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Care Home: The Firs, Budleigh Salterton

  • The Firs 33 West Hill Budleigh Salterton Devon EX9 6AE
  • Tel: 01395443394
  • Fax: 01395443830
  • Planned feature Advertise here!

The Firs is a large detached property situated a short distance from Budleigh Salterton town centre and the sea front. Electronically operated gates have recently been fitted and people need to speak to a member of staff via a speaker to gain access. It has level access into the home with the lounge, dining room and some of the bedrooms located on the ground floor. Other bedrooms on the first floor are reached by a passenger lift. The gardens are of a good size and have ample room for sitting out. There are three summerhouses, which service users may also use. The home provides personal care for up to 29 older people who may have dementia. The local community nursing team supports the home. A comprehensive statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is made available to all potential residents before they make a decision about living at The Firs. A copy of the most recent inspection report is available on request. Information received from the home indicates that the current fees are £ 309£603 weekly. Services not included in this fee are hairdressing, theatre tickets, and meals out, some activities, for example pottery, painting, labelling of clothes, papers, magazines, wine at meals and chiropody.The Firs, Budleigh SaltertonDS0000047358.V377369.R01.S.docVersion 5.2

  • Latitude: 50.629001617432
    Longitude: -3.3369998931885
  • Manager: Manager post vacant
  • Price p/w: ~
  • UK
  • Total Capacity: 29
  • Type: Care home only
  • Provider: Buckland Care Ltd
  • Ownership: Private
  • Care Home ID: 15780
Residents Needs:
Old age, not falling within any other category, Dementia

Latest Inspection

This is the latest available inspection report for this service, carried out on 3rd September 2009. CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

For extracts, read the latest CQC inspection for The Firs, Budleigh Salterton.

What the care home does well People living at this home were generally very happy with life at the home; one person told us, "The care we receive at the Firs is First Class. No one could find a better place to be and I hope I shall be able to spend the rest of my life here", "I find The Firs a very happy place to be, and I am very contented to have such a good home" and " It is a very happy home with very friendly and efficient staff".The Firs, Budleigh SaltertonDS0000047358.V377369.R01.S.docVersion 5.2Visitors to the home during the day of this inspection told us "Lovely home, I use the criteria that if I had to move into residential care , please let it be The Firs", " Wonderful place, really brilliant, my [relative] loves it here, she calls it her home", " just like a hotel" and "very happy, staff are brilliant, keep us up to date". People spoke highly of the staff; we were told that staff were "respectful, friendly, kind, marvellous and caring". One relative said staff always appeared happy at work and were always smiling. During our visit staff were attentive and friendly in their approach to people living at the home. We saw staff skilfully meet the needs of individuals and ensure that individuals were offered choices. Good information is available to people to help make a decision about whether this home would suite their needs. A good admissions process ensures that the home can meet people`s needs. People`s health care needs are well met and the home works with other professionals, such as GPs and nurse specialists to ensure people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. People were happy with activities provided and most felt their social needs were met. People spoke highly of the food served at the home, which is of good quality and nutritious. The home can cater for various diets. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. Several people described the atmosphere at the home as warm, friendly and welcoming. People feel confident that their complaints or concerns will be addressed. There are systems in place to ensure that people living at the home are protected from harm or abuse. The environment is clean, comfortable and safe. People were very happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. Many people praised the staff team for their caring approach and attitude. The staff morale at the home is high and staff feel valued in their role and have a good sense of job satisfaction. Staff are recruited robustly to ensure that people are protected. The home is well managed, by the current management structure, with systems in place to ensure that people `have their say` about the development of the service. Overall, health and safety is well managed and people are safeguarded from harm.The Firs, Budleigh SaltertonDS0000047358.V377369.R01.S.docVersion 5.2Page 8 What has improved since the last inspection? One requirement and 7 recommendations for good practice were made at the last inspection. The Registered Person has provided evidence to the Commission that the security arrangements for external fences and doors do not unduly restrict the liberty of people using the service and comply with current legislation, good practice and guidance including the Mental Capacity Act and Deprivation of Liberty Safeguards. Assessments of peoples` health, welfare and social care have improved and now include sufficient detail and information on which a comprehensive plan of care may be based. Care plans has improved and included information to inform staff how to meet the needs of the individual. The quality of information in daily reports has improved and they are now being written in sufficient detail to ensure that aims of goals highlighted in individuals` plans of care have been met. People living at the home are provided with information about the meals being served to enable them to make a choice about the food they receive, including those who choose to stay in their rooms. Copies of outcomes of quality assurance surveys are not being sent to the Commission. The service works hard to ensure there are always enough staff on duty to meet peoples` individual health, welfare and social care needs.The Firs, Budleigh SaltertonDS0000047358.V377369.R01.S.docVersion 5.2 What the care home could do better: The home`s Statement of Purpose is not up to date to ensure that people are provided with sufficient, accurate, current information to enable them to make a decision about making The Firs their home. The views of people living at the home are not included in the home`s statement of purpose for any interested parties to refer to, or to the Commission. Copies of outcomes of quality assurance surveys are not being sent to the Commission. Improvement to information included in care plans should continue to be undertaken. Although