Care Home: The Firs, Witheridge

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What the care home does well One person living at the home who was asked this replied they were very happy, also saying, "You only have to ask. I don`t have to worry about a thing." Prospective residents` needs are fully assessed, to promote the success of any admission to the home. Good working with other professionals ensures health needs are met, protecting peoples` wellbeing. Peoples` privacy is respected, with promotion of their dignity. There is good promotion of choice generally, giving people control in their lives. People are able to maintain links with the community around the home as well as with family and friends, to further enrich their lives. People benefit from the attention given to concerns or complaints, which are used to improve the quality of care provided. The home is clean, accessible and well maintained, with further improvements planned. Most care staff have an accredited level of training, so people receive a safe level of care. What has improved since the last inspection? The risk of falling from windows has been reduced, protecting peoples` welfare. Better catering arrangements promote peoples` choice and a good diet. The manager has been registered by the Commission, helping ensure a person who is fit to be in charge runs the home. CARE HOMES FOR OLDER PEOPLE The Firs, Witheridge The Firs 27 Fore Street Witheridge Tiverton Devon EX16 8AH Lead Inspector Ms Rachel Fleet Key Unannounced Inspection 29th June 2007 9.40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Firs, Witheridge Address The Firs 27 Fore Street Witheridge Tiverton Devon EX16 8AH 01884 860679 01884 861580 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) South West Care Homes Ltd Alan Johnston Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th June 2006 Brief Description of the Service: The Firs provides personal care and accommodation for up to 24 people over retirement age, who have general personal care needs or mental health needs (including dementia). The home does not provide nursing care other than that which the district nursing service can provide. Nor does it offer intermediate care. Since access between floors is by stair or stairlift, the manager considers carefully whether the accommodation available would be suitable for each person enquiring about living at the home. South West Care Homes Limited owns the home, with Mr Alan Beale acting as the Company’s representative. Located centrally in Witheridge, approximately 10 miles from Tiverton, the home is close to a GP surgery, village shops, etc. There is public transport to Tiverton, South Molton and Barnstaple. The home comprises of a two-storey building, built in the early 1900s, and a newer purpose-built ground floor extension. There are 20 single bedrooms and two double rooms, most having en suite facilities. The home is surrounded by gardens that are well maintained and accessible. At the time of the inspection, weekly fees were £391- £550, with variation being partly due to which bedroom is to be occupied and the individual’s care needs. Fees include costs of activities (also paid for by the home’s fund-raising efforts), but do not include hairdressing, chiropody, toiletries, newspapers, magazines, or hospital transport costs. These are charged at cost price. The latest Commission for Social Care Inspection (CSCI) report on the home is in the entrance hall, or the manager will send out a copy on request. Reports can also be obtained through the Commission’s website. Besides the registered service above, accommodation is available in a bungalow in the homes grounds. Those living there do not need help with personal care, but may come to the home for activities and meals. Day care is also provided at the home. Neither of these is currently regulated by CSCI, although the Company has applied to register the bungalow so that people needing personal care can live there. The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This initially unannounced inspection took place over two days, as part of the normal programme of inspection. The manager was absent on the first day but arranged to meet for a second day (6 July 2007) to look at management matters. During 10.5 hours spent at the home, we met half of the 22 people living at the home, either individually or in groups, around the home. We also met the one person at the home for day care on each day, as well as care and domestic staff. We looked particularly closely at the care and services offered to three people, as a way of judging the standard of care and services generally. This group included men and women, people with dementia, people with physical health needs, and people admitted both for a short stay and long term support. Where possible we spoke with these people in more depth, and tried to contact any health or social care professionals involved in their care. We looked at their care records and associated documents closely, and spoke with staff about these. We looked at their bedrooms and shared areas in relation to their needs. Some people had dementia, which prevented them from answering questions in detail. But we spent time observing general care and interactions between staff and the people who live at the home. We also read records relating to staffing (including training and recruitment), accidents and fire safety, and looked at service areas such as the kitchen and laundry. We discussed our findings with the manager Alan Johnston before leaving. He had provided information before the inspection, about the management of the home, their own assessment of what they do well, and plans for improvement. Prior to this visit, we sent surveys asking for feedback about the home. We sent 11 surveys to people who live here, of which nine were returned; three were completed by the person themselves, and six were completed with help from relatives or friends of the person to whom they were sent. One person said they would like to speak with us; six surveys were anonymous. Five surveys were sent to health and social care professionals who attend people living at the home, but none were returned. Of five sent to staff, there were two responses. Information gained from all these sources and from other information about the home given to the Commission since the last inspection is included in this report. We