspection the manager confirmed that they had already addressed, or were addressing the issues highlighted at the site visit. Key inspection report Care homes for older people Name: Address: Firstlings 7 The Street Heybridge Maldon Essex CM9 4NB     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: Vicky Dutton     Date: 1 6 0 3 2 0 1 0 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 30 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Firstlings 7 The Street Heybridge Maldon Essex CM9 4NB 01621853747 01708478151 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sohal Healthcare Limited Name of registered manager (if applicable) Glenys May Gormer Type of registration: Number of places registered: care home 32 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 32 The registered person may provide the following category/ies 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, Dementia - Code DE Date of last inspection Brief description of the care home Firstlings is a large detached three-storey property, which was originally constructed as a vicarage. The home is privately owned by Sohal Healthcare, which is a company owning several other care homes in the eastern area. The home is registered to accommodate 32 elderly people. People living at Firstling may also have care needs Care Homes for Older People Page 4 of 30 Over 65 32 32 0 0 Brief description of the care home associated with dementia. The accommodation provided is all in single rooms, with twenty-five rooms offering ensuite toilet facilities; one room also has a private bath. Communal bathing facilities comprise four bathrooms (all with assisted baths). The main lounges/dining rooms are on the ground floor with quiet sitting areas on the first and second floors. The home benefits from two conservatories and attractively maintained gardens. There is a shaft passenger lift serving all three floors and stair lifts to all floors. There is an internal courtyard that is accessible from a number of doors on the ground floor and has wheelchair ramps. Firstlings is situated on a busy main road with regular public transport services. Local shops in Heybridge are close-by, with the main town centre of Maldon approximately half a mile away. Car parking is available at the front of the building. The fees for the home range between £2200.00 to £2596.25p monthly depending on the accommodation, the needs of the resident and funding arrangements. Fees do not include the cost of toiletries, hairdressing, chiropody and newspapers. Care Homes for Older People Page 5 of 30 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 was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent six and a half hours at Firstlings. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to complete. The AQAA tells us how management feel they are performing against the Care Homes for Older People Page 6 of 30 National Minimum Standards and how they can evidence this. The AQAA for Firstlings was completed by the provider. It was adequately completed, gave us all the information we asked for and helped us in our assessment of the home. Before the site visit a selection of surveys had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from ten people living in the home, six staff and two relatives. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the manager, provider and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives for their help throughout the inspection process. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Firstlings continues to provide service that people are happy with, and provides a home where people enjoy living. Firstlings has experienced a recent change in manager. The new manager has been in post for about six months. Although the new manager is competent, hard working and knows what they need to do, this inspection identified some areas where improvements can be made. Although people are happy with the care they receive, planing peoples care so that all Care Homes for Older People Page 8 of 30 of their needs are identified and catered for could be better. Care planning needs to be more consistent so that it provides a clear and detailed basis for staff to work in a person centered way with residents. The way peoples medication is managed needs to be reviewed so that it shows best practice in all respects. Staff training needs to be kept up to date so that staffs knowledge and skills are current. Although staff have received basic training in dementia care, they would benefit from having more in depth training in this area for which which the home is registered. Following the inspection the manager confirmed that they had already addressed, or were addressing the issues highlighted at the site visit. 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 30 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 30 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. People will be given assistance to ensure that the home is suitable to meet their needs. Evidence: We saw that the home had a Statement of Purpose and Service Users Guide in place. These had been updated in January 2010. The manager said that people were given copies of these documents when they were thinking about moving into the home. Firstlings also has a brochure available that provides brief details about the home. The Service Users Guide did not highlight arrangements for paying for care and details of fees as is now required. Fees were mentioned briefly in the homes brochure but amounts were not specified. The manager said that they write the fees in at the time of any enquiry and give this information to people. On ten residents surveys returned nine people said that they had received sufficient information about the home to help them to decide if it was the right place for them. The manager and provider both said that people are encouraged to visit the home and spend time there before making a Care Homes for Older People Page 11 of 30 Evidence: decision to move in on a trial basis. The previous inspection identified that following admission a questionnaire is used to find out if the admissions process was satisfactory and met peoples expectations. The manager confirmed that following a break in their use due to the change in management at the home, these were being