Care Home: The Firs Residential Home

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What the care home does well The Firs provides small group living in an attractive well-maintained building. Residents can expect to have their needs assessed before a placement is offered. They can expect to have good access to health services and to be encouraged to maintain their independence. Meals in the home are varied and balanced and are well appreciated. Staff are provided in sufficient numbers to respond to residents needs, and are recruited in line with regulations, which affords residents protection. What has improved since the last inspection? A Nursing Care specialist had been appointed to Anchor for support and advice, and auditing of medication practice, care plans, infection control, diet and nutrition. The home had fully implemented a revised format for care planning; care plans had been competed in a timely way, and all elements of the plan had been regularly reviewed. No unpleasant odour was observed in the home during the inspection. Regular staff supervision was evidenced. What the care home could do better: The home must ensure that the Service User Guide includes all of the information required by regulation, to ensure that prospective residents have all of the information they are entitled to enable them to make an informed decision about the home, and that current residents have immediate access to the formal complaints policy without having to ask for assistance to obtain this. This enables them to make an anonymous complaint should they feel the need to do so. The prescribed medicine must be available to residents at all times, to ensure that their health needs are met and that pain is properly controlled. There must be a programme of activities all residents can participate in, and residents who are isolated by virtue of infirmity or sensory deprivation must be given regular opportunities for stimulation through leisure or recreational facilities that meet their needs. Arrangements should be made to ensure all residents with a spiritual interest are given opportunities to have their needs met in this respect. Appropriate signage on dementia units would aid residents` orientation and independence. There was scope for improvement in some housekeeping aspects of the home. Some residents and relatives thought that the laundry system had some problems, the manager was aware of this, but it still needs to be addressed. High surfaces in the kitchen need to be kept clean at all times. CARE HOMES FOR OLDER PEOPLE Firs Residential Home, The 186 Grange Road Felixstowe Suffolk IP11 2QF Lead Inspector Mary Jeffries Unannounced Inspection 2nd October 2008 14:00 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 Home, The DS0000024387.V371264.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 Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firs Residential Home, The Address 186 Grange Road Felixstowe Suffolk IP11 2QF 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) 01394 283278 01394 284504 june.blaxall@anchor.org.uk keri.sherwood@anchor.org.uk Anchor Trust Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (20) of places Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 1 The home may accommodate up to 20 people over the age of 65 years, of either sex, who require care by reason of old age. 2 The home may accommodate up to 30 people over the age of 65 years, of either sex, who require care by reason of dementia. 3 The maximum number accommodated must not exceed 40 persons. 11th September 2007 Date of last inspection Brief Description of the Service: The Firs Residential Home for Older People was built in 1991 on the land adjacent to a former local authority home. The home offers accommodation and care for up to forty service users, within four individual living units, each accommodating ten people. The two living units situated on the first floor of the home are allocated for older people with a diagnosis of dementia, therefore presenting more complex individual needs. One unit on the ground floor, Willow, is for flexible use; residents with dementia may be accommodated on this unit. The home is owned and administered by Anchor Homes Trust, a non-profit making organisation that provides housing and residential care throughout the country. Twelve of the forty beds are offered on a private basis and the remaining twenty-eight beds are block purchased by Suffolk Social Care Services. The home is situated in a quiet road in a residential area of Felixstowe. There are several local shops close by and a superstore a short distance away that includes a pharmacy, a post office and local GP practice. The home is purpose built and offers a high standard of accommodation on two floors. The home has one room, which is allocated for respite care. The Service User Guide states the current fees for private paying customers range from £643-£743 per week. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection was unannounced and took place over five hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. This included a completed Annual Quality Assurance Assessment (AQAA). The AQAA is issued by the Commission for Social Care Inspection (CSCI) and returned completed by the manager. This self-assessment gives providers the opportunity to inform the CSCI about their service and how well they are performing. We (CSCI) also assessed the outcomes for the people living at the home against the Key Lines of Regulatory Assessment (KLORA). Five members of staff provided pre inspection surveys prior to the inspection and one professional pre inspection survey was received. Four residents and five relatives returned pre inspection surveys. On the day of the inspection a tour of the premises was made and a number of records were inspected, relating to people using the service, staff, training, the duty roster, medication, quality assurance and health and safety. Three residents, including one who had been recently admitted, were tracked. Two of these had dementia. The other resident was spoken with, and residents were observed on Pine unit for people with special needs during the afternoon. The manager of the home was available during this inspection and fully contributed to the inspection process. Members of care staff and ancillary staff contributed. What the service does well: The Firs provides small group living in an attractive well-maintained building. Residents can expect to have their needs assessed before a placement is offered. They can expect to have good access to health services and to be encouraged to maintain their independence. Meals in the home are varied and balanced and are well appreciated. Staff are provided in sufficient numbers to respond to residents needs, and are recruited in line with regulations, which affords residents protection. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 7 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 Home, The DS0000024387.V371264.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 Home, The DS0000024387.V371264.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): 1,3,6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can expect to be fully assessed before moving to the home, but cannot be assured that they will receive all of the information they are entitled to in order to make an informed decision about whether to move into the home. EVIDENCE: Residents were found to have Service User Guides (SUG) in their rooms. The The Service User Guide stated the range of fees but did not include all of the information required by regulation. Whilst the fees were stated, it did not state whether the same fee was charged for residents supported by Social Care Services, and although it listed details of some additional charges it did not state clearly whether all other costs were included in the fee. It did not state the method for payment of fees. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 10 The information on the complaints policy complaints contained in the SUG was not sufficient. The document does not contain a summary of the Statement of Purpose, and there is no clear statement about the philosophy and purpose of care, and whilst the description of the units detailed who lives on these units there was not a clear statement of eligibility criteria for the home. The document did not include a standard contract. Prospective residents have a right to all of this information to enable them to make an informed choice about the home. The AQAA stated that all staff had received basic training in he assessment process during the previous year. One resident tracked had been admitted from hospital, and their records showed been assessed prior to moving into the home, whilst still at hospital. This assessment however was not signed or dated and must be. They also had a community care assessment dated a month prior to admission on their file. Two other residents files inspected showed that they had also had preadmission assessments. The Service User Guide states that prior to admission any potential resident is invited to visit the home. One resident spoken with said that they could have visited the home, but didn’t because their daughter knew it, and they thought that they could always move if they did not like it. Another said that they had come along with their relative to have a look at the home before they decided to move in. The home does not provide intermediate treatment. Firs Residential Home, The DS0000024387.V371264.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, 10, 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to have a care plan, that is regularly reviewed, and to have good access to health services. EVIDENCE: The AQAA states that since the last inspection they had appointed a Nursing Care specialist for support and advice, and auditing of medication practice, care plans, infection control, diet and nutrition. The three residents care plans inspected had been audited by the nursing care specialist. care plans included a section on health care needs. One of the residents who was tracked had recently become less mobile, and at their most recent review a new mobility care plan had been formulated. Records for this resident contained ongoing records of night checks and weights. The risk assessment for tissue viability for one of the residents who was tracked was not dated. A health professional that provided a pre-inspection survey stated that there was good communication between their team and the home, and that individual health care needs are usually met by the home. They also noted Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 12 that staff appear to make every effort to maintain high standards of care, physical and mental health. Three residents surveyed indicated that they always receive the medical support they need, one that they usually do. One of the residents tracked had recently been seen by the dentist, and records of General Practitioner appointments were detailed in residents care plan. The health professional had added that staff are always ready to seek help and advice to improve residents’ health care needs. They noted that the home has usually responded appropriately if they have raised concerns