Care Home: The Firs

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What the care home does well The home had demonstrated that it had developed and improved services for people who lived at the home. People had needs assessments and a detailed care plan file. This helped to ensure their needs were identified. The care plans checked were detailed and recorded people’s personal care and health needs, they had been regularly reviewed to ensure they could meet people’s changing needs. People had risk assessments to help protect them from harm. These had also been reviewed regularly. These practices help to protect people’s safety. Staff and some relatives were aware of the contents of people’s care plans and staff were knowledgeable about people’s individual needs. This helped to protect people’s welfare. Two relatives and one person who lived at the home told us they were satisfied with the health care support they received at the home. One relative gave us an example of how the staff team were closely monitoring their relative’s health care. They told us “This showed me they are on top of things”. We asked people who live at the home if they felt they were treated with respect and dignity and whether their right to privacy is upheld. This is what they told us about the staff, “They are caring and friendly”. “I can’t find any fault with the care I get, it’s very good”. “The staff are lovely; they are just like one of us”. “I’m happy here”. “It’s a caring and friendly home”. We spoke to two relatives to find out whether they thought their relatives were treated with dignity and respect and they told us, “I am happy with my relatives care. They were in another home before and this is much better”. “The staff and the owners are great, approachable and nothing is too much trouble”. “My relative has always been happy and content. They have always looked after them and treat them nice”. “They always keep them looking clean and tidy”. The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Medication was managed appropriately and this protected people’s welfare. Overall, we found that most people thought the lifestyle experienced in the home matched their expectations and preferences, and satisfied their social, cultural, spiritual and recreational interests and needs. People had a range of activities to take part in if they so wished. People who live at the home told us, “We have got an activities board in the reception hall, there is something on each day and occasionally at weekends. I like to do the Bingo; it’s quite exciting you know”. Another person said, “I like to do Dominoes with Katherine, we have a good laugh”. “She will put on whatever we want really”. Someone else told us,” I like to see the singers, they come about every two months, they are very good, very entertaining”. A relative told us, “My Mother really enjoys the Bingo”. Another relative said about their Aunt, “She’s not interested in activities. She has her own routine and will join in the singing when an entertainer comes, but other than that they just enjoy doing their own thing”. During our visit we were able to see that people were supported to maintain contact with their family and friends as they wished. Numerous relatives were visiting on the day we were there. Visitors started to arrive from 10.30 am and were observed to be made welcome by staff. They told us, “The staff always give me a cup of tea, they are friendly and I know I can call in at any time”. People told us and we observed that that they receive a wholesome and appealing balanced diet, in pleasing surroundings at times convenient to them. After lunch we asked people for their views of the meals, One person said, “The food here is good, always a choice and if you don’t want what’s on the menu, the cook will make you something else”. Another person said, “They ask me every morning what I want, the food is good, I don’t have a big appetite but there is always something to tempt me”. People were able to make complaints to ensure that their rights were upheld. We asked people if they knew how to make a complaint and they told us, “I just tell the staff if anything is wrong”. Another person said, “I would tell the managers”. Staff were trained about the local adult safeguarding procedures. This helped to protect people’s welfare. The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Page 8The home was clean, tidy and homely. There were no malodours in the home. The staff told us that several communal areas of the home had been redecorated and new furniture and furnishings had been purchased, in order to meet people’s needs. These included lounge chairs and curtains. People who live at the home told us, “I like my bedroom, yes I’m very satisfied”. Another person said, “My bedroom is fine, it’s warm and cosy”. One person told us they were going to move in to one of the newly refurbished en-suite bedrooms, they said, “I’m really looking forward to the move as I will be more independent in my wheelchair in a bigger room”. People who lived in the home were protected by the recruitment and selection policy and procedures in place. This will protect their welfare. There were adequate numbers of staff on duty, on the day of our visit, to ensure that people’s diverse needs could be met. People were in safe hands as the majority of the staff had received adequate training and were competent to do their jobs. What has improved since the last inspection? Some care staff had completed First Aid training to ensure people’s safety. This meant that 10 of the 15 staff had now completed the First Aid training to ensure that there was at least one person per shift who had this training. This will help to protect people’s health and welfare. Care plans checked were adequately detailed to ensure the staff knew how to manage people’s health needs appropriately. People with diabetes were being offered an appropriate diet to meet their needs. People’s continence care needs were recorded and staff knew how to support people appropriately and this protected people’s