started again. We looked at the files of two people who had recently moved into the home and saw that pre-admission assessments had been undertaken that provided basic information about peoples needs. A more detailed Care Assessment on Admission was seen to be undertaken when a person moved in. Both documents formed the basis for creating an ongoing care plan. Care Homes for Older People Page 12 of 30 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. People can feel confident that they will receive good care that meets their individual needs in ways that they would wish. Evidence: From surveys and discussion on the day people are happy with the care and support that they receive at Firstlings. On ten residents surveys returned eight said that they always received the care and support they needed. People said, They take care of me and look after all my needs, Im a very satisfied customer, and My family did me a great favour in getting me here, I am well cared for. On the day we visited people looked well cared for, were appropriately dressed and were happy and relaxed. Management and staff spoken with had a good awareness of peoples individual needs, and were observed to support people in their preferred individual routines. For people with communication difficulties we saw that a picture/symbols book was available to try to help people to express their care needs and choices. The manager hopes to develop this aspect of work further so that each carer has a small picture/symbol book that can be carried around with them. Care Homes for Older People Page 13 of 30 Evidence: To see how well peoples care is planned for and arranged so that staff are aware of peoples needs, and meet them in an individual way we looked at four peoples care records in some detail. We found care plans to be comprehensive and to cover the issues identified in the pre-admission and on admission assessments. Care plans generally provided staff with good information to enable them to care for people in ways that they prefer. Care plans detailed peoples needs, and actions required to meet these needs, under various headings. These included day and night routines, personal hygiene, mobility, mental health, emotional needs and communication. Although this was not evidenced in any way the manager said that care plans are compiled in consultation with residents and/or their families. However a recent resident/relatives meeting said, First discussion on care plans. Explained what they are and where they can be found. All welcome to see Mum or Dads if needed. Once a care plan is established it is kept under regular review. However to get a full picture of peoples changing needs staff would need to read all or the most recent review statements as the actual care plan is not updated to reflect changes in needs. This could lead to confusion and error. Care plans did not always cover all of peoples current needs. For example one person was assessed and given exercises to do. This was not in a care plan. Where people have short term care needs such as illnesses or other issues, short term care plans are not put in place to make staff aware of these needs and manage them appropriately. Daily records are maintained but these are held separately from peoples care files. This is not best practice as it will not encourage care staff to use care plans as a daily working document. The manager said that care staff involvement with care planning is now growing so that they have a good awareness of peoples detailed care plans. Risk assessments are generally undertaken to reflect aspects of risks associated with peoples care. However there were shortfalls. For example one person was seen to have bed rails on their bed. Their use was confirmed by staff, but there was no assessment or mention of the use of bed rails in the care folder. From discussion and records looked at, people receive good health care support at Firstlings. Were the additional support of other professionals such as the mental health team, occupational therapy or other specialisms to meet individual needs is needed, this is identified and arranged. People use local health services and a chiropodist, optician and continence adviser visit the home on a regular basis. Whilst records of care indicated that people were receiving appropriate support this could be better identified through clear assessments and resulting care planning for areas such as tissue viability, nutrition and falls. The appearance of these assessments was variable on files sampled. However when falls had occurred good records were maintained in falls diarys and body charts. Peoples weight is monitored and a nutrition record kept to help to identify any issues at an early stage. Care Homes for Older People Page 14 of 30 Evidence: Apart from inhalers no one living at Firstlings currently manages their own medication. We looked at systems in place to see if this aspect of peoples care was managed in a safe and effective way. Each person had their own medication folder in place with a photograph and basic details. We saw in care files that some residents had given consent for staff at the home to manage their medicines for them. Whilst medication is generally managed safely our sampling of records and systems in place did identify a number of practice issues that need to be addressed. A good audit trail needs to be maintained through staff who are trained and authorised to administer medication being clearly identified. A sample of their signature/initials to be used on the medication administration record (MAR) sheet should be available. Handwritten entries on the MAR sheet must include accurately transcribed instructions signed by two staff. Boxed/bottled and topical applications should be dated when commenced. Where medicines are prescribed to be taken as and when required (PRN) clear protocols should be in place so that they are used in a consistent manner. Temperatures should be monitored in storage areas to ensure that medicines are stored in optimum conditions. Following the inspection the manager confirmed that all these areas had been addressed. A senior member of staff said that staff have received training in the management of medicines from the supplying pharmacist. A training matrix indicated that the manager