Care Home: The Firs Residential Care Home

What the care home does well People are encouraged to visit the home before making a decision to move in. Initial assessments from placing authorities are always gained, as part of the assessment process. People have good access to health care provision. Important relationships are promoted and visitors are welcomed at any time. People are clear about the ways in which they can raise any concerns. Clear adult protection policies are in place to safeguard people from abuse. What has improved since the last inspection? A new care plan format has been introduced, which is more person centred. The plans are regularly reviewed. An activity organiser has been recruited so people now have greater opportunities for social activity both in the home and within the local community. Written authorisation is gained from the GP in relation to any changes in anticoagulant therapy. The district nurse has provided tissue viability training for staff. Staff are no longer using their loyalty store cards when undertaking people`s personal shopping. More fresh vegetables have been added to the menu. Food items are now dated when opened. CARE HOMES FOR OLDER PEOPLE Firs Residential Care Home (The) 2 Lickhill Road Calne Wiltshire SN11 9DD Lead Inspector Alison Duffy Unannounced Inspection 7th July 2008 09:50 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 Firs Residential Care Home (The) DS0000067611.V365658.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. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firs Residential Care Home (The) Address 2 Lickhill Road Calne Wiltshire SN11 9DD 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) 01249 812440 The Firs Care Home (Calne) Limited Heike Sampson Care Home 20 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (19) of places Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th August 2007 Brief Description of the Service: The Firs is a residential care home registered to care for twenty older people, one of whom may have a diagnosis of dementia. Mrs Sehnaz Butt of the Firs Care Home (Calne) Limited, owns the home. Mrs Butt owns another care home within the Bristol area and spends her time between the two services. The Registered Manager is Mrs Heike Sampson. The home is situated within a residential area on the outskirts of Calne town centre. There is a fair walk into the town although people would probably find a car journey more appropriate. There are two twin and sixteen single rooms. All are on the ground floor and have access to a call bell system. Communal areas consist of a dining room and two adjoining lounges. There is an enclosed garden to the rear of the property. Staffing levels are maintained at two members of staff throughout the waking day with an additional member undertaking a 9am – 2pm shift. At night a member of staff undertakes a waking night. Another member of staff provides sleeping in cover and can be called upon, as required. Management on call support is available at all times. Nursing or intermediate care is not provided at the home. Any required nursing task would be referred to the Community Nursing Team. Firs Residential Care Home (The) DS0000067611.V365658.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 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection took place on 7th July 2008 between the hours of 9.50am and 6.20pm. Mrs Sampson and Mrs Butt were available throughout the inspection and received feedback. We met with people who use the service in their own rooms and within communal areas. We met with the staff members on duty. We looked at the management of peoples’ personal monies and the medication administration systems. We observed the serving of lunch. We looked at care-planning information, training records, staffing rosters and recruitment documentation. As part of the inspection process, we sent surveys to the home for people to complete, if they wanted to. We also sent surveys, to be distributed by the home to peoples’ relatives, their GPs and other health care professionals. The feedback received, is reported upon within this report. We sent Mrs Sampson an Annual Quality Assurance Assessment (AQAA) to complete. This was returned on time. Information from the AQAA is detailed within this report. All key standards were assessed on this inspection and observation, discussions and viewing of documentation gave evidence whether each standard had been met. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the experiences of people using the service. What the service does well: People are encouraged to visit the home before making a decision to move in. Initial assessments from placing authorities are always gained, as part of the assessment process. People have good access to health care provision. Important relationships are promoted and visitors are welcomed at any time. People are clear about the ways in which they can raise any concerns. Clear adult protection policies are in place to safeguard people from abuse. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Although a new care plan format has been developed, greater detail would ensure people’s needs are clearly reflected. Staff should record factual information and not include personal details of people within other documentation such as the communication book. When a potential risk is identified such as a risk of developing a pressure sore, measures to minimise the risk must be stated. All assessments must give an accurate assessment of the risk. Advice and information should be gained in relation to supporting people with a visual impairment. Staff should receive training in this area. Staff must sign the medication administration record to demonstrate that they have administered all prescribed medication. Care plans must be in place for medications prescribed, as required. Staff must ensure they observe people taking the medication, they have administered. People’s competency must be assured if they use inhalers without staff support. While the home is generally cleaned to a good standard, attention must be given to non-visible areas such as the underside of the bath hoist. Feedback received from quality questionnaires must be coordinated and used as part of an annual development plan. All feedback should be displayed so that participants can see the outcome of the process. Quality audits should form part of the home’s quality assurance system. Please contact the provider for advice of actions taken in response to this Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 7 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. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 8 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 Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 9 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): 3. Standard 6 is not applicable to this service. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are encouraged to visit the home and are assessed before admission, enabling an appropriate placement. EVIDENCE: Within the AQAA, Mrs Sampson stated ‘all prospective service users are encouraged to visit the home. Prospective service users who are unable to visit will be assessed in their own home. Prospective clients are invited to stay for lunch to enable them to speak to other residents who live at the home. We discuss a four week trial, so they can try the service and assess quality and suitability of the home. A review will then take place to establish if the placement is suitable.’ Within a survey, a care manager told us ‘manager assesses clients prior to admission to the Firs in order to check all information is gathered and correct. She visits in hospitals or in own homes, as needed and always ensures Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 10 equipment is in place before patients’ arrival and that medical/nursing teams are aware, as needed.’ Another care manager told us ‘I always undertake an assessment for needs of identified risks, which are then faxed to the home manager. The home manager also undertakes her own in depth assessment to ensure the needs of the service user can be met within the home. This ensures a good transition and ensures the right services are in place.’ The majority of people told us they had enough information about the home to help them make decisions. Specific comments included ‘my son came to look around and then I moved in’ and ‘I didn’t know so much about the home. This is the first home, which I came to stay in and I liked it.’ We looked at two written assessments of newly admitted people. We saw that one assessment was not signed or dated. Documentation contained information about people’s basic care needs. We advised greater clarity in some areas. For example, one assessment stated ‘hearing – some loss.’ There was no evidence of the extent of the impairment or how the person was to be supported. The Firs does not provide intermediate care, so standard 6 is not applicable to this service. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Greater clarity within care plans would ensure people’s individual needs are fully reflected. People have good access to health care provision. Medication care plans would help staff to administer ‘as required’ medication more effectively. People’s rights to privacy and dignity are maintained. EVIDENCE: We saw that a new care plan format had been developed. The format was more person centred and appeared an improvement on the previous care plans. We advised greater clarity in some areas. For example, terms such as ‘give assistance when bathing,’ ‘ensure nails are clean’ and ‘staff need to assist with washing and dressing’ were stated. One plan stated ‘has Alzheimer’s.’ There was no information about the person’s needs in relation to this condition. We saw that one person had very poor vision. The care plan stated ‘use touch appropriately to inform him of where you are.’ We suggested that information within the plan be developed further. We asked a staff member what aids were available to the person. They said ‘he only has a walking stick.’ We advised Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 12 that guidance, in relation to vision impairment, should be sought from the Hearing and Vision Team. We saw that staff supported the person with their mobility. They did not interact with him. At one point, he bumped into a chair. We said an assessment was needed to ensure the person received appropriate support for their vision impairment. Staff would benefit from training in this area. Staff told us that the person spent a fair amount of time alone. We suggested that consideration should be given to how the person’s social needs could be met more readily. We saw that another care plan stated ‘XX is confused, can show challenging behaviour.’ There was no evidence of what may trigger potential incidents. The plan stated ‘spends most of his time walking around. Sometimes over sleeps during the day – won’t sleep at night.’ We saw that the person slept for most of the time during the inspection. The person’s relative told us that ‘that’s usual.’ We advised that investigation into the reasons for this be undertaken. At the last inspection we saw that one person’s alcohol intake was being monitored. We made a recommendation that this should be fully discussed with the person and their care manager. There was no evidence within the care plan that this had taken place. We saw that there was some information within daily records that should have been detailed on the person’s care plan. This included a sore area of skin and its management. Within one record it was stated ‘open sore on leg, D/N to visit tomorrow.’ There was no follow up of the district nurse’s advice or intervention. Another daily record showed that a dressing had been replaced. There was no written evidence of the wound. There were bowel-monitoring charts in place. At the last inspection, we advised that the reason for these be clarified. Mrs Sampson told us the charts were required as part of a person’s care. We said if they were needed, they should be fully completed and evaluated. Some terminology within daily records was subjective. This included ‘no problems, very confused, quite agitated, very impatient this morning and no problems as such.’ We advised staff record accurate factual information. We saw that there was a separate file detailing ‘methods of approach.’ We suggested that this information be maintained on the person’s care plan. There was also a communication book. This contained personal information about people. We said the communication book should only be used for messages between staff. Confidential information about people, their needs and required support should not be included. There were assessments on the person’s file regarding tissue viability, nutrition, manual handling and the risk of falling. Manual handling assessments were not also signed or dated. We advised that some of the content of these assessments be reviewed. For example, one person was described as average weight although was only five stones. They told us they ate very small meals and did not have a good appetite. The nutrition assessment did not highlight Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 13 any risk. Another nutritional assessment highlighted cause for concern yet ‘no action required at present’ was stated. The initial assessment from the placing authority identified weight loss and ‘needs encouragement to eat.’ Regular monitoring of the person’s weight was not in place. Within a falls assessment, ‘medium risk’ was identified. Measures to minimise the occurrence of falls was not evident. We also saw that control measures to minimise a person’s risk of developing a pressure sore were not in place. Within the ‘methods of approach’ file, two entries stated ‘has open areas on his spine’ and ‘sacrum looks angry.’ We saw that greater clarity with the information and the intervention, which followed, should be in place. Each person had a record detailing any healthcare intervention. This included the GP, district nurse, chiropodist and optician. Only staff who have received training, administer medication to people. People do not manage their own medication. We saw that the staff member administering medication in the morning did not ensure people had taken their medication. One person was given two inhalers. They were not supported with these and took many inhalations of both inhalers. There was no evidence on the care plan that the person was able to manage this medication safely. We saw that some pain relief was prescribed ‘as required’ yet it was being taken regularly, four times a day. Other ‘as required’ medication was not identified on the person’s care plan. It was therefore not clear, what triggered an administration. Staff had not always signed to demonstrate they had administered medication. Medication was stored securely, however the controlled drug storage did not comply with current legislation. At the last inspection we made a requirement that written authorisation be gained from a GP in relation to any changes in anticoagulant therapy. This had been addressed. We saw there were printed details from the GP on the medication administration record. Within various care plans it was stated ‘maintain dignity and respect at all times.’ We advised that the information should identify how this was to be achieved in practice. People told us that staff respected their privacy. They could spend time in their room and their personal care was delivered in private. One person said ‘they treat me with respect when they deliver my personal care.’ Another person said ‘I never feel rushed with my personal care. They treat me respectfully, I have no worries or concerns.’ Within a survey, a care manager told us ‘staff knock and wait before entering a service user’s room. Service users report that they are treated in a manner, which respects their privacy.’ Within one plan there was good detail about enabling privacy within a relationship. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are offered social activity provision both inside the home and within the wider community. People are encouraged to maintain links with their families and friends. People are encouraged to be as independent as possible, yet the support they require is not always clearly detailed in their care plan. People enjoy the meals provided. EVIDENCE: At the last inspection, we made a requirement to ensure that people have greater opportunities for activity both in house and on an external basis. In response to this, an activity organiser has been recruited. There is now a weekly activity plan, which is displayed on the notice board. A regular newsletter has also been developed. Whilst these are positive developments, we advised that both formats could be more user friendly. For example, larger print, pictures and colour would