Care Home: Firwood House

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What the care home does well Staff are enthusiastic, motivated, experienced and change very little. They feel the manager looks after them very well and say he has "turned [the home] around". Relatives are very pleased with the care staff provide. One said the home "treated my father with dignity and kindness". Another said it was "a very warm, caring & thoughtful place to be...wonderful...nothing is too much trouble". A third relative commented, "we feel confident and have peace of mind that mum is in a caring, safe and happy home". There is a good choice of meals. One relative felt her mother was "well fed" and praised the "...nice little extras, like providing fruit cut up into segments". Staff take action if they have any concerns about the safety or wellbeing of a service user. The building`s design means service users stay in small, homely, domestic size units. These are kept clean and tidy and smell fresh. What has improved since the last inspection? The manager and all of the staff team have worked hard to make the following improvements. A lot of work has been done to make sure the home is in charge of who is booked in to stay and which room they have. This keeps service users safe and they no longer have to change bedrooms. Ways of helping them settle in have also been introduced. Record keeping has got better (for records about service users and for those about staff), helping service users get the care they need. When a service user is aggressive, this is taken more seriously, with something done to keep everyone safe. All staff, including domestic and catering staff, have had training about intermediate care and about infection control. This has helped staff understand the home`s new service and will help keep everybody healthy. There are more social activities, helping service users have an enjoyable and stimulating stay. Major refurbishment work is taking place, creating a more attractive and better-equipped home. Service users will get even better care as staffing levels are going to increase. What the care home could do better: The intermediate care service should carry out a review to make sure it is working as well as it can. To make sure service users are getting the care they need, improvements in record keeping need to continue. More informal social activities are needed, to help service users who find it difficult to join in organised activities. To keep everyone safe, all staff need to have the planned fire safety training. CARE HOMES FOR OLDER PEOPLE Firwood House Crompton Way Bolton BL2 2PE Lead Inspector Sarah Tomlinson Unannounced Inspection 11th April 2008 07:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firwood House Address Crompton Way Bolton BL2 2PE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01204 337770 01204 337772 rob.rimmer@bolton.gov.uk Bolton Metropolitan Borough Council Mr Robert Henry Rimmer Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered for a maximum of 27 service-users to include: *Up to 27 service-users in the category of DE (E) (Dementia over 65 years of age). 20th June 2007 Date of last inspection Brief Description of the Service: Firwood House is owned by Bolton Council and is run by their Social Services department. It is registered with us (the commission) to provide specialist care for up to 27 older people with confusion/dementia care needs. There are currently 19 short term (respite) places, 1 emergency place, 1 long term (permanent) place and 6 intermediate care (rehabilitation) places. Bolton Social Services and the local Primary Care Trust jointly provide the intermediate care service. The home’s care staff and three specialist support staff (assistant practitioners) provide on site care. Physiotherapy and occupational therapy staff, nurses, social workers and doctors visit regularly. Firwood House is in a residential area of Bolton (off Crompton Way), and is close to bus services. The home is purpose built, on 2 floors, with a lift. There are 27 single bedrooms, all with wash hand basins (no en-suites are available). The building is divided into 5 units - Fern, Lilac and Rose on the ground floor, Magnolia and Primrose on the first floor. The intermediate care service is provided on Rose unit. Each unit has its own small dining and lounge area, plus bathroom and toilet facilities. The building is surrounded by gardens and there is parking at the rear (access via Tintern Avenue/Glaisdale Close). A separate day centre is also based in the building and is open seven days a week (this is for older people with confusion and is run jointly with local mental health services). There are also other community services run by Bolton Social Services on the first floor. They have a separate entrance and offices. Current fees for respite range from £101.00 to £425.35 a week (hairdressing, dry cleaning and toiletries are extra). The intermediate care service is free. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection visit, which the home was not told about beforehand, lasted about 10 hours. We looked around the building and spent time on all 5 units, watching how staff cared for service users. We talked to several service users and to staff (including carers, care supervisors, assistant practitioners, domestics and the manager). We also looked at some paperwork. Before the inspection, we had sent surveys to people who visit and work in the home. Seven relatives and 1 staff member returned them. Their views are included in this report. We have also used information from a form called an Annual Quality Assurance Assessment (AQAA). The home has to complete this each year, telling us what they do well and what they would like to do better. What the service does well: What has improved since the last inspection? Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 6 The manager and all of the staff team have worked hard to make the following improvements. A lot of work has been done to make sure the home is in charge of who is booked in to stay and which room they have. This keeps service users safe and they no longer have to change bedrooms. Ways of helping them settle in have also been introduced. Record keeping has got better (for records about service users and for those about staff), helping service users get the care they need. When a service user is aggressive, this is taken more seriously, with something done to keep everyone safe. All staff, including domestic and catering staff, have had training about intermediate care and about infection control. This has helped staff understand the home’s new service and will help keep everybody healthy. There are more social activities, helping service users have an enjoyable and stimulating stay. Major refurbishment work is taking place, creating a more attractive and better-equipped home. Service users will get even better care as staffing levels are going to increase. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was now in control of an improved referral and admission process, protecting service users’ safety and promoting their well being. A similar review of working arrangements in the intermediate care unit should benefit its service users. EVIDENCE: Since the last inspection, two of the three long term residents had sadly died. Consequently, as the home no longer accepts residents for long term care, the number of respite places had increased from 17 to 19. We looked at information provided to service users and families about the home – the Service User’s Guide (brochure). This had been updated and was Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 9 clearer to read and easier to understand. The manager planned to include photographs and/or pictures so it is in a more suitable format for the people who use the service. Some practical difficulties regarding this were discussed. We advised a separate booklet (e.g. a ‘Firwood House photograph album’), to be shown rather than given to prospective service users, could be trialled as a temporary response. The Service User’s Guide was part of a new ‘Information Pack’. A copy this was kept in each bedroom and displayed on new notice boards at the entrance to each unit. At the last inspection, we had recommended ways of improving the admission process were looked at, as this can feel overwhelming, particularly for people suffering confusion and short term memory loss. A range of improvements had been introduced – staff now used a new admission and discharge checklist with respite service users (parts of which were repeated a few days later as a brief ‘reminder session’); to help as a memory and orientation aid, staff were now expected to wear name badges; and to ensure staff were familiar and confident with the Service User’s Guide, its purpose and content had been discussed at staff meetings. The manager was also looking at ways of helping service users find their room, e.g. personal ‘memory boxes’ placed outside (bedroom doors currently displayed the service user’s name). We discussed the number of respite admissions during a day. These were usually limited to two, but as occurred during this inspection, could reach three. Two of these new service users displayed considerable signs of anxiety. Action was taken to help these people settle in (including plans to minimise a reoccurrence). We discussed innovative ways the admission process could be further developed to lessen its stress. For example, whilst flexibility is required regarding admission times (due to a reliance on family members or Social Services transport to bring the service user), the allocation of who will be the ‘admitting carer’ could be more planned. A carer would only admit somebody if they were near the beginning of their shift (to enable them to work closely with the new service user, giving them special attention throughout the day). The same carer would, ideally, be back again the next morning to support this new service user. Shift patterns and the high number of part time staff were obstacles to this at present, but the manager was hoping to streamline shift start and finish times. Whilst flexibility is obviously needed to accommodate families’ requests, encouraging set ‘admission days’ with accompanying staff shift patterns, might also help. The manager had already identified the need to maintain better continuity of key worker between admissions. As key workers were currently assigned by room, it was not always possible for a service user to have the same room and therefore the same key worker for each stay. Allocating key worker status on admission rather than by room might help with this. We were impressed with the amount of work that had been done regarding taking control of the referral and bed allocation process. We had been concerned at the last inspection that referrals were made and accepted without Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 10 the full involvement of the home. The admission criteria had now been reviewed and responsibility for allocating places and confirming referrals now clearly lay with the home (with staff actively checking referral information, particularly for a new service user). Whilst the Social Services department (not the home) continued to operate the actual computer based bed-booking system, a referral was only now accepted and a specific bed allocated after the referring social worker had gained the clear agreement of the home. Written assessment information was then provided (prior to admission), which we saw in care files. The problem of room swapping we had noted at the last inspection had stopped. Referrals were only now accepted if a specific bed was available for the entire period requested. Also, if a person’s stay was extended once they had arrived, they no longer had to vacate their room if a previously booked admission had been allocated the same room (the new admission was now given a different room). The manager had met with the referring social work teams to reinforce the above practices and expectations. The need to stagger admissions for intermediate care was discussed. Currently, predicted discharges were often organised to take place on the same day. This resulted in several admissions (to fill these vacancies) then occurring all on the same day. This could be avoided and planned differently to promote a less stressful admission experience for the service user. We also discussed the arrangement of no set times for occupational, physiotherapy and nursing staff to visit or contact the unit (apart from the weekly multidisciplinary meeting). The assistant practitioners spent considerable time telephoning these staff to arrange visits. The manager had already identified this a poor use of their time. The intermediate care service at the home is locally unique - in its size (6 places only); in its provision of rehabilitative care to older people with significant confusion levels; and in its physical isolation from the main intermediate care service, which was based with all therapy and nursing staff, elsewhere. As it had now been operating at Firwood House for a year, we felt it would be beneficial for the PCT team leader to review the service with the manager of the home (to address the points raised above). Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Considerable improvement in assessing and documenting service users’ care needs had promoted their health and wellbeing. To build on this, consistency is still needed to ensure all needs are fully understood and met. EVIDENCE: We looked at four care files. At the last inspection we had been concerned information about the help respite service users needed was out of date (with care plans from previous visits being re-used without being updated). A new system had now been introduced whereby a revised care plan was used for each visit. This had been reinforced by changes to the filing system, whereby the updated care plan, assessment information and any relevant previous documents were placed in a new working file (for the duration of the person’s Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 12 stay). Care plans were generally of sufficient detail to guide staff and showed the involvement of families (regarding how service users liked to be cared for). Risk assessments were in place and were now being formally reviewed on admission. A pressure area assessment form had also been introduced. Service users received health care support, e.g. from district and community psychiatric nurses and the nutrition service. However, links were not always made back to relevant care records (e.g. supplement drinks had been advised and provided after weight loss, but the resident’s diet care plan, although reviewed since, had not been updated with this information (regarding any weight loss or the action that had been taken)). At the last inspection we had been concerned how incidents of physical aggression were monitored and acted upon. However, notifications of serious incidents, with evidence of prompt and appropriate action, were now being sent to us. Staff feedback also indicated they felt much more supported and this issue was taken more seriously. Both the risk and the occurrence of aggressive behaviour were now being recorded in care records. Generally, staff also had a good understanding of how to support particular individuals to lessen or manage the risk of aggression. However, there were still some gaps. Two risk assessments had not been updated following recent incidents. An incident form for one of these had also not been completed. More detail about triggers and practical guidance for staff would still be helpful. (Such extra detail would also benefit service users who became very anxious, e.g. one care plan detailed, “can become quite anxious”, but gave no help to staff about preventing or reducing such distress). Risk issues were also discussed regarding the behaviour of a service user on the intermediate care unit (including being found in other service users’ bedrooms at night). Consideration of capacity/intent and any practical measures taken to reduce the risk (e.g. use of a pressure mat to alert night staff if the service user got out of bed; locking/not locking bedroom doors on the unit) should have been more clearly documented. The complex issue of service users refusing help with personal care (e.g. not letting staff change a soiled continence pad) was also discussed. This was raised by a relative and by staff (regarding staff not being able to restrain service users in these circumstances). Staff demonstrated a good understanding of the issues involved (e.g. their ‘duty of care’; protecting a service user’s dignity; concerns about physical intervention). However, they also requested more guidance regarding a specific service user (about what was expected of them and how to support this person appropriately and safely). We discussed this with the manager, who responded promptly. Immediately after the inspection, he raised the issue with the referring social worker, with clearer guidance being agreed and detailed in the service user’s care file. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 13 With regard to the intermediate care service, a ‘skills plan’ (summarising service users’ abilities) continued as the main document to guide staff. Produced by PCT staff and reviewed weekly, a copy was kept in care files and on display in bedrooms. A range of up to date risk assessments were also in place. Care staff had requested similar guidance (to the skills plan) for use with respite service users. Although this could provide a helpful reference tool for a rapidly changing service user group, it would introduce yet another document to update and would also duplicate information in care plans (which were not in use on the intermediate care unit). We suggested the existing care plan could be revised to make it easier to use. Trialling this and a ‘skills plan’ could be a possibility. The home had again experienced several outbreaks of vomiting and diarrhoea over winter. These had been short-lived, with prompt action taken in response (with carpets steam cleaned before re-opening to remove any remaining viral traces). All staff, including domestics, had received infection control training. Due to the specialist needs of service users and the respite service provided, we advised this training was repeated annually. The pharmacy inspector had visited the home at the last inspection, resulting in minor improvements being required and recommended. These had generally been made. A new carbonated record book was in use to record the disposal of medicines and medication administration records (MARs) showed medicines were being given as prescribed. However, written confirmation of medication was not yet being requested on or before admission (via a fax from the GP). Handwritten MARs were not always being signed and countersigned, and two pain relief patches were in the controlled drugs cupboard although records showed they had been returned with the service user on discharge. Due their confusion, communication difficulties and memory loss, most service users were unable to tell us what it was like to stay at the home. However, we observed most staff caring and speaking to service users in a warm and competent manner. Staff had a good understanding of service users’ individual needs, working hard to meet them in a busy and frequently changing environment. The key worker role continued to promote service users’ dignity, with one responsibility being to assist ‘their’ service user to bathe or shower (rather than this being shared across the staff team). One relative told us, staff “treated my father with dignity and kindness”. Another said the home was “a very warm, caring & thoughtful place to be…wonderful…nothing is too much trouble…kindness itself”. A third relative commented, “we feel confident and have peace of mind that mum is in caring, safe and happy home…when mum was upset as she thought no-one was going to visit her, a member of staff phoned me and let me speak to mum to reassure her”. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range and frequency of social activities had improved. Records need to evidence this. A good choice of meals, including options that met the specialised needs of service users, was provided. EVIDENCE: At the last inspection we had been concerned about the lack of regular, social activities. Care staff and the manager explained this had greatly improved. Although an activities co-ordinator was not directly employed, the activities coordinator from the adjoining day centre now came across most weekdays to run a group or invited service users to join in social sessions in the day centre. Occasional social evenings were also held in the main, communal lounge, with an activity, (e.g. slide show) taking place after a shared tea. A weekly programme of activities had been developed. This was in an easy read, pictorial format and on display in each unit. Unfortunately, its small size meant it was difficult to use. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 15 It was unclear how many service users were benefiting from the above improvements. Of two service users we looked at, their records described mainly “television watching”. We were particularly concerned there was only one entry for the whole of March 2008 for the home’s long term resident. We again advised they needed a specific, individualised weekly activity programme. A personal life history for this resident could also be developed (providing details about their job history, previous hobbies, interests and important people in their life). The therapeutic benefits of service users doing ordinary, everyday tasks were also discussed. Although occasionally in place, this could be developed much further (e.g. providing dusters and ornaments; indoor gardening, newspapers and magazines to hold; folding napkins/towels, helping set and clear tables at mealtimes, making their own bed). This would also benefit those service users who were not able to sit and join in planned, formal activities. The manager had also recognised the need to develop links with local churches and religious groups. Visitors felt they were made welcome. When we had arrived at 7.15am, one service user was up. Night staff confirmed they were under no pressure to get people up, with service users able to wake naturally and choose what time they got up. Regarding food choices, service users were asked the day before about their preferred options. Good practice was noted, as there were hot choices for both lunch and tea. We observed different meals being provided. Service users continued to eat in one of the small lounge/dining areas, with a hot trolley serving each unit. At the last inspection, the manager had introduced (paper) napkins. Tables looked pleasant and attractive, with tablemats and flower centrepieces also now used. Good practice was also noted with the introduction of a finger food menu. This helped maintain the nutritional and calorie intake of more active service users. A relative felt her mother was “well fed” and praised the “…nice little extras, like providing fruit cut up into segments”. We advised a daily menu (in an appropriate format) was introduced, as no information was currently provided to help service users remember (or relatives know) what meals were about to be served. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A staff team who were confident and able to use safeguarding procedures protected service users. Complaints were welcomed, taken seriously and acted upon. EVIDENCE: Since the last inspection the complaints procedure was now displayed through out the home (on new notice boards at the entrance to each unit). A copy continued to be provided to each service user in both the brochure (Service User’s Guide) and now also in the new information pack. The procedure was clearly written, easy to understand and provided in large print as standard. A full record of both informal and formal complaints was kept. The home had received one formal complaint since the last inspection. Parts of this had been upheld, regarding a service user’s own wheelchair being misplaced and confusion over discharge arrangements. One relative raised a minor issue regarding laundry going missing, even when labelled. The manager was planning to try individual net bags to help prevent this. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 17 As identified at the last inspection, all care staff have had abuse awareness training. Good practice was noted, as soon all staff who work in the home (including domestic and catering staff) will be trained in this area, with refresher training then provided every two years. Further good practice was noted, as staff were clearly familiar with and understood their safeguarding responsibilities. Staff had recently reported concerns about suspected inappropriate behaviour of another staff member (a bank carer) towards service users. This had been followed up promptly, with no suspicion or evidence of abuse found. As detailed earlier, staff also had an understanding of the issues regarding restraint. We were told Bolton Social Services is currently developing a policy and procedures about this, which will provide helpful formal guidance. Since the last inspection, the manager and care supervisors had attended training about the new Mental Capacity Act 2005. We advised on site training was used to cascade relevant issues to care staff (e.g. about ‘capacity’ and about how care staff are often the ‘decision maker’). Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Firwood House provided service users with a clean, comfortable, attractive and safe place to live. The recent and planned refurbishments are greatly improving the home. EVIDENCE: Firwood house was comfortable and pleasant, with a good standard of furniture and fittings. The building’s design of five smaller units (rather than one large, communal lounge) and the use of wallpaper in many areas helped create a homely, more domestic environment. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 19 At the last inspection, some areas had looked uncared for with mismatched curtains, missing lampshades and an absence of pictures. New curtains and blinds had now been fitted in all lounge and dining areas and in bedrooms on one unit. Other refurbishment work had also been carried out. The lounge and dining area on lilac unit had been redecorated to a high standard, with new easy chairs, new dining tables and chairs (with arm rests and glide rails) and new flooring. On rose unit, a bathroom had been converted into a wet room, with a new mobile, reclining electric shower-chair. Calendars and clocks had been provided to help meet the orientation needs of service users. In response to some televisions being pulled over, new flat screen, digital televisions had been provided in most units, with these being secured to walls. A lock had also been fitted to the first floor laundry, with the door now being kept shut (and locked) when unoccupied. Further major work was planned during this financial year (with funding agreed). The rather gloomy entrance was to be completely refurbished, including new lighting and a proper reception area. All bathrooms and toilets were to be upgraded, including two new rise and fall baths, new tiling and centring of toilets (to improve access). The lounge and dining area on rose unit was also to be refurbished. We found the home was clean, tidy and smelt fresh. Liquid soap and paper towels were provided throughout. At the last inspection, we were concerned the 9am start time of domestic staff made it difficult to clean lounge areas (as service users were sitting in them when domestic staff came on duty). A new start time of 8am had been agreed and was now in place. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were protected by generally very good recruitment practices and benefited from an experienced, stable, well trained staff team. Planned increases in staffing levels and extra training will further improve the quality of the service. EVIDENCE: On the day of the inspection, enough staff were on duty to meet the needs of service users. Five care staff were on duty during the morning, four on an afternoon and evening, and three overnight. An assistant practitioner was also on duty on rose unit (from 8am to 10pm). Random examinations of rotas showed staffing levels were maintained. Funding had been secured to increase these, to enable five care staff to be on duty throughout the working day (from 7.30am to 10pm). Recruitment for these hours is planned for June/July this year. Further funding to provide an additional full time care supervisor post was also being arranged. Good practice continued, with care supervisors receiving a paid, 15-minute handover. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 21 Service users continued to benefit from a consistent, stable, experienced staff team. There were two vacancies for part-time care staff (these hours were currently worked by existing staff). At the last inspection we had found staff were anxious about the new intermediate care unit. Feedback at this inspection indicated staff now felt more competent and confident about working on the unit, with the different staff teams working well together. The manager and the PCT team leader had provided a programme of three training sessions about intermediate care to all staff who worked in the home (including domestic and catering staff). Rather than the two previous, separate offices, all staff now shared one office (with intermediate and respite care files now kept together). To build on these improved working relationships, we suggested streamlining assistant practitioners shift start times with those of care staff (in the forthcoming review of shift patterns). The urgent need for a receptionist had been discussed at the last inspection. Due to redeployment, this post had not yet been filled, but remained a matter of urgency (e.g. releasing care supervisors from answering the busy telephone to support staff and service users). With regard to NVQ training, we were impressed to be told by the manager that all care staff (100 ) had NVQ level 2 or 3 (with four of the five care supervisors also having attained NVQ level 4). We had been concerned at the last inspection, that up to date, accurate staff training information was not available. At this inspection, we found staff now had their own individual files. These showed staff had received a range of relevant training including food hygiene, nutrition, challenging behaviour and an annual moving and handling update. (The need to clarify if the separate ‘hoist training’ course was also subject to an annual refresher was discussed). However, staff had not received annual fire safety training. The manager explained this was to be addressed very shortly, through new ‘e-learning’ computer based training. Service specific training was discussed (regarding understanding and meeting the specialised needs of service users with confusion/dementia). Twelve staff had previously attended an in-depth, six-month ‘dementia studies’ course. The home had been allocated eight further places for the next course (from 9/2008). Staff recruitment records were held centrally at Social Services. A sample of these was looked at during a visit to this office, by two of our inspectors, in July 2007. Information seen included completed application forms with full employment histories, health information, contracts and criminal record checks. However, whilst proper references were in place for most staff, two had been employed without receipt of a written employment reference Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 22 (although confirmation was received after our visit that a verbal reference had been obtained for one new starter). Also, whilst evidence regarding proof of identity and relevant qualifications and training were seen at interview, copies were not being kept. However, a range of good practice was noted. This included the use of a formal short-listing process; an interview panel (consisting of at least two staff); standardised interview questions (with responses recorded and scored); detailed health questionnaires (reviewed by the local authoritys occupational health department) and a comprehensive 7-day induction for care staff. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefited from an excellently managed home. EVIDENCE: The manager, Mr Rob Rimmer, had been in post for one year. We had confirmed him as the home’s Registered Manager on 6th September 2007. Mr Rimmer has the professional qualifications, knowledge and experience (as a nurse, social worker and senior manager with the Registered Manager’s Award) to run the home. He is effective and highly competent, ensuring staff follow policies and procedures, whilst also providing them with support and guidance. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 24 At the last inspection, staff felt things had started to improve under Mr Rimmer’s appointment. At this inspection, staff were motivated and felt very positive about the changes that had been and were continuing to be made. They felt the manager listened to their views and acted upon them. One carer said any concerns raised were not forgotten and they were kept informed about any that could not be sorted out straightaway. Another staff member said Mr Rimmer had “turned [the home] around”; whilst another commented “things get done”. The AQAA contained excellent information, which was supported by our inspection findings. It told us about changes that had been made and recognised areas where there was still need for improvement. Staff received formal supervision on a regular basis. A range of staff meetings were held, including weekly ones with care supervisors and monthly ones with care staff. To improve attendance at the latter, Mr Rimmer was holding them twice - on a morning and then again in the afternoon. Since the last inspection, the manager had reviewed the quality assurance system. The survey given to service users/relatives had been changed to make it easier to use. To improve the response rate, a more proactive approach was now taken, with the survey being sent home with the service user on discharge (as prompted on the discharge checklist) (with a prepaid envelope). The first survey cycle had just been completed, 17 had been returned between December 2007 and April 2008 (a response rate of 43 ). The feedback had been positive, with service users and their families feeling welcomed and commenting meals were good. To meet and build further links with families, an open day had also been held and a newsletter sent out. The plan was to collate responses and any other feedback two or three times a year. We suggested feedback could also be requested over the telephone, especially when there was no actual contact with the family (e.g. when the service user was discharged to the adjoining day centre or was taken home by Social Services transport). We advised involved professionals and visitors (e.g. district and community psychiatric nurses, social workers, podiatry service, hairdresser) should also be surveyed. Money kept on residents’ behalf was stored safely and securely, with appropriate records kept. We checked three balances at random and found them to be correct. However, we were concerned to find a large number of bank cards and a chequebook being kept on behalf of one service user. The manger was aware this was not good practice and intended to address the matter asap. Prior to the inspection, the home had provided details (in the AQAA) showing all safety and maintenance checks were up to date. During the inspection we Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 25 confirmed the fire alarm, emergency lighting and means of escape were being checked weekly. Regular fire drills had also been held. Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 4 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X 3 3 X 3 Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 15 (1) (2) (b) (c) Requirement To promote service users’ health and welfare, their care needs must be recorded in all relevant documents and kept up to date. To ensure medication can be accounted for, all medication records must be completed accurately. Timescale for action 30/06/08 2 OP9 13 (2) 30/06/08 3 OP12 12 (4) (b), 16 (2) (n) To demonstrate service users are 30/06/08 taking part in planned and informal social activities, records must be kept. To ensure the home’s only long term resident receives meaningful stimulation appropriate to their needs, an individualised weekly activity programme must be developed. 4 OP30 23 (4) (d) To ensure staff and service users’ safety, all staff must complete the planned fire training. 30/06/08 Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP6 Good Practice Recommendations To ensure the intermediate care unit is operating as efficiently and effectively as possible, the PCT should review work practices with the home manager (regarding support arrangements from therapy and nursing staff, and discharge/admission management). To ensure service users receive the correct medication • • 3 OP15 medication should be confirmed in writing (preferably by fax) with the service user’s GP on or before admission hand written entries on MARs should be signed, checked and countersigned. 2 OP9 To help service users remember what meals were to be served, a daily menu should be displayed in a helpful format. To release senior care staff from reception and administrative duties, the receptionist post should be filled as soon as possible. To further develop the quality monitoring system, feedback should be sought from professionals and agencies involved with or who visit the home. 4 OP27 5 OP33 Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Firwood House DS0000030981.V361791.R01.S.doc Version 5.2 Page 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. 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