and four members of staff have undertaken training. Only the manager and deputy manager have undertaken recent training, and three senior or acting senior staff appear not to have undertaken any training in medication administration. The manager confirmed that they had undertaken in house training using information provided by the current pharmacist. It was also said that the home are in the process of changing pharmacist and then further training will take place. During the day staff were observed to be respectful to people and responsive to their needs. Privacy was maintained when personal care tasks were being carried out. One person told us, The staff respect my wishes and let me have my privacy. A relative said, They are great at making the person feel valued, safe and respected. Care Homes for Older People Page 15 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have opportunities to have a fulfilling lifestyle, maintain contact with friends and family and enjoy good food. Evidence: During the site visit we spoke to a number of residents. People felt that they made choices in their daily lives. People felt that their individual choices were listened to and respected. For example one person told us that they preferred to stay in their room where they have all their things about them. This was respected by staff. Another person said, My routines are followed, I can go to bed in the afternoons as I like to do. Care plans viewed identified peoples preferred rising and retiring times. The home employs an activity co-ordinator. Their hours did not appear on the duty rota but it was stated that they worked fifteen hours per week. The activities coordinator told us that they had not had any specialist training for the role and had not completed dementia training. This should be addressed to enhance their knowledge and skills for this important role. The activity co-ordinator was enthusiastic about their role and had ideas for further developments. The activity co-ordinator hours are usually worked in the afternoons but can be flexible to do evenings or weekends. We saw, and the manager confirmed, that are staff also undertook activities with Care Homes for Older People Page 16 of 30 Evidence: residents and interacted well with them. Care files included a Getting to Know You sheet that provided basic details of peoples history and interests. The home are just starting to work on life story books. We saw an example of one that had been started. It contained photographs and things of interest to the resident. This work will give staff an additional tool in working with residents, particularly those with dementia. The home has a lively feel and and a range of activities are offered to residents. One person said, A lot goes on if you wish to take part in it. People enjoy bingo, ceramics painting, cake making and decorating and flower arranging. On the day of the site visit people enjoyed a visit and a sing-along and dance with outside entertainers. The home has recently had a large pavilion erected in the grounds. This provides a good space for activities and other events. We saw that materials to promote reminiscence were available. The home has pleasant grounds and residents are encouraged to get involved in gardening. One resident told us that they had brought in a lot of pots from home which they were going to help clean up and plant when the weather got better. Special events take place during the year such as the celebration of festivals, barbeques and other events. The manager said that people used the local community to a degree by occasional trips to the shops. Trips out are planned for the summer. Activities undertaken are recorded. Again these are held separately to peoples main records which may not promote a joined up approach to care documentation. People seemed happy with the level and range of activity offered. On ten residents surveys returned nine said that the home always arranged activities that they could take part in if they wished. There are opportunities for people to fulfil their spiritual needs through holy communion being offered and an outreach group visiting the home for song and prayer. People told us that they are able to enjoy having visitors at any time. The service users guide outlines that visitors will always be welcome and that tea and coffee is always available. Although on surveys two people felt that the meals could be improved, feedback on the food provided at the home was mostly positive. People said, Great food, The food is very good, and I have no complaints about the food. The home operate a four weekly rotating menu, with choices being offered for each meal. People said that they are asked what they would like and given a choice. A member of staff said, I think the kitchen staff try to meet the needs of each individual and accommodate their likes and dislikes. Lunch on the day of the site visit looked appetising and plentiful. It was well presented and people said that it was nice. Staff offered people appropriate assistance, and we saw that aids such as plate guards were available and in use to help people in maintaining their independence. The home has a pleasant dining room and the tables were nicely presented to provide a pleasant environment to eat in. Care Homes for Older People Page 17 of 30 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 are cared for safely through staff knowledge and practice. Evidence: The home has a clear complaints procedure in place that is easy to understand. The complaints procedure would benefit from some revision to make it clearer to people that any complaints can also be referred directly to the local authority. People said that they knew who to talk to if they had any concerns or issues. When we looked at the homes complaints records we saw that no complaints had been recorded. The manager confirmed that none had been received, and that any minor day to day issues were dealt with proactively. We (CQC) have received one complaint about the service which was referred under safegurding procedures. (See below) One safeguarding referral was made in relation to the home over the last year. This was fully investigated by Social Services and found to be completely unfounded and unsubstantiated. Staff training records and staff