CARE HOMES FOR OLDER PEOPLE
Fern Lodge 24 - 26 Compton Road London N21 3NX Lead Inspector
Susan Shamash Unannounced 21 July 2005 @ 11.00 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Fern Lodge Address 24 - 26 Compton Road, London, N21 3NX Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8360 6219 Mrs Angela Hunt Mrs Angela Hunt PC - Care Home only 20 beds Category(ies) of OP - Old age registration, with number of places Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 13 January 2005 Brief Description of the Service: Fern lodge is a privately owned registered care home for 20 older people located in a residential area of Winchmore Hill, North London. It is situated within a few minutes walk of public transport services and close to a number of amenities such as shops, churches and GP surgery. The registered provider Mrs Angela Hunt is also the registered manager of the home. Accommodation is provided on the ground floor and the first floors in ten single rooms and five shared bedrooms, all of which meet the minimum spatial standards. None of the bedrooms have en suite facilities, though they are all fitted with wash hand basins. A lift facilitates access to the first floor. The home has a well-tended garden, with a patio accessible through French windows. The stated aim of the home is to ensure that the individuality of care to service users is emphasised; that staff provide this, pay attention to detail, and are highly experienced and professional in their care of the elderly. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately five hours and was carried out as part of the routine inspection schedule for the home and to check on compliance with an immediate requirement made at the previous inspection. There was one vacancy at the home at the time of the inspection. The inspector was able to speak with three members of staff and ten residents during the visit. A tour of the building was conducted and staff and care records were inspected in addition to maintenance records for the home. A basic fire safety audit was also conducted. What the service does well: What has improved since the last inspection?
Five requirements were made at the previous inspection, three of which were met and one of which (an immediate requirement) was partially met. As required all residents have care plans and there was evidence that residents or relatives (where appropriate) are consulted regarding their care plans and this is recorded. More detailed information is also recorded in care plans generated from comprehensive assessments as appropriate. Formal supervision meetings are recorded for every staff member, and details of subjects discussed in these meetings are specified as required. Although there was some improvement in the information stored within staff files, there remain items missing from these files which may compromise the
Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 6 safety of residents, so this immediate requirement is not fully met from the previous 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. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4. (Standard 6 is not applicable.) New service users can be assured that their needs will be assessed prior to being admitted and that these will be met effectively at the home. EVIDENCE: The referring authorities provide a comprehensive assessment of the service users needs and a care plan, which is the basis for planning the care of each service user. Where possible potential service users or their representatives are encouraged to visit the home prior to admission. In general, service users spoken to advised that their needs were met appropriately within the home, and care plans inspected indicated that these were based on comprehensive assessments as appropriate. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Service users have care plans that are generally updated regularly to ensure that their health, personal and social care needs are being met appropriately, however their safety could be further ensured by recent photographs of each service user being available within the home. Medication is stored, administered and recorded appropriately, thus protecting the welfare of all service users. Service users are treated with dignity, sensitivity and respect. EVIDENCE: Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 10 The details of health and personal care recorded, and feedback received from service users spoken to, indicated that the home generally provides a level of care that service users are satisfied with. As required at the previous inspection care plans were available for all service users within the home. However a new requirement is made regarding the need for a recent photograph of each service user to be available. Four service user plans were inspected and were found to include signatures of service users or advocates where appropriate to evidence their consultation as required at the previous inspection. Care plans included sufficient detail to ensure that service users health care needs are provided for, and included monthly care plan evaluations as appropriate. Risk assessments were included within the format of the care plans, however it is recommended that the risk assessment format used for manual handling of service users be used for other risks also, in order to address these areas more fully. Records of medication administration and storage were found to be satisfactory although a recommendation is made regarding the recording of prescribed medicines needed only on an ‘as and when’ (PRN) basis. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. A high standard of provision is made to meet service users’ social, cultural, religious and leisure needs or preferences, and ensure that service users have choice and control over their own activities. Contact with family members and friends is encouraged, so that service users are not isolated at the home. Varied, nutritious and appetising meals are served at the home to meet service users nutritional needs. EVIDENCE: Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 12 The service users spoken to during the inspection were positive about the care provided at Fern lodge. The programme of activities inside and outside of the home was spoken of highly by service users. During the morning of the inspection several service users were escorted to a local social club, and during the afternoon of the inspection a ‘diversion therapist’ encouraged service users to participate in an exercise programme. The manager told the inspector that entertainers visited the home frequently, and a nun gives holy communion at the home regularly for those who are interested in participating, and one service user attends a local church. Some service users had been on a trip to Worthing this year with the local social club. Service users told the inspector that the food was of a good standard with sufficient choices and variety available. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18. The home has appropriate procedures for addressing complaints and concerns raised, ensuring the protection of service users. Appropriate procedures are in place at the home to protect service users from the many forms of abuse. EVIDENCE: Whilst the home has policies that protect the service users from abuse, requirements made regarding recruitment practice, under Standard 29, could leave service users vulnerable. Records of complaints are recorded clearly as are the actions and outcomes, and a clear policy and protection for the protection of service users from abuse is in place. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26. The home is generally bright and open plan, well furnished, decorated and maintained, meeting the needs and tastes of service users. However some concerns are raised over the cleanliness and hygiene practices which may place service users at risk of cross infection. EVIDENCE: Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 15 The building was generally found to be in a good state of repair and decorated appropriately. The home has a homely atmosphere on entering the premises and service users spoken to indicated that they were satisfied with their accommodation. A pleasant garden area is also available to service users at the rear of the home. Bedrooms were personalised as appropriate, and within close access of lavatories and bathrooms, in addition to which commodes were available in most service users’ rooms. The inspector was, however, concerned to note during a tour of the building during the service users’ lunch time, that many of the lavatories were not clean, and that a small number of soiled flannels remained by the sinks in some service users’ rooms. A requirement is made that cleaning procedures and the frequency of laundering flannels at the home be reviewed to limit ensure adequate infection control for all service users. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Adequate and generally appropriately trained staff are available in the home to meet the needs of service users. However training in fire safety is required for all staff members and regular fire drills involving night staff members must be undertaken to ensure the safety of service users. Inadequate information remains stored on each staff file to ensure that service users at the home are fully protected by rigorous recruitment practices. EVIDENCE: Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 17 The employment of new staff and the necessary checks to be undertaken continues to be an issue at Fern Lodge. This is of particular concern as an immediate requirement was made accordingly at the previous inspection. The registered manager needs to ensure that the recruitment procedure is robust and protects the service users. In particular up to date work permits must be available for every staff member and a new enhanced CRB disclosure and two verified references including one from the most recent employer in social care must be obtained prior to any staff member commencing work at the home. Inspection of staff files and discussion with staff members generally indicated that staff receive a range of relevant training and some staff have completed their NVQ and are awaiting verification. The manager advised that staff had completed training in the administration of medication and were awaiting their certificates. It is required that fire safety training be provided to all staff and that the night staff be involved in regular and relevant fire drills for the night shifts in the home. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36, 37 and 38. The home is generally being run with the best interests of service users in mind. The home does not take responsibility for the finances of any service users in the home. Staff receive regular formal and informal supervision, but would benefit from more regular meetings to ensure that they are able to meet service users’ needs to the best of their abilities. An application must be made to vary the registration of the home so that service users who have developed dementia since moving into the home may remain in the home. There is room for improvement in the fire safety procedures, and ensuring that current safety maintenance certificates are available for the home to protect service users.
Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 19 EVIDENCE: Discussion with service users and staff indicated that the manager continues to be supported by her staff team. Service users advised that they felt that the registered person runs the home well and listens to their views. The records of staff appraisals and supervision meetings were up to date as required at the previous inspection. However there were insufficient records of staff meetings taking place in the home and a requirement is made accordingly. It is recommended that the content of informal staff meetings be recorded. The manager advised that the home does not take responsibility for the finances of any service users in the home nor is the manager appointee for any service user, instead relatives or advocates undertake this role. Records indicated that fire drills and alarm tests were being conducted at appropriate intervals. However it is required that some of the drills be undertaken with night staff to ensure that they are clear as to action to be taken during the night shift should there be a fire alert. No current insurance certificate or gas and electrical safety certificates were available at the time of the inspection and a requirement is made accordingly. However certificates were available for portable appliances testing, water chlorination and lift servicing as appropriate. A basic fire safety audit was undertaken by the inspector, and it was noted that the home must produce a written fire risk assessment and emergency plan to be reviewed at least six-monthly. Advice must be sought from the local fire prevention office with regard to the absence of self-closing fire doors on the bedrooms of each service user. An application must also be made to the CSCI to vary the registration of the home so that service users who have developed dementia since moving into the home may remain in the home. Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x 2 x 2 STAFFING Standard No Score 27 3 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 2 2 2 Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 21 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 7 Regulation 17(1)(a) Sched 3(2) 16(2)(k) 23(2)(b) (d) Timescale for action The registered person must 2nd ensure that recent photographs September of each service user are available 2005 within each service users plan. 12th August The registered person must ensure that a review is 2005 conducted of the cleanliness in toilets throughout the home and the frequency at which flannels are replaced in service users rooms to ensure that standards of hygiene and infection control are raised. The bucket chair comode in room 5 must be repaired/replaced. The registered person must obtain all the information detailed in Schedule 2 of the Care Homes Regulations 2001 in writing before a staff member commences work at this home. Copies of items identified as missing during the inspection should be sent to the local CSCI area office. This IMMEDIATE REQUIREMENT is restated. (Previous timescale of 14/02/05 not met). The registered person must Requirement 2. 24, 26 3. 29 19(1)(b) (4)(b) Schedule 2 2nd September 2005 4. 29 19(1)(a) 2nd
Page 22 Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 5. 30,38 13(4)(c) 23(4)(e) 6. 36 18(2) 21(2) Care Standards Act (2000) 7. 37 8. 38 13(4)(a) 9. 38 13(4)(a) 23(4)(a) (c)(v) ensure that she is only employing staff that have current authority to remain, and work in the country. (Previous timescale of 14/02/05 not met). The registered person must ensure that fire safety training is provided to all staff members, and fire drills are arranged for the night staff periodically. The registered person must ensure that staff meetings are held at least six times annually and that these are recorded. The registered person must ensure that an application is made to the CSCI for a minor variation to the conditions of registration, so that named service users who have developed dementia since living at the home, may remain resident at the home. The application must be accompanied by social workers and medical recommendations that each named service user remain at the home. The registered person must ensure that current gas and electrical installation safety certificates and an employers liability insurance certificate are available for the home with copies sent to the local CSCI area office. The registered person must ensure that a written fire risk assessment and emergency plan are available for the home and that these are reviewed sixmonthly. A copy must be sent to the local CSCI area office. The local fire prevention authority must be contacted with regard to the issue of service users bedroom doors not self- September 2005 2nd September 2005 30th September 2005 30th September 2005 2nd September 2005 2nd September 2005 30th September 2005
Page 23 Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 closing. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 7 Good Practice Recommendations It is recommended that the service users manual handling risk assessment format be used for other risks, rather than using the care plans to include information about these risks. It is recommended that the registered person consult with the general practitioner with regard to medicines that could be prescibed as as and when (PRN) medications to simplify recording on the medication administration records. It is recommended that the content of informal staff meetings be recorded. 2. 9 3. 36 Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Solar House, 1st Floor, 282 Chase Road, Southgate, London, N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fern Lodge G59 S10673 Fern Lodge V232432 21.07.05 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