the service has improved the system for involving people in the reviewing of their care plans has improved this continues to be inconsistent. Records are not always kept when they, or their representatives, have been involved or consulted. Arrangements should be made to promote and make proper arrangements to meet peoples` health and welfare needs at the home. This relates to scant information recorded about psychological health monitoring and any preventative restorative or care provided. Assessments of risks relating to falling and nutrition should be undertaken for all people living at The Firs. All staff should comply with the homes` infection control policies and procedures. This relates to wearing protective clothing to prevent the risk of cross infection when dealing with laundry. The service should develop a system to ensure that the laundry area is kept clean and safe. A system for ensuring that all staff attend mandatory training, and that accurate, up to date records are maintained, should be established at the home. The service should continue to seek to recruit a suitable person to be registered as manager of The Firs.The Firs, Budleigh SaltertonDS0000047358.V377369.R01.S.docVersion 5.20 Key inspection report CARE HOMES FOR OLDER PEOPLE The Firs, Budleigh Salterton The Firs 33 West Hill Budleigh Salterton Devon EX9 6AE Lead Inspector Michelle Oliver Key Unannounced Inspection 3rd September 2009 09:30 DS0000047358.V377369.R01.S.do c Version 5.2 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, Budleigh Salterton DS0000047358.V377369.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, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs, Budleigh Salterton Address The Firs 33 West Hill Budleigh Salterton Devon EX9 6AE 01395 443394 01395 443830 firscarehome@aol.com 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) Buckland Care Ltd Manager post vacant Care Home 29 Category(ies) of Dementia - over 65 years of age (29), Old age, registration, with number not falling within any other category (29) of places The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the new accommodation will not be brought into use until the Commission for Social Care Inspection has received written confirmation that Planning Department, Building Control, Environmental Health Department and Devon Fire and Rescue Service requirements have been met. That the new accommodation will not be brought into use until an inspector has visited to confirm that the extension is ready for occupation and has been built according to plans which have been agreed with the Commission. Potential users of the two first floor rooms in the extension completed during November 2005 must be made fully aware that there is a restricted view from the rooms due to the height of the window sills, and that there is limited natural light because of the windows’ size. Users who accept an offer of accommodation in either of the rooms must be given first refusal of any other bedroom which becomes available. The home must apply to East Devon District Council for planning consent to enable the two first floor rooms in the November 2005 extension to have their sills reduced in height to enable a user either seated or in their bed to have a reasonable view of the outside world in order to meet the terms of National Minimum Standard for Care Homes for Older People number 25(3). Once planning approval is granted no new service users are to be admitted to the two first floor November 2005 extension rooms until the terms of National Minimum Standard for Care Homes for Older People number 25(3) is met. The Statement of Purpose and Service Users Guide must clearly describe the restricted view and light in the first floor rooms in the 2005 extension until the window sills have been lowered to meet the terms of the National Minimum Standard for Care Homes for Older People number 25(3). 2. 3. 4. 5. 6. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 5 Date of last inspection 4th August 2008 Brief Description of the Service: The Firs is a large detached property situated a short distance from Budleigh Salterton town centre and the sea front. Electronically operated gates have recently been fitted and people need to speak to a member of staff via a speaker to gain access. It has level access into the home with the lounge, dining room and some of the bedrooms located on the ground floor. Other bedrooms on the first floor are reached by a passenger lift. The gardens are of a good size and have ample room for sitting out. There are three summerhouses, which service users may also use. The home provides personal care for up to 29 older people who may have dementia. The local community nursing team supports the home. A comprehensive statement of purpose and service user guide is available at the home, which includes details about the philosophy of the home and details about living at the home. This is made available to all potential residents before they make a decision about living at The Firs. A copy of the most recent inspection report is available on request. Information received from the home indicates that the current fees are £ 309£603 weekly. Services not included in this fee are hairdressing, theatre tickets, and meals out, some activities, for example pottery, painting, labelling of clothes, papers, magazines, wine at meals and chiropody. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means that people who use this service experience good quality outcomes. This inspection was undertaken over 8 hours on 1 day by one inspector. As part of this inspection we spoke with several people living at the Firs and staff and also spent time observing the care and attention given to people by staff. Prior to this inspection we sent surveys to 10 people living at the home, 6 staff and 8 health care professionals. We received responses from 8 people living at the home, 6 from staff and 4 from health care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. To help us understand the experiences of people living at this home, we looked closely at the care planned and delivered to three people. Most people living at the home were seen or spoken with during the course of our visit and three people were spoken with in depth to hear about their experience of living at the home. We also spoke with 9 staff, including the General Manager, deputy and ancillary staff, individually. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Currently the fees of between £309 & £603 are charged. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Copies of the inspection report are available from the office. What the service does well: People living at this home were generally very happy with life at the home; one person told us, “The care we receive at the Firs is First Class. No one could find a better place to be and I hope I shall be able to spend the rest of my life here”, “I find The Firs a very happy place to be, and I am very contented to have such a good home” and “ It is a very happy home with very friendly and efficient staff”. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 7 Visitors to the home during the day of this inspection told us “Lovely home, I use the criteria that if I had to move into residential care , please let it be The Firs”, “ Wonderful place, really brilliant, my [relative] loves it here, she calls it her home”, “ just like a hotel” and “very happy, staff are brilliant, keep us up to date”. People spoke highly of the staff; we were told that staff were “respectful, friendly, kind, marvellous and caring”. One relative said staff always appeared happy at work and were always smiling. During our visit staff were attentive and friendly in their approach to people living at the home. We saw staff skilfully meet the needs of individuals and ensure that individuals were offered choices. Good information is available to people to help make a decision about whether this home would suite their needs. A good admissions process ensures that the home can meet people’s needs. People’s health care needs are well met and the home works with other professionals, such as GPs and nurse specialists to ensure people have access to the care they need. People can be assured that caring staff will respect their privacy and dignity and enable them to make choices within their daily lives. People were happy with activities provided and most felt their social needs were met. People spoke highly of the food served at the home, which is of good quality and nutritious. The home can cater for various diets. Relatives told us they were always welcome at the home and that they were informed of important issues concerning their relative. Several people described the atmosphere at the home as warm, friendly and welcoming. People feel confident that their complaints or concerns will be addressed. There are systems in place to ensure that people living at the home are protected from harm or abuse. The environment is clean, comfortable and safe. People were very happy with their accommodation. The home has sufficient aids and equipment to support the need of the people living there. Many people praised the staff team for their caring approach and attitude. The staff morale at the home is high and staff feel valued in their role and have a good sense of job satisfaction. Staff are recruited robustly to ensure that people are protected. The home is well managed, by the current management structure, with systems in place to ensure that people ‘have their say’ about the development of the service. Overall, health and safety is well managed and people are safeguarded from harm. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? One requirement and 7 recommendations for good practice were made at the last inspection. The Registered Person has provided evidence to the Commission that the security arrangements for external fences and doors do not unduly restrict the liberty of people using the service and comply with current legislation, good practice and guidance including the Mental Capacity Act and Deprivation of Liberty Safeguards. Assessments of peoples’ health, welfare and social care have improved and now include sufficient detail and information on which a comprehensive plan of care may be based. Care plans has improved and included information to inform staff how to meet the needs of the individual. The quality of information in daily reports has improved and they are now being written in sufficient detail to ensure that aims of goals highlighted in individuals’ plans of care have been met. People living at the home are provided with information about the meals being served to enable them to make a choice about the food they receive, including those who choose to stay in their rooms. Copies of outcomes of quality assurance surveys are not being sent to the Commission. The service works hard to ensure there are always enough staff on duty to meet peoples’ individual health, welfare and social care needs. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 9 What they could do better: The home’s Statement of Purpose is not up to date to ensure that people are provided with sufficient, accurate, current information to enable them to make a decision about making The Firs their home. The views of people living at the home are not included in the home’s statement of purpose for any interested parties to refer to, or to the Commission. Copies of outcomes of quality assurance surveys are not being sent to the Commission. Improvement to information included in care plans should continue to be undertaken. Although the service has improved the system for involving people in the reviewing of their care plans has improved this continues to be inconsistent. Records are not always kept when they, or their representatives, have been involved or consulted. Arrangements should be made to promote and make proper arrangements to meet peoples’ health and welfare needs at the home. This relates to scant information recorded about psychological health monitoring and any preventative restorative or care provided. Assessments of risks relating to falling and nutrition should be undertaken for all people living at The Firs. All staff should comply with the homes’ infection control policies and procedures. This relates to wearing protective clothing to prevent the risk of cross infection when dealing with laundry. The service should develop a system to ensure that the laundry area is kept clean and safe. A system for ensuring that all staff attend mandatory training, and that accurate, up to date records are maintained, should be established at the home. The service should continue to seek to recruit a suitable person to be registered as manager of The Firs. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 10 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, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 11 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, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 12 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): 3&6 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. The home provides clear, detailed information to people considering moving in. People can be confidant that they will receive the care and support they need if they do move into the home. EVIDENCE: People who are considering moving to The Firs are provided with sufficient information needed to enable them to make an informed choice before making The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 13 a decision. This was confirmed in surveys returned from people living at the home prior to this inspection. The home provides a Statement of Purpose that clearly sets out their objectives and philosophy, gives a clear account of the specialist services provided, quality of