Inspection on 06/11/07 for Fermoyle House Nursing Home

This inspection was carried out on 6th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fermoyle House Nursing Home 12/07/07

Fermoyle House Nursing Home 26/05/06

Fermoyle House Nursing Home 14/10/05

Fermoyle House Nursing Home 28/04/05

Fermoyle House Nursing Home 19/10/04

Fermoyle House Nursing Home 10/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Fermoyle House Nursing Home 121-125 Church Road Addlestone Surrey KT15 1SH Lead Inspector Pauline long & Vera Bulbeck Unannounced Inspection 6th November 2007 09:40 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 Fermoyle House Nursing Home DS0000017610.V353607.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. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fermoyle House Nursing Home Address 121-125 Church Road Addlestone Surrey KT15 1SH 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) 01932 849023 01932 847183 Pinebird Ventures Limited Miss Angela Rosemary Partridge Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 32 beds providing nursing care for older persons from the age of 60 years 12th July 2007 Date of last inspection Brief Description of the Service: Fermoyle House has been adapted to provide accommodation and nursing care for thirty-two residents 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 small 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. The fees for this service range from £449.17 per week and £575 per week. These fees do not include personal items and hairdressing. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced site visit and formed part of the key inspection process and took place over nine hours commencing at 09.40 am and ending at 18.40pm. Mrs V Bulbeck and Mrs P Long, Regulation Inspectors carried out the visit. A full tour of the premises was undertaken. Four care plans were sampled and the care observed for the four individuals. The inspectors spoke with the majority of residents to obtain feedback. Feedback from some of the residents was limited due to their communication difficulties. Several relatives were spoken to on the day and following the site visit and all of the staff on duty were spoken to during the visit. A number of records were observed. The registered manager Ms Angela Partridge was on duty. There were thirtyone residents living in the home on the day of the site visit and there was one vacancy. The inspector would like to thank the residents and staff for their co-operation and hospitality during the inspection. The residents living in the home wish to be called resident’s. What the service does well: What has improved since the last inspection? All of the previous requirements have been met. Care plans are more comprehensive and provide staff with clear guidelines in respect of residents Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 6 needs. Risk assessments have been up dated and are more robust. The home has implemented and is using the water low tool for the assessment of potential risks to resident’s pressure areas. All staff including the provider has received the protection of vulnerable adults training. A new activity organiser has been recruited and a number of activities have been organised for the festive season. Some carpets have been replaced and some of the bedrooms have been redecorated. One double bedroom was in the process of being decorated on the day of inspection. The provider of the home has had new double glazed windows and doors fitted through out the building. The front of the premises had been recently painted and a new sign had been fitted. What they could do better: The home must review the risk assessments carried out on the bed rails in use in the home, in order to ensure that the risk assessments are robust and clearly identify potential risks. Whist it was noted that risk assessments had improved staff must sign them. It was noted that one of the residents being cared for in their bedroom had considerable needs and these needs were not being fully or appropriately met. The home should refer this individual to the appropriate professionals in order to assess their current level of need to help determine whether the home can continue to care for them. The manager must undertake a review of the stock medication in the home as there was a considerable amount being stored. The premises provide considerable challenges for the management team in respect of the on going need for upgrading and refurbishment of the home. These challenges are detailed in the environment section of this report. The inspectors advised the management of the home to produce an action plan as to how they intend to ensure the premises meet the changing needs of the residents. Some areas in respect of health and safety need to be improved, for example; staff need to be reminded of COSHH (Control of Substances Hazardous to Health) Guidelines. It is recommended that staff undertake a refreshertraining course in this respect. The provider must make arrangements to ensure monthly Regulation 26 visits are undertaken and reports produced. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 7 Up to date and accurate records must be kept of all health and safety checks undertaken in the home. The management must address the requirement made following the visit from the Environment Health Officer on 23/04/07 in respect of staff walking through the kitchen to the staff area and managers office. 