have not received any complaints about the home in that time. The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: When asked this question, one person said they would like to be taken swimming, but added that the home is currently getting information from people at the home about what they would like to do with their spare time. Some people already have more fulfilled lives as a result of improvements made by the home since the last inspection, but others would benefit from improvements in their daily life based on a very person-centred approach. Another person said, “More staff would be good”, so they did not have to wait so long at busy times of day, whilst a second staff was found when they needed help. Staffing is adequate, but needs review to ensure peoples’ needs The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 7 can be met, and met in a timely way. Staff receive an adequate level of training and support, but some would benefit from additional training to help them meet the needs of all residents well. More individualised information in some peoples’ care records would help ensure they receive care that meets their unique needs. Medication procedures would better protect people from medication errors if one aspect were improved. Measures have been taken to try to protect people from abuse, but staff knowledge of local reporting procedures as well as recruitment procedures must be addressed, to improve the level of protection. Peoples’ personal finances are adequately safeguarded, although systems in place could be improved to promote their best interests. Written information provided by the home about the service it offers must be reviewed to ensure people are properly informed when choosing where to live. Although various strategies are being used to try to ensure the home is run in the best interests of people who live there, the Company’s responsibilities regarding registration requirements must be addressed to ensure this. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Firs, Witheridge DS0000066437.V337388.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 The Firs, Witheridge DS0000066437.V337388.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. The home does not offer intermediate care. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have access to information about the home that helps them decide where to live, but written information provided by the home is not adequately reviewed to ensure people are properly informed. Good systems are in place to ensure prospective residents’ needs are fully assessed, promoting the success of any admission to the home. EVIDENCE: Some people spoken with or who returned surveys had previously lived locally so already knew of the home, some also knowing people who had lived here. One person had been for day care first, before moving in, which the manger felt was a good way of introducing people to the home. All felt they had had enough information prior to choosing to move in. The home’s Statement of Purpose and Service User Guide have been helpfully combined, but the version provided to us had some errors, and did not refer to the dementia care The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 10 provided by the home. The manager agreed to review this and send us the new version. Someone who had power of attorney for a person living at the home said, in an anonymous survey, that the person had a contract and it would be helpful if they too were given a copy. The manager said this is usually provided, and he would try to ensure all such current supporters had a copy. Assessments of people’s needs were seen, carried out by senior staff at the home. Information was available from Social Services care plans for individuals, as well as through meeting with the person. The manager said he considers peoples’ needs carefully in view of the building’s constraints, since there is no passenger lift between floors, for example. He said that a letter sent out by the home’s head office, offering people a place at the home, included confirmation that the home could meet their assessed needs. No copies were available at the home; we suggested these should be kept at the home, so it was clear to staff what had been said or offered to individuals coming to live at the home. The Firs, Witheridge DS0000066437.V337388.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 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are adequate, but there is a risk that some people will receive less person-centred care because of a lack of individualised information in their care plan and associated records. Good multidisciplinary working ensures health needs are met, to promote peoples’ wellbeing. Medication policies and procedures are adequate, but they could better protect people from medication errors if one aspect was improved. There is good respect generally for peoples’ privacy, with promotion of their dignity. EVIDENCE: Each person who lives at the home has a care plan, which gave staff general guidance on how to care for people. However, some lacked information specifically about the individual – such as one person’s interests or preferences The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 12 (though care plans for two other people included this information). Two people had sight problems but care plans didn’t include how this affected their daily life, with monthly reviews of their care plan not reflecting this either. People said their care plans had not been discussed with them, but some were aware of them, whilst others felt staff discussed their care with them regularly, during care giving. Although monthly reviews had been recorded regularly, evaluation of the care given was sometimes minimal - such as ‘No’ regarding activities/outings, in successive reviews for one person (who told us they didn’t go to events because they had impaired sight). So it was not clear that staff reflected on the appropriateness or effectiveness of all care planned and given to individuals. Some information in care plans needed updating, or signing and dating to show when the information or assessment had been written and by whom, for future reference and review. Comments in surveys for people who lived at the home included, “Minor problems dealt with promptly” – with examples given of chiropody, support stockings, and treatment for dry skin. Another said, “I