Inspection on 15/01/07 for Fern Lodge

This inspection was carried out on 15th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fern Lodge 03/12/07

Fern Lodge 03/01/06

Fern Lodge 19/10/04

Fern Lodge 25/06/04

Similar services:

Claremont House

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Firstlings

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Fern Lodge 108 Broad Road Bocking Braintree Essex CM7 9RX Lead Inspector Key Unannounced Inspection 15th January 2007 10:30 Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 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 Fern Lodge DS0000017715.V327987.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 and Care Homes for Adults 18 – 65*. 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. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fern Lodge Address 108 Broad Road Bocking Braintree Essex CM7 9RX 01376 550432 01376 342928 braintreehcltd@aol.com 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) Braintree Health Care Limited Mrs Jennifer Woolliams Care Home 8 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (1), Learning disability (8), Learning disability of places over 65 years of age (8) Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Persons of either sex, under the age of 65 years, who require care by reason of a learning disability (not to exceed 8 persons) Persons of either sex, aged 65 years and over, who require care by reason of a learning disability (not to exceed 8 persons) One person, over the age of 65 years, who requires care by reason of a learning disability and dementia, whose name was made known to the Commission Two persons, under the age of 65 years, who require care by reason of a learning disability and dementia, whose names were made known to the Commission The total number of service users accommodated in the home must not exceed 8 persons 3rd January 2006 Date of last inspection Brief Description of the Service: Fern Lodge is a care home registered to provide accommodation, personal care and support to eight people; of either sex, under the age of 65 years and over the age of 65 years, who have a learning disability. The home is owned by Braintree Healthcare Ltd, and the Registered Manager is Mrs Jenny Woolliams. Fern Lodge is a purpose built bungalow situated in pleasant secluded surroundings, in a semi rural location on the outskirts of the town of Braintree, in the county of Essex. All bedrooms are of single occupancy and offer spacious accommodation with a small lounge area, kitchen facilities, en suite bathrooms and patio access to the garden. The home also has a dining room, lounge and an attractive garden with garden furniture. The home is not registered to admit people who have a diagnosis of dementia. A variation to the current condition of registration was agreed by the CSCI, to enable the home to continue to provide care to those individually named service users with changing needs related to dementia, as long as their assessed needs can be met. The inspector was advised that the current fees ranged between £695.00 to £1000.00 per week, at the time of the inspection. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 15th January 2007, over a period of seven hours. Fern Lodge is registered to accommodate service users, under and over the age of 65 years, who require care by reason of a learning disability. All of the Key National Minimum Standards (NMS) relating to the mixed category of Young Adults and Older People and the intended outcomes were assessed in relation to this service to reflect the wide range of service users needs met by the home. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at relating to the residents, staff recruitment, training, staff rosters and policies and procedures. A partial tour of the premises was undertaken, interaction between staff and residents was observed and discussions were held with Mrs Jenny Wooliams, the Registered Manager and staff. The inspector was pleased to meet with Mr Brian Sweeney, the responsible person and one of the directors of Braintree Healthcare Ltd, the registered provider of the service. Mr Sweeney was visiting the home. This report has been written using accumulated evidence gathered from the service prior to and during the inspection. Information was also gathered from questionnaires sent to users of the service and their relatives and views expressed are included within the contents of the report. Those residents not able to fully express their views were observed to be happy, relaxed and comfortable. What the service does well: Fern Lodge presented a warm, homely and caring environment for people living there. Interaction between staff and residents was calm, positive and respectful. The residents were relaxed and observed to enjoy good relationships with the staff and said they liked living at Fern Lodge. Mrs Wooliams, the registered manager is very committed to the service and is an excellent role model to her staff team. Together they deliver a good standard of care and have a good understanding of the residents needs. Staff working at the home said they felt supported in their work and were provided with opportunities to develop their care practice through training. Completed surveys were received from five relatives and they all expressed satisfaction with the overall care provided and that the home was welcoming and supportive. One relative commented that their relative ‘was looked after very well and is very happy living at Fern Lodge, the staff were always happy and do a very good job’. Fern Lodge DS0000017715.V327987.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. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3,4,& 5 (Young Adults) and 1, 2,3,4 & 5 (Older People) Standard 6 in Older People does not apply to this service. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There home did not demonstrate how the needs of the most recently admitted service users’ needs were considered prior to their admission. The care home demonstrated that the service was able to meet the assessed needs, including changing needs, of the current service users accommodated at Fern Lodge. Service users benefit from a contract or terms and conditions agreement with the home. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 9 EVIDENCE: The homes Statement of Purpose reflected the aims and objectives of the service and informed prospective service users of the services and facilities offered at Fern Lodge. The document was also produced in Makaton. Further development was recommended to produce the document in an easy read format with the use of pictures for those service users with limited literacy skills and do not use Makaton as a form of communication. The deputy manager who said that this work could be carried out with the residents welcomed this recommendation. Only one resident had been admitted to the home since the last inspection. This was an emergency admission directly from hospital and the residents’ needs were noted to be complex and highly dependant. The home was therefore unable to initiate a normal transition period for this person with trial visits to the home. The relatives visited the home on the residents’ behalf. During the previous inspection residents confirmed they had supported visits to the home prior to their admission. The manager advised the inspector that two visits were undertaken to the resident in hospital and information was gathered from the nursing staff, relatives and staff from the individuals’ previous placement. The residents care file did not contain a written assessment format that the service used to gather information about the residents needs prior to their admission. A joint Primary Care Trust (PCT) Continuing Care and Care Management assessment was available in the residents file but this was out of date and did not reflect changing needs. Since the assessment was carried out the resident had spent three months in hospital prior to admission to Fern Lodge. The lack of recorded essential information gained through assessment does not indicate how the residents’ individual needs were considered prior to admission. The home provided aids and equipment appropriate to support the care needs of the service users. There was evidence of a good level of staff training to promote good care practice and enable staff to develop the skills required to meet the assessed needs of the service users accommodated. Staff demonstrated an awareness of specific communication needs and channels with the service users, providing support and encouragement enabling them to make choices throughout their day. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 10 Care files seen included an agreement of terms and conditions between the service and the individual accommodated. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 & 9 (Younger Adults) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care plans demonstrated that the individuals presenting needs were identified and encompassed clear objectives. They lacked the level of detail required to understand how staff should support the individual in relation to achieving the desired outcomes. The home maintains a diverse approach in respecting and promoting service users rights, assisting them to make decisions about their lives as needed, providing support in taking responsible risks within an ordinary lifestyle and consulting and encouraging participation in all aspects of the home. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 12 EVIDENCE: The home successfully runs two specific programmes of care within the one service: support towards a more independent lifestyle for the younger adult and care and support for the older person with changing needs due to the ageing process. The residents have a wide variation of needs and the home continues to achieve a good balance of empowerment and inclusion, promoting an ordinary lifestyle. Residents are consulted with regard to the running of the home through regular resident meetings and one to one consultation for those with limited communication, enabling them to express choice, concerns and desires. The care plans examined demonstrated that the residents presenting needs and achievable outcomes and objectives were identified. Encouragingly they also identified the consequence for the resident if the need was not met, highlighting the importance for staff to meet needs. Disappointingly they lacked clear information and guidance for staff in relation to achieving the outcomes. For example one care plan explained that the well being of the resident (with a neurological disorder) is promoted through stimulation and encouragement to use their senses or the resident would become socially isolated. The care plan, however did not inform staff of how to provide the required stimulation. Another plan identified communication as a need, stating that the resident had limited verbal communication and calls out when in distress. The plan informed staff that the resident required patience and interaction to understand and meet the residents’ needs and take the opportunities when the resident is demonstrating that they wish to communicate. The plan did not provide guidance in ways to communicate and interact with the resident, information that should be gained through continual assessment. From observation and discussion with management and staff it was clear that they generally understood the individuals needs and provided a level of care that the residents appreciated. However the absence of clear-recorded guidance