spoken with confirmed that training in safeguarding had been undertaken. We saw that good information was available for staff and they had access to the appropriate forms to use if an incident occurred. The home have their own policies and procedures in place relating to safeguarding vulnerable adults. Some residents at Firstlings have the potential to behave in ways that are challenging for staff. We saw that some staff had received training in managing challenging Care Homes for Older People Page 18 of 30 Evidence: behaviour, but that this was some time ago. The manager acknowledged that this was an area that they may need to revisit. Care plans reflected to a degree peoples behavioural needs, but see earlier comments regarding information being recorded in review statements. Care Homes for Older People Page 19 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable and pleasant home. Evidence: Firstlings is a large red brick house that was once the vicarage to St Andrews church next door. It has been extended and adapted to its current use. The accommodation consists of twenty five en suite rooms and seven single rooms with wash hand basins. There are communal bathroom/s with assisted bathing facilities on each floor. Accommodation is over three floors with access being provided by a passenger lift and stairs. The lift has an audio output so that people know where they are and what is happening. There is plenty of communal space and various seating areas throughout the home. The home is very well decorated, furnished and maintained. A maintenance person is available to ensure that any issues are dealt with in a timely manner. The home is well equipped with aids to meet individual needs and requirements. There is pleasant outside space for people to enjoy, and we saw people using the grounds to sit and walk in during the site visit. People spoken with were very happy with the accommodation provided. One person said, My [relatives] room and the care home itself are kept to a high standard of cleanliness and tidiness. On the day of the site visit the home was very clean and odour free. One person said, My room and the care home is kept in a lovely condition. The Laundry is well done. The laundry area is suitable to meet the needs of the home. The member of staff in Care Homes for Older People Page 20 of 30 Evidence: the laundry was knowledgeable and had undertaken relevant training such as infection control and management of hazardous substances. Care Homes for Older People Page 21 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported for by caring and well trained staff. Evidence: We received positive comments about staff working at Firstlings. The staff are really good, The staff are great, and, The staff are are very nice and pleasant to get on with, were some of the comments made. Surveys, discussion and observation showed that staff are positive about their role. Staff said, We give quality care to the residents, We work well as a team and provide good care, and, I think the staff communicate very well between each other and try to the best of their ability to meet the needs of residents, and, We treat each resident as an individual, always giving them choices and putting them first. Staff are always given full support. The home provides a friendly atmosphere and we are always there for the residents family and friends. Staff turnover at the home has been significant over the last year with seven staff having left. However many staff have worked at the home for a number of years and this has provided consistency and continuity for residents. On the day of inspection twenty nine people were being accommodated. We looked at staffing rotas and saw that staffing levels were being maintained at four care staff and a senior during the morning, three care staff and a senior during the afternoon evening and two care staff and a senior at night. The manager and deputy manager both have some supernumerary time but also work covering shifts. Additional support Care Homes for Older People Page 22 of 30 Evidence: and hours are provided for domestic, laundry, catering and residents activities. In talking to ancillary staff and observing practice it was clear that they are very much integral to the team and have a good knowledge of, and rapport with residents. On ten residents surveys people said that staff were always available when they needed them. Staff spoken with said that they thought the current staffing levels were adequate as a number of residents were self caring. When a resident used their call bell we noted that staff attended promptly and were pleasant and understanding. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Information provided on the AQAA and discussed at the site visit indicated that out of 18 care staff ten currently hold an NVQ, and a further four staff are working towards this qualification. The manager also said that newer staff will be starting an NVQ later in the year. The home have therefore achieved over the 50 basic target, and show a commitment to maintaining a well trained workforce. The previous inspection found that recruitment procedures and practice at Firstlings were satisfactory and protected residents. We looked at the files of two members of staff who had most recently started work at Firstlings to ensure that good practice was being maintained. We saw that all proper checks had been undertaken. SOVA first, and Criminal Records Bureau checks had been undertaken, references taken up and proof of identification sought. On staff surveys people said that their recruitment was carried out fairly and thoroughly. On six staff surveys three said that their induction covered the things they needed to know very well, and one that it mostly had. We saw from staff files that induction processes are in place to ensure that staff have a good initial introduction to the home during their first days and weeks. One member of staff had not started their induction programme in a timely manner on starting work at the home. This needs to be monitored to ensure that staff are properly supported in their early days. We saw that following on from the basic induction staff go on to undertake a range of training and undertake Skills for Care Common Induction Standards through a workbook. On