about a resident’s care, and that reviews of residents are held regularly and matters openly discussed. The care plans inspected had been regularly reviewed and included up to date details of residents’ circumstances and needs, including risk assessments. The health care professional indicated on their survey that they supported individuals to live the life that they choose. The relative’s survey asks, “Does the home meet the different needs of different people?” Those who answered this question stated that it always or usually did, one commented; “I think so, I’ve seen no sign of discrimination vis a vis age, disability or gender. There is never any sign of irritation from the staff they are always interested and supportive.” The administration of teatime medication was observed. The carer administering the medication advised that they had recently received update training from Boots, they had a good manner with residents, and locked the drugs cabinet every time they left it. They were seen to be very patient with residents with dementia. The medication records contained a photograph of each resident. Where there was a prescription for 1 or 2 tablets, as required, the number of tablets given was entered. In one case, two medications that had been prescribed after the Medicine Administration Record (MAR) sheets had been composed had been added; these entries were signed and dated. The MAR sheets were all completed correctly. The AQAA noted that over the last twelve months team leaders had been encouraged to check MAR sheets after each medication round, ad a register had been introduced to record this effort. One resident required strong painkilling patches; these had been ordered two days prior to the inspection but had not arrived, there was a note in the diary that these must be chased on the day of the inspection, and there was evidence that this had been done, however, the resident had not had their patch that morning. The carer acknowledged, “we should have ordered them earlier.” The carer confirmed that they were not waiting for any other medication. The AQAA notes that the home could improve the ordering system for medication. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 13 An audit of controlled drugs was undertaken. Records and stocks were found to tally. The AQAA stated that a new audit programme for all aspects of medication had been introduced in the last year, and that Team Leaders are encouraged to check Medicine Administration Records (MAR) after each medication round. One resident spoken with explained that staff had asked them what name they wanted to be called by when they first came, and said that the staff continued to treat them with respect. The health professional’s pre inspection survey stated that they thought the home always respected residents’ privacy and dignity. Carers were seen to relate well to individual residents, to be patient and to engage them when speaking with them. There is a memory tree in a communal area in the home, which holds cards in respect of previous residents who have passed away. In the garden, some of the benches have plaques, to show that they have been donated in memory of past residents. The AQAA stated that in the next twelve months; the home plans to develop care plans for end of life care. End of life wished were included in care plans. Firs Residential Home, The DS0000024387.V371264.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, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to enjoy freedom to make choices, but cannot be assured that there is a good range of activities available and suitable for all. EVIDENCE: All four residents who provided us with a “Have your say” survey stated that they always like the food. Menu boards were on display on the individual units, menus for the week were inspected. They showed that the home provides a good range of meals, with an alternative always provided, and that at teatime there is always a hot option. Main courses included turkey and leek stew and cottage pie. On the days these were served options were sausage and onions and vegetable bake. One resident who had had the lamb and vegetables for lunch on the day of the inspection said that it “wasn’t bad, but not up to scratch, the lamb wasn’t tender”. She said that she would tell the carer, as the cook would want to know. Another resident said that it was good most of the time. They advised that they could have a cooked breakfast if they wanted one. The cook was enthusiastic about their job, and their interest supported the resident’s comment that they would want to know if the meal was not quite Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 15 right for any reason. They advised that residents were asked in the morning what they wanted to eat, and before the meal was served they were shown the two options on two plates to confirm or alter their choice. This was a helpful way of ensuring residents with dementia had a meal they really wanted. All staff had received dining with dignity training during the last year. Residents can have snacks on the units whenever they wish. Residents have kitchenettes within the individual units and those that are assessed to be able to do so are encouraged to make use of these. The cook advised that three residents currently required a soft diet, and that no one required a liquidised diet at present. They were able to show a HACCP, (Hazard analysis of Critical Control Points) which supports the safe production of food. This did not include any details of where food should be purchased, this needs to be included. Residents spoken with advised that