the accommodation, qualifications and experience of staff and how to make a complaint. However, this document has not been updated since 2008 and some details are out of date. Also the document does not include results of a recent quality assurance survey which would inform people who are thinking of living at The Firs of the views, comments and experiences of people already living at the home. [Please refer to standard 33] The manager told us that the statement of purpose is due to be updated. During this inspection we looked at the admission records of three people, one of whom had recently been admitted to the home. We talked to them about how they chose the home, about the information that was shared with them and about the discussions and agreements that were reached on the care they need. None of the people spoken to during this inspection had been actively involved in arranging their move to The Firs and said that their relatives had arranged everything for them. All of them said that they were happy with the care and support they receive at the home. All prospective residents and / or their family or representatives are encouraged to visit the home, meet others living there and have a meal if they choose before the decision is made to make The Firs their home. The manager or deputy manager visits people who are considering moving to the Firs, to undertake an assessment of their health and social care needs. This is to ensure that the homes’ environment and number and experience of staff, can meet their individual needs. The assessment records we looked at showed that information had been gathered to form the basis of a plan of care. All prospective service users are assessed before admission to The Firs to make sure their needs can be met. The assessment is carried out by either the manager or deputy manager and is undertaken at the persons current residence or during a visit The Firs if they wish. People are encouraged to visit the home, spend some time at the home stay for lunch or join in with social activities before making a decision to make The Firs their home. A copy of the service users guide and a brochure is given along with any other information they may require and a copy of the homes Statement of Purpose, and the home’s most recent inspection report is also available. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 14 Individual care plans are prepared based on the pre-admission assessments. On the day of admission to The Firs the manager an assessment of the persons current health and social care needs is undertaken and more detailed care plans are drawn up. Copies of comprehensive assessment and plans of care for people who are not privately funded and are admitted through care management are obtained. The home does not provide intermediate care. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 15 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): 7,8,9 & 10 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. Systems in place generally inform staff about peoples’ care needs, although lack of adequate detail in some care plans may prevent truly individualised care for everyone. People’s health needs are well met with good multidisciplinary working, and the management of medication is generally satisfactory, helping to protect people’s welfare. People feel they are treated with respect and that their privacy is upheld by caring staff. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 16 EVIDENCE: Surveys received from 5 people living at the home showed that they “always” and 3 people said they “usually”, receive the support they needed at the Firs. Four health and social care professionals contacted said that people’s needs were “usually” met by the service. The manager told us the home is continually working towards improvement and care plans continue to improve. This means that staff will be provided with information about individual needs and wishes of people living at The Firs. Two staff who responded to questionnaires confirmed they are always, 1 “usually” and 1 “sometimes”, given up to date information about the needs of people they support or care for. Each person living at The Firs has an individual plan of how their health and social care needs will be met by staff. Detailed planning, recording and reviewing peoples care will ensure that staff are up to date with changes, people will receive appropriate care to achieve positive outcomes and care given will be person centred. Care planning at The Firs is made up from an assessment of a persons daily activities, for example washing, dressing, mobility and continence. We looked at 3 care plans in detail [case tracked] and saw that information recorded in relation to daily activities, was comprehensive. For example plans included details of what a person could actually do for themselves and chose to continue to do to retain their independence or what their aims or goals were. Details had been recorded of how a person had chosen to have care delivered and their likes and dislikes however we did not see any evidence that they had been involved in drawing up or reviewing their care plan, or had been told about any changes. Reviews of these care plans had not been signed or dated. We looked at the care plans for another person and noted that their relative had been involved in drawing up detailed personal care plans and had signed their agreement to how staff would provide care. Not all care plans provided information relating to how certain situations could be managed. For example, we noted that no specific care plans had been drawn up in relation to health care needs for a person who experienced episodes of “confusion, anxiety and aggression”. We saw several entries in daily reports relating to this persons aggression, anxiety and confusion, which had been managed at the home by consulting the persons’ doctor resulting in The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 17 the person being prescribed medication but no care plan of how this was to be monitored had been drawn up. Several episodes of aggression and leaving the home unaccompanied had been recorded in daily reports written by staff. Staff had also consulted a health care professional in the care of a person who was losing weight but no plan had been drawn up to provide staff with information of how to manage this situation or to monitor changes. Not having plans of how staff will manage people’s individual health care needs means that people could be at risk of these needs not being monitored, reviewed or met effectively. Plans of care are reviewed regularly; however there was no evidence that people are involved in this review of their care. Those people spoken to could not remember being involved in this but were confident that they are well cared for and their needs are met by the home. Assessment of potential risks to people living at the home is