Inspection on 08/08/07 for Fern Villa

This inspection was carried out on 8th August 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fern Villa 21/01/09

Fern Villa 22/01/08

Fern Villa 19/12/06

Fern Villa 14/06/06

Fern Villa 07/11/05

Fern Villa 11/07/05

Fern Villa 20/09/04

Fern Villa 17/05/04

Similar services:

Abbey The

Snydale Care Home

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Fern Villa The Green Ellerker East Riding Of Yorks HU15 2DP Lead Inspector Christina Bettison Key Unannounced Inspection 8th August 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fern Villa Address The Green Ellerker East Riding Of Yorks HU15 2DP 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) 01430 422262 01482 666013 Mr Jeremy William Southgate Mrs Rita McDonagh Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th December 2006 Brief Description of the Service: Fern Villa is a care home registered for 23 people over 65 years of age, most of which have some level of dementia. The home is situated in the quiet village of Ellerker, which is close to the M62 motorway. It is a converted house with a modern extension, which overlooks fields at the back and the village green at the front. The first floor is served by a stair lift for less ambulant residents. There is a small sheltered garden with patio furniture and parking area. The home is privately owned. Weekly fees range from £300- £370 per person per week. Information on the service is made available to current service users via the statement of purpose, service user guide and inspection report Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit took place over 1 day in August 2007. Surveys were not posted prior to inspection, however the owner, the manager, two staff and three relatives were spoken to on the day of the visit. The interactions between staff and residents was observed to find out how the home was run and if the people who lived there were satisfied with the care and facilities provided. The inspector looked around the home and looked at records. Information received by us over the last twelve months was considered in forming a judgement as part of the inspection process. Prior to the visit the inspector referred to notifications sent to the Commission for Social Care Inspection, the event history for the home over the past year and the completed pre- inspection questionnaire. The site visit was led by Regulation Inspector Mrs. T. Bettison, the visit lasted 8 hours. Most of the staff appeared caring and treated service users with respect and dignity, however there have been two recent safeguarding adults relating to some staff not respecting service users, these are in the process being investigated. What the service does well: Service users and their relatives are provided with information so that they know what to expect from the home. Most of the residents have a single room that is nicely personalised to their own taste, providing them with a private area to their liking where they can spend private time or receive visitors. Relatives are very involved in the home and are made to feel welcome, making sure that family can keep in contact. Resident’s medicines are looked after well. Residents and their relatives concerns are listened to and staff make sure they take action to sort problems out quickly. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 6 Relatives commented “ the staff are wonderful and the manager marvellous” “All the staff are very nice with the residents” “The food is very nice, it is traditional home cooked food, meat, potatoes and vegetables usually and they adhere to residents preferences, for example one lady doesn’t like gravy so she has her meal dry” “Overall the care is good and mum is happy” Another relative commented “ mum had a very traumatic time at a previous care home was very frightened and nervous on arrival at Fern Villa and in all fairness she is a lot more relaxed and better cared for than she was” What has improved since the last inspection? What they could do better: There has been little improvement made since the previous inspection, and the majority of the outstanding requirements have not been met. From the previous inspection there were 7 requirements made and 9 recommendations and all but 2 requirements and 1 recommendation are still outstanding. At this inspection there have been a number of new requirements added. Relatives commented that areas for improvement are “a large TV and videos/DVD of old films would be nice, more regular activities and stimulation, a separate cleaner as bedrooms are not always clean”. Residents must have a thorough assessment of their health, personal and social care needs so that the staff know what they need to do to meet their needs. All of the service users must have a plan and risk assessments and they must say what staff need to do to make sure the residents health, personal and social care needs are met and that they are protected from harm. Residents need to have a plan of activities/interests and records kept to show that they are happening and staff need to help them to maintain their independence as much as possible. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 7 One resident commented in the survey to the question;- are the staff available when you need them? “ I have needed the toilet several times but there is no one around to ask” and to the question are there any activities arranged by the home that you can take part in? “not very often” and “could do with more cleaners carers cannot do it all” and “I think more staff would help, I get very bored looking at walls and would welcome more entertainment”. When residents have medicines that are taken “when needed” the instructions for staff need to be clear when and why they can help them to take it and staff need to receive training in how to safely administer medication. Staff must be recruited properly and vetted so that residents are protected from harm. There needs to be enough staff in the home so that the staff can meet the needs of residents and carry out all of their duties safely. A relative commented in a survey to the question;- how do you think the care home can improve:- “ by increasing staff particularly early evening when there is usually only 2 carers and when putting residents to bed or getting them ready for bed. There are long spells when other residents are left unattended. By having a big screen TV in view of all residents. More activities- more interaction. Encourage residents to socialise together. Garden needs to be made tidy and safe for residents to use. Dining chairs with arms to make residents safer at the dining table. Occasional outings would be nice. Laundry is in need of a tumble dryer, need to employ a cleaner to free the carers to do their jobs to a better standard.” New staff need to do basic training (induction) in how to work with older people within 6 weeks of starting the job and all staff must be provided with basic training, e.g. fire awareness, first aid, moving and assisting, infection control and basic food hygiene. The home needs to have training plan and all staff need to have an individual training plan and must be provided with training that is directly related to the needs of the residents in the home e.g. NVQ level 2, how to deal with behaviour that may harm residents or staff, how to care for people with dementia. The owner must ensure that the home is safe, clean and comfortable at all times and meets residents individual needs. Equipment and supplies must be checked by a qualified person to ensure that they are safe to use and keep residents safe. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 8 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 Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents have a contract or a statement of terms and conditions that state the fee to be paid and what they can expect from the home. Residents needs are not thoroughly assessed prior to admission, meaning that the manager and staff are not aware of their needs and consideration is not given as whether the home is sufficiently resourced and staff have the skills to meet their needs. EVIDENCE: There have been three new admissions to the home since the previous inspection. All three of these residents have been admitted for short-term care only. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 11 Two of the new admissions care files and a care file of a permanent resident were examined as part of the site visit. None of the files contained a detailed assessment of the residents needs, however one resident had been an emergency admission due to flooding of their property however they hade been in the home some considerable time and an assessment had still not been completed. There were no copies of care management assessments and although the owner had developed an in house document for assessment that covered all of the areas in NMS 3.3, the quality of the recording and information in this document was very poor. Therefore the manager and staff are not aware of what residents needs are and therefore unable to meet them fully. On examination of a care file and the daily recordings it became apparent that one of the service users displays symptoms of a medical condition, when questioned about this the manager responded by saying that she knew the resident was on medication for the symptoms but didn’t know what her medical condition was. This is clearly unacceptable and the manager was advised to undertake thorough assessments of all residents, involving social services where they are the funding authority and ensuring that the residents GP is consulted and medical information detailed. In addition to this consideration has not been given as to whether the home is sufficiently resourced to meet all of the residents needs. (See the staffing section of this report) Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience poor outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents health and personal care needs are met on an informal basis by inadequate numbers of staff, the quality of the residents care plans, risk assessments and recording methods are very basic and do not meet data protection guidelines. These shortfalls have the potential to place people at risk and means that there is the potential for their needs to be not met. EVIDENCE: All residents have a care file and three care files were examined as part of the inspection process. The residents care plans were extremely basic and they did not reflect the full range of needs and do not ensure that all aspects of health, personal and social care needs are identified and planned for and did not detail accurately what staff need to do to meet residents needs. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 13 Because of the inadequacy of the assessment information (completed by the owner) the manager had not been able to develop detailed residents care plans, as she does not have sufficient information to do so. In one care file examined there was a very basic resident care plan that did not cover all identified needs and there were no risk assessments completed. This particular service user has been assessed by the OT as needing a hoist for moving and assisting and one is on order however the staff are having to physically manoeuvre the resident whilst they are awaiting delivery of the hoist. There had been no moving and assisting risk assessment undertaken and the staff have not received training in moving and assisting tasks. This places both the resident and staff at risk of harm /injury. In another care file examined this resident had on a couple of occasions fallen out of bed, there was no risk assessment in place to try to minimise the risk of this happening again. In another care file the resident walks with two sticks and was self medicating, again there were no risk assessments relating to these areas. In general care plans stated e.g. “ 2 x carers for mobility, 2 x carers for personal care, washing and dressing, good diet”. But did not detail what the resident can do for themselves or how they would need or prefer their assistance to be provided. No detail of whether residents preferred a bath or showers, or likes and dislikes relating to food/drinks. There had been no nutritional screening undertaken for anyone. Although relatives are involved in the home, there was no