for staff to follow does not demonstrate a level of consistency and continuity that residents can rely on in receiving support from staff. Each of the examples sited indicate staff are required to apply their own understanding of achieving the intended outcome. This lack of consistency and continuity does not allow for the resident to become familiar with; and appropriateness of support given, and for staff to be sufficiently confident to deliver safe and appropriate care in the most supportive manner. Particularly in the case of new and inexperienced care staff and may result in the opposite effect to the intended outcome. Based upon observation throughout the inspection, carers did provide a supportive service based, in part, upon intuitive care that is informed by Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 13 broadly agreed and intended outcomes within the plan of care. It seemed that for most part, staff are directed verbally by the manager in carrying out various management strategies particularly supporting residents that are more challenging instead of following an agreed plan of care. The files examined contained records of risk assessments and related risk management strategies however these did not link in with the care planning arrangements and outcomes. One resident presents carers with an ongoing challenge of verbal and physical abuse towards staff. The manager described various diversion approaches that were being explored to ascertain the best way in which the resident may respond to interventions, some of which were reflected within the risk management paperwork. It would benefit staff and the resident if the approaches to be taken were linked within the care planning arrangements relating to the management of all needs and include agreed regular review and evaluation. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. 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. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. 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. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. 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. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 (Young Adults) and 10,12,13, & 15 (Older People) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 15 Opportunities were given to access the nearby community and service users were supported to participate in activities, which are age appropriate and according to their preference, contributing to a fulfilling lifestyle. The service enhances the daily lives of the residents living there through the provision of stimulation and occupation. EVIDENCE: Fern Lodge caters for a wide varying level of dependency and need, including needs associated with the older person. One resident has developed dementia and another has mental health needs. The range of activities and participation within activities is varied and appropriate with resident’s age range, motivation and dependency. Residents were confident and relaxed and there were several examples observed that demonstrated residents enjoy a positive and supportive relationship with carers. Carers spoke with residents in a positive and friendly tone using appropriate language and communication methods. Sensory lights and items, movement mats and a ball pool are provided for residents with sensory, cognitive and mobility needs. Interaction by staff and residents with high support needs was observed continually throughout the inspection and diversion strategies such as a hand massage was also observed for one resident who was unsettled. Various activities were provided in house and ex residents now living in the organisations supported living scheme visit the residents and join in the activities. On the evening of the inspection the visitors arrived to participate in music and movement. Staff spoken with felt the home was in tune with an ordinary lifestyle for the residents and offered opportunities for the residents to access the community and participate in chosen leisure activities individually or as a group; shopping, lunch or coffee outings, cinema and bowling. Festive and anniversary occasions were celebrated. Comments received from residents and relatives indicated satisfaction with the type and level of activities available and with the quality of life they had. Feedback from relatives comment cards indicated that the home was welcoming and encouraged their participation in their relatives care. Most service users participated in menu planning and shopping. Meals were prepared and cooked by the care staff and the more independent service users were given the opportunity to assist, with support. The inspector was advised that meals were an area the home was considering in a quality review. The inspector discussed good practice initiatives relating to improving resident participation and informed choice with pictures or photos to promote visual Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 16 perception and understanding; and to consider dietician review of the menus provided in line with recommended good practice. Records identified the food provided daily for each individual but they did not give any indication of the amount of food and type consumed. Weight monitoring was evident and it was noted that one resident had a consistent gradual weight loss over a six-year period. Whilst it is acknowledged this may not be significant, the lack of sufficient detail in the nutritional records does not enable the records to determine the residents’ appetite or whether a satisfactory diet in relation to the food and amount is consumed. The home provides an informal and homely environment and encourages residents to be as independent as possible. Carers undertake the main support role within the home regarding cleaning, laundry and cooking, and those residents who wish to may participate in these areas. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) Service users retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 (Young Adults) and 8, 9, 10 & 11 (Older People). Quality in this outcome are is excellent. This judgement has been made using available evidence including a visit to this service. Residents are treated with dignity and respect. Residents’ physical and emotional needs are met. Residents are protected by the homes policies, procedures and practices for managing medication. Residents are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 18 EVIDENCE: Promotion of dignity and respect was demonstrated throughout the inspection, including how residents were helped to ensure appropriate appearance and encouraged to maintain their independence about the home. Support from carers, was observed to be given to residents in a way that ensured each person was respected and regarded as an individual. For example carers knocked on bedroom doors before entering, used appropriate language and tone and were patient and attentive to residents at times when individual presenting behaviour was challenging. The home demonstrated close working relationships with the Primary Healthcare team, including evidence of guidance and prompt intervention from healthcare professionals and support organisations. The Manager sits on the local Health Action Group and Health Action Plans (HAP), a Department of Health initiative, were developed for each resident in line with good practice. Health Action Planning is a system introduced to promote wellbeing. The initiative highlights an awareness to identify and record occurrences and observations over a period of time that may otherwise go unnoticed in identifying healthcare needs for people with learning disabilities. The gathered information is recorded and may be used in partnership with the GP in annual health checks and medication reviews. Dental, eyesight and chiropody checks are also recorded within the HAP. Service user’s medication was stored within locked cupboards in their own private accommodation. The current service user’s did not retain, administer or control their medication and required support and assistance. A policy and procedure for the safe receipt, recording, storage, handling, administration and disposal of medicines were in place for staff guidance. Medication was dispensed by the local pharmacy into Monitored Dose Systems (MDS). To monitor and ensure safe practice the manager had recently introduced daily audit checks for the administration and recording of medication. All staff responsible for administering medication will receive further accredited training in this area from Chelmsford, Anglia Polytechnic University in the New Year, in addition to the basic training already undertaken. From conversations with staff and information submitted to the Commission it was evident that the home responded appropriately to the changing needs of the residents at the end stages of life. The ethos of the service to provide a home for life is strongly upheld and a previous request made by two recently deceased residents and their family to continue to be cared for at the home was advocated. The family were supported and stayed at the home during the last days with their relative. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 19 The home sought guidance in their delivery of palliative care from the Community Liason Nurse for Care Homes and provided comfort, sensitivity and dignity. Some residents were bereaved from the loss of two fellow long-term residents during the last six months and had attended the funeral for their most recent loss of a fellow resident the day prior to the inspection day. The staff at the families’ request organised a themed funeral in the residents’ favourite football colours and residents participated in the preparations, including choice of music and theme. Photographs, supplied by the family, were made into a collage by residents and staff, and displayed in celebration of the residents’ life. Openness and inclusion are part of the homes philosophy in supporting the residents through their grief. The experience is handled sensitively and helps to reduce the resident’s fears of death and dying. The planting of a yellow rose bush is being arranged for the spring, at the resident’s request, in memorial for one of the deceased residents, who had a love for the garden and the colour yellow. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 (Young Adults) and 16,18 & 35 (Older People) Quality in this outcome area is good. The key NMS under this outcome heading are generally met but there are some areas of improvement required in other outcome areas that have some impact in this area and will need to be addressed. This judgement has been made using available evidence including a visit to this service. The homes complaint and adult protection policies and procedures are comprehensive and robust to guide staff. The home responds efficiently and appropriately to issues of concern and complaints. Residents’ financial interests are safeguarded. EVIDENCE: The Commission had not received any complaints about the service since the last inspection. The home takes any concerns raised seriously and undertakes appropriate action. The inspector was advised of one concern raised by a Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 21 visitor in relation to staff conduct. This was dealt with formally and appropriately to the satisfaction of the visitor. A record of the incident and the action taken was held on the records of the staff member. The manager was advised to also keep a separate complaints log to identify all issues raised, details of the