they could make choices about their daily lives, and get up and retire to bed when they wanted to do. A member of staff who replied to our survey noted that they considered that the home is good at giving residents, “a high level of personal freedom and choice about what time they get up, and the food they eat.” Whilst there are some activities available, there is scope to improve this across the home and for people who cannot join in mainstream activities. One member of staff surveyed had commented that; “The residents could do with more stimulation such as events within the home. This again comes down to money and staff available.” The responses of residents to a question on our “Have your Say” survey about activities varied. One thought that there were always activities they could take part in, two thought that there usually were, and one that there only sometimes were. One resident spoken with said that there was bingo, but that they couldn’t think of anything else. A resident who lives on Cedar advised that there was “something” happening in the lounge on “a number of days” each week. A carer spoken with advised that they sometimes played cards with residents and sometimes read with individual residents. We saw a resident who was spending the day in their room, who was blind and deaf. The carer advised that this resident did not do very much all day, as they could no longer listen to their radio which they had enjoyed, but that the carers go in and check on them several times throughout the day. The care plan stated that this resident was to be checked at 11.30am, 1.30pm and 6.00 pm, and 2 hourly at night. In addition to meals, times this meant that the resident had contact throughout the day, but the plan did not specify than any specific activities, for example hand massage, were to be carried out. The carer was asked if this was offered and they said not. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 16 This resident spoke to us about religious services; and having had involvement with the church. A carer was asked about this, They said that the person would not go to a service as they could not hear it. The AQAA states that the home has access to a number of local churches. At the residents’ last review it was noted that they no longer came out of their room for special occasions, but there was nothing on file to indicate that ways in which the persons spiritual needs could be met had been explored. The AQAA states that the home knows it could improve on providing more individual focussed activity, and that staff training on promoting individual daily life and social activities was planned for the next twelve months. The home was holding interviews for an activity coordinator on the day of the inspection. Residents spoken with advised that their relatives were made welcome in the home, and could visit when they wanted to. One relative noted on their survey that the main office is not always staffed, so sometimes they have to wait to go in. Relatives surveyed indicated that they were kept up to date with important issues about their relative; three thought that they always were, two that they usually were. One commented that “This is always very prompt”, although another stated that they were not informed that their relative had been ill for several weeks, and were only contacted when they needed to go into hospital. Firs Residential Home, The DS0000024387.V371264.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, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that that they will feel able to make a complaint and that it will be dealt with properly under the home’s procedure, but if they are not independently mobile they may not have access to the formal policy without having to ask, which would make it difficult should they feel they wanted to make a formal anonymous complaint. EVIDENCE: All four residents who answered the pre inspection survey indicated that they know how to make a complaint, and that staff listen to them and act on what they say. Four of the five relatives indicated on their surveys that they know how to make a complaint and three thought that the home had always or usually responded appropriately of they had needed to raise concerns about their relatives care. All five staff surveyed stated that they knew what to do if a resident or their representative has concerns about the home. The AQAA stated that eight complaints had been received in the previous 12 months, that all had been dealt with within 28 days and that 2 had been upheld. One complaint was as yet unresolved at the time of the inspection, this was detailed in the log, as well as the others received and dealt with. The home’s complaints policy was on display in the home. Anchor homes complaints policy directs complaints to a Business Services Team in Bradford, Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 18 and does not specify a named person to complain to. Given that this may be a barrier for residents wishing to make a formal complaint, the home had developed a process for handling informal complaints, directing them to the Registered Manager. This informal procedure is detailed in the SUG, and residents are directed to the formal policy and the complaints forms available in the entrance to the home, should they wish to use the formal complaints procedure. The details of where to address a formal complaint and the timescale and process was not detailed in the SUG. Although the SUG states do not be afraid to ask for assistance, it is important that anyone wishing to use the formal procedure may do so confidentially, and these details must be