was recently ill and could not have had better care anywhere.” Care records showed regular assessment of whether individuals were at risk of pressure sores or unsafe because of mobility problems. Staff meeting minutes showed expected standards of personal care had been discussed at a more recent meeting. People looked well cared for other than one person wearing glasses badly in need of a clean. District nurses, a physiotherapist and a social worker had recently been contacted because staff were concerned about aspects of peoples’ health. Someone with diabetes said they had regular checks at their surgery and the hospital, being taken there by the home. One person had had an eye test in recent months; another had an imminent hearing appointment. Care notes showed staff had recognised that someone was unable to sleep because of pain despite taking medication for pain, acting quickly to ask the GP if a better medication could be provided. People asked were generally satisfied with how the home managed their medication for them. One person would have liked to be self-medicating but said they understood why they couldn’t, having discussed it with staff. Comments in one survey from a relative included that staff monitored medication. Care records showed some peoples’ GPs or psychiatrists had reviewed their medication, and that staff had monitored the effectiveness of medicines subsequently prescribed. Records were kept of medicines received into the home, given out to people, and disposed of by the home. Some handwritten entries and alterations on The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 13 medication sheets had not been dated and signed by two staff to confirm the accuracy of instructions for staff giving out medicines. No issues were noted regarding recording of variable doses. A metal cupboard had recently been obtained for proper storage of certain medicines, but was not yet properly fixed in place. The manager is trying to address this, having sought advice from the Commission’s pharmacist inspector. The small amount of medication in it was properly recorded. One person said staff always knocked and asked if it was alright to come in. A female resident said they had asked that a male carer did not assist them with personal care and this request had been acted on. People said staff did not gossip to them about other people at the home. Most people said staff were respectful; one person said some staff chatted to each other whilst assisting them, which the manager said he would look into. One person has a kettle in their room, enabling them to easily offer visitors a drink. There were locks on toilet, bathroom and bedroom doors, for privacy. The manager confirmed the home is looking at how to improve privacy where there are partition walls, which do not rise to the ceiling, between a bathroom and toilet cubicles, allowing conversations, etc. to be easily overheard. The Firs, Witheridge DS0000066437.V337388.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 – 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A better quality of life is being adequately provided for some people at the home, although other individuals would benefit from improvements based on a person-centred approach. There is good support to enable people to maintain links with the community around the home as well as with family and friends, to further enrich their lives. There is good promotion of choice generally, so that people can have some control of their lives. People are benefiting from improvements in catering arrangements that promote choice and a good diet. EVIDENCE: A survey completed by a relative said activities for people at the home had increased in recent months and included live music, flower arranging, painting and craft. There is a small library in the conservatory. One person said, “We are The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 15 going to have a meeting to discuss future plans for activities I can take part in.” Daily notes about one person showed they spent their free time in a variety of ways – bowling, listening to music events at the home, enjoying visits by local school children, helping with household jobs such as sweeping or changing the tablecloths, and going out in the garden with staff to look at the fishpond. However, it appeared another person did much less (see Standards 7-10 in the previous section of this report). One person said the only time they were taken out was if their family took them, and they would like more organised outings. Some people said they were taken into the village by staff, but also said they would like to go more often. The manager had said in pre-visit information he hopes to improve activities for people with dementia. During a period of observation one morning of the visit, when some people were seeing the visiting hairdresser, a few were watching television or listening to the radio in one lounge; some were reading their papers or magazines. But other people were sat in the dining room, dozing. Staff were busy giving care to individuals elsewhere, engaging briefly at intervals. One felt the home did well in offering activities suitable for peoples’ interests and needs. Another said they tried to create a ‘therapeutic atmosphere’ through ongoing interactions with people living at the home, recognising that a daily planned event is not enough to meet social or recreation needs. They said there is an extra two hours of staff time a day for providing activities or social support. During the visit, the staff member on duty for this time said they had spent most of it with someone who was not feeling very well that day. People said they were visited not only by family but also by former neighbours and former customers. One of the people who lives at the home produces a newsletter (seen in the entrance hall), which includes reflections on events taking place at the home – such as some people going to a local fair, taken by off-duty staff. Church services or hymn-singing are held monthly at the home, led by local churches. People are also assisted to services at local churches at special times of year (Christmas, etc.). All rooms seen were personalised with peoples’ belongings – furniture, pictures, etc. It had been agreed one person could bring their cat with them. Someone who we asked about choice and flexibility in their life at the home felt they