investigation, action taken and outcome for audit and review purposes. Feedback from residents and their relatives was very positive. Residents were confident to tell the manager or deputy manager if they were unhappy. Three out of five relatives indicated in the surveys that they were unaware of the homes complaints procedure although all said they had never had a reason to complain. This may indicate the reason for a low awareness of the complaints procedure. Written compliments received from ex members of staff and students on work placements from Braintree College spoke highly of the positive experience they received at Fern Lodge, and the tutor of the dementia course commended the staff on their commitment and dedication to the course. An Adult Protection policy and procedure, including Whistle Blowing, was in place, which ran in conjunction with Local policy and Department of Health ‘No Secrets’ guidelines: to guide staff of the steps to be taken in the event of an allegation or suspicion of abuse being reported. The home had not received any abuse allegations. Staff had received in house training on abuse issues and the manager was advised to seek structured training from the Local Authority Essex Vulnerable Adult Protection Committee. Staff would benefit from broader peer participation, shared experiences and discussion. Staff records examined did not demonstrate that new staff had received adequate training in the areas of protecting vulnerable adults. The shortfalls identified in the homes recruitment practice did not serve to help protect residents living at the home. Care files examined demonstrated that physical and verbal aggression by a resident is understood and dealt with appropriately. Mostly relatives, solicitors or guardians carried out current residents’ financial management. The manager was the appointee to manage the income support for two residents. Appropriate lockable facilities are provided for residents to keep their personal money and records were kept and audited regularly. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 & 30 (Young Adults) & 19, 20, 21, 22, 23, 24, 25 & 26 (Older People) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises were in keeping with domestic style living arrangements and equipped to meet the service users’ assessed needs and lifestyles. Fern Lodge creates a comfortable, homely and safe environment and areas seen were clean to a high standard. Individual bed/sitting rooms enabled the service users to express their individuality and promote independence. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 23 EVIDENCE: Fern Lodge is a purpose built building, meeting National Minimum Standards with regard to private and communal space, bathroom and toilets. Individual accommodation was decorated and furnished to a high standard, personalised to each individual and offered en suite facilities, a private sitting area, a kitchenette and access to the garden. Sensory areas, made up of various coloured lights and textures are set up in areas of the home to enhance stimulation for those residents with sensory needs. A rolling programme of redecoration and maintenance was efficiently managed by the permanent employment of a maintenance person. The maintenance person carried out routine health and safety checks and day-to-day repair work of the premises, including electrical personal appliance testing. The home was light, airy and pleasant and the layout of the building enables residents to have garden views from all aspects of the home. The garden provides a pleasant extension to the home. It is well kept and thought out to provide interest and stimulation during the warmer months; with a patio, garden furniture and parasol’s, a sensory garden providing colour and smells and a vegetable patch. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 (Young Adults) and 27,28,29,30 & 36 (Older People) Quality in this outcome area is poor, in that it has some strength’s but one area of particular weakness that requires immediate improvement. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to the needs of the service user’s and staff were aware of their roles and responsibilities. Staff training continues to improve and further initiatives are being undertaken to ensure the development of a skilled workforce. Record keeping and supporting documentation relating to recruiting processes and practices was poor and did not provide evidence of robust procedures carried out to protect service users. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 25 EVIDENCE: The ratios of care staff to service users were determined according to service users assessed needs calculated by the Residential Forum, a tool recommended by the Department of Health. Staff spoken with enjoyed working in the home and demonstrated a good understanding and commitment to the service users within their care. They were aware of their individual roles and responsibilities and felt they received good support and development opportunities from the management. Staff held additional responsibilities for household tasks such as cleaning, laundry, cooking and the kitchen. At the time of this inspection less than 50 of the care workforce had completed a course of learning leading to National Vocational Qualification (NVQ) level 2 in care. This is mainly due to recent staff turnover. The inspector was advised that out of the 17 care staff employed, 5 had successfully completed NVQ and 3 were currently working towards completion. The home had successfully accessed funded places for those staff over the age of 25 years to commence NVQ training in February of this year. The new workers had completed the homes induction relating to policies procedures and arrangements particular to the service user group and service