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. Fermoyle House Nursing Home DS0000017610.V353607.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 Fermoyle House Nursing Home DS0000017610.V353607.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): 3, 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives are provided with the appropriate information in order to make a decision as to whether or not the home can meet the resident’s needs. Care needs assessments are undertaken prior to residents being admitted to the home. The home does not provide intermediate care. EVIDENCE: The homes statement of purpose and residents guide has been updated and contained relevant information. It was noted that the old residents guide and statement of purpose was on file and the inspectors advised the management of the home to remove the old documents, this was done at the time of the inspection. Discussions with relatives indicated they had been provided with a copy of both the documents. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 10 Care Needs assessments were in place. The registered nurse and manager stated that health care needs assessments are undertaken by the health care professionals prior to the home undertaking their own care needs assessment. The care needs assessments sampled covered all activities of all daily living including health care. The home does not provide intermediate care. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents individual care plans are good and reflect their care needs and goals, however the needs of one resident are not being appropriately met. The residents are protected by robust medication policies and procedures. The arrangements in place in respect of ensuring the privacy and dignity of the residents must be reviewed. EVIDENCE: Improvements have been made in the care planning process at the home. Four care plans were sampled and evidenced a full review has been undertaken. The format has been changed to be more person centred and to ensure that all identified care needs have clear guidelines and an action plan in place to ensure these needs are fully met. All of the care plans sampled had been reviewed and signed by a representative of the home. Discussions with relatives confirmed that they had been involved in the care planning process. All of the care plans sampled indicated that risk assessments had been undertaken on the use of bed rails, risk of falls, and manual handling issues. The inspectors advised the management of the home to undertake a review on Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 12 the use of protection covers for the bed rails in order to ensure residents who use bed rails are not injured. It was observed that several residents were cared for in their bedrooms. It was noted that one particular residents needs were not being met in respect of the impact their behaviours was having on the other residents. Discussions were had with the manager and provider in this respect and the home must review this individuals care needs to help determine whether Fermoyle House is the most suitable place for them to continue living in. All risk assessments had been dated but had not been signed. Discussion took place with the registered nurse who stated that some risk assessments were waiting for the relatives to visit the home to agree with the assessment. There was evidence of letters to families confirming the homes request for their input. A recommendation was made at the previous inspection for the home to assess any pressure damage amongst the resident group in the home and to consult with the local tissue viability nurse as appropriate. There was evidence this had taken place with records on file to indicate a water low assessment had been undertaken, and advise having been sought from a health care professional. The mediation procedures, storage and practices were sampled and found to be satisfactory. It was noted however that a considerable amount of stock medication was kept in the home. This was discussed with the registered manager and she was advised to undertake a review. Medication records were observed and were well documented with no gaps in signatures noted. Medication administration was not observed, the registered nurse stated that only qualified staff undertake the administering of medication. The issue identified at the previous inspection in respect of a resident’s medication has been satisfactorily addressed. There were no controlled drugs used in the home. The inspectors observed that residents on the whole were treated respectfully and personal care was carried out with privacy and dignity in their bedrooms. However, several bathrooms and toilets were without a lock. It was also noted that there were no locks on any of the bedroom doors, this was brought to the provider’s attention. The registered manager must review the arrangements in place in order to ensure that the privacy and dignity is promoted and protected. Care plans must reflect resident’s choice in this respect. It was also noted that staff notices in respect of residents care had been posted in bedrooms and bathrooms. Discussions were had with the manager in respect of these notices being removed and being kept in a more appropriate manner, this was undertaken on the day of the inspection. Residents and relatives commented that they were treated sensitively and with respect. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 13 Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social and recreational actives are offered at the home, residents and their families are encouraged to participate. The food at the home is good, however, the dining areas do not meet the needs of residents. EVIDENCE: The home has recruited an Activities Organiser to come in two afternoons a week in order to provide the residents with some structured activities. The inspectors observed the activity programme for the month and this evidenced some activities every day, for example sing-along and reminiscence afternoons. They also have a live entertainer on a monthly basis. There are regular visits from an Aromatherapist and music for health entertainer. The manager stated that an outing had been booked for some of the residents to visit the Christmas lights in London. A Theatre company has been booked to perform a Christmas Pantomime “ Tickled Pink”. Relatives commented that activities are offered on a regular basis and that they hear the staff singing along with the residents. Residents are encouraged to go out with their families. One resident informed the inspector that she had been to her grandsons wedding at St Paul’s Cathedral in London on the previous Saturday, Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 15 she had brought back flowers from the wedding, which were on display in the small lounge. Care plans recorded residents religious faith and religious symbols were seen in various residents’ bedrooms. The inspectors observed a mealtime activity. Meals are served in a small dining room, which seats approximately six people, and in the two lounges. one of which was somewhat small for the number of residents accommodated. Whilst it was noted that some residents had a choice of where to eat their meals, the majority did not. The majority of the residents had their meals served to them on small tables. A number of residents were served their meal in their bedrooms. The dining area appeared cluttered with several chairs and pieces of furniture. The medication storage trolleys and cupboards are also kept in the dining room. It was noted that several of the residents in this area were in wheelchairs. The meals are served from a heated trolley in the kitchen, which is` adjacent to the dining room and staff have to walk through this area to take meals to residents seated in other parts of the home. The inspectors observed that all of the residents were wearing bibs. This was discussed with one resident, who commented that staff always put the bib on to protect their clothes, the inspector asked her how she felt about wearing a bib, and she commented that they were used to it now. While it is commended that staff take steps to protect the residents clothing perhaps consideration could be given to providing protection that would afford the residents greater dignity and respect. It was observed that residents sitting in armchairs with small tables in front of them had to lean forward in order to eat their meal. It was noted that this practice caused residents to spill their food. Some of the residents required help to eat their meals. Staff were observed providing support to those residents who required help in a sensitive and dignified way. The food at the home appeared nutritious and well balanced and was nicely presented. Residents, staff and relatives commented that the food was excellent. The inspectors checked the food storage areas and it was noted that quality food had been purchased with lots of fresh vegetables. One resident commented that the food is very good, however they prefer not to eat meat, but it is always served to them, staff tell them to just eat the vegetables. They informed the inspector they have never eaten a lot of meat and for a number of years and had been a vegetarian. They also commented in light of the recent foot and mouth outbreak they would prefer not to eat meat. This was discussed with the cook at the time, who stated she was not aware that this resident preferred not to eat meat. It is recommended that the cook meet with this resident to enable a nutritious menu incorporating their food preferences to be drawn up with the help of a dietician if necessary. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 16 As mentioned earlier in this section a number of residents have their meals in their bedrooms. The management of the home need to be satisfied that there are enough staff at meal times to ensure that meals are served at suitable temperature. As it was noted, a hot sweet of crumble and custard had been left on a resident’s bedside table whilst the member of staff was feeding another resident. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the homes policies and procedures in respect of complaints and protection from abuse. EVIDENCE: The homes complaints procedure was sampled and was found to be easy to read and understand. It was noted however that the details for the Commissions Office were incorrect. This was brought to the manager’s attention and was addressed on the day. The home has not received any complaints since the last inspection. Discussions were had with the residents and relatives and they commented that they were aware of the complaints procedures and had been give a copy of them. One relative commented that if she had any concerns she would discuss with the manager or the provider who were very approachable. The Commission has not received any complaints about this home since the last inspection. No safeguarding referrals have been made since the last inspection. A requirement was made following the last inspection in respect of staff undertaking training in Safeguarding Adults from Abuse. This requirement has been met; all of the staff including the provider have undertaken this training. Training records were sampled and evidenced this, staff also confirmed they Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 18 had undertaken this training. Scenarios were put to staff in respect of how they would report abusive situations; they demonstrated a good understanding of the procedures. Fermoyle House Nursing Home DS0000017610.V353607.