had a relationship of mutual co-operation with staff – understanding ‘they were one of a number’ and working together with staff, without staff dictating the routine. People who lived at the home described the food as “Not bad”, “Getting better”, “Better now”, “Excellent – they find something you like”. Two of these people didn’t like the hot options at tea, asking for sandwiches rather than beans on toast, fishfingers, or pasta bake, for example. A relative felt the food had improved, now including salads, etc. and fewer ‘stodgy’ puddings. Another The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 16 said, “Meals are well publicised and notable efforts have been made to encourage healthy eating with…more fruit. An area in which it is always possible to improve and vary. Hot drinks are not always hot enough.” Someone said people couldn’t always get a hot drink for visitors, something raised at the last inspection. The manager said he has obtained drink-making facilities for the dining room, but they are not available yet because he has not discussed relevant risk assessments with staff. The manager said menus were made available a week in advance (as requested by someone at the last inspection). Someone who lived at the home said the cook ‘mingled’ at meal times, and was open to suggestions. The current week’s menu looked appetising, but was not very varied in one aspect – beef was used in four of the lunches (sometimes on consecutive days) and pork for two days. People said they could always request an alternative, but the manager said he’s monitor this aspect of menu planning. At lunch, people were served from dishes of vegetables on each dining table, if they couldn’t help themselves. Staff were heard to ask what people wanted and if they wanted more. Later, a carer was overheard speaking to someone sitting at a dining table; as she passed, she had noted the person had a cold cup of tea, asked if she’d like another and fetched one for them. The Firs, Witheridge DS0000066437.V337388.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. The home has a good attitude towards concerns or complaints, using them to improve the quality of care for people living at the home. Adequate measures have been taken to try to ensure people are protected from abuse, but there is a risk that the effectiveness of these may be lessened because some concerns might not be addressed in the correct way. EVIDENCE: When asked about making complaints, someone living at the home said, “I’d just tell them, but I don’t complain because everything is ok”. They identified a particular member of staff whom they felt they could tell if they were unhappy. Another person said they probably could make a complaint, if they had one. One said, “You can go straight down and chat,” when asked if they felt able to make a complaint. A survey completed on behalf of someone with communication difficulties said staff usually pick up any distress they show. The manager had told us he felt staff now saw complaints in a positive light, as a way of improving things. He said he is always available and can be contacted out of hours if people wish to speak to him. A relative pointed out the complaints procedure is by the entrance, adding, “Problems can usually be sorted quickly by having a word with a staff The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 18 member”. The procedure on display had required information, and was in clear print. One relative felt requests – mostly about missing items – were not always responded to, but had related this to communication with staff who were often busy. Concerns raised about laundry were passed to the manager, although another person said staff would always go to look for missing items when asked. Staff spoken with were clear about what the home considered to be poor practice or abuse, saying they would report concerns to the manager or carer in charge. Personnel files showed they had had training on this subject; however, two were not sure which organisations outside of the home they could report concerns to if necessary. The manager has attended Devon County Council training on safeguarding, and said he would ensure staff were familiar with the information he subsequently made available to them – which included relevant organisations. See also section on ‘Staffing’ and sufficiency of recruitment information, with regard to having good safeguarding systems. The Firs, Witheridge DS0000066437.V337388.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 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People enjoy pleasant, clean, well-kept accommodation, but will also benefit from further planned improvements. EVIDENCE: People who were asked were happy with their accommodation. Someone who liked doing sewing said their room was sufficiently lit in the evenings. A vacated room was to be decorated and re-carpeted before being used again, with new carpets seen in other rooms. Communal areas have been decorated, and the conservatory made usable into the evening through improvements. There was level access to outdoor paved and garden areas, with seating provided. Someone who used a wheelchair unaided said they hadn’t encountered any hazards. Chairlifts provide access between floors, but staff said less physically able people tend to be accommodated on the ground floor. The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 20 People said minor repairs were dealt with quickly. Records showed a bath hoist had been routinely serviced recently, as had fire extinguishers. The home looked clean when we arrived for this unannounced visit, and there were no malodours anywhere. One relative said bedrooms and toilets were always spotless (but thought the kitchen looked in need of refurbishment). Another visitor thought the less routine cleaning was not done as well as in the past, but also commented, “Bathrooms are kept admirably clean, with supplies of clean towels.” No concerns were raised with us during the visit, but we saw a wheelchair in use had not been cleaned recently. Staff in the laundry described appropriate systems for dealing with soiled washing, and ways of minimising cross-infection. Handwash facilities were available. Machines had programmes with temperatures that ensured laundry could be disinfected. Staff confirmed disposable gloves and aprons were available, as well as disinfecting hand gel. Staff had to manually open a kitchen pedal bin, because the foot-operated mechanism was broken. The manager confirmed that this was being replaced, so that hand hygiene could be maintained. The Firs, Witheridge DS0000066437.V337388.