mention of this in care plans and very little information in relation to religious, cultural or other diverse needs. There was no evidence of reviews having taken place on any of the care files. There was little mention of health care needs in plans although there was evidence that GP, chiropody and the district nurse visit residents but very poor recording of outcomes for these visits, it is therefore difficult to track if medical conditions are improving or getting worse. The manager stated that she uses a book for recording everybody’s GP visits and when residents have had a bath and their bed changed. This is antiquated practice and does not protect resident’s personal information, the manager was advised to stop this practice immediately and make all recordings relating to residents in their individual care file. Where residents display behaviours that can be difficult to manage and specific techniques or methods of communication are needed in order to minimise the risks there were no behaviour management plans in place and staff have not received any training in how to work with people that have dementia. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 14 There were no protocols in place for the administration of medication on a PRN basis that specify which medication is to be given, how much and if more can be administered when and how much and in what circumstances. Discussion with staff and relatives suggested that residents basic care needs were being met even though there was a lack of clear plans and guidance. This approach is dependent on staff memory and good verbal communication systems. Residents are at risk of not having their care needs met if these informal systems break down. In addition to this although staff appeared willing and very caring, they are not provided in adequate numbers and did not have the skills, knowledge and confidence to meet resident’s needs due to the inadequate training provision and lack of supervision and staff meetings (see the staffing section of this report). In general the medication appeared to be well managed. The home stored medication securely, a new medicines trolley has been purchased and this was kept in a locked cupboard. The staff personal files indicated that not all staff had completed administration of medication training and there were no records to evidence that they had had their competency assessed. All medication was signed into the home and there were no missed signatures on the medication administration records observed. Stock control was managed and medication was returned to the pharmacy when no longer in use. Some residents are prescribed medication for pain relief and for behaviour management purposes. Protocols for the administration of medication on a “as and when required” basis need to be provided so that staff know when to administer PRN medication and when second doses can be given. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Relatives are involved in the home and keep good contact and wholesome nutritious meals are provided however a lack of activities within the home and community and poor record keeping does not evidence that residents have the opportunity to participate in stimulating and motivating activities that meet their individual needs, wants and aspirations. EVIDENCE: Residents are not being provided with a range of activities, either in-house or within the community there were little or no supporting documentation to evidence that service users needs in this area had been identified, planned for and therefore met. Staff and relatives spoken to said it would be extremely difficult to get residents out into the community for a walk or on a trip given the staffing limitations and the reluctance of residents to participate. In addition to this Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 16 there were limited resources within the home in which to provide stimulation. Staff and relatives stated that the purchase of a large TV and videos/DVD, S of old films would be beneficial and might provoke some discussion and reminiscence. One resident commented in the survey to the question;- are the staff available when you need them? “ I have needed the toilet several times but there is no one around to ask” and to the question are there any activities arranged by the home that you can take part in? “not very often” and “could do with more cleaners carers cannot do it all” and “I think more staff would help, I get very bored looking at walls and would welcome more entertainment”. There was very little information on care files as to how the home are enabling residents to maintain their skills and how their interests and/or hobbies are being supported and a lack of records of activities undertaken. Discussion with staff and relatives indicated that relatives and friends are able to visit the home and can use any of the communal facilities or the residents’ bedroom. There is no restriction on visiting times. The majority of residents have limited communication to express their choices and wishes and promote their independence. Any restrictions are not documented within their care plan. Relatives and staff commented that since the appointment of a new cook the provision of meals in the home is very good. One relative commented “breakfast is usually cereals, porridge and toast, lunch a two course traditional cooked meal with a pudding and tea is often sandwiches or something on toast and they are all offered supper of horlicks and biscuits”. The diet and nutritional needs of residents needs to be detailed in the care plan and include their likes and dislikes and nutritional screening needs to be undertaken for residents who are underweight or have difficulty with eating. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a complaints system and relatives stated that their concerns are listened and resolved appropriately. However due to the unsatisfactory staffing arrangements, poor care plans, and lack of behaviour management guidelines and lack of staff training residents are not protected from harm whilst in the care home. EVIDENCE: The home has a complaints procedure and policies and procedures for safeguarding adults. The CSCI have recently received an anonymous complaint, one element of the complaint was passed to the local authority under the safeguarding adults procedures. The other element of the complaint was that new staff are not completing CRB clearances prior to commencing work at the home and not receiving any induction. This was assessed as part of the inspection process and found to be substantiated. Out of eight staff personal files examined 5 staff did not have a CRB clearance and had not received any induction. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 18 The CSCI also received further information of concern, again one element of the concern was passed to the local authority under the safeguarding adults procedures, a strategy meeting was held and the provider asked to conduct an investigation. This had not been concluded at the time of the inspection visit. Other areas of concern raised that were assessed as part of the inspection visit were;• No assessments or detailed care plans in place and records kept on a shelf in the dining room. This was substantiated and requirements made. • The home smells, not enough cleaning materials and supplies of food limited. This was not substantiated, although the home did smell a little, both staff and relatives said that this was due to the glue used to fit the new carpets and the home doesn’t usually smell. There were adequate supplies of food stored and relatives and staff spoken to state that residents were well fed. D/N attends to dressings in the lounge, as there is no treatment room. This was substantiated and a requirement made. Staff do not have CRB checks prior to employment. This was substantiated and a requirement made. Mattresses are old, soiled and awful. This was substantiated however the manager stated that a number of them have been replaced and it is expected that the rest will be in due course. Carers spend a lot of time doing cleaning, washing, laundry and decorating. This was substantiated and a requirement made. Not enough staff in the home, there are 11 highly dependent service users in the home with dementia and only 2 staff on duty with the manager. This was substantiated a requirement made. • • • • • Some of the residents have dementia and some present behaviour that may pose a risk to themselves and others and staff files examined evidenced that staff have not received training in how to manage residents in times of distress and high anxiety and from examination of records and discussion with staff it became apparent that one of the residents has on occasions assaulted staff. From examination of the accident book it was apparent that one of the residents has had a large number of falls resulting in various injuries from cuts and bruises to a broken nose. Some of these entries had happened when the Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 19 two staff on duty were dealing with another resident and the remaining residents were left unsupervised. (see staffing section of this report). Although the manager stated that she had contacted the falls co ordinator she did not have any information or feedback on her visit and the resident had not been reviewed by the local authority. The manager was advised to call an urgent review and ensure that CPN involvement is sought and care management informed that the home are failing to meet the residents needs and keep him safe. One new member of staff spoken to stated that they “did not yet have a CRB clearance, they have received no supervision and has had no mandatory training and no service specific training and had no previous experience of care work”. Examination of staff files further evidenced that some staff did not have contacts of employment, five staff had not had any induction, all of the staff had not kept their mandatory training up to date and apart from some training in POVA and the key worker system, there had been no service specific training provided. The manager stated that staff have to pay for their own CRB clearances and do not get three paid training days per year. The unsatisfactory staffing arrangements, poor quality and lack of service user plans, poor attention to health needs and outcomes and equipment and supplies not been adequately maintained means that residents are not protected from harm whilst in the care home. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The environment provides residents with comfortable surroundings in which to live, however poor attention to maintenance and lack of cleaning does not ensure that the home is clean and safe. EVIDENCE: Fern Villa is situated in the quiet village of Ellerker, which is close to the M62 motorway. It is a converted house with a modern extension, which overlooks fields at the back and the village green at the front. The first floor is served by a stair lift for less ambulant residents. There is a small sheltered garden with patio furniture and parking area. The home is privately owned. The manager, staff and relatives commented that the home had been looking very shabby and had been in need of redecoration. The owner has undertaken redecoration in lounges, the dining room and some bedrooms. Some bedrooms Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 21 have had new carpets and laminate flooring has been fitted in the entrance hall and dining room. The home is a pleasant environment in which to live and meets resident’s needs, however outstanding recommendations have not been met since the previous inspection are as follows; • • • • • The call system must enable the service users to use it from any point in their rooms without the need for inappropriate adaptations. Service users’ bedroom doors must be fitted with appropriate locks and thereby enhance their privacy and dignity or a risk assessment completed which details why it would not be safe to do this. The routine checks of the hot water outlets should be recorded so that the checks are verifiable. Old furniture must be removed from the gardens. Loose paving slabs must be made good so that they do not pose a health and safety hazard for residents who may wish to walk in the garden. These are now required to be attended to. There has been poor attention to maintenance of equipment and services and some relatives commented that resident’s bedrooms have been found dirty. The staff have to clean as well as provide care to the residents. Given the staff hours in the home this is unacceptable and the registered person must review the care staff hours provided and give consideration to employing a cleaner. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The current staffing arrangements are not sufficient to meet the needs of the residents, staff are not being adequately recruited, supervised and both mandatory and specialised training is unsatisfactory placing residents at risk. EVIDENCE: The inspector was informed that the home currently has 14 staff in total, comprising of • • • • 1x Registered manager 1x cook 11 x care assistants 1 x gardener/handyman that works Fridays only The rota evidenced that there are 2 care assistants allocated per day shift and the manager works as carer from 7.30am – 12.00. There are also 2 waking night staff. The home currently has 14 residents living at the home of which most of them have dementia. Staff confirmed that the majority of residents need 2 staff to assist with their personal care and in addition to this the records evidence that there have been increased incidences of falls and difficult behaviour. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 23 Staff have the responsibility of cleaning bedrooms, bathrooms and all communal areas, supporting service user to attend appointments, activities, and in addition to this attend to the care needs of residents. One resident commented in the survey to the question;- are the staff available when you need them? “ I have needed the toilet several times but there is no one around to ask” and to the question are there any activities arranged by the home that you can take part in? “not very often” and “could do with more cleaners carers cannot do it all” and “I think more staff would help, I get very bored looking at walls and would welcome more entertainment”. Examination of staff files further evidenced that some staff did not have contacts of employment, five staff had not had any induction, all of the staff had not kept their mandatory training up to date and apart from some training in POVA and the key worker system, there had been no service specific training provided. The manager stated that staff have to pay for their own CRB clearances and do not get three paid training days per year. A training plan was not available and the home does not have 50 of staff qualified to NVQ level 2. A relative commented in a returned questionnaire “ to our knowledge very few staff have qualifications. Several have many years experience and skills. We don’t feel that all the staff are fully aware of how to cater for the needs of residents with dementia” And in response to the question;- how do you think the care home can improve:- “ by increasing staff particularly early evening when there is usually only 2 carers and when putting residents to bed or getting them ready for bed. There are long spells when other residents are left unattended. By having a big screen TV in view of all residents. More activities- more interaction. Encourage residents to socialise together. Garden needs to be made tidy and safe for residents to use. Dining chairs with arms to make residents safer at the dining table. Occasional outings would be nice. Laundry is in need of a tumble dryer, need to employ a cleaner to free the carers to do their jobs to a better standard.” None of the staff had had an appraisal and none have received any supervision, in addition to this there was no evidence that any staff meetings had taken place. The registered person is required to review the staffing structure and improve the care staff hours provided in the home to ensure that they can meet the Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 24 needs of the residents and to ensure that staff are appropriately trained for their role. The registered person is also required to ensure that staff are up to date with all mandatory training and service specific training is provided in dementia and managing behaviour that may pose a risk to themselves or others and medication training that includes a competency assessment. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 36, 37, and 38 Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. The management and conduct of the home is unsatisfactory and does not demonstrate that it is acting in the best interests of the people that live there. EVIDENCE: Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 26 The manager of the service has had some time away from the home and at the time of inspection had only been back at work for a week. All staff and relatives spoken to said she was very caring, supportive and approachable and is trying her best. However the owner of the home is responsible for all areas requiring financial input and that is where the problems appear to lie. A number of the requirements made although do not require any financial input the limited staff numbers mean there is not time to complete the work required and attend training without leaving the home short staffed. There is a lack of detailed residents care plans and guidelines, poor attention to providing both mandatory and service specific training. Risk has not been managed effectively and therefore service users are not being protected from harm. Incidences of behaviour management are not being managed appropriately and recorded and monitored and no action has been taken to address this. The restrictions of the current staffing structure and number of care hours provided within the home mean that although the staff are willing they do not have the time within the shift to undertake all of the duties required to ensure that service users complex personal, health and safety needs are met and that a range of activities are provided that meet their diverse needs. The manager could not find evidence that supplies and equipment had been serviced/maintained appropriately; this does not protect residents from harm. The registered person is required to ensure that the following certificates and records are