undertaken as part of the care planning process and kept under review. The care plans we looked at included assessments of risks associated with, mobility, orientation leaving the home unattended, not taking medication, risks of ill health and speech problems. Assessments for the 3 people we case tracked did not include the risks of falling and nutrition. Staff at The Firs aims to ensure all people living at the home are weighed monthly to ensure that their nutritional needs are met. We saw a record that indicated that a person had lost weight during a 3 month period during which they had not been weighed. No care plan of how this persons nutritional need would be monitored had been drawn up. This means that this person may be at risk of their nutritional needs not being met. People benefit from regular opportunities to make their changing needs known. Staff confirmed this when they told us that people speak openly to staff and staff have good communication with all those living at the home and with members of management to whom they report any concerns. The home monitors peoples dental and optician checks and chiropodists are used according to peoples needs. This means that they benefit from the involvement of health care professionals to ensure that health care needs are met. We were told prior to this inspection that plans to continue improvement at the home includes improving communication amongst the staff to ensure all staff are aware of any changes to clients health and personal care. Also to make documentation in care plans easier to read and understand and to inform relatives of any changes to service users immediately it happens. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 18 Medication is generally well managed at the home. Medicines are stored securely and records were generally accurate, up to date and indicated that medication is generally appropriately administered. All staff that handle medicines have received training in the safe handling of medication, which ensures that people living at the home are cared for by competent, well trained staff The ethos of the service is that people are encouraged and supported to look after their own medicines if they wish and are able to do so. Lockable facilities are provided in all rooms for the safekeeping of medicines. None of the people currently living at The Firs are looking after their own medicines. People living at The Firs felt that their privacy was respected and we saw staff knocking on doors and waiting to be invited in before doing so and offering personal care in a discreet manner. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 19 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): 12, 13, 14 & 15. 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. People living at the home are offered choices in all aspects of daily living. Social activities are well managed and provide daily variation and interest for people living at The Firs. Meals are nutritious and balanced and provide individuals with choice and variety. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 20 EVIDENCE: People living at The Firs told us they are offered choices in all aspects of how they live their daily life. They told us they can get up, and go to bed when they choose and do whatever they choose to do during the day. We arrived at the home at 9.30 am; people were sitting in the lounge, others in the dining room, or conservatory and some were in their rooms. They told us they had chosen to get up when they had. We saw an assortment of Cds, tapes of books, and music, and board games in the lounge. Also displayed on notice boards are photographs taken during some of the outings that people living at The Firs have enjoyed. Five people who responded to surveys told us that there were “always” activities at the home they could take part in; two people felt this was “usually” the case and one person did not respond to the question. An activities organiser works at the home 3 times a week. During their visits they encourage people to take part in a number of activities that include games, crafts and exercising. Outings are also arranged and people told us how much they enjoy these. Many people choose to spend the majority of their time in their rooms due to health needs or because they choose not to join in with group activities; the activities coordinator, and staff, spends time on a one-to-one basis with those people. We were told that the activities co ordinator plans to introduce memory books for people who choose to take part, which will include information about people’s individual histories from the people themselves and family and friends. Details about a persons’ past life including occupations, relationships, hobbies and interests and important dates enable staff to see people as individuals and supports person centred care. Personal histories are particularly important for people who may have limited communication as it will provides staff with some insight into how to engage people meaningfully. We asked staff how they prevent people who prefer to stay in their room from the risk of social isolation and were told that staff visit them frequently, talk to them about daily events, their interests and tell them what activities are taking place so that they may change their minds. During this inspection we saw care staff visiting people who preferred to spend time in their rooms to make sure they were comfortable and did not need anything. All rooms have a nurse call system, which means that people can call for staff when they wish. The home has improved on the activities provided since the last inspection by introducing more variety and different entertainers and by arranging at least The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 21 one trip out a month. The home is currently working towards having a sensory garden in the grounds and the money has been raised through people living at The Firs and the activities person by holding different events.During this inspection plans were being made for a barbecue due to be held at the home soon. Comments in surveys included “ a hairdresser comes in weekly and there are regular entertainers visiting. Sometimes day trips are arranged.” Several people spoke about how their relatives/ visitors are made to feel welcome at the home. Visitors are offered drinks and are made to feel at home. We looked at the visitors book and it was clear that many people received visitors and they came at different times of the day. Throughout the day of this inspection several people came to The Firs and several people living at the home went out shopping or for a meal with their relatives. People moving into The Firs are encouraged to bring personal possessions and small items of furniture with them to make their rooms feel homely and this is agreed before admission. All of the rooms seen during this inspection were personalised