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Inspection on 28/04/05 for Fermoyle House Nursing Home

Also see our care home review for Fermoyle House Nursing Home for more information

This inspection was carried out on 28th April 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a good quality of care to service users by staff in a kind and caring manner. The catering facilities are well managed and the choice of food offered is wholesome, well balanced and appetising. All the service users who were able to express opinion stated that the quality and standard of the food was very good. The home is well managed and the manager very committed to staff training and development.

What has improved since the last inspection?

The large lounge has been fitted with a new carpet. This has enhanced the appearance of the lounge and promoted the comfort of the service users. The provider has purchased a new hoist to aid the manual handling procedures in the home. The manager has undertaken training to become the designated manual trainer for the home.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Fermoyle House 121-125 Church Road Addlestone Surrey KT15 1SH Lead Inspector Mary Williamson Unannounced 28 April 2005 10:00 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. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Fermoyle House Address 121-125 Church Road, Addlestone, Surrey, KT15 1SH 01784 482570 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) Pinebird Ventures Ltd Angela Partridge CRH N 32 Category(ies) of OP (Old Age) - 32 registration, with number of places Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 32 beds providing nursing care for older persons from the age of 60 years Date of last inspection 19th October 2004 Brief Description of the Service: Fermoyle House has been adapted to provide accommodation and nursing care for thirty-two service users who are elderly. The home is located in a residential area within easy access to the local shops and community facilities. There is also access to a local bus service. Accommodation is provided in single and shared rooms. The home has two lounges, and a dining area. The garden to the rear of the property is well maintained and is overlooked from the lounge. Car parking is available at the front of the home. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and the first to be carried out in The Commission for Social Care Inspection programme year 2005/2006. The inspection was undertaken over five and a half hours, by Mary Williamson the lead inspector for the service. Mrs. Angela Partridge the registered manager was present throughout the inspection. Fifteen service users, two relatives, eight members of staff, and the visiting chiropodist were spoken to during the inspection. There was positive feedback from the service users spoken to regarding the care provided in the home. Relatives also felt well supported by the manager and her staff team. A tour of the premises concluded that limited progress had been made with the general decor of the home. Several carpets need to be replaced, and identified areas (highlighted in the report) need to be decorated. Records relating to the care of the service users and the management of the home were inspected. Activities were limited on the day of the inspection with service users watching television or otherwise unoccupied. During the inspection the chiropodist was visiting the home and providing treatment for most of the service users. This was being carried in a service users bedroom on the ground floor which was an intrusion of privacy. The staffing levels are adequate and the manager is committed to the training and development of her staff team. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The management could improve the general décor of the home, as it does not meet the required environmental standards. The accident records indicate a large percentage of falls occurring at night or early morning. More training in manual handling, and greater supervision must be provided for the night staff. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 7 More leisure activities must be provided on an individual basis to promote stimulation and support for service users. Potential trip hazards, such as worn and frayed carpets must be replaced. A designated treatment area must be provided for health care professionals, as it is unacceptable to use a service users bedroom for this purpose. 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. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un 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 Fermoyle House H58 s17610 Fermoyle v224352 280405 Un 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) 1,3,and 5 The home has an admission procedure in place, which provides prospective service users and their relatives with the information required to make an informed choice about living in the home. It also enables the manager to determine if specific needs can be met. EVIDENCE: The home has a statement of purpose and service users guide in place. One relative confirmed that a copy of this was available prior to her husband being admitted to the home. The manager stated that she undertakes pre admission needs assessments on all prospective service users and the information gathered will determine the suitability of the placement. A selection of pre- admission needs assessments were sampled during the inspection. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 10 Trial visits will be accommodated whenever possible. However due to the ability of some service users there are occasions when relatives or a designated representative will make a decision on their behalf. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un 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,and 10 Individual care plans are in place, which contain all relevant information. Service users health care needs were seen to be generally met, with the exception of one service user whose changing needs require an alternative placement. There were shortfalls regarding privacy issues in the home. EVIDENCE: Individual care plans are in place, which are formulated from the preadmission needs assessment, input from the service user when possible, their relatives and any medical reports available. These plans are well maintained, and evaluated on a regular basis. All the service users are registered with a local GP who visits the home on a regular basis. There is also access to a dentist, chiropodist, and optician, pharmacist, district nurse, tissue viability nurse and a Community Psychiatric Nurse when required. There are currently two service users who have a pressure sore and pressurerelieving equipment is provided to assist in the treatment of these conditions. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 12 One service users needs are currently not being met and the multidisciplinary team are actively seeking an alternative placement. The chiropodist was visiting the home during the inspection providing treatment for thirty service users. This treatment was being carried out in a service users double bedroom on the ground floor. This is bad practice preventing both service users from access to their bedroom for most of the day and infringing on their privacy. Alternative arrangements must be provided for chiropody treatment. There is a risk assessment in individual care plans stating that locks are NOT provided on toilet and bathroom doors as the service users are considered to be at risk if locks are provided. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un 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) 12,13,14,and15 Social activities are limited and do not provide appropriate stimulation for service users living in the home. Family contact is maintained and encouraged. The food offered at the home is varied, wholesome and appetising. EVIDENCE: On the day of the inspection the service users were observed sitting in both lounge areas without stimulation. The television was turned on in the small lounge with some service users watching this. There was back round music provided in the large lounge but most of the service users were either sleeping or taking little interest in their surroundings. One service user stated that he would like a daily newspaper. The manager stated that musical entertainment is provided once a month. The staff provide video exercise, ball games, colouring and board games for the service users. The children from the local school visit six times a year on a Friday morning and sit and help the service users with colouring and games. Three people attend a day centre during the week, one service user goes to Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 14 church and one goes out with her family. Visitors are encouraged at any reasonable time. The catering arrangements in the home are good. Menus are planned on a three weekly basis. The choice of food is wholesome, appetising and nutritious. Special diets are catered for, and support is provided for service users who require help with feeding. Several service users, and a relative were very complimentary of the standard of food offered. Most service users choose to sit in the lounge areas to eat with only four service users sitting to the dining table. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 15 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) 16,17,and 18 The home has a satisfactory complaints procedure that is made available to service users, their designated representative and staff. A procedure for responding to allegations of abuse is in place. EVIDENCE: The home has a complaints procedure in place and a copy of this is provided to service users or their designated representative on admission to the home. One relative stated that she was aware of this procedure. Four service users had the opportunity to use the postal voting system in the forthcoming general election. There is an abuse awareness policy in the home and staff stated that training is provided on the prevention of adult abuse when they first start working in the home. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,24,25,and 26. The home was clean with malodour present in two rooms. Limited improvements to décor have been made. The outstanding requirements from the last inspection, and the water damage caused by a recent leak in a service users bedroom do not provide the service users with comfortable surroundings. EVIDENCE: The general cleanliness in the home was good. The staff spoken to were aware of the infection control procedure in place, and the management of an isolated case of MRSA in the home. Mal odour was present in two rooms which had been identified and being monitored by the manager. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 17 The home would benefit from an ongoing programme of redecoration and refurbishment to bring it in line with The National Minimum Standards. For example • • • • The carpet in the small lounge is badly worn and requires to be replaced. This is a requirement outstanding from the last inspection. The stair carpet on the back stairs needs to be replaced, as this is worn and a potential trip hazard. The general woodwork throughout the home needs to be repainted as this is badly damaged due to the wheelchair traffic. There is excessive water damage to room 25 following a leak, and the ceiling needs to be redecorated and the carpet needs replacing. There are sufficient numbers of toilets and bathroom situated throughout the home. The suitability of the bathrooms was an issue last year as twenty-seven service users use the assisted shower on the ground floor and five service users use the assisted bath on the first floor. The provider arranged a general mobility assessment undertaken by an occupational therapist, which indicated that this situation was satisfactory. However this situation is unsatisfactory as to meet The National Minimum Standards there should be 4 useable bathrooms for the number of people living in the home. Service users bedrooms are adequately furnished and have been individualised with personal items of furniture and belongings. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 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 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) 27,28,and 30 Staff in the home have a good understanding of the needs of the service users living in the home. They are appropriately supervised and meet the assessed needs of the service users. EVIDENCE: There was one qualified nurse and six carers on duty on the morning of the inspection. They all had an understanding of the assessed needs of the service users they were caring for. Relatives were very complimentary of the staff and the support they provide. The manager is very committed to the training and development of her team and she stated that two of her qualified nurses were currently undertaking NVQ level 4 training combined with assessors training. Two staff have completed NVQ level2 and two staff have done NVQ level 3 training. All staff have induction training followed by foundation training. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 19 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) 31,32,37, and 38 The home benefits from good leadership and management input ensuring service users needs are met. The standard of record keeping is generally good with the exception of Regulation 37 notifications not being sent to The Commission for Social Care Inspection for hospital admissions. The environmental shortfalls do not promote the health safety and welfare of the service uses living in the home. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 20 EVIDENCE: The registered manager is a qualified nurse with considerable experience in the provision of care to elderly people. She is well supported by her qualified staff and care team. The manager is currently undertaking her NVQ level 4 in management and some designated study time needs to be identified for this purpose. The standard of record keeping is generally good. However The Commission for Social Care Inspection must be informed of any admission of a service user to hospital under Regulation 37 notification. The accident records were examined and it was an observation that a larger percentage of falls are taking place during the night or early morning. The manager stated that she will provide an updated manual handling for the night staff. Provision must be made to make safe trailing wires from an air mattress. Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 21 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 3 x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 2 2 x x 2 x 2 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x x x 2 2 Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 12(1)(a) Requirement The home must ensure that changing care needs of service users can be met or an alternare placement provided. The home must make proper provision to respect the privacy and dignity of service users The home must provide activities appropriate to individual and collective assessed needs. The home must ensure that it provides for service users to make choices for example the provision of a daily newspaaper. The registered person shall ensure that all parts of the care home are kept reasonably decorated to include carpers. The registered erson shall ensure that sufficient numbers of useable bathing facilities are provided in the home. The registered person must keep the home free from offensive odours. The registered person must give notice in the event of a service users admission to hospital. The registered person shall ensure that all parts of the care home are hazard free to include Timescale for action 30/06/05 2. 3. 4. 10 12 14 12(4)(a) 16(2)(m) 12(2) 30/06/05 30/06/05 30/06/05 5. 19,20 and 24 21 23(2)(d) 30/06/05 6. 23(2)(j) 30/06/05 7. 8. 9. 26 37 38 1692)(k) 37 13(4)(a) 30/06/05 30/06/05 30/06/05 Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 23 trailing wires 10. 38 13(5) The registered preson shall ensure safe systems for the moving and handling of service users to include manual handling training for night staff. 30/06/05 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. Refer to Standard Good Practice Recommendations Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN National Enquiry Line: 0845 015 0120 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 Fermoyle House H58 s17610 Fermoyle v224352 280405 Un Stage 4.doc Version 1.30 Page 25 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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