Inspection on 19/08/05 for Fern Lodge Nursing Home

This inspection was carried out on 19th August 2005.

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

Fern Lodge Nursing Home 08/05/07

Fern Lodge Nursing Home 06/02/06

Fern Lodge Nursing Home 01/02/05

Fern Lodge Nursing Home 19/07/04

Fern Lodge Nursing Home 05/02/04

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

CARE HOME ADULTS 18-65 Fern Lodge Nursing Home 5 Eversley Park Chester Cheshire CH2 2AJ Lead Inspector Maureen Brown Unannounced 19 August 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Fern Lodge Nursing Home Address 5 Eversley Park Chester CH2 2AJ 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) 01244 372288 Fairhome Care Group Ltd Mr Marcus Fluegge Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) Both of places Mental Disorder, excluding learning disability or dementia - over 65 years (5) Both Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1 February 2005 Brief Description of the Service: Fern Lodge is a Victorian, three storey semi-detached house close to the Chester city centre. The home is situated close to a main bus route and ten minutes walk from the nearest shops. The house is also within walking distance of the Countess of Chester Health Park. Bedroom accommodation is on three floors. The home does not have a passenger lift and access to all floors is via a staircase. The bedroom accommodation consists of four twin bedrooms and thirteen single rooms and there are en suite facilities in one of the single rooms. There is an external fire escape. Service users’ primary care needs are due to mental disorder and in accordance with statutory requirements there are Registered Mental Nurses on duty at all times. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 19th August 2005. The total time on site was five hours. The inspector spent an hour and a half planning the inspection by reviewing previous inspection reports and the service history. The inspection included a tour of the home, inspection of records and discussions with eight residents, the manager, the deputy and the support workers on duty. Twenty-nine out of forty-three standards were assessed and most were met. Feedback from this inspection was given to the manager and deputy at the end of the inspection. What the service does well: What has improved since the last inspection? The home has developed an induction pack in line with TOPPS specification. This makes sure that staff are given the correct information and training at the beginning of their employment. Several bedrooms had been redecorated and four bedrooms had been recarpeted since the last inspection. A new double glazed door has been fitted in the smoking lounge. Carpets had been replaced in the main lounge, smoking lounge, hall, landing, stairs and corridors. This had significantly improved the environment for the residents. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 6 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 Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 & 5 Sufficient information is provided for residents to make a decision about moving into the home. Full assessments of needs are carried out to ensure that the home can meet the residents’ needs. EVIDENCE: The home’s service users guide was produced in a bound format and was easy to read. It contained the statement of purpose and function, brochure, service users contract, service users charter, private funding, philosophy of care and the complaints procedure. It also included the inspection report, terms and conditions of residence, management of risk, change of registration and feedback information. Each service user had a copy of this guide. Care plans examined showed that assessments had been carried out with each person before moving into the home. Each service user completed a selfassessment form and the manager completes a referral and pre-assessment document. These were seen on the service users’ files. Each person’s needs were well documented on the pre-assessment forms and this was reflected within the initial care plan. Service users had visited the home prior to admission and overnight trial visits were encouraged. Admissions were planned and ranged from a short visit to overnight stays, dependent on the needs and wishes of the person. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 9 The service users’ contract contained the room number, terms and conditions of occupancy, services provided, fees charged, rights and responsibilities of both parties, arrangements for reviews and services not included in the fees. A copy of this document was kept with the service users plan. A three-month settling in period was given for each new service user. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 The service users health, personal and social care needs are met by the staff team who enable them to maintain their privacy and dignity. EVIDENCE: Four service users’ care records were seen during this inspection. These were well presented in individual folders. Each contained personal information, a photograph, visiting professionals sheet, risk assessments, personal support and daily routines, review sheets and service contracts. The care plans seen were drawn up in consultation with the residents and family and were based on their assessed needs and risks. The care plans were reviewed on an annual basis and in conjunction with the residents. No information was available with regard to service users’ wishes on dying and death. (See recommendation No.1). The care plans were kept in the office and staff and service users confirmed they had access to the information. Risk assessments were in place for all the relevant activities that service users undertook. These included self-medication, finances, smoking, self-neglect, budgeting, nighttime security, room care and verbal aggression. These were up to date and reflected each individuals needs. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 11 Daily record sheets seen showed that significant information was recorded. These gave a very detailed and clear record and were signed by the carers. Service users confirmed they had chosen the décor and furniture within their own bedrooms and it was seen that each bedroom reflected residents’ personality and preferred taste of décor. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 16 & 17 Service users were able to take part in a range of activities of their choosing. Personal and family relationships were encouraged by the home and the staff team supported people with this. Service users dietary needs were well catered for with a balanced and varied selection of food that met peoples’ tastes and choices. EVIDENCE: The service users’ plans reflect the range of activities undertaken, including developing and using practical life skills, attending college and day centres and going to work locally. Service users spoken to said they enjoy going out and about in the community, to local shops, out for lunch, to the pub, meeting family or friends or going to the cinema. The home has access to a minibus that is shared with their “sister home” and all service users can access it. The manager said that some service users access the local education system via the “brookdale centre” attending literacy and computer courses. Other Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 13 service users enjoy occupation through the “Chapter” sheltered employment scheme, local charity shops and stores and one service user enjoys gardening. The service users said that family and friends visited and were made welcome by the staff. Service users shared with the inspector the contact they had with family members and said they could choose to see visitors within their own room or in the shared areas of the home. The menus were seen and these reflected people’s personal choices. The staff encouraged a healthy eating regime. The main meal today was fish, chips and peas. The inspector was invited to join in the mealtime. The service users choose the menus each week. Discussions are taking place with regard to the main meal being served in the evening rather than at lunchtime. This has been requested from the service user surveys that the home initiated. The manager said that he was going to discuss this with the management and the cook. Drinks are available throughout the day and a light meal is prepared in the evening. The staff acted in a very friendly but professional manner with the service users, having a laugh with them and enjoying their company. All the residents have access to the local community. On the day of the inspection many of the service users were out. Some service users had gone to Chester shopping, others shopped locally and some were working locally. The daily routines were good. Each service user had their own preferences for the day. A service user who is in the process of moving back into the community was going to his flat to spend a couple of nights there. Another service user had arranged his own holiday in Scarborough this year. One service user had visited Llandudno and four service users had decided to go together to Port Madoc. All were supported by the staff team according to their specific needs. All residents had keys to their bedroom doors and they confirmed that they could lock the door. They were aware that staff could override this in an emergency. The previous recommendation with regard to developing rehabilitation facilities for the service users remains outstanding. The manager said that he was in discussion with the bed manager to reduce the number of bedrooms available and use the extra rooms to provide a rehabilitation facility. (See recommendation No. 2) Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. 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. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Service users received support from the staff for personal care in accordance with their stated preference. Administration and control of medications were appropriate for the needs of the service users. EVIDENCE: The personal support and daily routine sheets seen described how the service users preferred to be supported in their daily routines. Times for rising and resting and personal care preferences were recorded, as was choice of clothing, hairstyle and makeup. All service users were dressed differently according to their own choice. Service users confirmed that staff supported them in their preferred way and that assistance with any care needs was conducted in private. Storage of medication was appropriate and a monitored dosage system was used. The medication administration sheets seen were signed and up to date. Controlled drugs were stored and administered appropriately. Stock balances were checked on a weekly basis. The home had a medication policy and no homely remedies were administered. The manager said other reference materials included a Medicines and Drug Guide, which showed pictures of Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 15 different tablets. The manager also said that the Royal Pharmaceutical Societies guide to The Administration and Control of Medicines for Care Homes and Children’s Services was also used for reference purposes. Within the care plans records of visiting professional sheets were seen. These recorded visits from and to the GP, hospital, optical and chiropody appointments. Residents spoken to said they access many of these services within the local community with the support of staff if required. The previous recommendation with regard to service users’ privacy in shared rooms had been resolved. Split walls and screens were used within the twin bedrooms. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Residents were satisfied with the support they received from the manager and staff. EVIDENCE: The home’s policy on complaints was seen and it contained timescales to be used in the event of a complaint and details of the Commission. Service users said they would speak to the staff if they had a complaint. Staff confirmed that they were aware of the procedure and would pass concerns onto the manager. The commission or the home had received no complaints since the previous inspection and all relevant paperwork was available in the event of a complaint being received. Service users said they felt “concerns they had would be dealt with appropriately”. A copy of the complaints procedure was displayed on the wall in the main corridor. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29 & 30 The home provided a clean and comfortable environment for the people to live in. EVIDENCE: The home was furnished in a domestic style and service users said that bedrooms were decorated to their preferred style. A selection of bedrooms was seen in agreement with the service users. The home was clean, tidy and free from any unpleasant smells. Records of menus and daily checks on fridge, freezer and hot food temperatures were kept. The Environmental Health Officer had undertaken an inspection on 1st August 2005 and all areas noted for improvement had been complied with except one recommendation, which was currently being dealt with. The laundry room had a commercial washing machine with sluice facility and a domestic style washing machine and drier, which the service users were encouraged to use. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 18 Recommendations in the previous inspection with regard to providing curtains or blinds in the bathrooms had been attended to. Also the upstairs shower cubicle and shower had been replaced. The damaged and worn carpets noted in the previous inspection have been replaced. Residents said “they liked living at the home” and that “they were happy with the environment”. They said that staff had a free and easy rapport with them and this was seen during the inspection. The atmosphere within the home was very good and staff chatted to residents in a friendly manner. The recommendation in the previous inspection about providing separate staff facilities remains outstanding. (See recommendation No. 3) Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 & 36 The manager provided clear leadership. Records were well maintained. Staff received support to enable them to meet residents’ needs. EVIDENCE: Observed day-to-day supervision of staff was good and the staff team confirmed that they were supported by the manager in their delivery of care to residents. The staff said that formal supervision was conducted on a regular basis and records were kept. During this inspection staff were seen providing care for residents in a dignified manner. Whilst assisting with mealtimes staff supported residents in the preparation of the meal as required. Six of the nine care staff have obtained NVQ level II in Care. A Registered Mental Nurse is on duty at all times. Rotas supported this. Mandatory training included moving and handling, first aid, fire awareness and food hygiene. All staff had completed mandatory training. The staff team was established, they were covering two vacancies of a cleaner and cook. Staff had worked at the home ranging from six months to fifteen years. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 20 During this inspection a staff induction pack was seen and noted to be line with TOPPS specification. This had been developed since the previous inspection. The pack was handed out to all new staff. It covered areas such as the staff member’s role, Health and Safety, recording systems and the policies, procedures and guidelines. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. 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 home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39 & 41 Residents’ records were kept safe and secure. EVIDENCE: Records seen were kept in good order. These were in line with the Data Protection requirements. Residents said they were aware of information kept about them. Residents’ files were kept secure. Care plans were discussed with the residents and staff said that residents give full input to the plans, which the residents confirmed. The registered manager said that he had been manager for fifteen years and he is qualified as a Registered Mental Nurse. He had completed the Registered Managers Award in 2004. From discussions it was apparent that he had kept up to date with his training and development. The fire safety officer visited 13.10.04 and made a number of recommendations. A re-visit was completed on 13.7.05 and all recommendations had been completed. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 22 Surveys had been sent to residents, relatives, stakeholders and staff during August 2004. A summary of this questionnaire was found in the service users guide and within the business plan. The manager said that the summary was also discussed with the residents and staff at their meetings. Staff and residents confirmed this. A new questionnaire was sent out in August 2005 and information on this was being collated at this time. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 23 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. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Fern Lodge Nursing Home Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 x 3 x x F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 24 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 Regulation None Requirement Timescale for action 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. Refer to Standard 6 11 28 Good Practice Recommendations The registered person should ensure that information was available with regard to service users wishes on dying and death. The registered person should consider how the home could develop rehabilitation facilities for the service users and space for service users to receive visitors in private. The registered person should provide staff with separate staff facilities. Fern Lodge Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 1 February 2005 Gadbrook Park Northwich CW9 7LT 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 Nursing Home F51 F01 S18746 Fern Lodge V244379 190805 Stage 4.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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