dignity. The acting manager showed us evidence that complaints made to the home since the last inspection had been managed appropriately. This helped to protect people’s rights. What the care home could do better: The owner and management at the service need to ensure they give explicit details about any safeguarding incidents to the local area safeguarding team. Requirements to ensure safeguarding procedures are robustly adhered to in the future have been made in this report to ensure people are safeguarded. We will continue to closely monitor all safeguarding referrals made by the home.The FirsDS0000018252.V378616.R01.S.doc Version 5.2 As a priority the newly recruited staff, need to complete all of the mandatory training to ensure they have the right knowledge and skills to ensure people’s health, safety and welfare. A permanent manager has been recruited and will start at the home on 10/12/09. The owner told us that they had completed a Criminal Records Bureau (CRB) check with us and would then apply to become the registered manager of the service. This needs to be done to ensure some stability at the service. The registration certificate which is on the notice board at the home is not a current certificate. This needs to be replaced as a priority to ensure people know the conditions under which the home is registered. Key inspection report CARE HOMES FOR OLDER PEOPLE The Firs 186c Dodworth Road Barnsley South Yorkshire S70 6PD Lead Inspector Shelagh Murphy Key Unannounced Inspection 1st December 2009 09:30 DS0000018252.V378616.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Address 186c Dodworth Road Barnsley South Yorkshire S70 6PD 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) 01226 249623 F/P 01226 249623 None Mr Azar Younis Vacant Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33) of places The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2009 Brief Description of the Service: The Firs is a care home providing personal care and accommodation for up to 33 older people. The home is on the same site as its sister home, Dorothy House. Dorothy House is registered separately and not covered by this inspection report. The home is owned by Mr Azar Younis. The Firs is situated approximately one mile from Barnsley town centre in one direction and the M1 motorway in the other direction. A main bus route passes the bottom of the drive. The home is all on one level and has 25 single and four double bedrooms. There are three lounge areas. One is a separate small lounge, one a small lounge leading off the dining room and the other a conservatory. There is a lawned area and a small car parking area to the front. Information of the services and facilities the home offers, including the home’s statement of purpose and service user guide, including the last inspection report is available in the entrance hall to the home and people’s bedrooms. The manager identified the fee as £356.77 per week. Additional charges are made for hairdressing, private chiropody, toiletries, papers and magazines. This fee was that applied at the time of inspection and people may wish to obtain more up to date information from the care home. The Firs DS0000018252.V378616.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 two star – good service. This means that people who use the service experience good quality outcomes. Shelagh Murphy carried out this unannounced visit to the service over one day and the total time spent on site was 6.5 hours. In the report we make reference to `us’ and `we’. When we do this we are referring to the inspector and the Care Quality Commission. We used a variety of information as well as our findings from the visit to assess the quality of services offered to people who lived at this home. Some time was spent with people who lived at the home. We spoke to three people to gauge their views about the quality of the service offered in the home and by the staff. We also spent some time observing a lunchtime meal being served to people to gauge, how staff at the home supported them. It also gave us some insight into how staff interacted with people and also an indication of peoples’ well being. Three staff attended interviews with us. Two relatives were also interviewed. We also gave out surveys to two staff, two relatives and two people who lived in the home. Some of their views have been included in this report. On the day of the site visit opportunity was taken to make a partial tour of the premises, inspect a sample of care records, check records relating to the running of the home and check some of the homes policies and procedures. The inspector checked all key standards and the standards relating to the requirements outstanding from the homes last key inspection. The progress made has been reported on under the relevant standard in this report. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Page 6 What the service does well: The home had demonstrated that it had developed and improved services for people who lived at the home. People had needs assessments and a detailed care plan file. This helped to ensure their needs were identified. The care plans checked were detailed and recorded people’s personal care and health needs, they had been regularly reviewed to ensure they could meet people’s changing needs. People had risk assessments to help protect them from harm. These had also been reviewed regularly. These practices help to protect people’s safety. Staff and some relatives were aware of the contents of people’s care plans and staff were knowledgeable about people’s individual needs. This helped to protect people’s welfare. Two relatives and one person who lived at the home told us they were satisfied with the health care support they received at the home. One relative gave us an example of how the staff team were closely monitoring their relative’s health care. They told us “This showed me they are on top of things”. We asked people who live at the home if they felt they were treated with respect and dignity and whether their right to privacy is