included in the SUG, so that everyone can access them independently. Whilst they knew how to make a complaint, two residents surveyed stated that they sometimes didn’t know who to speak to if they were unhappy, however, all four residents surveyed felt that when they do speak to staff, they listen and act on what they say. Two residents spoken with advised that they had no worries about letting someone know of they were concerned about anything The AQAA stated that four referrals had been made to adult safeguarding in the previous twelve months. This corresponded with information the home had sent to us and informed us about during the year, including copies of social workers letter regarding outcomes. The AQAA stated that 85 of staff had received training in Safeguarding. Recent training in the safeguarding of adults had taken place, and certificates for eleven carers who had attended this training were seen. Staff spoken to had a proper understanding of what constitutes abuse, and how they should respond. Firs Residential Home, The DS0000024387.V371264.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, 20, 22, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to enjoy small group living in an attractive home, but they cannot be assured that they will be fully satisfied with the housekeeping. EVIDENCE: The home is purpose built and offers a high standard of accommodation on two floors. The general standard of the environment is very good. The home is welcoming and provides a homely environment. Small group (quiet) areas are available throughout the home. The home is welcoming and provides a homely environment, with, for example, fresh flowers in communal areas. The main door into the rest of the home and the home’s lobby opens on a keypad system. A key fob system is in place in the units on the two first floor dementia care units, to offer protection form the staircases. Willow, which is downstairs which is used for older people or people with mild dementia has a Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 20 key fob system in place but the door is permanently open on a mag-lock attached to the fire system. All residents have access to the enclosed garden; those living upstairs can access this via the lift. Resident with dementia are risk assessed to establish whether they can use the stairs safely and come and go without assistance, and if this is the case they may be given a key fob. Communal lounge/ dining rooms have facilities for tea making and micro waving meals; the electricity for these facilities is on an override switch, so that they do not pose a risk to residents. This facility adds to the homeliness of The Firs, and supports the encouragement of residents’ independence. There was very limited signage to assist the orientation of people with dementia, for example the hairdressers room and the toilets were not distinguishable by colour or a picture. Only one resident’s room on one of the special needs units had an identifying picture in the door. One relative had commented on their pre-inspection survey that residents’ beds were sometimes not made properly. Two were checked at inspection and found to be properly made. This was discussed with the manager who advised that they had had some unsuitable sheets, and that these have now been discarded. All rooms have en-suite facilities. Hot water temperatures were taken at a number of outlets. Those within the units were all at appropriate temperatures, however, a washbasin in a toilet in the downstairs entrance area had very hot water, and the temperature taken was 48 degrees Celsius. This washbasin had a notice stating “Very hot water”, however, it was accessible to people with mild dementia, and this safeguard was not sufficient. This must be risk assessed. We were contacted immediately after the inspection to be advised this had been acted upon. All four residents who provided pre inspection surveys indicated that the home was always fresh and clean, and it was found to be so on this occasion; there were no unpleasant odours. One relative noted in their pre inspection survey that the toilet in their parents en-suit was stained. One relative commented on their survey that they thought the laundry service was poor, and that they had had to rummage for missing items. A resident asked about the laundry service said that they had no complaints, but another said that they had lost something about two months before that had not turned up. They advised that they worry about keeping their woollies nice, but that their daughter took these to wash. This was discussed with the manager who advised that staff put residents clothes back in their rooms. They advised that some anchor homes use a different laundry system but that they had not yet contemplated how this would work for them. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 21 The cook advised that they had not had a recent environmental health inspection, and so the kitchen was inspected. It was found to be generally in good order and clean, however there was some dust at high levels, the tops of both freezers required cleaning. The cook advised that the kitchen would have a deep clean before Christmas. Checks of freezer temperatures, food temperatures and cooked meat temperatures were maintained, and the cook was able to explain how they calibrated their thermometer. Food in the fridge, which had been opened, was covered and appropriately dated. There were three cracked floor tiles in the kitchen, which require replacement. There was a risk assessment of the food production process; it included an assessment of most but not all elements of the process. The AQAA stated that the home had received a Safe Site Award from anchor for infection control and auditing procedures. The certificate for this was seen at the inspection. It states that 90 of staff have received training on the prevention of the spread of infection. A group of three carers spoken with confirmed they had received this. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect that there will be sufficient care staff to respond to their needs, and that they will have been properly recruited so that residents are protected. EVIDENCE: Four of the five staff members who provided a pre inspection survey stated that there are usually enough staff to meet residents’ needs, one thought that there sometimes were. The SUG states that during the day the ratio of staffing on the two units where all of the residents have a dementia diagnosis is 1:5, and on the mainstream units it is 1:6. At night the ratio is 1:10 across the home, including a Team Leader. The manager advised that there had been a couple of times when they had been down on these numbers and were not able to get agency cover, and that team leaders had then worked on the floor of the home. The AQAA stated that the use of agency staff had reduced by 30 over the previous twelve months. Three weeks of rotas were inspected and they confirmed this information. A group of staff spoken with advised that they always had two carers on the special needs units, and that there was usually also a team leader to support them. They advised that at times, it had been necessary for the team leader to cover a carer role. Two of the residents who returned a pre Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 23 inspection survey indicated that there is always a member of staff available when they need them; two indicated that there usually is. In addition to care staff the home has an administrator, a chef and assistant chef and two kitchen assistants, housekeepers, a laundry assistant, a handy person and a gardener. Staffing levels appeared to be satisfactory on the day of the inspection, however, as noted in the daily life and social activities section, recreational activities, particularly for those who are not able to join in group activities was not sufficient. Staff qualifications are listed in the SUG. This shows that most day team leaders hold an NVQ at level 3, but that overall less than 50 of staff have NVQ2 or above. The AQAA states that the home has an NVQ training programme and its own assessors, and that there are plans to increase the percentage with NVQ2 in the next twelve months. It notes that 18 out of 54 care staff have NVQ, and that ten were working towards it. The AQAA states that robust recruitment procedures are in place. And that induction includes choices and values, communication, rights and responsibilities, safeguarding and death and dying. Two staff files were inspected and were found to have all of the required information, and checks in place prior to employment. Staff files showed that appropriate induction was in place. A resident spoken with said that the staff are very good, another said that they “look after me as well as they can do.” The AQAA states that the home has a robust training programme in place to educate staff on dementia care, and that ongoing training was occurring on tissue viability assessment, pressure area care and the Mental Capacity Act. It stated that this training would continue. All five care staff who provided a pre inspection survey stated that they were being given training that was relevant to their role. The AQAA noted that four staff had completed an enhanced dementia course, and that two of them had concentrated on food and nutrition, two on individuals’ life history. There was evidence in the home that this training was being put to use in changing practices in the home. The AQAA noted that in the next twelve months they plan to dedicate a team leader role to developing life histories and working with families to achieve this. A group of three carers were spoken with. They advised that within the last twelve months they had all received a one-day training course on dementia, that was around person centred care, and one of them said that they had also undertaken another course on person centred care. The professional who provided a pre inspection survey had noted that they thought one of the things the home does well is attend to the individual needs of residents. They also Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 24 stated they thought care staff usually had the right skills and experience to support residents, but that there were some difficulties in dementia care. This group of staff said that having spoken with those workers who had undertaken the four-day course, they felt that they could benefit from it. All of the staff members’ surveys stated that they met with their manager to receive support and discuss their work; three said that this was regular. There was evidence of regular supervision on staff files inspected. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 25 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, 37, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can expect to live in a home with an open atmosphere where the recently appointed manager has made a good start in identifying and addressing priorities so that their care will continue to improve. EVIDENCE: The Registered Manager had left since the last inspection. Another manager was in post; they have not yet applied to be registered. This was discussed with the manager, as they had been in post for nine months. The manager had previously worked at the Firs. They hold an NVQ level 3 and were able to show evidence that they were working towards the Registered Managers’ award. The AQAA states that they have completed three units towards it, including the NVQ assessor unit. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 26 The manager had made a good start on developing training and putting new care plans into place. The AQAA was received in time and was thoroughly and appropriately completed. The AQAA indicated that they were, generally, aware where there were areas needing to be developed in the home, and had plans to do so. A deputy manager had been appointed four weeks prior to the inspection, and this addition to the management team should benefit the home in supporting the manager. The atmosphere in the home was open. A member of staff had commented n their pre inspection survey; “Overall The Firs is an excellent place to work, friendly, relaxed and most of the time enjoyable.” Another commented; “From the start I was impressed by how friendly the staff are to each other and the residents.” Two relatives made written comments that supported this. One noted, “The day to day care is very cheerful and supportive, (their relative) is frequently pessimistic.” One of the residents tracked said that they had gone round looking at different homes, and that this one had stood out, as they looked the environment and the atmosphere. One relative commented, however, that they felt a “jollying along attitude may not always be appropriate.” Regulation 26 reports of a senior managers monthly quality control visits were available in the home and showed that these had been, on the whole, undertaken regularly. There was no report for July 2008. The Service User Guide states that the facility is available for residents to have certain monies held within a resident’s accounts system. The home’s policy on Residents Property and personal monies was inspected at the last inspection and the AQAA states that it had not changed since then. The policy states that each home will have a resident’s personal monies account which will be a non interest bearing current account, and a limit of £250.00 per resident is set. Internal records are to be maintained on the computerised system, which can provide individualised statements. Record for four residents were inspected. One did not hold any funds, and the largest amount held was £128.90. Lockable draws, where personal items could be kept could be kept were seen in residents individual rooms. The record sheet for the system requires two signatures to witness and evidence transactions. Receipts and records inspected demonstrated that this policy was being properly followed. We were advised that statements were issued every month. Records were seen to be kept securely. As detailed earlier in the report, one preadmission assessment inspected and one risk assessment for pressure areas were not dated. It is important that all records are signed and dated, as they describe a circumstance at a particular point in time, and anyone referring to the records need to be able to tell how current they are. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 27 The home has a fire safety plan, and there was evidence that night staff are trained every three months, day staff every six months. Records were maintained of monthly fire safety checks. The home’s certificate of registration and employers liability insurance were on display. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 28 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 2 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 2 3 Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 29 YES 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. 1. Standard OP1 Regulation 5 Requirement Timescale for action 02/10/08 2. OP9 13(2) The Service User Guide must contain all information as is required under the revised regulation, including details of fees, so that prospective residents have all of the information they require to make an informed choice. This is a repeat requirement from the inspection of 11/09/07 Resident’s prescribed medication 02/10/08 must be available for them in the home at all times, so that they can be given the medication they need. 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 OP12 Good Practice Recommendations Residents must be given opportunities through leisure or recreational facilities that suit their needs and capacities, so that they can be stimulated to engage with life. DS0000024387.V371264.R01.S.doc Version 5.2 Page 30 Firs Residential Home, The 2. 3. 4. 5. 6. 7. 8. OP13 OP19 OP22 OP26 OP27 OP37 OP38 Arrangements should be made to ensure all residents with a spiritual interest are given opportunities to have their needs met in this respect. The laundry system should be reviewed, with consideration given to customer views. Appropriate signage should be developed on the dementia units to support residents’ orientation and independence. Checks should be made to ensure that all areas including high surfaces and toilets in en suites are clean at all times. Given the large number of residents with dementia it is recommended that further specialist dementia training be extended to care staff. Care should be taken to ensure all records and key documents are signed and dated appropriately. The HaCPP (Hazard analysis of food production) should be reviewed. Firs Residential Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Home, The DS0000024387.V371264.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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