Care Home: The Firs

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What the care home does well The new manager is working hard to improve the environment of the home, how health and personal care are managed, the quality of daily life and social activities, staffing levels and how complaints and protection are dealt with. The manager is able to demonstrate that where there are still areas for improvement the service recognises them and manages them well. These changes are managed with consideration for the people who use the service. People who use the service are consulted and the manager looks at those things that directly affect people in their day to day lives. People are receiving health and personal care that meets their needs in a dignified and respectful way. The care home supports people to follow personal interests and activities and to keep in touch with family, friends and representatives. People have nutritious and attractive meals and snacks. The environment of the home is homely, clean, pleasant and hygienic. People who use the service tell us: "it is better than it was", "it is pleasant and staff are also pleasant", "it is very clean and fresh and there are no bad smells", "I am happy and contented", "it is a nice home", and "I am quite happy here". What has improved since the last inspection? People who use the service and staff tell us that everything has improved since the new management took over. The main improvements are: a new medications system; extensive redecoration and purchase of new furniture and mattresses; changes to the kitchen and food available; recruitment of new care staff; a change of staff culture; and the recruitment of full time activities and welfare liaison officer who is experienced in working with people with a diagnosis of dementia. These improvements mean that people are receiving a safer, more reliable service in a more pleasant environment, and enjoy opportunities for their own choice of activity. CARE HOMES FOR OLDER PEOPLE The Firs 105 Habberley Road Kidderminster Worcestershire DY11 5PW Lead Inspector Emily White Key Unannounced Inspection 13th May 2008 10:30 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 The Firs DS0000070912.V364193.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. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs Address 105 Habberley Road Kidderminster Worcestershire DY11 5PW 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) 01562 741358 01562 748273 Rebjon Care Ltd Mrs Stella Ann Gurney Care Home 26 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (26), Physical disability (26) of places The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service Care Home only - Code PC To people who use the service of the following gender: Either Whose primary care needs on admission to the home are within the following categories Dementia (DE) 26 Physical Disabilities (PD) 26 Older People (OP)26 The maximum number of people who use the service to be accommodated is 26 New registration 13/11/07 2. Date of last inspection Brief Description of the Service: Rebjon Care Ltd (provider) and Mrs S A Gurney (manager) are registered to provide personal care to 26 people, including those with a diagnosis of dementia and physical disabilities at the Firs residential care home. The home is a large house in a residential area of Kidderminster with good access to local facilities by road. Many of the residents are local to the area. A majority of the residents have a diagnosis of dementia. The home was re-registered under the new management six months prior to this inspection and during this time has undergone extensive work to the fabric of the building, as well as to staffing and practices. There have also been six new admissions following a suspension of admissions under the previous management. The current range of fees for the Firs is £390-£460, which is written in the service user guide. The fee information included in this report applied at the time of the inspection and the reader may wish to obtain more up to date information from the care service. The Firs DS0000070912.V364193.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. This was a key inspection, where we look at a range of areas covered by the National Minimum Standards for care homes for older people. To plan for the inspection we looked at the Annual Quality Assurance Assessment which is a form completed by the manager. This tells us about what the home does well, what it could do better and plans for improvement. We also looked at surveys sent to us from nine people who use the service, three staff and two other people linked to the home. During the inspection we met five people who use the service and looked at their experience of all aspects of the care there. This involved speaking to them, looking at records, observing life in the home and speaking to staff and the manager. What the service does well: The new manager is working hard to improve the environment of the home, how health and personal care are managed, the quality of daily life and social activities, staffing levels and how complaints and protection are dealt with. The manager is able to demonstrate that where there are still areas for improvement the service recognises them and manages them well. These changes are managed with consideration for the people who use the service. People who use the service are consulted and the manager looks at those things that directly affect people in their day to day lives. People are receiving health and personal care that meets their needs in a dignified and respectful way. The care home supports people to follow personal interests and activities and to keep in touch with family, friends and representatives. People have nutritious and attractive meals and snacks. The environment of the home is homely, clean, pleasant and hygienic. People who use the service tell us: “it is better than it was”, “it is pleasant and staff are also pleasant”, “it is very clean and fresh and there are no bad smells”, “I am happy and contented”, “it is a nice home”, and “I am quite happy here”. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The Firs DS0000070912.V364193.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 The Firs DS0000070912.V364193.