upheld. This is what they told us about the staff, “They are caring and friendly”. “I can’t find any fault with the care I get, it’s very good”. “The staff are lovely; they are just like one of us”. “I’m happy here”. “It’s a caring and friendly home”. We spoke to two relatives to find out whether they thought their relatives were treated with dignity and respect and they told us, “I am happy with my relatives care. They were in another home before and this is much better”. “The staff and the owners are great, approachable and nothing is too much trouble”. “My relative has always been happy and content. They have always looked after them and treat them nice”. “They always keep them looking clean and tidy”. The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Page 7 Medication was managed appropriately and this protected people’s welfare. Overall, we found that most people thought the lifestyle experienced in the home matched their expectations and preferences, and satisfied their social, cultural, spiritual and recreational interests and needs. People had a range of activities to take part in if they so wished. People who live at the home told us, “We have got an activities board in the reception hall, there is something on each day and occasionally at weekends. I like to do the Bingo; it’s quite exciting you know”. Another person said, “I like to do Dominoes with Katherine, we have a good laugh”. “She will put on whatever we want really”. Someone else told us,” I like to see the singers, they come about every two months, they are very good, very entertaining”. A relative told us, “My Mother really enjoys the Bingo”. Another relative said about their Aunt, “She’s not interested in activities. She has her own routine and will join in the singing when an entertainer comes, but other than that they just enjoy doing their own thing”. During our visit we were able to see that people were supported to maintain contact with their family and friends as they wished. Numerous relatives were visiting on the day we were there. Visitors started to arrive from 10.30 am and were observed to be made welcome by staff. They told us, “The staff always give me a cup of tea, they are friendly and I know I can call in at any time”. People told us and we observed that that they receive a wholesome and appealing balanced diet, in pleasing surroundings at times convenient to them. After lunch we asked people for their views of the meals, One person said, “The food here is good, always a choice and if you don’t want what’s on the menu, the cook will make you something else”. Another person said, “They ask me every morning what I want, the food is good, I don’t have a big appetite but there is always something to tempt me”. People were able to make complaints to ensure that their rights were upheld. We asked people if they knew how to make a complaint and they told us, “I just tell the staff if anything is wrong”. Another person said, “I would tell the managers”. Staff were trained about the local adult safeguarding procedures. This helped to protect people’s welfare. The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Page 8 The home was clean, tidy and homely. There were no malodours in the home. The staff told us that several communal areas of the home had been redecorated and new furniture and furnishings had been purchased, in order to meet people’s needs. These included lounge chairs and curtains. People who live at the home told us, “I like my bedroom, yes I’m very satisfied”. Another person said, “My bedroom is fine, it’s warm and cosy”. One person told us they were going to move in to one of the newly refurbished en-suite bedrooms, they said, “I’m really looking forward to the move as I will be more independent in my wheelchair in a bigger room”. People who lived in the home were protected by the recruitment and selection policy and procedures in place. This will protect their welfare. There were adequate numbers of staff on duty, on the day of our visit, to ensure that people’s diverse needs could be met. People were in safe hands as the majority of the staff had received adequate training and were competent to do their jobs. What has improved since the last inspection? What they could do better: The owner and management at the service need to ensure they give explicit details about any safeguarding incidents to the local area safeguarding team. Requirements to ensure safeguarding procedures are robustly adhered to in the future have been made in this report to ensure people are safeguarded. We will continue to closely monitor all safeguarding referrals made by the home. The Firs DS0000018252.V378616.R01.S.doc Version 5.2 Page 9 As a priority the newly recruited staff, need to complete all of the mandatory training to ensure they have the right knowledge and skills to ensure people’s health, safety and welfare. A permanent manager has been recruited and will start at the home on 10/12/09. The owner told us that they had completed a Criminal Records Bureau (CRB) check with us and would then apply to become the registered manager of the service. This needs to be done to ensure some stability at the service. The registration certificate which is on the notice board at the home is not a current certificate. This needs to be replaced as a priority to ensure people know the conditions under which the home is registered. 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. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 2 checked. Standard 6 was not applicable to this home. People had needs assessments completed prior to being admitted to the service. EVIDENCE: We checked three people’s care files to see if they had needs assessments. One for a person who had lived in the home for five years, one for some one who had lived at the home for two years and one for a person who had recently moved in to the home. There were needs assessments in all of the files checked. The most comprehensive was for the person who had moved in to the home recently. On this file we found a pre admission needs assessment and an admissions needs assessment. This demonstrated that the home was The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 12 assessing people’s needs to ensure staff could meet their needs before they were offered a placement. During our visit we checked the homes registration certificate. The one displayed was out of date. The current registration certificate must be displayed in the service as a priority to ensure the service operating legally. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 and 10 checked. People had individual care plans, which contained enough information to ensure staff knew how to meet their individual care and health needs. People were protected by the homes medication procedures and practices. We observed and people told us that they were treated with dignity and respect by staff at the home. EVIDENCE: We checked three people’s care plan files. We found that each person’s health, personal and social care needs were recorded in detail and there were risk assessments in place to inform staff, how they should protect people’s welfare. We also spoke to two people who lived at the home and they knew about their care plans and one person said they had discussed their care needs with staff The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 14 and a relative told us they had been asked to be involved in a review of their Mother’s care. These practices help to protect people’s health and welfare. Two of the three care plans had been reviewed on a regular monthly basis. One person’s care plan needed to be reviewed this week. This was brought to the manager’s notice to address. At an adult safeguarding meeting on 23rd November 2009 we were advised by two care managers from Barnsley Metropolitan Borough Council that they had been in and reviewed the care plans for 19 people who lived at the home and their findings were that overall, the standards of care plans, risk assessments and reviews were good. This demonstrated that the home was meeting people’s needs in this area. We checked to ensure people’s continence care needs were detailed in care plans, as this was an area of concern at the last inspection. We found each person’s needs were detailed and after discussions with staff were satisfied that they knew how to appropriately support people. This helped to protect people’s dignity We checked to see if people’s health care needs were being met. The records checked showed evidence that people had the opportunity to see the G.P as required. As well as having access to support from other specialist community health teams such as district nurses, opticians, dentists, social workers and other specialist geriatric health support services etc. These practices help to ensure that people’s health care needs were met. Two relatives and one person who lived at the home told us they were satisfied with the health care support they received at the home. One relative gave us an example of how the staff team were closely monitoring their relative’s health care. They told us “This showed me they are on top of things”. The deputy manager told us that currently all of the people who lived at the home needed the staff team to administer their medication to them. We checked three people’s medication sheets and found them to be signed correctly. The service used, `Lloyd’s Monitored Dosage system’ cartridges and stored some creams and other medicines in the drug cabinets. The staff had recorded when people had been given medication and there was a system in place to return and reorder medication to ensure people always had a supply to meet their needs. On one of the hand written MAR sheets we found they had been signed for by two staff to ensure that people were being offered medication that had been checked appropriately. We checked to ensure the amounts were correct as recorded in the drug books and found this to be the case. The deputy manager told us that Lloyd’s pharmacy staff come and inspect the home’s medication systems on a regular basis. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 15 We observed staff interactions with people and at all times saw how people were treated with positive regard. Staff were professional yet informal and friendly with people who used the service. We observed how people were supported in a discreet manner to be changed or use the toilet. This protected people’s dignity. People we spoke to also told us they were treated well by staff. This is what they said, “They are caring and friendly”. “I can’t find any fault with the care I get, it’s very good”. “The staff are lovely; they are just like one of us”. “I’m happy here”. “It’s a caring and friendly home”. We spoke to two relatives to find out whether they thought their relatives were treated with dignity and respect and they told us, “I am happy with my relatives care. They were in another home before and this is much better”. “The staff and the owners are great, approachable and nothing is too much trouble”. “My relative has always been happy and content. They have always looked after them and treat them nice”. “They always keep them looking clean and tidy”. None of the people we spoke to had anything but praise for the way they were treated by staff and the owners and this demonstrated that people’s dignity was respected and their rights to privacy were upheld. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 12, 13, 14 and 15 checked. People had some opportunities to meet their social, cultural and recreational needs. People received wholesome and appealing diets in surroundings, which met their needs. EVIDENCE: Overall, we found that most people found the lifestyle experienced in the home matched their expectations and preferences, and satisfied their social, cultural, spiritual and recreational interests and needs. In the entrance hall of the home there was an activities board which was updated on a weekly basis. On each day there was at least one activity for the day, the types of activities for the week commencing 30/11/09 included making Christmas cards, dominoes, Bingo and making Christmas decorations. There was also a sign stating the day and date and this helped to orientate people. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 17 We then spoke to the activities co-ordinator who told us they worked on average 15 hours a week at the home. They showed us an activities folder which had all of the activities which had been offered to people over the last year, who had taken part in the activities and those who had declined. We looked in the book and found that there had been some outings from the home including a day trip to the seaside and a shopping trip. People had also had the opportunity to attend clothing and present parties. There was evidence that entertainers had also visited the service on a six weekly basis to offer singing shows. We asked people who lived at the home what they thought about the activities on offer. They told us, “We have got an activities board in the reception hall, there is something on each day and occasionally at weekends. I like to do the Bingo; it’s quite exciting you know”. Another person said, “I like to do Dominoes with Katherine, we have a good laugh”. “She will put on whatever we want really”. Someone else told us,” I like to see the singers, they come about every two months, they are very good, very entertaining”. A relative told us, “My Mother really enjoys the Bingo”. Another relative said their Aunt, “She’s not interested in activities. They have their own routine and will join in the singing when an entertainer comes but other than that they just enjoy doing their own thing”. A member of staff told us, “The recent clothing party went down well, people really enjoyed that”. During our visit we observed five people playing dominoes with the activities co-ordinator; people were seen to really enjoy this and were fully participating, laughing and joking with each other. We checked to see whether people’s spiritual needs were met. An example of how people’s spiritual needs were met were, two people we spoke to told us they had regular visits from a Nun from the local Catholic parish who visited them to give them Holy Communion. The activities co-ordinator told us that a choir from the local school was planning to visit the home in the next few weeks to put on a Christmas carol performance. All of these examples demonstrated how the service meets people’s social, cultural, spiritual and recreational interests and needs. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 18 During our visit we were able to see that people were supported to maintain contact with their family and friends as they wished. Numerous relatives were visiting on the day we were there. Visitor stated coming from 10.30 am and were observed to be made welcome by staff. They told us, “The staff always give me a cup of tea, they are friendly and I know I can call in at any time”. Three people who live at the home confirmed their relatives can and do visit them regularly. One person told us, “My family call in everyday”. These examples demonstrated how people were supported to maintain contact with family and friends. We checked to see if people were helped to exercise choice and control over their lives. We observed people to be offered everyday choices, such as choice of meals and drinks, where people wanted to go in the home and whether they wished to take part in activities. Some people also had access to their finances from the manager’s in the service. We checked to see if people received a wholesome and appealing balanced diet, in pleasing surroundings at times convenient to them. We spoke to the cook who advised us that some people who lived at the home required special diets to meet their health needs. In particular people who required soft diets and a diet appropriate to meet the needs of people with diabetes. We saw evidence that this had been recorded in people’s care files with details of the diet they required. We saw evidence that the cook publicised the menu for the day in the dining room. On the board was the full menu for the day and included many choices for people. For example at breakfast time people could have cereals, porridge, a cooked breakfast, toast, fruit and yoghurts. At lunchtime people had a choice for the main meal and a choice from five desserts. We ate a lunch with people and found the environment in the dining room was calm, the dining tables were laid appropriately and each person was served at the table individually. There were four staff in the dining room and they discreetly offered support and coaxed some people to eat. People were offered a choice of cold drinks. The meal we were offered was chicken casserole, mashed potatoes and two vegetables. This was hot and tasty. After lunch we asked people for their views of the meals, One person said, “The food here is good, always a choice and if you don’t want what’s on the menu, the cook will make you something else”. Another person said, “They ask me every morning what I want, the food is good, I don’t have a big appetite but there is always something to tempt me”. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 19 A relative told us, “I am really happy about the food offered here. My Mother is well nourished and I can tell this just by looking at her, she gets lots of drinks and snacks, it’s very good”. We observed the drinks round, which is carried out twice a day at 10.30am and 2pm. At the 10.30am round people were offered a choice of hot and cold drinks and a snack of fresh fruit or yoghurts. This was good practice and helped to ensure people were well hydrated and offered small amounts of nutritious food on a regular basis. These examples demonstrated that people’s nutritional needs were being met by the home. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 16 and 18 checked. People were able to make complaints to ensure that their rights were upheld. Staff were trained about the local adult safeguarding procedures. The management and owners of the service are referring allegations of abuse to the Local are Safeguarding team but are not robustly adhering to the relevant procedures to ensure people are fully protected. EVIDENCE: We checked to see if people and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. This is what we found; On the notice board in the entrance of the home and on the `service user’s notice board’, there was a copy of the home’s complaints procedure. This shows that the home were making the procedure available to people and their visitors/relatives. We then asked people if they knew how to make a complaint and they told us, “I just tell the staff if anything is wrong”. Another person said, “I would tell the managers”. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 21 Two relatives were asked about how they would make a complaint, one person referred to the complaints procedure and said they would follow this. Another relative said, “I think I’d just go and tell the manager”. When we asked the staff what they would do if some one made a complaint it was clear they knew how to instigate the complaints procedures. We asked the manager how many complaints had been made to the home over the last year. There were two complaints and they had been recorded and filed in the complaints book. Both had been resolved. We also saw evidence on the `service user’s notice board’, there was a comments and suggestions box alongside this were forms for anyone to put their views forward to the managers. The systems in place demonstrated the home had an accessible complaints procedure and that complaints were acted upon to ensure people’s rights were protected. We checked to see whether people were protected from abuse. From staff training records we could see that most of the current staff members had completed adult safeguarding training over the last year. Four newly recruited staff had not. The acting manager told us that this training had been booked for 10th December 2009. This training must be completed to ensure that all staff are aware of their responsibilities and the actions they must take to safeguard people. From interviews with two staff we know that they understood their responsibilities and the procedures to follow should any allegations of abuse be disclosed to them. The acting manager told us that three safeguarding referrals had been made by the home over the last year. These incidents related to issues including, staff mis-administering medication to a person, staff not using appropriate moving and handling techniques and staff presenting verbal abuse towards a person who lived at the home. All of the referrals resulted in safeguarding investigations to protect people. Barnsley Metropolitan Borough Council (BMBC) adult safeguarding procedures were instigated a strategy meeting and case conferences were arranged. As a result of the safeguarding investigations, undertaken by management at the home, disciplinary action against a number of staff was taken. This led to the owner acting to ensure that staff were either dismissed and other staff received disciplinary sanctions. The owner was advised to ensure that all staff who were dismissed, were referred to the Independent Safeguarding Authority, (vetting and barring scheme). They agreed to make these referrals. This will help to ensure people’s welfare. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 22 The management and the owners of the home worked together with us and BMBC adult safeguarding team to address the safeguarding concerns at the home. However, it became clear that when the initial referrals were made to the safeguarding team, not all of the information about the build up to the incidents and not all of the staff involved in the incidents were fully reported. This could have placed people at risk. The owner took responsibility for these omissions and has agreed that they would take this experience and use the `lessons learnt’ to inform practices within the home in the future. At the safeguarding case conference the owners and management at the service were told they must in future give explicit details about the incidents to the safeguarding team. Requirements to ensure safeguarding procedures are robustly adhered to in the future have been made in this report to ensure people are safeguarded. We will continue to closely monitor any future safeguarding referrals made by the home. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19 & 26 checked. People lived in a warm, homely, safe and comfortable environment. EVIDENCE: We took a partial tour of the building to ensure that people live in a safe, wellmaintained environment. We found that the home was clean, tidy and homely. There were no malodours in the home. The staff told us that several communal areas of the home had been redecorated and new furniture and furnishings had been purchased, in order to meet people’s needs. These included lounge chairs and curtains. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 24 For example the lounges were spacious and were arranged in to three distinct areas, one for people to sit and watch TV, a quiet area, and an area where people were listening to the radio. Lounge chairs were arranged in semi-circle to ensure that people could more easily speak to and see each other. There were blanket throws over numerous chairs and footstools for people to use to relax. There were also numerous occasional tables placed next to the lounge chairs, for people to place drinks and snacks on. The décor was fresh, light and clean as were the curtains and carpets. This provided a very homely and warm environment for people. The bathrooms and toilets checked were clean. In each room there was soap and paper towels to ensure good standards of hygiene. This helped to protect people’s health. The manager told us each person had their own bedroom, each room had a sink. And that people had adequate furniture to meet their needs. One person showed us their room. They told us they were quite satisfied with the décor, furnishings, lighting and heating in the room. They had personalised their room with some furnishings from their previous