setting. The inspector was advised that the new workers had commenced the Skills for Care Common Induction Standards. The deputy manager was supporting the staff in this process. The responsibility to ensure that those who assess workers against the Common Induction Standards have the skills and knowledge needed to carry out this role was discussed. The Common Induction Standards are an introductory link to each of the NVQ core units at each level and therefore it is of benefit to the learner that the programme is accredited and externally assessed to ensure the evidence provided meets induction outcomes against all of the knowledge requirements. It is recommended that the Common Induction Standards would be of benefit to those care workers who have not yet commenced NVQ training. Ten care staff had completed accredited training in Dementia care. Although the service is not registered to admit residents with dementia, this positive initiative was taken by the home at a time when some residents had changing needs relating to varying levels of dementia, of which there is now only one resident. Recruitment records for the four most recently employed members of staff were examined. All of the files contained omissions in documents required by regulation to help protect residents. Without this information the service cannot determine that the applicants they propose to employ are suitable candidates to care for vulnerable adults. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 26 Specifically, three of the four files did not contain a current satisfactory Criminal Record Bureau (CRB) check. In each case a POVA first check was not obtained prior to commencement of employment and supervisory arrangements undertaken were not evident. This is particularly disappointing since one carer had been employed since October 2006 and one since November 2006. In two cases a CRB was provided however this document was from their previous employment. The manager was reminded of CRB guidance, (a copy of which was sent to the home following the last inspection) and that CRB documentation is not portable from one employment to another. Not all files contained two references and a full employment history had not been explored where there were gaps in the employment history. Two of the staff members were from overseas and the home was unable to provide validated documentation relating to their current status. A copy of a resident permit was noted to be valid until 31st December 2005, indicating it expired one year ago. The manager was requested to address this matter urgently. The most recently employed member of staff was under the age of eighteen years. The individual had commenced employment prior to the receipt of a CRB check or two independent personal references being received. The inspector was informed that this individual was not undertaking personal care and was supervised at all times. There was no evidence available to demonstrate the supervisory arrangements in place with regard to structured induction or an identified qualified staff member to supervise and work alongside the new employee at all times inside and outside of the home, until such time they were 18 years of age. The Manager has a ‘hands on’ approach to managing the home, frequently working alongside care staff providing some practical supervision through daily contact. Staff meetings also provided additional opportunities to discuss concerns or care related issues. Some progress has been made with formal individual recorded supervisions, however these need to be more frequent and fully documented to reflect all the elements necessary to support staff in developing and sustaining their working practice. Staff files examined did not demonstrate that formal supervisions were undertaken regularly, particularly with new staff working on night duty. It was noted that information obtained from the inter net, pertaining to a residents medical condition and associated complex needs was provided for staff and kept in the residents care file. Whilst the provision of information is acknowledged as a positive means to broaden staff knowledge base, further development is required to ensure the reading is complimented by more structured initiatives. This would support staff in their learning and ensure their understanding of a complex subject. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 27 During discussion with the manager it was recognised that steps were being taken to address these areas. The inspector was advised that the manager and deputy manager had secured places on a course ‘How to Get the Best from Your Staff’. The contents of the course include supervision, training mentoring and counselling, coaching and performance management. The outcomes of a staff survey carried out by the home on Staff Stress Management indicated a high positive response with regard to demand of job, level of control on work, support from management, understanding of role, and involvement in change. Some negative response was noted with regard to some staff relationships but mostly this was satisfactory and staff were not exposed to unacceptable behaviour. Action was being taken to improve staff relationships. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 28 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. 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. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 (Young Adults) and 31,32, 35 & 38 (Older People). Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 29 The manager has the required qualifications and experience and is competent in running Fern Lodge. There is a strong ethos of being open and transparent in all areas of running the home. The manager is focused on the individual needs of the residents and communicates a clear sense of direction to her staff. The manager is aware of the areas that require improvement and is improving and developing systems that monitor practice and compliance with the homes plans, policies and procedures. EVIDENCE: The Registered Manager, Mrs Wooliams, has successfully achieved NVQ level 4 in management and care (Registered Managers Award) and an externally accredited modular Dementia Care course. Mrs Wooliams demonstrated a sound knowledge base and an understanding of the residents psychological, physiological and healthcare needs. A commitment to training and development was evident and there was clear evidence of progress in achieving the homes aims and stated purpose. Quality assurance and monitoring systems were not fully in place to meet NMS. Although it was acknowledged the home had begun to address quality issues; and self-monitoring objectives were identified such as supporting people to manage their medication; develop sensory activities with allocated time for residents and menus to include resident participation. There was insufficient evidence available to demonstrate an open and analytical review of the service currently provided, and identify the actions required that would impact on outcomes for residents and ensure continuing improvement. Records relating to maintenance of equipment, utility services, safety systems and risk assessments were in order. These included electrical and gas safety certificates and fire safety and system checks. The home has a maintenance person who maintains the grounds and property to ensure those aspects of safety for residents and staff is maintained. The Environmental Health officer carried out the food hygiene and safety inspection on the same day as the inspection. Food safety assessments, food storage and temperature records were examined. A minor shortfall in records was found. Although this was previously highlighted during the last staff meeting, the manager will address this again. All staff had received food hygiene training and some had recently attended the Safe Food Better Business seminar and received a coaching visit. Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 30 Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 2 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 4 27 4 28 X 29 4 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 1 35 3 36 3 CONDUCT AND MANAGEMENT Standard No Score 37 3 38 3 39 2 40 3 41 X 42 3 43 X 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Fern Lodge Score 3 4 3 4 DS0000017715.V327987.R01.S.doc Version 5.2 Page 32 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 YA2 Regulation 14 Requirement Timescale for action 01/04/07 2. YA6 3. YA34 The registered person must demonstrate that the needs of the service user have been fully assessed prior to their admission and that the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. 15 The registered person must after 01/04/07 consultation with the service user or their representative prepare a written care plan as to how the service user’s needs in respect of his health and welfare are to be met. This is a repeat requirement not met within given timescale of 01/04/06 01/04/07 19 (1) The registered person shall (1) (a) (b) not employ a person to work at (c), the home unless(a) the person is fit to work (5) (d), (9), (10) at the care home (a) (b), (b) you have obtained in DS0000017715.V327987.R01.S.doc Version 5.2 Fern Lodge Page 33 (11) (a) (b) (c). (c) respect of that person the information and documents specified in paragraphs 1-9 of Schedule 2. You are satisfied on reasonable grounds as to the authenticity of the references referred to in paragraph 5 of Schedule 2 in respect of that person. (5)(d) full and satisfactory information is available in relation to the worker in respect of each of the matters specified in paragraphs 1-9 Schedule 2. (9) where the conditions set out in paragraph (10) are satisfied the registered person may permit a person to start work at the care home notwithstanding that paragraphs (1)(b) and (5)(d) have not been complied with in so far as they relate to paragraph 7 of Schedule 2. (10) the conitions are(a) a criminal record certificate has been applied for in respect of the new worker pursuant to section 113 or, if applicable, section 115 of the 1997 act; and (b) full and satisfactory information in respect of the new worker has been obtained in relation to paragraph 7 of Schedule 2 in so far as it relates, where applicable, to sections 113(3A) or 115(6A) of Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 34 the 1997 Act and sections 113(3C)(a) and (b) or 11596B)(a) and (b) of that Act. (11) where a registered person permits a new worker to start work pursuant to paragraph (9) the registered person shall(a) appoint a member of staff, who is appropriately qualified and experienced, to supervise the new worker pending receipt of, and satisfying himself with regard to, the outstanding information in relation to a criminal record certificate; (b) so far as is possible, ensure that the staff member is on duty at the same time as the new worker; and (c) ensure that the new worker does not escort service users away from the care home premises unless accompanied by the staff member. This is a repeat requirement not met within given timescale 01/04/07 The registered person shall establish and maintain a system for evaluating the quality of the services provided at the care home. This is a repeat requirement not met within given timescale 01/04/06 4. YA39 24 (1) 01/06/07 Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fern Lodge DS0000017715.V327987.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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. 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