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, 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People who use the service move into the home having had their needs assessed and being assured that these needs will be met. EVIDENCE: Six of the 21 people who use the service have moved in since the new management started. The service has a statement of purpose, which sets out the aims and objectives of the home, and includes a service user’s guide, which provides basic information about the service and the care the home offers. The guide is available to people in a standard format. This is the service user guide and statement of purpose from the previous management and the current manager wishes to develop new versions. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 9 People we spoke to were not able to remember what information they had received but all said that the manager had visited them before they moved to the home. We spoke to someone who had moved in 6 weeks ago. He “knew about the home before arriving” and had met the manager beforehand. Of the nine surveys received from people who use the service, one said they had not received enough information before moving in, one could not remember and seven said that they had received enough information. The service looks at assessment information to see if they can meet the future service user’s needs before they decide to offer a place. No one is admitted whose needs are above the staff skills and ability to care for them. Where relevant an assessment from social services is used to support the information about a person. Assessments by the home are carried out with a checklist and a photograph but could be provide more detail about the person. For example, an assessment contains statements under personal cleansing: “now needs a little assistance with personal care” and under social aims: “to take part in any activities to keep busy, enjoys socialising”. This could include more detail about whether the person can manage any of their personal care themselves, what specifically they need help with, and what specific activities they enjoy. Some of the detail used for the “life history” section of the care plan could be obtained at this stage to support people to make decisions, particularly for those with a diagnosis of dementia. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 10 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, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s individual health and personal care needs are met in a flexible way that respects their privacy, and maintains their dignity. EVIDENCE: We looked at five people’s health and personal care support. The life story section in the care plan is very detailed which is a good example of person centred care for people with a diagnosis of dementia. The life story has information from families where communication is difficult, but where possible individual sections of the care plan are signed by the person using the service to show agreement with the plan. Changes are also signed by the person if they are able to do so. The care plans are followed through from the life story, for example “very smart and always to be dressed in a tie”. Observation confirmed people to be dressed as requested in their plans. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 11 Staff respect privacy and dignity and listen to what is important to people who use the service. All surveys from people said that staff listen to them and that they get the right medical support. Discussions with people who use the service show that they feel staff will listen to them and take action. Discussions with staff show that they understand the importance of choice and making decisions, for example what clothes to wear that day/ what time to go to bed. The daily notes are written in a detailed and respectful manner and show that people are helped to assist themselves where possible, for example washing their own face/ upper body. Observations of staff interactions and interviews with staff showed they are aware of the importance of treating people with respect, for example one staff member said she had been instructed by the manager in how to address people who use the service appropriately. Personal healthcare needs including specialist health, nursing and diet are clearly recorded in each care plan. They also show where there are changes in health needs. Care plans are reviewed monthly and contain physical and psychological overviews as well as separate sections for particular health needs and risk assessments. Records of all health visits are available, for example, GP, physiotherapist, district nurse, and continence advisor. Care plans are amended as necessary according to new instructions from outside health professionals. The service is quick to respond to people’s changing needs. Care plans and daily notes show that health concerns are followed up quickly, for example when someone had difficulty using equipment, the doctor was called immediately and physiotherapy started 6 weeks later. Events relating to behaviour are followed through to a behaviour monitoring chart which has information on what starts the behaviour, what the behaviour was and what helped the situation. Daily notes from staff and decisions to contact relevant health professionals shows that the monitoring is being used to understand needs and choices of those people who find communication difficult. The home operates a new medication system which was set up by the new management. The home has received a letter from the pharmacist from the Primary Care Trust following an audit carried out in February 2008. This letter is very positive and says that there are no shortfalls in management of medications. We observed staff administering post lunch medications appropriately. During staff interviews and checking of three staff files we noted that all staff had completed an appropriate medication course. We note the Personal Cleansing record within the care plan contains gaps in all care plans tracked. The manager believes this to be a recording issue which is supported by the daily records, which are well kept and very detailed, and confirms people are receiving personal care as required. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 12 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, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service supports people to follow personal interests and activities, and they are able to keep in touch with family, friends and representatives. The food available is nutritious and appealing. EVIDENCE: We observed that people who use the service are involved in planning their lifestyle and take part in meaningful activities. The new activities and welfare liaison officer has started a personal history profile for each person in addition to the care plan, looking at their childhood, adolescence, adulthood and retirement as well as people’s likes and dislikes. This is done by speaking to people and their families. She is also starting an activities questionnaire for people to see what they would like to do, and has a system for recording and reviewing this. One person who prefers to spend time alone told us he is happy and likes the staff and food. He said he likes football and is able to keep up with all matches on TV by having access to the TV guide. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 13 People who use the service have good access to the local community. The activities and welfare liaison officer has organised several trips by bus to museums, pub lunches, luncheon clubs, and coffee mornings at the sister home. There is also one to one activity, for example people told us they enjoy walking the dog, going to town shopping or for coffee. There are plans to assist requests by individuals for trips further away by using a key worker system. The home has bought 2 wheelchairs which will make this easier for people with reduced mobility. Religious needs are taken into account, for example communion for the Catholic Church and Church of England, but no other religious needs are identified at present. We saw photographs in the lounge of recent activities, such as people cooking in the kitchen, visiting animals and with the house dog. The staff help with communication skills, to enable people who use the service to make choices about their daily life. The activities and welfare liaison officer has experience of working with people with a diagnosis of dementia and understands person centred working. There is evidence from the activities log and daily records that staff are trying to engage with people with communication difficulties and are noting their likes and dislikes, what has worked and what hasn’t. The staff and manager respond to people’s expression of likes and dislikes through monitoring behaviour and recording appropriately, for example respecting people’s wishes to eat alone in their room. One person told us that the staff and manager are very nice and listen to him. He moved recently and was able to move with his wife into a double room. He said he “would like to have more walks and a martini in the evening” but felt able to raise things if he wanted to. The menu is varied with choices that include people’s favourite foods. The meals are balanced and nutritious and cater for people’s dietary needs, for example there are two people with a diagnosis of diabetes. The cook is doing a preferences sheet for everyone. She said that the food quality is better under the new management, she is able to order what she wants, and there is always enough for everyone. The food is home cooked where possible. We checked menus and saw that they offer a large choice at breakfast: cereal, fruit porridge, cooked breakfast etc. Lunch is a hot meal for example chicken pie or fish. We observed people eating meals in their bedroom, lounge and dining room according to their choice. The dining room is small but has a relaxed friendly atmosphere. All people who use the service told us that they like the food, for example “Meals are all very good, all cooked on the premises and well presented and a good variety”. The manager told us that she intends to start the “MUST” (malnutrition universal screening tool). Weighing and dietary information is in people’s care plan. Both the cook and kitchen assistant are aware that work is planned for nutritional assessments. The Firs currently has a cook from 7.30-2 and 1 part time kitchen assistant; the manager is recruiting for another kitchen assistant for tea time. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 14 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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. They are protected from abuse. EVIDENCE: People say that they are happy with the service provided, and feel safe and well supported. We looked at minutes from “residents” meeting which show that people feel free to express their concerns. In November and December people talked about laundry, activities and staff shortages. These issues have been addressed through recruitment. During discussions with people who use the service everyone said that the staff are approachable and they could talk to the manager if they had a problem. No one had anything they wished to complain about. No one could remember being given information about how to complain but did not think this was a problem as they would talk to the manager. However information from people who returned surveys showed that only three out of nine always know who to speak to if they are not happy or know who to make a complaint to. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 15 Staff know when incidents need external input and who to refer the incident to. They are aware of the system for staff to report concerns about colleagues and managers. We spoke to three care staff and two kitchen staff. All are aware of the meaning of safeguarding or protection, and whistle blowing and felt supported to act in these areas. The care staff are confident of what to do if an incident was reported to them or if they witnessed an incident. All staff expressed confidence in management to deal with matters of safeguarding should they arise. Many staff said that they had attended training on dementia and challenging behaviour or had asked to be included in this. There is no complaints or safeguarding procedure specific to the Firs, but the home is currently using a policy developed by the manager at the sister home. The manager told us she intends to develop a specific policy and complaints procedure for the Firs. The home keeps a full record of complaints and this includes details of investigations and any actions taken if a complaint was made. Discussion with the manager showed recognition that sometimes “minor” issues should be recognised as complaints. One area of concern had been raised with the Commission for Social Care Inspection before the inspection. We looked at records and spoke to the person concerned, which showed us that the matter had been dealt with properly. We also found that the home had learnt from this by improving communications, for example starting a communication book for staff which is regularly used. The AQAA identifies that a quality assurance system is to be developed which will include complaints, whistle blowing and disclosure. The manager has obtained information from “Train to Gain” (government advice for businesses) for advice for training and has a commitment to a training programme for staff over the next 12 months. The manager has identified the need to help staff to recognise when a complaint is being made, how to deal with it quickly and how to deal with difficult situations, as well as looking at staff roles and responsibilities when dealing with complaints and protection. So far all staff have had medication and first aid training. Dementia, challenging behaviour and Mental Capacity Act training are all planned for staff – some have attended this already. New staff have a “Skills for Care” (minimum standards) induction which covers issues of abuse. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 16 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, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a safe, well-maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: The manager told us that the fabric of the house very poor when she started six months before our inspection. The environment was one of the first priorities and 10 skips are used to clear old furniture, mattresses etc. New contracts have begun to be set up for maintenance. We spoke to staff and people who use the service who confirmed that the physical environment had changed for the better. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 17 During a tour of the home we saw that it is an environment that meets the needs of the people who live there. The bathrooms and toilets are fitted with appropriate aids and adaptations. Bedrooms have en-suite facilities. The dignity of people who use the service is helped by easy to read signs for reorientation, many have photographs outside bedrooms for identification, and innovative ways to discourage people from using equipment inappropriately, which avoids the locking of doors and an institutional feel. The lay out and design of the home allows small groups of people to sit together, with three separate sitting areas with TV in one, and radio in another. There is a small smoking room for one person who wishes to continue to smoke. There is a homely atmosphere with house pets and magazines. Communication needs are respected, for example photograph albums of recent activities, a weather notice, very large print calendar, and signs for toilets. People who use the service are encouraged to personalise their bedrooms. Bedrooms are only shared in limited situations and when this happens it is only by agreement with the people concerned, usually the case of a couple. Bedrooms have been redecorated following the new management and before new people moved in. The home is well lit, clean and tidy and smells fresh. There is an infection control policy. On the day of the inspection two ants had been seen by the cook in the kitchen. The pest control officer had already visited and had been booked for six-weekly visits. Bathrooms are clean but we saw some items of terry towelling, soap bars and clothing which may present concerns regarding infection control. The manager said that as people with a diagnosis of dementia are given freedom of the house it is common for items to be moved or left behind in bathrooms, but agreed that this should be closely monitored. The manager has arranged for the Fire officer due to visit, and the Environmental health officer is booked. Electricity and gas safety checks have been carried out, legionella water testing had been done. PAT (portable appliance testing) are due the week following the inspection. The home has identified areas for improvement and development in the kitchen and garden. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 18 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are met and they are cared for by staff that have been properly checked before they start work and who get the relevant training and support from their manager. There are enough competent staff on duty to support the people who use the service. EVIDENCE: Since the new management started there have been four new senior carers recruited and a new care supervisor who has done the RMA (registered managers award). There is a good clear recruitment procedure. We checked staff files which contain pre employments checks, interview questions including a spelling and numeracy test and questions about care situations. The recruitment procedure could be improved by involving people who use the service if possible. Several staff we spoke to said they knew things were not run properly before and welcome the changes. The manager told us that existing staff have accepted the changes and that she believes her task is to reinforce to them that the previous standards are not acceptable. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 19 People who use the service have confidence in the staff that care for them. They told us that staff working with them are able to meet their needs. All people who use the service said they liked the staff and found them approachable. “They always listen to you if you want something”. “The manager is very nice and supportive and sat with my husband for hours when he was ill”. Comments from surveys said that staff are “usually” or “always” available. We saw staff spending time with people who use the service and observed choices being offered, for example the day was very hot and staff went to everyone offering drinks and encouragement. Some people sat outside and were offered sun cream. One person declined this and his choices were respected. All the staff we spoke to were clear about their role and what is expected of them. New staff are clear of their roles for example, “making sure people get what they need”, “helping people to tell us their choices”. The staff we spoke to felt comfortable working with people with a diagnosis of dementia and did not feel there are any areas of difficulty. Daily records show staff are attentive and know how to respond to people’s needs. Good observations and recording are made by both night and day staff. On the day of the inspection there were enough staff available to meet the needs of the people using the service, despite there being overall staffing shortfalls of one carer, admin support, one tea time kitchen staff, and one laundry staff. These are in the process of being recruited – the manager has received applications and there were interviews happening on the day of inspection. There is no use of agency staff. We looked at staff files which show that supervision sessions are regular. Staff we spoke to said they find supervision helpful. Notes and action points are taken of meetings and sessions, and progress is regularly reviewed. Records detail any concerns or problems. New staff had had an induction and felt well supported. They have supervision every 1-3 months but are able to ask for help in between if needed. The service recognises the importance of training, and will be implementing a training programme. Training needs forms are not filled out but certificates of courses attended are in staff files. The manager is aware that there are some gaps in the training programme and plans to deal with this. The manager puts a high level of importance on training and staff report that they are supported and feel able to ask for training if they need it. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 20 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, 37, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a home which is run in their best interests by a competent manager. Their financial interests are safeguarded and the health, safety and welfare of people and staff are protected. EVIDENCE: The manager has the required qualifications and experience and is competent to run the home. She is known to have managed a service judged as “Excellent” and our inspection shows that she has used her experience to improve the Firs. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 21 While many of the policies and procedures from the sister home are being followed in principle, the manager recognises the need to create specific policies for the Firs. There are no existing policies or paperwork available from the previous management. The management prioritises the areas to be changed according to the things that directly affect people who use the service. People who use the service, staff and other professionals have all commented through surveys or by speaking to us that there have been improvements to the home in its environment, medications, staffing levels, activities and food, and care planning and recording. All people who use the service said they are happy and had seen changes for the better. People who use the service have some involvement in the changes through “residents” meetings and involvement in their own care planning. During our discussions with staff and people who use the service it was clear that the manager is very much a part of the life of the home. “she is here all the time”, “she spends time with people”. Discussions with staff show that the manager has started to develop a strong staff team and understands the importance of training and supervision and giving staff feedback on their work. The AQAA contains clear, relevant information that lets us know about changes that have been made and where the home still needs to make improvements, for example, a review of the statement of purpose and service user guide, reviews of care plans, nutritional screening, people becoming more involved in decision making, training for staff on safeguarding, improvements to the kitchen and garden, further recruitment and training, and the need to set up a quality assurance system. These are all things which have been identified during our visit, which suggests that the management is able to recognise and manage improvement. The home was able to show that it closely monitors health and safety. Accident, behaviour monitoring and falls records are available and followed through to records by staff that are using these on a daily basis. Records are of a good standard and are always completed. A communication book has been introduced that staff regularly use. Appropriate professionals relating to health and safety have been contacted, for example health professionals, fire, environmental health, pest control and maintenance checks had been carried out. People’s money (personal allowance) is kept in a safe and they have an inventory of valuables/ record of money in safe keeping. The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 22 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 2 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 3 3 3 3 The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No – new service 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 OP16 Regulation 22 (1) Requirement The manager must develop a complaints procedure specific to the service so that all staff and people who use the service are clear about the process for complaints. The complaints procedure must be relevant to the needs of the people who use the service so that they can use it appropriately. The complaints procedure must be provided to everyone who uses the service so that they know how to make a complaint. The manager must develop a safeguarding procedure, specific to the service, which is easily accessible by staff, so that people who use the service are protected from harm or abuse. Timescale for action 09/07/08 2 OP16 22 (2) 09/07/08 3 OP16 22 (5) 09/07/08 4 OP18 13 (6) 09/07/08 The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 24 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 Develop a detailed service user guide and statement of purpose specific to the service, that can be made available in different formats so that people are clear about the service being offered Develop a detailed pre admission assessment which considers people’s needs in a person centred manner, so that their needs can be appropriately met as soon as they move to the service Develop a key worker system to help new people with a diagnosis of dementia so that the transition from the community is made easier Encourage self medication where possible so that people are able to maintain independence in some aspects of their lives Develop staff understanding of the Mental Capacity Act to ensure that people are involved in decision making about limitations to their freedom Monitor infection control measures in shared bathrooms so that people can be confident the service is hygienic Develop a training plan for staff so that records and development can be monitored and to ensure people are receiving care that meets their specific needs Complete a quality assurance and monitoring programme specific to the service so that people can be confident their views are accounted for and the service is being run in their best interests 2 OP3 3 4 5 6 7 8 OP4 OP9 OP17 OP26 OP30 OP33 The Firs DS0000070912.V364193.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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