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 poor. This judgement has been made using available evidence including a visit to this service. The premises provide considerable challenges for the management team in respect of the on going need for upgrading and refurbishment of the home. Standards of cleanliness were good ensuring the residents lived in a clean and hygienic environment. EVIDENCE: It was noted that some improvements have been made to the environment since the last inspection for example: New double-glazed windows and doors have been fitted New carpets have been laid in some communal areas and bedrooms The outside of the building has been painted and a new sign is in place. The premises provide considerable challenges for the management team in respect of the on going need for upgrading and refurbishment of the home. The changing needs of the residents have impacted on the physical Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 20 environment and layout of the home. The majority of the residents living in the home are not ambulant and need to be transported in a wheelchair. The inspectors observed that staff had difficulty around the home manoeuvring the wheelchairs due to restricted space. This was further evidenced on the first floor and ground floor corridors by the damage caused to the walls, doors and skirting boards caused by transporting residents in wheelchairs. It was noted that bins including a clinical waste bin and a linen trolley were stored on the first floor landing. The inspectors advised the registered manager to review this area in order to improve the appearance of the landing. Whilst it was noted that holders for paper towels were fitted in the bathrooms and toilets they were without paper hand towels. This does not promote good infection control measures. Issues regarding the bathrooms and toilets were identified at the time of the last inspection. The inspectors were informed by the manager the one bathroom on the first floor is in the process of being developed into a wet room/shower room for the benefit of the residents. It was also noted that hot water was continually running from two taps in the bathroom. This was discussed with the registered manger and provider who commented they were aware of the situation and the handyman had been informed and the work was to be undertaken the following week. The small lounge had several residents seated watching television. In order to enable a member of staff to take a resident to the toilet furniture had to be moved before the resident could be transferred safely from the armchair into the wheelchair. It was noted that when residents were taken to the toilet on the ground floor there was very little room for staff to manoeuvre the wheelchairs safely, and residents were kept waiting in the corridor, for the toilet to be vacated. Due to the restricted space staff were unable to push the wheelchairs fully into the toilet. Staff commented that residents had to be physically assisted to be able to use the toilet, and commented that it was difficult. This was discussed with the registered manager at the time. Several residents are cared for in their bedrooms. On the day of the site visit it was noted that all of the bedrooms doors were closed. One resident commented that she liked to have her door left open, she informed the inspector that the staff had told her that the door must be kept closed whilst the inspectors were in the building. The inspectors observed that there were no door guards fitted to any bedroom doors, or fitted to the fire alarm system. It was unclear as to how the doors were kept open. This was discussed with the manager and provider during feedback at the end of the site visit. It was agreed that a review would be undertaken of those residents requiring their bedroom door to be opened and that appropriate measures would be put in place to facilitate this choice safely. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 21 As mentioned earlier in this report there are concerns around the dining area, which need to be addressed. A requirement was made by the Environmental Health Officer on 23/04/07 in respect of staff walking through the kitchen to access the office and staff area. This requirement remains a problem for the management of the home in respect of the only alternative access is through the main lounge and garden to reach the office. It was noted that a resident was seated in an armchair in front of the door, the inspectors experienced difficulty accessing the sliding patio door without disturbing the resident. However it was observed by the inspectors that staff and management were accessing the office via the kitchen. This was discussed with the registered manager and provider during the feedback at the end of the inspection. It was noted that the top step on the fire escape was covered in shingle. This was due to a new double glazed door being fitted and the shingle had been dislodged and needs