enhance the content and make them more eye catching. The activity organiser told us she makes sure she spends time with each of the people using the service. We saw some people doing flower arranging. One person went out into town with their family. The activity organiser looked at a Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 15 magazine with one person. An external facilitator supported one person with an art session. Other activities undertaken include ball games, pet therapy, card games, scrap booking and crosswords. There are also quiz nights, slide shows and BBQ’s. A hairdresser visits the home weekly and some staff do manicures. We saw from the notice board that plans are in place for a magic show in November. A choir has been arranged for December 2008. There have also been ‘belly dancers,’ a cheese and wine party and the Wild Life Trust has brought owls to the home. There has been a talk on butterflies and moths. Trips to Longleat and a local garden centre have been undertaken. People are supported to go into town, if they wish to go shopping or to the bank. Within surveys, people spoke positively about activities although one relative commented that more provision would be beneficial. A care manager said ‘patients are encouraged to join in activities and outings but some chose not to do so and this is respected.’ Another care manager said ‘a lot of various activities are organised on a regular basis for residents (outings, belly dancing/fashion parades etc.)’ A relative told us ‘since the arrival of the activities coordinator, social events, trips and general functions seem to have increased. A varied calendar of events has taken place/is planned and I feel more of these activities would help the residents a great deal.’ We saw that staff generally interacted well with people using the service. Some staff used terminology such as ‘darling’ and ‘sweetheart’ rather than addressing people with their preferred form of address. We saw one person, with a visual impairment, being supported with their mobility. Staff interaction was minimal. Some people appeared to sleep for long periods. People told us that they could have visitors at any time. They could entertain in their own room or in the communal areas. Within surveys, relatives told us that they are always kept up to date with important issues. One relative said ‘I am always informed with a telephone call straight away.’ Another said ‘Yes, XX has had a couple of falls, I’ve had several phone calls and that’s with the manager, Mrs Sampson was most concerned these matters were attended to as soon as possible, and that I was aware.’ One person told us that staff respected their wishes about how they had their personal care delivered. A staff member confirmed this. The details were also recorded in the person’s care plan. Some people told us that they could follow their own routines such as staying in their bedroom to watch television. They said they were not disturbed. One person told us that they went to bed early after their tea. Within care plans there were many entries stating ‘promote X’s independency.’ It was not always clear how this was to be achieved. We said clarity was needed in relation to the support the person needed. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 16 Within a survey, a care manager told us ‘people are asked what they would like to do and seem to behave, as they would in their own homes.’ We saw that the cook works 40 hours a week. There is a four-week rotating menu. The cook said the menu is flexible and often changed in relation to the weather. At breakfast, there is a choice of porridge, cereal, prunes, toast and marmalade or jam, served with tea or coffee. A cooked breakfast is available on a Sunday. We saw the lunchtime meal was faggots or sausages, mashed potatoes, cauliflower and mixed vegetables. The dessert was fruit flan and cream. Tea was corned beef hash and tomatoes or assorted sandwiches. There was pineapple fool or ice cream to follow. We saw that drinks were available throughout the day. A hot drink is offered at 7.00pm. The cook told us that nobody had any specific dietary needs. At the last inspection we saw that a high level of frozen vegetables and convenience food was being used. We made a recommendation to review and assess this in terms of nutritional value. The cook told us that she was now purchasing fresh vegetables and fruit from a local supermarket. She said some frozen vegetables are used, although she aims to serve at least one fresh vegetable each day. We saw that the fridge contained fresh salad items yet there were no fresh vegetables. Containers of food in the fridge had been dated to show when they had been opened. There were some packets of opened dried fruit in the cupboards, which were not securely sealed. We said it would be good practice to regularly rotate packets and tins of dried food to ensure items remain in date. The cook told us that she likes to go into the dining room to chat with people when they are eating. This enables her to make sure people are happy with the meals. It also provides the opportunity for feedback and special requests. We saw the cook do this. People told us that they enjoyed the food served. One person said ‘It’s good food and plenty of it.’ Another person said ‘food is very good, we get a choice and I can ask for a sandwich, if I wanted one’. A relative told us ‘everyone is well looked after and they have good food here.’ Within surveys, people told us they liked the meals. One care manager said ‘service users are given choice, as to where they would prefer to eat their meals. Service users are offered alternative meals, if there is nothing on a menu, which they like or feel able to eat.’ Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are aware of how to raise any concerns they may have. People are assured greater protection through well-managed adult protection systems. EVIDENCE: Within surveys, people told us that they knew how to make a complaint. One person told us they would tell their family. Staff were also aware of what to do if they received any concerns about the service. One member of staff said ‘I would refer them to my manager to speak to.’ Another staff member said ‘ask questions to what the concerns are, ring manager and tell of concerns and if health, ring the relevant people i.e. doctor or D/N or ambulance if urgent.’ A care manager told us ‘staff have always responded very well to any concerns raised.’ Within the AQAA, it states that there is a copy of the complaint procedure within each person’s room and the communal areas. We also saw copies on people’s personal files. A relative told us that they had their own copy of the procedure. They said ‘I don’t envisage needing to use it. I’m quite happy to speak to Heike or the staff informally in conservation, if there are any problems.’ A record of formal complaints is maintained. Since the last inspection we have received one formal complaint about the service. The complaint was passed to Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 18 Mrs Butt to investigate. Mrs Butt arranged a meeting with the complainant and issues were satisfactorily resolved. Copies of the local reporting adult protection procedures, ‘No Secrets in Swindon and Wiltshire’ were displayed on the notice board in the corridor and in the office. The Safeguarding policy was out of date. We said the revised version should be available within the home. During the inspection, we asked staff, a hypothetical question about abuse. One member of staff said ‘I know the ‘No Secrets’ procedure and the whistle blowing policy.’ Another staff member said ‘if I was worried I would go to Heike or above.’ One member of staff could not remember if they had seen a copy of ‘No Secrets.’ Staff said they had received training in the protection of vulnerable adults. We saw that adult protection had been discussed in a recent staff meeting. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a comfortable, well-maintained environment. The standard of cleanliness is generally good. EVIDENCE: Within the AQAA, it states ‘the home is clean, comfortable and well maintained. We are always changing our carpets and furniture to ensure our service users get the best comfort.’ We saw that some rooms had been decorated. The maintenance person told us that the refurbishment of the home was ongoing. He was currently decorating a room, before the arrival of a new person. People are encouraged to furnish their room, as they wish. All rooms are on the ground floor. There are two adjoining lounges and a dining room. All areas were comfortable. People told us they were happy with the environment. Specific comments included ‘my room is being decorated. I picked the colours Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 20 for the paint and carpets,’ ‘my bedroom is nice and clean,’ ‘I would like a bigger wardrobe really’ and ‘I have everything I need in my room.’ People were able to access their call bell in their rooms. There was a central panel in the lounge to identify the person needing assistance. A number of call bells were activated during the inspection. The sound of the call bell was loud and sounded throughout the home. Consideration should be given to how the sound could be minimised to be less intrusive for people. We saw that the general standard of cleanliness was good. However, one bathroom had a shower cubicle, which was not used. This was being used as a storage area and was in need of a thorough clean. A wet mop had been placed in the corner. We advised that mops be stored in accordance with infection control guidance. The underside of the bath hoist contained brown deposits. We said that staff must ensure that they clean this area thoroughly to avoid the risk of cross infection. We saw that one of the baths was stained. The floor covering in one of the toilets was showing its age and would benefit from replacement. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to address people’s basic care needs but do not enable regular quality, one-to-one time with people. People are protected through a well-managed recruitment procedure. Not all staff are up to date with their mandatory training, which may affect people’s wellbeing. EVIDENCE: We saw that staffing levels are maintained at two members of staff on duty throughout the day with an additional shift between 9am and 2pm. At night, there is one member of waking staff and another provides sleeping in provision. One member of staff told us ‘we have enough staff on duty, 3 staff to get people through their routines.’ Within their survey, another member of staff told us ‘when busy, sometimes we find it difficult if one staff doing bath, another with a service user and someone else rings, we either have to leave the lounge empty or leave the person who rang until someone else is free. This doesn’t happen too often though.’ One person told us ‘the staff are very busy but it depends on the time when you need something. If it is in the morning or the evening you may need to wait. If it’s afternoon they come to you quickly.’ We saw that the shift patterns of staff do not overlap. There is limited time for handovers at the start and end of each shift. At the last inspection we made a recommendation to consideration employing domestic staff over the weekend Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 22 period to enable care staff to concentrate on people’s care needs. This has not been addressed. Within surveys, a care manager told us ‘staff and the manager appear to have the right skill mix. Residents appear calm, relaxed and happy.’ Another care manager told us ‘the quality and standard of staff/carers Firs employ with a nursing background and the quality of care has improved in the last few months, partly I feel the quality of the staff also has….’ They continued to say ‘through my frequent visits to the Firs, I have always found the staff and manager approachable, helpful and friendly. There has always been a relaxed and happy environment, which is displayed from staff and service users. There are no improvements which I can think of to improve the quality of care provided to service users, I have/continue to care manage.’ People were positive about the staff. Specific comments included ‘staff treat me nicely,’ ‘it couldn’t be better, they do what they say they do,’ ‘if you are worried they (staff) will talk to you’ and ‘staff are nice, can’t complain about anything.’ We looked at the recruitment documentation of three most recently employed members of staff. All files contained the required information. All prospective staff had been checked against the Protection of Vulnerable Adults register before commencing employment. This assured their suitability to work with vulnerable people. We said that the decision to employ a person with a conviction should be clearly evidenced. At the last inspection we saw that prospective staff members were spending a day in the home as part of the recruitment process. They were inadequately supervised. Mrs Sampson told us that this has been addressed. Mrs Sampson now spends time with the person during the time they are at the home. We saw that staff training is promoted. Training records demonstrated that subjects such as care planning and recording keeping, stoma care, mental health awareness and dementia care had recently been undertaken. The district nurse had also facilitated a training session on pressure area care. The cook told us that they had completed food hygiene training. This was undertaken in November yet a certificate had not been received. There was a training matrix in place. The matrix identified that some staff had not received mandatory training such as first aid, food hygiene or manual handling. Within the AQAA, it was stated that all except two new staff have National Vocational Qualification (NVQ) level 2. Two staff have started NVQ level 3 and four more staff are expecting to start later in the year. Within surveys, a care manager told us ‘the manager ensures that staff receive regular and adequate training and that qualified people are providing relevant training.’ A relative told us ‘[the staff are] very knowledgeable and have the Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 23 right skills.’ Also, ‘I have never seen a member of staff unable to deal with any situation.’ Staff confirmed that they had received training relevant to their role. One member of staff said ‘we are enrolled on a variety of training days ranging from short (1½ hour) courses on stoma care to longer 2 day courses on mental health awareness etc.’ Another member of staff told us ‘I have received training in manual handling, challenging behaviour, dementia, Alzheimer’s, Medication and POVA.’ Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 24 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, 33, 35 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has the experience and skills to fulfil her role. While people are able to give their views about the service, an annual development plan would formalise future improvements to the service. Greater formalisation of the safekeeping systems of peoples’ personal monies would ensure greater protection. An investigation into the times when people are falling would minimise the risk of further occurrences. EVIDENCE: Mrs Sampson has been the manager of the home since August 2003. She has completed the Registered Manager’s Award. Mrs Sampson works on a Monday to Friday basis yet visits on a weekend, as required. Within the AQAA it was stated that Mrs Sampson had recently completed a team-leading course. The AQAA stated that the improvements for the next twelve months were ‘further Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 25 training courses were planned to ensure she [the manager] can support the team in the best possible way.’ One relative within their survey told us ‘Heike is a very caring person. My XX was ill at night and the carers phoned me and always straight away. When I got to the home, Heike was there worried and concerned for him. He was glad to see me and also glad to see Heike who he has a lot of trust in.’ A member of staff told us ‘I am well supported by Heike and I get regular 1-1 supervision and relevant training.’ A care manager told us ‘through my frequent visits to the Firs, I have always found the staff and manager approachable, helpful and friendly.’ At the last inspection we made a requirement to devise and implement a quality assurance system. In response to this, satisfaction surveys have been sent to people and their relatives. The information received has not as yet been coordinated. We advised that this is undertaken and an action plan be developed. We said the feedback should also be displayed for the interest of all participants. A number of people have placed amounts of their personal monies, for the home to hold safely. We looked at the systems for managing this. Cash amounts corresponded with the balance sheets. We recommended that two members of staff should sign all transactions. We also recommended that the receipts were numbered and attached to the identified balance sheets. Mrs Butt told us that she regularly audits the systems for managing peoples’ monies. At the last inspection we made a requirement that staff must not use their personal loyalty cards when undertaking shopping for people. We saw that this had been addressed. There were various health and safety policies in place. The fire log book demonstrated satisfactory testing of the fire alarm systems. Regular fire drills had taken place and staff had received up to date fire instruction. Mrs Sampson told us the testing of the portable electrical appliances had been arranged. Within the accident book we saw that the majority of accidents had occurred during the evening and the night. We advised that the reasons for this be investigated. A number of environmental risk assessments are in place. These have been recently updated. Radiators in people’s rooms have been covered. Those in the lounges and dining room remain uncovered. We said that potential risks associated with uncovered radiators need to be addressed within the risk assessment process. Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 2 Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 13(4)(c) Requirement Any potential risks identified within assessments must be addressed with adequate control measures and clear intervention. This must be stated in care plans and address the risk of falling, developing a pressure sore and poor nutrition. Timescale for action 31/08/08 2 OP9 13(2) 3 OP9 Reg 17(1)(a) Schedule 3(m) Reg 13(2) 4 OP9 This was identified at the last inspection but has not been addressed. All staff must ensure people 07/07/08 have taken the medication administered to them. Staff must sign each administration on the medication administration record. Individual plans of care relating 31/08/08 to medication must in place and regularly reviewed, including those for medicines prescribed ‘as required’. A controlled drug cupboard that 31/10/08 meets the current storage regulations, The Misuse of Drugs and Misuse of Drugs (Safe Custody) (Amendment) Regulations 2007 must be DS0000067611.V365658.R01.S.doc Version 5.2 Page 28 Firs Residential Care Home (The) 5 OP26 13(3) 6 OP30 18(1)(c) (i) 24 7 OP33 purchased and installed. The underside of the bath hoist 07/07/08 and the shower must be regularly cleaned to minimise the risk of infection. All cleaning items such as mops must be stored according to infection control guidance. Staff must receive up to date 31/10/08 training in first aid, manual handling, food hygiene and visual impairment. A quality assurance system that 30/09/08 audits the home and involves people and other stakeholders must be developed and implemented. This was identified at the last inspection and has been met in part. Any potential risks associated with uncovered radiators in communal areas must be addressed within the risk assessment process. A review of accidents must be regularly undertaken. This must include the investigation into the time that most falls are occurring. 8 OP38 13(4)(c) 31/08/08 9 OP38 13(4)(c) 31/08/08 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 OP7 Good Practice Recommendations Care plans must contain sufficient detail, to ensure staff are fully aware of people’ needs. Terms such as ‘give assistance’ should be avoided. This was identified at the last inspection yet has not been Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 29 2 3 4 OP7 OP7 OP7 addressed. Staff should ensure that they record factual information within peoples’ daily records rather than subjective terminology. Staff should cease recording people’s personal information within the communication book. Consideration should be given to greater individuality within care plans including whether aspects such as bowel monitoring are required for everyone. Mrs Sampson told us that this had been considered and bowel charts were deemed an important aspect of people’s care. If so, the charts should be fully completed and evaluated. If there is a need for any restriction, such as alcohol intake, this should be fully discussed with the person and their care manager. The restriction should be fully documented with the care plan. This was identified at the last inspection yet has not been addressed. The activity plan and newsletter should be in a format more conducive to people’s needs. A copy of the revised policy ‘Safeguarding Vulnerable Adults in Swindon and Wiltshire’ should be available within the home. Consideration should be given to how the call bell system could be quieter and less intrusive. Consideration should be given to the replacement of the flooring in the identified bathroom. Consideration should be given to employing domestic staff over the weekend period to enable care staff to concentrate on people’s care needs. This was identified at the last inspection yet has not been addressed. Consideration should be given to the impact existing staffing levels have on the quality of care provided to people. A member of staff should countersign any transaction undertaken with the safekeeping of peoples’ personal monies. All receipts should be numbered and orderly stored. 5 OP7 6 7 8 9 10 OP12 OP18 OP19 OP19 OP27 11 12 OP27 OP35 Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Firs Residential Care Home (The) DS0000067611.V365658.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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