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 – 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers and skill mix are adequate, but need review to ensure peoples’ mental health needs and social needs can be met, and met in a timely way. A good proportion of staff have an accredited level of training, so people receive a safe level of care. Recruitment systems are in place but they are not robustly used to ensure prospective staff are fit to work in care setting, resulting in a poorer level of protection for people living at the home. Staff get an adequate level of training and support, but some would benefit from additional training to help them meet the needs of all individuals well. EVIDENCE: Someone who lived at the home said, “If the staff are busy they always come to tell me, and come to me as soon as possible.” Another said the home wasn’t ‘overly staffed’ but staff worked very hard to ensure people were cared for. Two people said staff answered call bells quickly, although one said they often did not get the help they needed till some time later if it was a busy time of day. The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 22 Two people said this was often a wait of at least 30 minutes, one feeling this was because other people at the home now needed much more attention. A relative felt staff were around, but they were sometimes difficult to locate in the large premises; they felt the home should have more staff. The manager said that domestics’ hours have been increased in the daytime, relieving care staff of some household duties so they have more time for care. There has also been an extra staff member on duty for two hours every day for some months, to promote activities (although giving personal care took priority if necessary). Staff said the manager always checks how staff are managing, and would act if they said they needed help or advice. Nearly all staff have a nationally recognised care qualification or its equivalent from their country of origin. The two staff that do not are on relevant courses. Two people, one of whom was quite deaf whilst the other had poor sight, said staff were mindful of their disabilities when with them and providing care. Other people said staff knew what help they needed. A relative felt staff were trained to care for people with dementia, with someone who lived at the home observing staff were patient with people who were confused. Staff spoken with said the home used training videos for staff to reflect on their own dementia care practice. They knew people at the home as individuals – how they liked to spend their time, something of their personal history, etc.; one said they had asked families to bring in photo albums, so staff could talk to the person about relevant people or places. They said they had not had any training on providing recreation or activities for people with dementia, and would welcome this. The training programme provided did not include social care topics, but the manager showed us training material he has just obtained on providing activities for people. It emerged in discussion with the manager that only staff without a nationally recognised care qualification are given an induction of a recognised minimum standard, when newly employed. Others (with a qualification) receive a more minimal induction. He agreed to review this, to ensure all new staff have the basic knowledge and skills needed for this particular care setting. Supervision notes were seen that reflected a range of discussions with individual staff, including some training. One person said some staff did not handle them properly when moving them with equipment, although another person said they were handled appropriately and gently. The manager said he would ask the home’s manual handling trainers to look into the issue raised. Half of the staff are from overseas. Two relatives referred to communication difficulties with staff, because staff were busy or because English was not their first language. One relative felt overseas staff had a safe level of English but limited conversation skills were affecting the quality of their engagement with people they cared for. People living at the home, when asked, said they did not The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 23 have communication difficulties with staff, one adding they repeated things if not understood. One person when asked if they got the care & support they needed, said, “Always - very happy here.” One person thought staff were very caring, saying, “They are very kind to me”. Overseas staff were very keen to improve their English. Some support is in place, and the manager said they will be enrolling in local English classes. The Company’s representative also told us all staff from overseas will be undertaking a language course, within the next year, to gain a nationally recognised qualification initially, progressing onto a second course thereafter. Four staff personnel files were checked. We noted that some peoples’ references were addressed to ‘To whom it may concern’ rather than indicating they had been requested for this care setting specifically, where they had come from an agency. One person who had been employed for some years had not had the enhanced level of police check that is now required, having a standard disclosure form instead. Recorded start dates for the other staff, when compared to other information kept, showed an initial police check was not obtained before their employment. This was identified as an issue at the last inspection. The Firs, Witheridge DS0000066437.V337388.