and people spoke about the pleasure having their own things around them gave them. Three people responding with surveys felt that staff listened and acted on what they said, three said this was “usually” and two “sometimes” the case. We saw staff offering people choice, for example what they wanted to eat and drink. Surveys showed that six people “always” and two “usually” enjoyed the food served at the home. All people we spoke to told us how much they enjoy the meals served at the home. People can choose to have their meals in the pleasant dining room or in their rooms if they wish. The home has a comfortable, homely dining room, tables are well laid with tablecloths, and napkins and all had a small vase of flowers making it an attractive place to eat. A notice board outside the dining room clearly shows the meal that is being served for lunch and a menu showing evening meals. A large board in the dining room also now clearly shows what the lunch dish will be. People who choose to have their meals in their rooms had been told by staff what they were going to be served for lunch. The meal we saw being served on the day of our visit was well presented, hot and everyone said they had enjoyed it. The meal was served at a leisurely pace and staff assisted those who needed help discreetly. Comments in surveys included “The food provided by the chef always includes fresh ingredients and is beautifully cooked” The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 22 The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 23 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): 16 & 18. 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. People living at the home can be confident that any issues raised will be taken seriously and that they, and staff, are protected from abuse by robust policies and procedures. EVIDENCE: All of those people living at The Firs who responded to surveys confirmed they “always” knew who they could speak to informally if they were not happy at the home and all but two confirmed that they knew how to make a formal complaint. Not all people living at the home were able to tell us whether they were aware of the home’s complaints procedure but those who could told us they knew who to speak to if they have any concerns or complaints and most were aware of the complaints procedure. One person told us, “I haven’t got any complaints but if I did I know I could always talk to any member of staff, they are all so The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 24 kind”. Another person told us they would “probably tell my son and they would deal with it”. All staff who responded to surveys and those we spoke to confirmed they knew what to do if someone had concerns about the home and would listen to any issues people may have and pass the concern/complaint to the manager. No complaints have been made to the Commission since the last inspection. We were told that 3 complaints have been made to the home since the last inspection. The home has developed a system to maintain records of all complaints received and how they are managed. We saw documentation confirming that two of the complaints received at the home had been dealt with, together with records of responses to the complainant, which included details of how the manager had looked into the issues. The manager told us the third complaint had been dealt with but the outcome had not been recorded. Staff spoken with said they had received training to help them recognise any poor practice or evidence of abuse and all were aware of their responsibility to report any concerns. Staff spoken to gave examples of unacceptable practice, including verbal abuse, and knew they must report this to senior staff. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 25 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): 19, 20, 23, 24, 25 & 26 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. The standard of the environment within the home continues to be good providing residents with a safe, attractive, clean and homely place to live. The home does not have systems in place to ensure the laundry is kept clean and hygienic. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 26 EVIDENCE: People spoken to during this inspection said they were very comfortable living at The Firs. The Firs is a 28 bedded home, which is accessible for disabled people with a slope to the front door and a lift to the first floor. All private rooms we visited, with people’s consent, were personalised with items such as pictures, photographs and various pieces of furniture and have ensuite facilities. The home also has bathrooms fitted with hoists and equipment for special needs. The home has an open, welcoming reception area, where several of those living at the home enjoy sitting and talking to staff and visitors. Décor is of a good standard; fitting and fixtures such as furniture, curtains, carpets, pictures, lamps throughout the home are of a good quality and refurbishment and redecoration is on going to ensure the home remains comfortable and homely. On the ground floor there is a large lounge and adjoining conservatory, a smaller “quiet lounge” a separate dining room, which can accommodate most people living at the home with a conservatory leading off. Since the last inspection the lounge has been redecorated with a new carpet, curtains, a large screen digital television and several new lounge chairs. The dining room has also been redecorated, several bedrooms have been decorated and recarpetted .The home has changed over to the new digital TV system and several digital TVs have been bought. The home also employs a full time maintenance person and The Firs is well maintained with the lounge areas especially homely and very comfortably furnished. Bathrooms are well equipped and the home has a good provision of equipment to aid peoples independence, for example extra handles in toilets/bathrooms, seat raisers and hand rails in all corridors. The dining room is very well presented. Tables are well set with cruets, fresh flowers, napkin rings and napkins. People have the choice of communal areas both inside and outside the home; this means that people have a choice of place to sit quietly, meet with family and friends or to be actively engaged with other people living at the home. They also said how much enjoyment they get from the gardens at the Firs. The house is set in a large gardens and the home employs a gardener who ensures the garden is well tended. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 27 All doors to people’s private accommodation are fitted with locks to promote peoples privacy. However, we noted one door had been fitted with a Yale type lock and were told that this had been requested by the occupant of the room. The person had a key and staff confirmed that they also had access to a key in case of an emergency. We checked the lock and found that staff would not be able to unlock it from the outside if the person had locked the door from the inside and needed assistance. We discussed this with the person who requested the lock who told us that they were unaware of this. We also discussed it with the manager who readily agreed to address the problem whilst retaining the person’s independence and privacy. At the time of this inspection the home was extremely clean and fresh and we were told by people living at the home that it was always like this. In response to surveys 4 people confirmed the home was “always” 3 “usually” and 1 “sometimes” fresh and clean. One person commented in a survey, “ the home is always clean and doesn’t smell”. The laundry is well equipped and appeared to be well organised. There is a good supply of protective clothing and hand-washing facilities at the home and the laundry has equipment, which should effectively reduce the risk of cross infection. Everybody was well dressed at the time of this visit and several said that their clothes are well looked after. The homes laundry has been reorganised since the last inspection and now has individual baskets, which are clearly marked with names of people living at the home and their room numbers. When laundry is ready to be returned to people items are put in these baskets and staff take them to peoples’ rooms. Prior to this inspection we received a letter from a person living at the Firs complaining that a number of items had “ gone missing” for 2 months, after they had gone to be laundered, We spoke to the manager about this and were told that this had been looked into at the time and the issue has since been resolved. Staff described good infection control practice; we were told they “always” wear gloves and aprons when dealing with laundry to ensure that people are protected from the risk of cross infection. However, during our visit to the laundry a carer was sorting laundry and putting items to soak but was not wearing any protective clothing. The laundry floor was littered with general debris and large amounts of dust had accumulated especially behind the drier, on the day of this inspection. We were told that it is the responsibility of carers to keep the laundry clean and tidy, but is no particular person’s responsibility to do so. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 28 Staff described good infection control practice; we were told they “always” wear gloves and aprons when dealing with laundry to ensure that people are protected from the risk of cross infection. However, during our visit to the laundry a carer was sorting laundry and putting items to soak but was not wearing any protective clothing. One person told us that their laundry is taken away and returned the same day and it is always beautifully done. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 29 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): 27, 28, 29 & 30 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. People benefit from having trained, skilled staff in sufficient numbers to support them, and the smooth running, of the home and who have been recruited following the home’s robust recruitment procedure. EVIDENCE: Four people living at the home responding with surveys said that there were “always” enough staff available when needed and 4 felt that staff were “usually” available when needed. Three staff, in response to surveys, felt there are always and 1 “sometimes” enough staff to meet individual care needs of people living at The Firs. In response to “what could the home do better” a member of staff commented 2 additional staff when the home is full, to meet clients needs”. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 30 A health care professional, who responded to a survey, commented “Increased staffing levels would improve the time available for supporting residents with communication and feeding needs. Staff currently have the will and the skills to do this but always the time”. The Firs does not currently have a Registered Manager in post. The post has been vacant since March 31st 2009. The Commission were told of the arrangements made for the management of the service during the period it takes to recruit a suitable person to the post. The General Manager for the Company that owns the Firs now spends the majority of their time at the home. The deputy manager, who has worked at the home for some time and is experienced and respected by all people living at the home and staff, has taken over the day to day management of care at the Firs. We discussed the situation with the General Manager who told us that they have had several applications for the post but none of the applicants have been suitable. The service is determined to “get the right person for the job”. At the time of this inspection the general manager, deputy manager senior carer, four carers, domestic and a chef were on duty. The manager or deputy is on duty until 4pm leaving 4 carers on duty until 8pm when night staff, consisting of 2 carers, comes on duty until 8am the following morning. The home also employs a person to come in to help serve breakfast and evening meals, and a maintenance person, gardener and an administrator. We looked at the duty rota and found that these staffing levels were usually upheld. However, the General Manager did not appear on the rota, which does not give an accurate picture of the staffing levels at all times. Throughout this inspection we saw staff respond to peoples needs promptly in a kindly and respectful manner. Communication systems at The Firs ensure that all staff are kept up to date with the changing needs of people on a daily basis. All staff attend a handover session when they report for duty. During this inspection we sat in on the afternoon handover, during which some very relevant information was shared. One care had not been working at the home for several days and was updated on information going back to the last time they were on duty. We later saw this carer looking at the care plans for a person who had moved into the home since the care had last been on duty. This means that staff are kept up to date with the needs of people living at The Firs. We looked at the recruitment files for three recently employed staff. All included evidence that the home had conducted a robust recruitment The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 31 procedure. Files included details of past employment, application form, training, evidence of identity, police checks and references. Ensuring that the homes robust recruitment procedure is carried out when any person is employed means that people living at the home are protected from the risk of unsuitable people being employed at the home. Newly employed staff all undertake a period of induction training. This introduces them to the homes policies and procedures, the layout of the home, health and