to be cleared. The garden was well maintained and tidy. However, there was an old washing machine stored in the garden that needs to be removed. It was also noted that there was no ramp access from the two lounges into the garden. The provider needs to consider the layout and access to the garden to enable residents to use the garden safely, as it was noted the majority of the residents are not ambulant and therefore it would be difficult to manoeuvre wheelchairs. The provider must review the temperature in one of the ground floor bedrooms as on the day of the site visit it was found to be very cold. This was discussed with the registered manager and the provider on the day of the visit. There were two portable radiators in use in the home on the day of the site visit and both were found to be very hot and had trailing wires. The registered manager removed both radiators on the day and stated they would not be used again. Discussions were had with several relatives who commented that the environment is poor and one in particular commented, “the home is not a five star hotel”. However, the relatives commented that in spite of the environment the care in the home was very good and this was their main concern. The home was found to be clean and hygienic, with good infection control measures in place. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs were being met by appropriately trained staff in sufficient numbers to meet their needs. EVIDENCE: On the day of the site visit it was noted that the registered manager, registered nurse, six care staff, two cleaners, the cook and an assistant cook were on duty. There was some concern regarding the high dependency levels of the residents currently living in the home. This was discussed with the management team and they were advised to undertake a review of the staffing levels to ensure there were sufficient staff on duty to meet the needs of the residents. This was undertaken during the site visit by the care consultant, he stated that he had accessed the Residential Staff Forum Calculation Tool and that this tool indicated that the home is exceeding the recommended staffing levels. The inspectors advised the registered manager to keep staffing/dependency levels under review. Discussions were had with staff in respect of staffing levels in the home and the inspectors were informed that the staff felt staffing levels were adequate. One relative commented that staff are never too busy to make relatives feel welcome and always offer a cup of tea. Several relatives commented that staff were very kind and caring. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 23 Recruitment procedure and practices were sampled and they were found to be good. All relevant documents were in place to ensure the health, safety and well being of residents for example CRB checks and two references. Application forms were well documented, there was evidence of interviews being undertaken, which demonstrated equal opportunity procedures are practiced at the home. A number of training courses have been undertaken at the home, for example; manual handling, first aid, infection control, tissue viability, and medication. The manager stated that some of the care staff had undertaken an NVQ (National Vocational Qualification). Care staff spoken with confirmed this. The manager stated that staff had untaken training in respect of the control of hazardous substances, however it was noted that some hazardous substances were not stored appropriately. It is recommended staff undertake a refresher course in this respect. One new member of staff commented that they were undertaking their induction training. It was noted that several of the residents at the home were somewhat confused, and whilst some staff had undertaken training in dementia care all staff would benefit from this training. which would help to ensure that resident’s needs were appropriately met The training records were in place for each individual member of staff. The home would benefit from implementing a training plan to ensure that any gaps in staff training are easily identified and addressed. The care consultant commented that he would assist in implementing this training plan. Fermoyle House Nursing Home DS0000017610.V353607.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from the registered managers approach and leadership skills. Further work needs to be undertaken to ensure that the homes quality assurance systems are more robust. Residents are not fully protected by the health and safety practices and record keeping at the home. EVIDENCE: The registered manager is experienced and competent. She is a registered nurse and has undertaken the Registered Managers Award and NVQ 4 in care. Residents and staff benefit from her management approach to the running of the home, and positive comments were made in this respect. Staff and relatives commented that the Registered manager was `flexible, approachable and supportive. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 25 Discussions were had in respect of the Quality Assurance process at the home. It was noted that the registered provider had not undertaken any Regulation 26 visits. This was discussed with the provider who stated that the care consultant would be undertaking the monthly visits with the provider starting in November 2007. Resident surveys were undertaken in June 2007 and nine were returned with positive comments being made for example “very happy with staff and management”. The manager stated `that the home would be holding a resident’s meeting on the 14/11/07 and this was confirmed by staff and posters displayed throughout the home. Regular staff meetings are undertaken and minutes of these meetings were sampled. The manager informed us that the home does not manage any resident’s finances, and any monies spent on a resident’s behalf for example; hairdressing or chiropody would be invoiced to relatives or power of attorney. During the sampling of records, it was noted that corrector fluid had been used on the staffing rota, this was brought to the registered managers attention at the time and it was agreed that the use of correction fluid must cease. Records in respect of health and safety were sampled. On the whole they were found to be satisfactory for example fire records, food safety records, gas and heating records. It was noted, however, that there were no records indicating that the testing for Legionella had been undertaken. The provider stated this would be attended to without delay. It was noted that substances hazardous to health were not appropriately and safely stored, for example the cupboard under the stairs, which contained two extra large boxes of washing powder, was unlocked. The laundry room was also unlocked and contained a similar COSHH substance. This was brought to the manager’s attention, who removed the boxes from under the stairs and stored them in the laundry. The laundry door was locked and the key removed from the door. It is recommended that the staff are be reminded of the requirement for all hazardous substances to be appropriately and safely stored, and to undertake refresher training in this respect. The provider stated that he undertakes the PAT (Portable Appliance Testing) at the home. There were no records to evidence this apart from stickers on two of the portable appliances sampled in the staff area. Discussions were had with the provider in respect of keeping up to date documented records of the equipment tested. He stated that he would do this. As discussed earlier in this report there is one outstanding requirement in respect of the Environmental Health Report made on the 23/04/2007. This needs to be addressed as a matter of priority. The inspectors contacted the Environmental Health Officer (EHO) regarding the outstanding requirement, the (EHO) who stated she was happy with the cleanliness of the kitchen and was confident that the advise she had given to the home would be acted upon. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 26 During the site visit the management were asked if their category of registration had changed. The inspectors were informed that all residents were within the homes category of registration. Following the site visit a relative informed CSCI that a resident with dementia had been admitted to the home. The management of the home must ensure that if a resident with dementia has been admitted to the home they must apply to the Commission to vary their categories of registration. Furthermore the home must ensure that all residents admitted to the home fall within their category of registration. Fermoyle House Nursing Home DS0000017610.V353607.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 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 3 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 12(1)(a) 14(2)(a) (b) Requirement An up to date care needs assessment must be undertaken by an appropriate health professional to ensure the needs of an identified resident are fully met. In order to ensure a resident’s privacy and dignity all bathrooms and toilets and bedrooms must have suitable locks, which can be opened by staff in an emergency. An action plan in respect of the updating and refurbishment of the home must be produced. This plan must include timescales for work to be completed and a copy of the action plan must be submitted to the (CSCI). Regulation 26 visits must be undertaken monthly and written reports produced. A copy of the reports to be sent to the (CSCI). The appropriate authorities must be contacted to undertake and carry out tests on the homes water storage for Legionella bacteria. DS0000017610.V353607.R01.S.doc Timescale for action 06/12/07 2. OP10 12(1)(4)( (a) 21/12/07 3. OP19 23 21/12/07 4. OP33 26(4)(a)( b)(c) 12(1)(a) 13(4)(c) 21/12/07 5. OP38 21/12/07 Fermoyle House Nursing Home Version 5.2 Page 29 6. OP38 7. OP38 13(4)(a)(c Door guards must be fitted to 21/12/07 ) the bedroom doors of those 23(4) residents who prefer their bedroom doors to remain open. Any door restrictors must be part of the fire alarm system. 12(1)(a) Suitable records must be 06/12/07 13(4)(a) maintained in respect of the (c) testing of portable electrical appliances. 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. 3. 4. Refer to Standard OP38 OP14 OP9 OP38 Good Practice Recommendations The risk assessments carried out on the use of bed rails should be reviewed. The arrangements in place for protecting resident’s clothes at mealtimes should be reviewed. A review of the levels of stock medication should be undertaken. The staff should undertake a refresher training course in respect of the safe storage of hazardous substances. Fermoyle House Nursing Home DS0000017610.V353607.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Oxford Area Office Burgner House 4630 Kingsgate, Cascade Way Oxford Business Park South Cowley Oxford OX4 2SU 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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