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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Various strategies are used to try to ensure the home is adequately run in the best interests of people who live there, although all responsibilities must be addressed to ensure this is achieved. People’s personal finances are adequately safeguarded, although systems in place could be improved to promote their best interests. There is good attention to health and safety matters, promoting the welfare of everyone at the home. EVIDENCE: Alan Johnston has recently been successful in his application to register with the Commission as the home’s manager. He has been a registered manager The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 25 before, at a home for people with similar needs, and has a management qualification. However, he is undertaking a nationally recognised care qualification, at a higher level, to update and consolidate his experience and knowledge in the care field. The home uses a survey annually to get the views of people who live at the home and those who visit. This is due to be circulated soon, and the manager said findings would be shared at future residents’ and staff meetings. One person said they had had a recent meeting with the manager, and felt he had fully listened to them. Minutes of a staff meeting showed appropriate communication when answering the door had been discussed with staff - one of a few examples noted that showed various work practices are monitored, and improvement encouraged where found necessary. The manager confirmed the Company’s representative visits regularly to monitor the home, as required by us; reports on these visits were not available at the home, but have since been sent to us. We found that two people living in an adjacent bungalow – accommodation not registered with us - were receiving some personal care from the home’s staff. As soon as this issue was brought to the responsible individual’s attention, the Company applied to register this accommodation, to ensure it meets our standards and is suitable for those living there. We checked the accounts of three people for whom the home keeps personal spending monies. Individual records with corresponding cash balances were seen, with receipts kept for expenditures. However, dates of entries on these records were not the same as those on receipts, and there was no other system to confirm which receipt the entry related to – for example, where regular hairdressing receipts were obtained, being the same amount each time. Also, the manager was the only person with access to peoples’ monies, so people could not get their money in his absence. He agreed to review this. Window restrictors were in place where checked for. There was very hot water from one bath during the visit, not identified by the home’s weekly water temperature checks; this was quickly made safe whilst a more suitable longterm solution was to be obtained. We saw certificates for recent servicing of electrical items and the fire safety system. People living at the home confirmed fire alarms are tested regularly, whilst a relative said fire drills took place. The kitchen and equipment in it looked clean. Fridge and freezer temperatures were within recommended ranges for safe food storage. Staff have yearly training on certain health and safety subjects, including fire safety by an external trainer, and safe handling by two staff who have been trained for their role. Other health and safety updates are carried out in-house. We suggested senior staff responsible for this should have updating from an external source to ensure they were still giving staff appropriate information. The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 26 Safe use of household cleaning products, and a manual handling issue (relating to a particular individual) had also been discussed at staff meetings this year. The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 27 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 The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 28 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 2 8 3 9 2 10 3 11 X 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 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 2 34 X 35 2 36 X 37 X 38 3 The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 6 Requirement You must keep the Statement of Purpose & Service User Guide under review, revising them if necessary and sending the Commission the new version within 28 days. Timescale for action 31/08/07 2 OP29 19 You must not employ a person to 31/08/07 work at the care home unless they are fit to work at the care home, which includes that there is full and satisfactory information available about them as specified in Schedule 2 – particularly timely POVAfirst checks where a CRB disclosure has not been obtained. Timescale of 05/07/06 not met. You must comply with Regulations 4 & 16(1) – providing facilities & services in accordance with the required Statement of Purpose - in order that you do not commit an offence for which you could be prosecuted. 31/08/07 3 OP33 43 The Firs, Witheridge DS0000066437.V337388.R01.S.doc Version 5.2 Page 30 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 You should ensure each person’s care plan is drawn up with the person’s involvement where possible, that they contain sufficient detail and are updated in a way that reflects their changing needs, to ensure all aspects of needs are met in a person-centred manner. You should ensure - for the safe administration of medicines - that for all hand written entries on the Medication Administration Record (MAR) Charts, the person making the entry dates & signs it and this is then checked and signed by a second person. You should ensure leisure & recreational activities suit individuals’ preferences and capacities, with particular consideration given to those with dementia, other cognitive impairments & physical disabilities, to promote their wellbeing. You should ensure robust procedures are in place for responding to suspected abuse, by improving staff knowledge of local reporting procedures, to safeguard people living at the home. You should ensure staffing numbers and skill mix are appropriate to meet the needs of people living at the home and the purpose of the home. You should ensure the staff training & development programme ensures staff can fulfil the aims of the home. You should establish systems whereby a) People living at the home have better control of their own money, in that access to money held by the home for them is not dependent on one particular staff member alone; and b) Individuals’ accounts are more easily auditable with regard to records of transactions and related receipts. DS0000066437.V337388.R01.S.doc Version 5.2 Page 31 2. OP9 3. OP12 4. OP18 5. OP27 6. 7. OP30 OP35 The Firs, Witheridge Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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