Inspection on 26/10/06 for Ferguson Lodge

This inspection was carried out on 26th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ferguson Lodge 22/10/08

Ferguson Lodge 17/10/07

Ferguson Lodge 21/02/06

Ferguson Lodge 07/02/05

Ferguson Lodge 23/08/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Ferguson Lodge Ferguson Lane Benwell Village Newcastle Upon Tyne Tyne & Wear NE15 7PL Lead Inspector Allan Helmrich Key Unannounced Inspection 26th October 2006 13:00 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 Ferguson Lodge DS0000000445.V302776.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. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ferguson Lodge Address Ferguson Lane Benwell Village Newcastle Upon Tyne Tyne & Wear NE15 7PL 0191 241 1212 0191 2411211 philip@ewart-dilworth.co.uk 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) Ewart & Dilworth Ltd Mr Philip Lawrence Ewart Care Home 46 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (33), of places Sensory impairment (3) Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named resident may be under pensionable age. Date of last inspection 21st February 2006 Brief Description of the Service: Ferguson Lodge is a care home that was purpose built in 1999. It can accommodate forty-six older people, ten of whom suffer from dementia and three who have a sensory impairment. The home is on three floors and there is a passenger lift to all levels. All bedrooms have en-suite toilet and wash hand basin. There are five communal lounges one of which is a designated smoking lounge. There is a hair dressing room that the visiting hairdresser regularly uses. The home is located in the West End of Newcastle upon Tyne and is a short walk from local shops and public houses. The area is easily accessible as it is on a bus route to other parts of Newcastle. Inspection reports and information about the home are readily available. The weekly fees are £355 - £365. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s first annual unannounced key inspection visit. The inspection was conducted over three separate days and took 10 hours. Time was spent talking to the manager, some care staff, several residents and their visitors. Some of the home’s care records were reviewed and the systems that maintain residents safety. Some residents’ case records were specifically looked at as well as the actual care provided for those residents. The residents were also spoken to. This is called ‘Case Tracking’. Questionnaires were provided for residents and visitors to the home. Responses were received from two residents, nine visitors/relatives and two social care professional. The home completed a questionnaire before the inspection and together information provided is used in the report. What the service does well: The home is modern and well maintained. Senior care staff know the residents well and ensure care needs are well met. The proprietor and some staff can sign to residents with sensory impairment. People are only admitted into the home after an assessment shows their needs can be addressed. Several residents stated they enjoy the meals and that care staff are good. One resident said he enjoys going out regularly to shops in the local area. The home has a telephone system that allows residents to make and receive calls in private in their bedrooms. Positive comments about the care provided were; The care and professional attitude is good. The standard of care is good. My complaint was dealt with without fuss. Very clean. Total satisfaction. Happy with all the home does. Ferguson Lodge DS0000000445.V302776.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. 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. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 7 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 Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process reduces the possibility of admitting someone whose needs cannot be met. Intermediate care is not provided. EVIDENCE: Four care plans reviewed contained details of an assessment done by senior staff prior to a place being offered. This assessment was done before admission to the home and included information provided by care managers. This ensures the home can provide the level of care needed by the resident. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 9 Professional visitors stated the home operates with a professional attitude and that the standard of care is good although there are occasional communication problems with staff. The home does not accept referrals requiring rehabilitation but respite beds are available. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are addressed. The home has appropriate procedures for handling and administering medicines which means that residents health is maintained. Residents’ privacy and dignity is maintained. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 11 EVIDENCE: Four care plans were reviewed. Following the assessment described under Standard 3, a social assessment is done. Care plans describing to staff how care is to be provided are written and risks in daily living are assessed. Risk assessments record how risks can be reduced. Each resident’s health is assessed and this is regularly reviewed. A care plan clearly showed the significant changes in one residents’ health and how this is addressed. Residents, weights are regularly recorded and care plans are generally reviewed monthly to ensure the care provided meets the individual’s needs. No one in the home currently has a pressure sore but systems are in place to assess residents at risk and ensure that equipment to support them is available. Not all care plans included a photo of the resident to identify them to new staff. A care plan for smoking should be replaced with an assessment of any risks associated with this. Any agreements made with the resident to maintain his and others safety should be included. Records are kept when residents see health professionals but these are difficult to follow and should be reviewed to clearly show these appointments in a list. The system for the administration of medicines was checked and found to be good. Staff who dispense medicines are trained and records are maintained for ordering, receiving, administering and disposal. Medicines are stored safely. Residents seen were dressed appropriately in their own clothes. Staff were seen to treat residents respectfully and deal with any personal issues with dignity. Locks on bathroom and toilet doors checked during a tour of the building worked smoothly. Residents spoken to during the inspection all said that staff provided good care and this was generally confirmed in the returned questionnaires. One visitor wrote they were totally satisfied and a resident wrote they were happy with everything the home does for them. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 12 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents can choose what to do although activities are limited. Visitors are welcome in the home and an information newssheet is produced to keep residents and visitors informed. A range of good food is provided in the home. EVIDENCE: During the inspection residents were seen doing light exercise and playing bingo. The home has an activities list and staff record the activities that happen in the home. Some residents go out independently and others visit day services and church events. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 13 Residents spoken to were generally content in the home but several did say there was little in the way of activities and the days could be long. The home does not employ anyone specifically to encourage activity in the home. One resident said she loved bingo but didn’t do anything else. Some residents in the smoking room said they enjoy a cigarette and conversation with each other. Residents stated they could choose when to get up in the morning and what to do during the day. Visitors were seen during the day in various areas of the home talking to residents. Those spoken to stated that visiting was not restricted. The home has a visitors’ policy to ensure residents’ rights are respected. Residents and their families are encouraged to handle their own finances and a system is in place to invoice families for services provided outside of the normal care services. Information about advocacy is on the home’s notice board. The proprietor stated that anyone without family support would be directed to this service. Most of the residents spoken to said that the meals provided were either good or excellent. One resident who said he does not eat much said the meals were alright. A sample of the menus provided prior to the inspection showed that each day residents were provided with a range of vegetables and fruit. The lunchtime meal was observed. It was unhurried with adequate staff numbers supporting residents in a quiet dignified way. The kitchen is well equipped and a range of foodstuffs to enable the cook to meet individual choice was available. The unit for residents with dementia has a staggered lunch to ensure each resident is supported to enjoy the mealtime. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are safe but the system in place to record complaints is not fully maintained. This means that quality in the home may not be improved. EVIDENCE: The home has a complaints procedure and this is given to each new resident. A copy of the complaints procedure is also displayed in the home. Two complaints have been made about the home since the last inspection. Neither of these complaints was recorded by the home. The proprietor stated that one complaint that was sent by the commission had not been received by the home. However he is to have a meeting with the complainants to try and resolve the issues. A copy of the complaint was forwarded to the proprietor after the inspection. The proprietor accepts that encouraging complaints can provide information to improve the service for residents. He is therefore going to amend his complaints procedure to include concerns and record these in addition to any formal complaints received. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 15 Staff are provided with training related to protecting vulnerable adults and procedures are in place regarding this. Staff spoken to understand how to protect vulnerable people. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 16 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. The home is safe and well maintained for residents. Systems are in place to keep the home clean. EVIDENCE: The home was purpose built in 1999. There are three floors with a passenger lift between them. All areas of the home are accessible to residents with a physical disability. The home has a programme of decoration and replacement of furniture. On a tour of the building it was found to be well maintained and reasonably clean. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 17 The laundry contains a good standard of equipment to ensure clothes are cleaned and dried. The laundry floor was clean and storage space was good. Not all residents have a basket to retain their clothes before being replaced in their rooms. This means clothes are stored together with the possibility of being replaced in the wrong room. The home has systems for infection control and a sluicing facility. Two comments about odours in the home were made on the questionnaires returned. One said there were strong unpleasant smells in the home and the other said there was a strong horrible smell as soon as you walk through the door. During a tour of the building some odours were found but cleaning staff had appropriate cleaning equipment and rooms were being aired to address these problems. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 18 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 adequate. This judgement has been made using available evidence including a visit to this service. Good staffing levels enable residents’ needs to be met. The home is close to achieving the standard for the numbers of staff who have a care qualification. The recruitment procedure helps keep residents safe. Staff are provided with training that is relevant to the needs of the people they care for. Some staff have not had their training updated. EVIDENCE: All care staff are aged over 18 and staff left in charge of the home are over 21 years of age. Appropriate care staffing levels are provided to meet residents needs. The rota showed that there are six carers during the day and three carers at night. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 19 In addition the owner is also the manager and he is available in the home each day. The home employs an administrator and a maintenance person. The home has suitable domestic, laundry and catering staff hours. Existing staff provide cover for absences. Comments recorded on questionnaires praised the quality of the staff team and those residents who commented liked the staff and felt they provide a good standard of care. The home employs 20 care staff. Nine staff have achieved National Vocational Qualifications (NVQ) Level 2 or 3 in care. Three staff are currently working towards this qualification. A sample of staff recruitment files were examined. They all contained appropriate references and had Criminal Records Bureau (CRB) checks carried out. This reduces the risk of employing unsuitable people. New staff do induction training. Each staff members training is recorded and training certificates are in the individual staff files. A range of training is provided that includes safe working practices, fire safety, moving and handling, first aid and food hygiene. Senior staff had completed medication training. Not all training is up to date and the manager should review his records and ensure all training is updated. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. The manager has not demonstrated his ability to provide good care by obtaining the Registered Managers Award. The home has a quality monitoring system but this has not been fully introduced into the home to better promote good care practices. A system to monitor residents’ financial interests is in place. Some systems to ensure residents’ are safe and accidents are followed up should be re-assessed. There is a suitable system in place to record financial transactions and to help residents who require it to keep their monies safe. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager was registered in April 2004. At this time he was enrolled with Newcastle College with the intention of obtaining the Registered Managers Award. The manager feels the support to obtain this award has not been appropriate and is looking at another training provider to complete this award. The award demonstrates the abilities of the recipient to manage a care home for vulnerable people. A quality monitoring system has been purchased for use in the home and the manager has been looking at how this can be used to provide information to improve the standards of care. So far no action plans have been produced but some systems are being assessed. The home has not yet developed specific questionnaires to find out what residents and visitors think about the standard of care. A system is in place to encourage residents and their families to control their own finances. The home sends invoices for any monies they spend on behalf of residents. Any monies that are held for residents are recorded and each transaction has two signatures. Systems are in place to ensure the home is safe for residents. Certificates were seen to demonstrate maintenance tasks carried out by external contractors were done. Water temperatures are checked and a risk assessment is in place to show the water system is free from Legionella. This assessment should be amended to include shower heads to ensure a safe environment. The home carries out many of its own assessments that require a person assessed as competent under the Health and Safety Regulations. Accidents in the home are recorded but a system is not in place to formally follow them up. A fire risk assessment has been produced and regular fire checks are recorded. Staff training in fire safety is carried out. Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 2 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 2 X 3 X X 2 Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Ensure all care plans contain a recent photo of the resident. Change the care plan that was identified at the inspection regarding smoking to an assessment of risk and include any agreements made with the resident that restricts their choice. 50 of the care staff team should have NVQ level 2 or above. Review the homes training records and ensure update training is provided. The manager should obtain the Registered Managers Award. The manager must review the care provided using the home’s quality assessment document and produce plans of improvement for those areas identified. Questionnaires should be developed to obtain the opinion of residents, relatives and visitors to the home. Timescale for action 31/12/06 2 3 4. 5. OP28 OP30 OP31 OP33 18(1)(c) (i) 18(1)(c) (i) 9(2)(b)(i) 24 31/03/07 28/02/07 31/05/07 28/02/07 Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 24 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 The manager should review the activities provided by the home and decide whether a specific person designated to provide activities would improve this standard. Use the homes quality monitoring system to assess the standard of activities and involve residents and their families in any discussion. Amend the complaints procedure to demonstrate to residents and visitors the home’s commitment to using complaints to improve the service provided. Ensure all complaints are recorded and dealt with in accordance with the home’s procedures. 3. OP26 Ensure residents’ clothes are stored individually in the laundry to limit the possibility of loss. Review the systems associated with odour control following the comments made on questionnaires. 4. OP38 Improve the systems associated with health and safety; • The outcome of all accidents should be followed up and any actions recorded. • Add testing the shower heads to the Legionella risk assessment already produced. • Contact the local authority environmental health department about the practice of using a person employed in the home checking hoisting equipment and any other safety checks. 2. OP16 Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Ferguson Lodge DS0000000445.V302776.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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