Surveys and in discussion staff made positive responses to questions about training saying that training offered gave them the skills that they needed. We were provided with a training matrix and sampled some staff training records. These indicated that staff have undertaken a range of training including dementia care, loss and bereavement, and continence care to support them in their role. The manager confirmed that the dementia care course undertaken is a basic half day course. As the home is registered to provide dementia care staff need good skills in the area. The manager is aware that the level of training in this area could be improved and further Care Homes for Older People Page 23 of 30 Evidence: courses are being looked at. Care Homes for Older People Page 24 of 30 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. People live in a safe and well managed home. Evidence: Since the previous inspection there has been a change of management at the home. The current manager has been in the role for about for about six months having previously been the deputy manager. The manager is experienced in care and is currently undertaking a management qualification relevant to the role of home manager. They are also in the process of applying for registration with us. (CQC.) The manager has a very positive attitude and plenty of ideas about how to continue to improve the service. During the site visit, and following the site visit they were keen to rectify any shortfalls and act on advice and discussion. People made positive comments about the management of the home and felt that the provider and manager were friendly and approachable. When we visited the home was well organised, and the information needed to undertake the inspection was readily available. Discussion and information viewed at this inspection showed that the manager is aware of things happening in the home and proactive in dealing with issues when they arise. Care Homes for Older People Page 25 of 30 Evidence: People commented that Firstlings, Is a happy home with a nice atmosphere. We saw that a monthly newsletter is produced to keep people aware of things happening in the home and activities and events. Residents meetings have not taken place regularly to provide people with a forum for discussion and involvement. Records showed that prior to one recently held in February this year, the previous meeting was in February 2008. The manager hopes to establish these on a regular basis. Similarly staff meetings have been infrequent with the last minutes being available dating from September last year. The provider has strategies in place to ensure that the quality of the service is kept under review, and that people have the opportunity to express their views about the service. The provider said that they visit the home on a regular basis once or twice a week and talks to people individually. They said that they are very thorough in their approach to undertaking visits that are required by Regulation to be undertaken once a month. Reports of these visits showed that there was a robust approach. At Firstlings surveys to to quality check peoples experience of the pre-admission and admission process are being re-instated. It was stated that surveys are also sent out once a year to residents and other people involved with the service. We saw that the most recent annual survey had taken place in January 2009. We saw from records of this survey that responses had been positive. The AQAA was completed by the provider. It was was adequately completed and showed us that management know what they do well and areas where they can improve. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Monies checked were correct, with receipts in place for all transactions. Staff spoken with and records viewed showed that staff receive regular supervision to support them in their roles. However currently the system of supervision is wholly based around observation of practice and feedback, with no one to one time to discuss any other issues such as the philosophy of the home, training needs, or specific resident or other issues. This should be incorporated into the system. We saw that annual staff appraisals are also undertaken. The AQAA completed identified that systems and services within the home are monitored and maintained. A sample of records looked at confirmed this. A partial tour of the premises showed that the home was well organised and safe. When the fire service last visited the home in June 2009 they found everything to be in order. A local fire risk assessment was seen to be in place. Care Homes for Older People Page 26 of 30 Evidence: Records showed that the fire alarm system is tested on a monthly basis. From fire records available it was not possible to determine that regular fire drills take place to ensure that staff know what to do in the event of an emergency. We saw that a drill had taken place in February this year, with a previous one recorded for March 2009. It was felt that other drills had been held but that the records had gone astray. The manager undertook to look into this. The most recent environmental health officers visit last year found that excellent standards of food hygiene were being maintained and awarded the home a five star rating. Training records showed that staff training in core areas such as moving and handling is ongoing. From records available there are some shortfalls training and update training for staff in areas such as infection control, health and safety, and food hygiene. The manager is aware of this and is in the process of booking further courses. Following the inspection the manager confirmed that training courses had been booked for the near future to cover health and safety, First Aid and fire, with confirmation of other courses being awaited. This will ensure that staff have up to date knowledge and skills. Care Homes for Older People Page 27 of 30 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 28 of 30 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 Care Homes for Older People Page 29 of 30 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. 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. Care Homes for Older People Page 30 of 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!