CARE HOMES FOR OLDER PEOPLE
Fernbank 25-27 Gratwicke Road Worthing West Sussex BN11 4BN Lead Inspector
Mrs D Peel Unannounced Inspection 01:00 2 February 2006
nd 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 Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 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. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Fernbank Address 25-27 Gratwicke Road Worthing West Sussex BN11 4BN 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) 01903 202821 South Coast Nursing Homes Limited Mrs Susan O`Connell Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Fernbank is a care home able to accommodate up to thirty-two residents who are over the age of sixty-five years of age. The home is situated in a quiet residential area of Worthing close to shops and other facilities. Communal area consist of a dining room two lounges and additional sitting area in the entrance to the home. The private accommodation is arranged on two main floors that are served by passenger lift/stair lift and an additional mezzanine floor, which is accessed by a short flight of steps. The majority of bedrooms have en suit facilities. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This announced inspection took place over 2.5 hours on the 2nd February 2006 and was carried out by a Regulatory Inspector and a Pharmacist Inspector. This was the second visit to the home this year and it was carried out to complete Fernbank Care Home’s annual inspection programme for the year 2005 required by the Care Standards Act 2000. The inspectors arrived at 1pm and were met by the registered manager, training officer and staff on duty. During the visit the inspector saw the majority of the 21 residents living at the home and spoke with 5 residents at length about there views of the home. The care records of 3 residents were viewed during the visit along with other records, which showed how care needs were being met. Staffs were spoken with informally during the visit to find out what it is like to work at the home and what training has been provided. Not all the National Minimum Standards for Older People were assessed at this inspection but throughout the year all key standards have been assessed. This report may be read in conjunction with the previous report dated 1st August 2005 to gain broader view of the homes provision of a care service. What the service does well: What has improved since the last inspection?
There is an ongoing programme of redecoration within the home, which includes the redecoration of bedrooms when they become vacant. Bedroom furniture is gradually being replaced and new furniture includes a lockable cupboard for residents to use. Some residents have opted to have a lock on their bedroom door and records show that residents are consulted about having locks on their bedroom doors. Further staff have attended Adult protection training and it is anticipated that all staff will attend this training. There has been improvement in the reporting of incidents to the Commission for Social Care and Inspection since the last visit to the home.
Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 6 Many of the radiators at the home now have covers and there is an ongoing programme to cover the remaining unguarded radiators. 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. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 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 the following standard(s): 2,4,5 Prospective residents, their relatives and friends have an opportunity to visit the home to look at the facilities available and assess its suitability before moving in for a trial period. EVIDENCE: A resident who had recently moved to the home spoke about their experience of leaving their own home to move into a care home. This resident had been in hospital and would have found it too difficult to visit the home prior to moving in so a relative and a friend had visited a number of care homes on her behalf and thought Fernbank would meet her needs. The home has a contract which states the fee paid and what the fee covers. The manager confirmed that the number of the room occupied is now written on the contract. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10 Care planning systems give clear information to assist with all aspects of health, personal and social care needs. Records are in place to monitor the health care needs of residents to make sure that any signs of residents being unwell are recognised. The home could demonstrate good medication practices and were keen to implement improvements. Residents are treated with dignity and their right to privacy is respected. EVIDENCE: Three care plans were inspected at this visit with other records being viewed to see how care needs were being carried out. The home is currently introducing a new care planning system which the organisation has provided to ensure that all the homes within South Coast Nursing Homes Limited have a consistent approach to care planning. Records showed that the heath of residents is monitored and that residents have access to the normal heath service professionals. One resident spoke about visits from the district nurses to provide treatment and other residents spoke about visits from the doctor. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 10 Medication policies and procedures were available to staff. Staff who administer medicines had received training from a local college or the supplying pharmacist. Before staff administer medicines on their own, further support and assessment had been given by senior staff, although this process was not recorded. The home had reviewed risk assessment of self-administration of medicines and staff had started to use the new documentation. An internal review of medication handling had identified to staff an improvement to be made in recording medicine administration. Lockable storage was clean and tidy. Eye drops with the manufacture’s directions for cool storage were not stored in a fridge. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 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 the following standard(s): 12 The home provides a lifestyle that respects privacy, dignity and choice, matching resident’s expectations and individual preferences. EVIDENCE: Residents spoken with at this visit were of the opinion that the routines of the home are reasonably flexible. One resident commented that they likes to stay in their room for meals but that staff let him know when there is an activity or form of entertainment taking place so that he can choose to go downstairs and take part if he wants. Another resident commented that they liked their room because it wasn’t far from the lounge and staff were always popping in to see if she was all right. Residents confirmed that the home has different activities taking place and on the morning of the visit there had been a music and movement session, which some residents spoke about. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 18 The home has policies and procedures for responding to adult protection matters training is provided to ensure that staff are able to recognise and report abuse. EVIDENCE: Fernbank has its own policies and procedures to safeguard residents from abuse in addition to the West Sussex Multi Agency policies and procedures. Adult protection training is on the company-training schedule and the inspector was told that staff are encouraged to attend the training Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 13 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 the following standard(s): The home is clean and residents have a comfortable, homely environment to live in. Bedrooms are comfortable and meet the needs of the residents. Residents are encouraged to contribute to making their bedrooms their own by having their own personal possessions around them. Residents may be at risk from a fire emergency should the requirements of the Fire Officer not be carried out. EVIDENCE: At this unannounced inspection Fernbank was clean and well maintained. There is an ongoing maintenance programme at the home, which ensures that the home remains fresh and welcoming. Communal areas feel homely and residents have comfortable bedrooms, which many have personalised with their own possessions. Recently redecorated bedrooms have new furniture, which includes a lockable cupboard. Some residents have chosen to have a lock on their bedroom door whilst records show that other residents have opted to not have a lock fitted.
Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 14 The Fire Officer visited the home on the 20th January and made a number of requirements, which must be carried out within agreed timescales to protect residents from fire emergencies. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None EVIDENCE: Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): There is no formal quality assurance system in place to measure how successful the home is at meeting its aims and objectives and the Statement of Purpose of the home. Resident’s financial interests are safeguarded by policies and practices within the home. Environmental risk assessments are in place, but residents may be at risk from fire emergencies if the requirements of the Fire Officer are not carried out. EVIDENCE: Fernbank does not have a formal quality assurance system. Residents say that the manager does consult with them about daily routines within the home and that they are able to speak to her if they have a “grumble”; however the company does not use a quality assurance system to monitor how far it is succeeding in meeting its aims and objectives and statement of purpose. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 17 The Responsible Individual on behalf of the company has not provided the CSCI with monthly written reports of unannounced visits to the home as required by Regulation 26 of the Care Homes Regulations 2001. Resident’s monies are overseen by their families and advocates. Fernbank then invoices resident’s families and advocates for any additional expenditures, which are not covered by the fee, paid. The Fire Officer has made requirements which must be carried out to protect residents from fire emergencies. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 18 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 x 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 1 4 3 3 4 4 2 3 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 1 1 X 3 X X 1 Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 19 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 OP33OP32 Regulation 26 Requirement Timescale for action 01/03/06 2 OP33OP32 24 3 OP38OP19 13.4(a) 23.4 Regulation 26 reports must be supplied to the CSCI in accordance with Regulation 26.5. (Previous timescales of 1/6/05 and 1/9/05 not met) A formal quality assurance 01/07/06 system must be established. (Previous time scales of 1/6/05 and 1/10/05 not met) Requirements of the Fire Officer 01/03/06 must be carried out. Provider must inform the CSCI by timescale for action as to what steps have been taken to carry out requirements made by the Fire Officer. 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
Fernbank Refer to Standard OP9 Good Practice Recommendations Records should be kept of assessment of competence in
DS0000014515.V279568.R01.S.doc Version 5.1 Page 20 2 3 OP9 OP38 medicine administration Medicines should be stored at temperatures indicated on the manufacturers labelling. The few radiators which remain uncovered should be covered to protect residents. Fernbank DS0000014515.V279568.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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