safety issues and conditions of employment. They also undertake an induction course covering care specifically related to health and social care needs of the people they care for. Individual staff files include confirmation of all training undertaken. Several staff have not undertaken manual handling training within the last 12 months and 7 staff have received no manual handling training and not all staff have undertaken up to date fire training. Throughout the day we saw staff assisting people to move safely and according to good practice. We discussed this with the General Manager who told us that they were aware that training needed to be prioritised and feels that the recording of training is not accurate as staff have attended more recent training than the records show. Their plans for continued improvement at The Firs includes improving the recording of training that has been undertaken, encouraging better staff attendance of training courses and employing a manager for the home. Information received prior to this inspection told us that, of the 23 permanently employed staff at the home, 3 have achieved a Nationally recognised qualification [NVQ] at level 2 or above, 5 at level 3 and 3 staff are working towards attaining NVQ level 2. Comments in surveys included “All staff very caring and helpful, also very welcoming”, “staff are always there to help us in whatever is needed” and “the staff are always cheerful and kind with endless patience”. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 32 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): 31, 33, 35, & 38. 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. Although the home does not currently have a Registered Manager in post the home has a management structure in place that is working hard towards trying to make sure the home is run in peoples’ best interests and to promote stability. Health and safety is managed well. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 33 EVIDENCE: The General Manager told us that although the service does not have a Registered Manager, and has not had one since March 31st; the service has a good management team who work well together. The service employs an administrator who deals with finances of staff and residents. Regular residents meetings are held at the home, attended by the manager and occasionally the cook attends to discuss any menu issues. A copy of the minutes is made available to staff to enable them to see where problems are occurring and to see the good comments shared. These meetings give the manager the opportunity to discuss problems staff may be having with serving meals etc. We were told that people living at the home often have some good ideas on how to improve services. The home also undertakes annual Quality Assurance surveys when surveys are sent out to relatives for their views and also regular visiting professionals. Some people living at The Firs choose to have their personal money dealt with by the home. This means that a float is kept so that day-to-day items such as toiletries, hairdressing, papers and magazines can be bought as people wish. We saw records and receipts kept by the home; these were accurate and up to date. Prior to this inspection the General Manager sent us information about the management of the home and how the home has carried out improvements based on the feedback from the last inspection. They and staff have worked hard to meet the requirement and recommendations made at the last inspection. Records are securely stored and would be made available to people living at the home, or their representative, with their consent. Records are kept in lockable filing cabinets and those seen were up to date. Records required by regulation for the protection of people living at the home are maintained. Training records indicate that staff are not up to date with manual handling, fire safety, safe handling of food, first aid and infection control. [please refer to Staffing Standard 30.] Records confirm that fire alarms and emergency lighting tests have been carried out regularly. An assessment of identified hazards and associated risks relating to the environment, including fire hazards, has been undertaken. Information received before this inspection indicated that all equipment is well maintained regularly, all of which contributes toward ensuring that The Firs is a safe place for people to live. The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 34 The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 35 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 x x x N/A 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 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X 3 3 3 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, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 36 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 The home’s Statement of Purpose should be up to date to ensure that people are provided with sufficient, accurate, current information to enable them to make a decision about making The Firs their home. Improvement to information included in care plans should continue to be undertaken. Care plans must include enough detail to inform staff how to meet the needs of the individual. This is to ensure that people receive the care they need in the manner they choose. Individuals should be involved when their care plans are reviewed or kept informed of any changes. 2. OP7 The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 37 3. OP8 Arrangements should be made to promote and make proper arrangements to meet peoples’ health and welfare needs at the home. This relates to scant information recorded about psychological health monitoring and any preventative restorative or care provided. 4. 5. OP8 OP26 Assessments of risks relating to falling and nutrition should be undertaken for all people living at The Firs. All staff should comply with the homes’ infection control policies and procedures. This relates to wearing protective clothing to prevent the risk of cross infection when dealing with laundry. 6. 7. OP26 OP30 The service should develop a system to ensure that the laundry area is kept clean and safe. A system for ensuring that all staff attend mandatory training, and that accurate, up to date records are maintained, should be established at the home. The service should continue to seek to recruit a suitable person to be registered as manager of The Firs. A report of any review undertaken by the provider should be sent to the Commission. A copy of the report must also be made available to everyone. This is to ensure that people have a say in the running of their home. 8. 9. OP31 OP33 The Firs, Budleigh Salterton DS0000047358.V377369.R01.S.doc Version 5.2 Page 38 Care Quality Commission Care Quality Commission South West Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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