located/arranged and retained on site. • • • • • • • • Bath hoist- last serviced in April 2006- no maintenance since. Premises electrical hard wiring certificate – no records available Portable Appliance Tests – no records available Fire detection and fighting equipment - the owner checks these and the last date was 29/8/96 Emergency call equipment- – no records available Oil Heating system– no records available Water temperature testing – no records available Fire officers report dated 24/4/06- indicated a number of areas that needed attention. The fire officer has been contacted by the inspector and states they have received a letter from the owner stating that all areas have been attended to. Wheelchair checks – no records available. Legionella safety- no records available • • Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 27 • • Environmental Health Food Safety Act - requirements made. The manager stated that all requirements had been met however the inspector has requested a follow up visit from environmental health. The Fridge/Freezer needs to be repaired/replaced due to a broken handle. The owner undertakes regulation 26 visits on a monthly basis however this has failed to be effective in highlighting the areas for improvement and identifying how compliance with regulations/requirements from statutory agencies will be addressed. None of the QA documentation was examined by the inspector during the site visit. Residents care files were kept on a shelf in the dining room and the manager stated that she uses a book for recording GP visits and when residents have had a bath and their bed changed. This is antiquated practice and does not protect resident’s personal information, the manager was advised to stop this practice immediately and make all recordings relating to residents in their individual care file. In addition to this care files must be kept in a locked cupboard to ensure residents personal information is kept safe and secure as per the Data Protection Act 1998. Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x 3 1 1 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 2 x x 2 x 2 2 x STAFFING Standard No Score 27 1 28 1 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 x x x x 1 1 1 Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 14 Requirement The registered person must ensure that residents are thoroughly assessed prior to admission (a copy of the care management assessments must be on file) so that the staff are aware of and are able to meet resident’s needs and the home must not admit residents whose needs they cannot meet. The registered person must ensure that resident’s health, personal and social care needs are set out in a plan of care so that staff are aware of and able to meet residents needs. Timescale for action 31/10/07 2 OP7 15 31/10/07 3 OP7 13 (4) The registered person must 31/10/07 ensure that risk assessments are undertaken with particular attention to falls, moving and assisting and the management of difficult behaviour so that residents are protected from the risk of harm. The registered person must ensure that resident’s health DS0000019669.V348245.R01.S.doc 4 OP8 13 91) 31/10/07 Fern Villa Version 5.2 Page 30 needs are identified and met and that recordings of visits from health professionals clearly evidence outcomes for residents so that it is clear that resident’s health needs are being met . 5 OP8 12 (2) The registered person must ensure that a review of the bathing routines for service users is undertaken to ensure that they receive a bath at a time and frequency of their choosing so that residents are able to exercise choice. A formal programme of nutritional screening for the service users must be developed. Advice on this programme should be obtained from an appropriate health care professional such as dietician so that staff are know when residents are at risk of malnutrition and can take steps to prevent this. 31/10/07 6 OP8 12 (1) 31/10/07 7 OP8 12 (1) The registered person must 31/10/07 ensure that a set of sit-on scales is made available so that staff can weigh those service users who are not weight bearing to ensure that none of the residents are underweight and suffering from mal nutrition. The registered person must ensure that when residents are self-medicating that an assessment of their competence to undertake this is completed and lockable facilities are provided so that residents are protected from harm. The registered person must ensure that when residents are DS0000019669.V348245.R01.S.doc 8 OP9 13 (2) 31/10/07 9 Fern Villa OP9 13 (2) 31/10/07 Page 31 Version 5.2 prescribed medication on a as and when basis that a written protocol is in place advising staff under what circumstances it can be administered so that residents are protected from harm. 10 OP9 13 (2) The registered person must 31/10/07 ensure that all staff who administer medication have received appropriate training and are assessed as competent so that residents are protected from harm. The registered person must ensure that resident’s consultation with and treatment by health professionals is carried out in a private area to ensure that resident’s privacy and dignity is respected. The registered person must ensure that all records relating to residents are maintained in individual care files to ensure their privacy is respected. The registered person must ensure that a programme of social activities for the residents should be reviewed to ensure that it meets with individual’s needs and wishes. The registered person must ensure that resident’s interests and hobbies prior to moving into the home are respected and opportunities to continue these are provided, in order for residents to partake in activities and hobbies that meet their individual wants and aspirations. 31/10/07 11 OP10 12 (3) 12 OP10 17 31/10/07 13 OP12 16 (2 m and n) 31/10/07 14 OP12 16 (2 m and n) 31/10/07 Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 32 15 OP18 13 (6) The registered person must ensure that residents are protected from harm by the provision of training in how to deal with behaviour that is difficult to manage and safeguarding adults training and staff must not start work until they have been appropriately vetted. (CRB Clearance) 31/10/07 16 OP19 23 The discarded/unwanted 31/10/07 furniture must be removed from the grounds of the care home to ensure that residents live in a comfortable and safe environment. (This was a requirement from the previous inspection and is not met) The registered person must refit the paving slabs in the garden to ensure that they do not pose a health and safety hazard. 