CARE HOMES FOR OLDER PEOPLE
Ferendune Court Ash Close Faringdon Oxfordshire SN7 8ER Lead Inspector
Carole Moore Unannounced 25 April 2005 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 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. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ferendune Court Address Ash Close, Faringdon, Oxfordshire, SN7 8ER Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01367 243834 01367 244421 Anchor Trust Samantha Bell Care Home 48 with nursing Category(ies) of Dementia (6), Old age, not falling within any registration, with number other category (48), Physical disability over 65 of places years of age (9) Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28/04/05 Brief Description of the Service: Ferendune Court is a purpose built home that opened in 1992 in Faringdon. It is divided into three units, one looking after elderly residents in their own flatlets, one unit looking after residents for a short stay and one looking after the more dependant resident with long term nursing needs. Each resident in the residential unit has their own flatlet that has a bedroom, lounge, hallway and ensuite shower room with toilet and wash hand basin. Each flat has its own lockable front door. There is one flat identified for residents coming in for short stay. The home has a nine-bedded nursing wing on the ground floor. The home has a short stay nursing unit and there are strict admission procedures for these beds. There is an agreement between Anchor Trust and the primary care trust on referrals for admission. There is a good range of assisted baths and toilets in addition to the ensuite facilities. There are two ground floor sitting rooms and access to a large pleasant dining area. A lift serves all floors. There is a patio area outside the lounge/dining room with an attractive bank of shrubs and flowers beyond.
Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on the 25th April 2005 and was conducted by two inspectors. The purpose of the visit was to see how the home is meeting the National Minimum Standards and to look at areas where there have been some recent difficulties. The visit took seven hours and, during this time, the inspectors talked to 12 residents, several members of staff and two relatives who were visiting that day. The inspectors looked at some written records relating to the care residents were given, medication records and how the home stored the medication. The inspectors also toured the building looking at areas of the three units within the home and, with the resident’s permission, visited individual bedrooms. Training was taking place during the inspection to further develop carers’ skills in writing the residents’ care notes. This necessitated agency staff being on duty for that training day. The home was clean, tidy and fresh smelling. Residents were seen relaxing in the main lounge and some residents chose to spend the afternoon in their own rooms. The inspectors were introduced to the regional manager, Georgina Shiers, who advised us that she was implementing the training for all staff and assured the inspectors that there should be a great improvement in the recording of care plans. The inspectors also acknowledge that only one member of the senior team was on duty that day as one senior member was on long term sick leave and the registered manager had been seconded to manage another home. . There has been a complaint made by a relative and this has been fully investigated. An action plan has been put in place to rectify the shortfalls identified during the investigation. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection?
The registered manager and her senior nurse have both been on the training organised by Social Services in relation to the protection of their vulnerable residents and they will be training all staff in this area. This should ensure that all residents are well protected from harm. A nutritional screening assessment has been introduced to help staff determine the residents’ risk of poor nutrition. This will ensure that residents are regularly checked and weighed to enable them to maintain a healthy lifestyle. A new way of supervising staff has been introduced and this will help staff to address any difficulties over the care of residents and give staff the opportunity to have individual time with their line manager. Training was taking place on the day of the inspection covering the importance of the keyworker role, recording, planning and documenting information in residents’ notes. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 & 4 On the Rresidential wing assessment of the residents’ needs are carried out before admission in order to demonstrate that the home is able to fully meet the residents’ overall needs. On the nursing wings assessment of residents was being carried out but there was insufficient information and detail in the initial assessments. EVIDENCE: Residential Wing: Four residents’ files were read and it was clear that a member of the senior team carried out assessment. Records seen were clear and showed an understanding of residents’ needs. Staff spoken to confirmed that residents had access to additional services to ensure that they received additional help and assistance with aids and adaptations. They were referred to the day hospital for hearing aids, walking frames and wheelchairs and this was well documented in the residents’ care notes.
Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 10 Nursing/Short Stay Wings: From records seen there was no clear pre admission assessments for short stay visits. It was clear that district nurses liaise closely with the nurses at Ferendune Court but it would have been helpful to have clear information in the care notes. One set of records relevant to the nursing wing was disorganised with no front sheet and no date of admission, and one resident spoken to was able to provide significant information about his care needs that had not been recorded. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 On the residential wing residents have good care plans drawn up with their involvement. These care plans enable carers to provide care in a manner acceptable to the resident. The home has appropriate policies in place to manage medication in a safe manner. On the nursing/short stay wings residents care plans were unsatisfactory. Medication is generally well managed but there is room for improvement in some areas. EVIDENCE: Residential Wing: Evidence was found at this inspection by reading four residents’ files and in talking to residents about their individual health, personal and social care needs. The information was clearly presented and easily understood and residents felt involved in the planning of their care. One resident stated, “The staff are really helpful and everything is just grand”.
Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 12 Senior carers confirmed that nutritional assessments have been introduced and this was clearly seen in the care notes. All care plans are regularly reviewed and this was also clearly recorded. A random selection of medication was checked against the medicine administration record and this was found to be satisfactory. However, there was a backlog of unused medication that needs to be returned to the pharmacy. Nursing/Short Stay Wings: Evidence was found by reading four residents’ care notes and in talking with staff. There was a lack of detail about recent changes to a resident’s health/condition and care planning was disorganised with some records incomplete. For example, one resident had been assessed for a new wheelchair with extra support to enable him to sit upright, but there was no indication in the care notes as to when this would take place. There was no link made between the daily entries staff made in the care notes and the aims of the care plan. Records of medication were looked at and there were no residents able to be responsible for taking their own medication, except for a few using inhalers for breathing problems. The medication records should show when the resident is self-medicating. There was some confusion over residents who come in for a short stay and what happens to the medication that is brought in by the resident. The medication was seen stored in the medicine cabinet and it should be labelled and returned to residents when they leave. The home should make sure it has an up to date list of people’s medicines from the medical practice before the person is admitted. The time of giving medication in the morning is at about 7.00am, before the residents have breakfast. Consideration should be given to altering the time of the medicine round, as many medicines need to be taken with or after food. It was clear that checks were being made regularly on the number of controlled drugs that were being held. It is recommended that these checks are recorded. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 On the day of the inspection, there was no activity taking place and nothing listed on the notice board as to future planned activities. EVIDENCE: Four residents were spoken to and one stated,”There is nothing to do but sleep”. In discussion with the senior team it was made clear that the home has appointed a new activities co-ordinator and she has not, as ye, developed a programme of activities for the residents. Past inspections have shown that there has been a good range of activities to suit those residents that wish to be involved and it is hoped that this will be resumed as soon as possible. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Residents are protected as far as possible from abuse. EVIDENCE: Staff spoken to confirmed that they were clear about their responsibilities in relation to “whistle blowing” should they have any concerns, and that this formed part of their induction and ongoing training within the home. The senior management team has also taken up further training in relation to the protection of their vulnerable residents and this is to be filtered down to all staff within the home. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 & 26 The home was bright, clean and tidy at the time of the inspection and provides a safe and comfortable environment for all residents. Consideration needs to be given to all doors being fitted with devices that close in the event of a fire and this will then allow those residents who like to have their doors open to do so safely. EVIDENCE: The domestic team was busy throughout the inspection ensuring that the home was clean, pleasant and hygienic. The general standard of cleanliness and décor was good. There was one exception in the short stay unit - one room was looking “tired” with stains on chairs and marks on the walls, and this does need attention. In the nursing wing one room was visited with the resident’s permission and it was cluttered and untidy. It would have helped if the ensuite had some form of storage for toiletries.
Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 16 Staff are vigilant and usually remove cleaning products and store them safely. However, it was noted that a container of toilet cleanser was left on top of a toilet cistern in the sluice room and the sluice room door was open. Two fire doors were seen propped open in the short stay unit and this practice must stop. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The home was staffed with mostly agency staff on the day of the inspection. The home currently lacks consistent leadership. EVIDENCE: Training was in progress during the inspection and this necessitated agency staff being employed for that day. The home does have some difficulty in recruiting permanent staff and the acting manager confirmed that they do rely heavily on agency staff. The area manager was present for part of the inspection and she was fully aware of the lack of consistent management. One member of the senior team has been on long term sick leave and the registered manager has been frequently seconded to another home. Ferendune Court is a large home with three separate units and this does need to be managed effectively. On the day of the inspection senior carers were taking responsibility for the residential wing. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 & 38 Staff receive regular recorded supervision sessions. All accidents and incidents are recorded. Ferendune Court promotes the health and safety of its residents. EVIDENCE: A new Anchor plan for supervision has been implemented and this covers a variety of aspects to be discussed with the carer. Staff spoken to confirmed that they receive regular supervision and appreciate the one-to-one time they receive. The accident and incident book was inspected and clearly all staff are aware of the importance of recording such incidents and the correct procedure to follow. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 19 The health and safety of residents has a high priority at Ferendune Court but this needs to be extended to making sure that all fire doors are either closed or have devices that close the doors when the fire alarm sounds. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x x x x 3 x 2 Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 21 no 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 38 Regulation 23 Requirement The home must ensure that fire doors are not wedged open. A suitable device must be installed to protect the health and safety of residents. Timescale for action 01/07/05 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. 2. Refer to Standard 3 9 Good Practice Recommendations All residents should have their needs fully assessed prior to admission to the home. Residents care plans must be in sufficient detail to provide clear guidance to staff on the actions to be taken to meet their health and welfare needs. Reviewing the medication at the early morning round is recommended. Checking current medication on admission for short stay residents is recommended. Residents who take their own medication should have this clearly recorded in their notes and be monitired.
H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 22 3. 4. 5. 9 9 9 Ferendune Court 6. 7. 8. 9 9 38 All unwanted medication should be returned to the pharmacy. It is recommended that routine checks of controlled drugs are recorded. Staff should be vigilant in the safe storage of hazardous substances. Ferendune Court H57-H08 S27147 Ferendune Court V222231 250405 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Burgner House, Cascade Way Oxford Business Park South Colwey, Oxford OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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