home and there were family photographs and pictures on the walls. There were no malodours in the room and they told us heir bed was comfortable and the bedding was changed on a regular basis. The person took pride in showing us their room. We looked at two other people’s rooms and they were well decorated furnished, personalised and warm. This ensured that people’s dignity was protected. People who live at the home told us, “I like my bedroom, yes I’m very satisfied”. Another person said, “My bedroom is fine, it’s warm and cosy”. Another person told us they were going to move in to one of the newly refurbished en-suite bedrooms, they said, “I’m really looking forward to the move as I will be more independent in my wheelchair in a bigger room”. A relative told us, “I come everyday and it’s always nice and clean and warm”. Another relative said, “They do a good job in keeping the place fresh and clean because it’s not easy in a big place like this”. One of the owners of the home told us that, some areas of the home were currently being refurbished to provide better accommodation for people. The old conservatory area had been refigured to provide a wet room and new bedrooms with en-suite facilities for people who lived at the home. These rooms did not alter the number of beds the home was registered for. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 25 Staff and people who lived in the home told us that the home had good laundry facilities, there was a member of staff who worked in the laundry area and they told us they had all of the equipment and cleaning materials needed to ensure that people’s collective needs were met. People told us their clothing always returns from the laundry clean and ironed. In order to ensure good standards of hygiene within the home we observed, throughout our visit, numerous examples of good practice. In the entrance hall there was a bottle of alcohol gel and all staff and visitors were asked to use this on their entry and exit from the home. Staff told us and we observed them using plastic gloves and aprons when they supporting people with personal care. We spoke to the domestic staff advised us they were given adequate equipment and materials to ensure they could carry out their role appropriately. We also observed staff cleaning areas with antibacterial sprays etc. These practices help to protect people’s health. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 and 30 checked. People who lived in the home were protected by the recruitment and selection policy and procedures in place. There were adequate numbers of staff on duty, on the day of our visit, to ensure that people’s diverse needs could be met. People were in safe hands as the majority of the staff had received adequate training and were competent to do their jobs. EVIDENCE: We checked to see if people’s needs were met by the numbers and skill mix of staff. On the day of our visit there were three care assistants and a deputy manager on duty to support 19 people who lived at the home. They were supported by a domestic staff, a laundry staff, a cook and a kitchen assistant. There was also a student working at the home. An activities worker was also on duty for some time during the day. This was observed to be an adequate staffing level to meet people’s needs. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 27 Staff told us, “I have worked here for a few months now and there are always enough staff on duty”. A relative told us, “I think that there are enough staff, as I can always find someone if I need to”. We observed throughout our visit that staff were very visible and were always available to people, they would walk round, chat to people, offer support discreetly and appeared to be well organised and busy. We then checked to ensure that people were being supported by appropriate staff. We checked three staff recruitment files and all had the appropriate records to meet the regulations in order to keep people safe. We then checked the staff mandatory and specialist training records. The manager showed us a staff training matrix. It detailed all of the training staff had completed over the last year. This showed that the majority of care staff had completed the mandatory training including fire safety, food hygiene, Infection control, health and safety and moving and handling. And 10 out of 15 staff had completed the First Aid training. The deputy manager said that the other staff requiring this training would be offered this in the New Year. Some of the newly recruited staff had not all completed mandatory training. This training needed be completed as a priority to ensure that all staff are suitably trained and skilled to work with people to protect their safety and welfare. The specialist training matrix showed that only a proportion of the staff had completed aspects of this training. But it showed the areas covered included, Mental Capacity Act, Diabetes care, Tissue viability, Parkinson’s disease and Record keeping. We also found that over 70 of the staff team had completed the National Vocational Qualification (NVQ) 2 or above in care awards. The deputy manager told us that one member of staff was currently working towards this award and that four newly recruited staff needed to begin the award in the New Year. When we spoke to staff they told us, “I have done all of the mandatory training and have completed the NVQ2 care award. Another person said, “We have all done a lot of training over the last year, I feel I have got the skills to support people safely”. This evidence shows the service was committed to ensuring they had a skilled and trained workforce to meet people’s needs. From our observations it was clear that staff had the skills to communicate effectively with people who lived in the home. This included both care staff and The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 28 ancillary staff who come into regular contact with people. Staff showed respect for people, their relationships were observed to be informal and friendly at all times. Several staff told us they were very happy at work and that morale had improved vastly over the last few months. This helped to ensure that people were supported by a staff team who felt valued. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 33, 35 and 38 checked. People were confident in the management of the home. The home was being run in the best interests of people. There was some evidence to show that the owner monitored service standards within the home. Some Health and Safety checks had been carried out appropriately. Other monitoring at the service needed to be more regularly carried out. EVIDENCE: There was no registered manager at the home on the day of our visit. The owner told us that a new manager had been recruited and will start their employment at the home on 10/12/09. They advised us the new manager had The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 30 already applied for a Criminal Records Bureau (CRB) check. They stated that they would also be applying to become registered with us in the near future. On the day of our visit there was an acting manager in charge of the home. They had been in post for the last three months and told us they were experienced and had previously been a registered manager of a care home. There was also a deputy manager in post. Staff told us they had confidence in these managers, who they described as, “Approachable”, “Friendly and supportive” and one staff told us, “If we’re unsure of anything we can go and ask for help”. This helped to ensure staff were supported appropriately. We checked to see if the home is run in the best interests of people who live there. People who lived at the home said, “The owners are lovely, he has told me I can have one of the new en-suite rooms”. Another person said, the managers are good, I can talk to them and they have always helped me out”. A relative told us, “The owners are friendly, they always come and have a chat, can’t do enough really”. A member of the catering staff told us, “There is no food budget as such; I buy in what I need for people”. They told us, the owners had always ensured they had this control. This meant they could purchase good quality food and ensured people had adequate choices to meet their individual needs”. These were examples of how the owners demonstrated that the needs of people who lived at the home were paramount. The manager told us that the majority of people or their representatives managed their own finances. We checked three people finances, which were kept by the home. All transactions were recorded by two signatories and receipts held in envelopes. The finance records maintained were clear and the acting manager told us, only they and the deputy manager had keys to the safe. We checked whether the amounts of money held by the service and the amounts in people’s account sheets tallied and they did. These practices helped to protect people from financial abuse. One person told us their nephew managed their finances, and they managed a small amount of their own money and were quite happy with this. We saw evidence that the service had health and safety policies and procedures in place. As part of the site visit we examined some of the maintenance and servicing records. The certificates for gas, electricity and fire The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 31 equipment maintenance were up to date. We then checked the home own monitoring systems for fire and water safety. During the period of time August to September 2009, some weekly checks for water temperatures, fire alarms and emergency lighting had not been recorded and this was brought to the acting manager and the owner’s attention to address. This is to ensure people’s safety. We checked to see whether the owners were monitoring the service on a regular basis. We asked for Regulation 26 reports and found that not all of these had been completed and sent in to us on a regular monthly basis. We have asked for the October and November 2009 reports to be sent to us to ensure the home had been adequately monitored to ensure people’s health, safety and welfare. The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 33 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 OP18 Regulation 13 Requirement Timescale for action 31/12/09 2. OP30 18 3. OP38 23 4. The Firs OP33 26 The registered person must ensure that all relevant information is provided to the Local Area Adult Safeguarding team, when making referral. This is to ensure people are better protected from harm. The newly recruited staff must complete appropriate adult safeguarding training. This will help to ensure people are protected from abuse. All staff must complete the 31/01/10 mandatory training required to carry out the roles they perform safely. Therefore evidence that staff have completed this training must be sent in to us. This is to ensure that all staff are adequately trained to support people safely. The registered person must 31/12/09 ensure that regular monitoring of fire equipment and water temperatures are carried out at the home to protect people from harm. Regulation 26, owners 31/03/10 DS0000018252.V378616.R01.S.doc Version 5.3 Page 34 monitoring reports, must be sent in to us on a regular monthly basis and in a timely manner until the new manager has been registered with us. This will ensure that we can continue to monitor the quality of the service and thereby protect people’s welfare. 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 OP1 Good Practice Recommendations So that people know the conditions under which the service is registered, the most up to date certificate should be displayed. The new manager should apply to be registered by CQC. This will help to ensure that people are living in a well run service. 2. OP31 The Firs DS0000018252.V378616.R01.S.doc Version 5.3 Page 35 Care Quality Commission Yorkshire & Humberside Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.yorkshirehumberside@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. 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