31/10/07 17 OP19 23 18 OP22 23 The registered person must 31/10/07 ensure that call system is more flexible and enables the service users to use it from any point in their rooms without the need for inappropriate adaptations so that residents are able to request help when they need it. The registered person must ensure that service users’ bedroom doors are fitted with appropriate locks and thereby enhance their privacy and dignity. Where this is not possible due to the complex needs of resident a risk assessment must be undertaken and a copy held on file. The registered person must ensure that routine checks of the DS0000019669.V348245.R01.S.doc 19 OP24 23 31/10/07 21 Fern Villa OP25 23 31/10/07 Page 33 Version 5.2 hot water outlets are recorded so that the checks are verifiable so that residents are protected from harm. 22 OP27 18 The registered person must review the care staff hours and provide sufficient numbers of staff to meet the assessed needs of residents at all times and enable stimulating activities to take place. Additional staff must be recruited to allow care staff more time to spend with service users on an individual basis and to free the manager to do her duties. (This requirement is outstanding from two previous inspections) The registered person must provide domestic staff to ensure that the home is maintained in a clean and hygienic state and free from dirt and unpleasant odours. Records for staff, which must be kept in the home, must include all the information listed in schedules 2 and 4 of the Care Homes Regulations 2001. This must include copies of the staff’s Contract of Employment and verification that the vetting procedure has been fully undertaken such as copies of personal references and CRB checks. This is to ensure that staff working in the home are suitable and that residents are protected from harm. (This requirement is outstanding from the previous two inspections and is not met). 31/10/07 23 OP27 18 31/10/07 24 OP27 18 31/10/07 25 OP29 19 31/10/07 Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 34 26 OP30 18 The registered person must ensure that all staff receive formal induction training within 6 weeks of commencement in post so that they know what is expected of them and what the residents needs are and are able to meet them. The registered person must ensure that all staff receive at least three paid training days per year so that they are skilled and competent to meet residents needs. The registered person must ensure that the home has a staff training and development programme that ensures staff meet the aims of the home and meet the needs of the residents. The registered person must ensure that all staff receive mandatory training to assist them to carry out their duties safely including the following topics: Moving and assisting Basic food hygiene First Aid Infection control Fire safety They should also receive training in National Vocational qualification level 2 and in subjects relating to the ageing process. (This requirement is outstanding from two previous inspections). 31/10/07 27 OP30 18 31/10/07 28 OP30 18 31/10/07 29 OP30 18 31/10/07 30 OP30 18 The registered person must ensure that all staff receive training in how to meet the DS0000019669.V348245.R01.S.doc 31/10/07 Fern Villa Version 5.2 Page 35 needs of residents with dementia and those that present behaviour that is difficult to manage so that staff are clear about their roles and responsibilities and that they can keep themselves and residents free from harm. 31 OP31 9(2)18 The registered provider must ensure that the registered manager has the time off rota needed for her to ensure that all the records as required by the Care Homes Regulations 2001.Schedule 4 can be properly and fully maintained. (This requirement is outstanding from the previous two inspections). 32 OP37 17 The registered person must 31/10/07 ensure that resident’s personal information is kept secure, up to date and in good order and are constructed, maintained and used in accordance with the Data Protection Act 1998 and other statutory requirements. The registered person must ensure that the home is safe by obtaining certificates of safety for the following;• • • • • • • • PAT Electrical hard wiring Emergency call system Bath hoists Wheelchair checks Water temperature checks Evidence that the water is free from the legionella bacteria. Oil Heating system 31/10/07 31/10/07 33 OP38 23 Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 36 34 OP38 23 The registered person must repair/replace the fridge/freezer with a broken handle. 31/10/07 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 OP12 Good Practice Recommendations The registered person should consider the purchase of a large screen TV and videos/DVD’s and activity resources for use in house. The registered manager should inform the Commission when she has completed her National Vocational qualification level 4 in the management of care. The registered person should review the manager’s job description to ensure that it is appropriate and that it enables her to fully undertake her management duties. It is also recommended that a deputy manager be appointed to act in the absence of the manager and thereby provide management continuity for the staff, service users and visitors to the home. The registered person should consider providing the staff with appropriate facilities to enable them, for example, to discuss confidential matters without being overheard by the service users. This is particularly important during staff shift changes. 2 OP31 3. OP32 Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Fern Villa DS0000019669.V348245.R01.S.doc Version 5.2 Page 38 - 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. 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