CARE HOMES FOR OLDER PEOPLE
Fernbank House Fernbank House Torrs Park Ilfracombe Devon EX34 8AZ Lead Inspector
Susan Taylor Unannounced Inspection 18th October 2005 10:00 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 House DS0000055784.V255129.R01.S.doc Version 5.0 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 House DS0000055784.V255129.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fernbank House Address Fernbank House Torrs Park Ilfracombe Devon EX34 8AZ 01271 866166 01271 866166 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) Trevor William Leek Mrs Susan Lorraine Leek Mrs Susan Lorraine Leek Care Home 11 Category(ies) of Dementia - over 65 years of age (11), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (11), Old age, not falling within any other category (11) Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. That the registered manager is Mrs Susan Lorraine Leek. When either of the residents currently sharing Room 8 leaves the home, the registered person will notify the Commission in writing and the particulars and conditions of this registration will revert to those held on the 21st June 2004 27th April 2005 Date of last inspection Brief Description of the Service: Fernbank House is a care home for up to eleven older people who may also have dementia or mental illness. Twenty-four hour personal care is provided for service users. The house is a detached Edwardian Villa set in a conservation area of the town. There is a sloping drive leading up to the entrance with level access. Seating areas are placed strategically around the gardens, which have various focal points. With the exception of one bedroom, all are single. En-suite facilities are available in seven bedrooms. The rooms vary in size and outlook. The accommodation is situated on three floors all served by chairlifts. There is level access on each floor. The accommodation is comfortably furnished and well decorated. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took five hours over one day. Six out of nine residents gave their views, as did three staff. The registered persons were on holiday at the time, which meant that the person in charge did not have access to some of the records that the inspector needed to see. The inspector was able to make judgements about nearly all of the key standards based on feedback, observation and records that could be examined. The focus of the inspection was key national minimum standards covering daily life and social activities, complaints and protection, staffing and management. In addition to this, legal requirements covering recruitment procedures, quality assurance and health and safety issues were followed up. At the last inspection, the people living at Fernbank House told the inspector that they preferred to be referred to as ‘residents’. This term is used throughout the report. What the service does well:
Medicines are managed in a professional way that ensures resident’s healthcare needs are met. There are few restrictions at Fernbank House. Residents are able to maintain close links with their families and friends. Meals are varied, appetising and provide residents with plenty of choice. Residents are able to voice concerns about their care safe in the knowledge that their views will be respected and properly investigated. Residents are protected from abuse by the policies; practices and training that are in place at Fernbank House. The home has a competent team of staff that are in sufficient numbers to meet the needs of residents. There is a training and development culture that ensures that residents are cared for by properly qualified and experienced staff. Resident’s, staff and visitor’s views are respected in this home. The health and safety of residents, staff and visitors is promoted at Fernbank House. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 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 House DS0000055784.V255129.R01.S.doc Version 5.0 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): None EVIDENCE: Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 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): 9 The management of medicines ensures that resident’s healthcare needs are met. EVIDENCE: Medication Administration Record charts are in use and no gaps in the record were seen. All medicines were seen to be stored in a locked cupboard, which was securely affixed to the wall. The medicines policy for the home covered all aspects of ordering, receipt, administration, recording, and disposal of medicines. Staff told the inspector that training on the safe handling of medicines is carried out but there is no system for the regular review of competence to administer. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 10 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): 12,13,14,15 Currently there are insufficient varied and interesting activities to suit individual resident’s expectations, preferences and capacities. There are few restrictions at Fernbank House. Residents are enabled to maintain close links with their families and friends. Meals are varied, appetising and provide residents with plenty of choice. EVIDENCE: An activities programme was displayed on the dining room wall, which the inspector used as a focus of discussion with a group of residents in the lounge. Resident’s comments included: “I’m bored I’d like to go out more or do more activities”. “We normally have a party for birthdays”. “There’s a programme of activities but we don’t tend to follow it”. Records kept of activities completed showed that few activities were recorded since April 2005. The individual social care needs of two service users were tracked by reading two care files. The social history for both had not been completed, and therefore did not provide the team with a background of preferences and expectations about daily living or activities that the individual wanted to be involved in. A mobile library visits the home regularly. Residents showed the inspector large print books that were in the lounge. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 11 The inspector was told, “We get a lot of families visiting”, which was backed up by the large number of entries in the ‘Visitors book’. The inspector observed lunch being served. Alternatives were offered for all courses of the meal. Residents made positive comments about the lunch such as “The food is excellent” and “I really enjoyed my lunch”. The record of meals provided demonstrated that meals are varied, and alternatives are offered at every sitting. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 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): 16,18 Residents are able to voice concerns about their care safe in the knowledge that their views will be respected and properly investigated. Policies, procedures and training to protect residents from abuse are evident at this home. EVIDENCE: Residents told the inspector “If I needed to, I would complain to [the registered persons], I have every confidence in them.” “No complaints at all.” “You couldn’t find a better place. It’s wonderful.” The complaints procedure was displayed in a prominent place. The registered persons were on holiday on the day of the inspection, and staff in charge did not have access to the records that might relate to complaints. Staff were respectful and attentive with residents. The home had an Adult Protection policy that incorporates guidance on Whistle blowing. Staff interviewed had clear understanding of what constituted abusive practice. Both stated that they would have no hesitation in reporting such a matter to the manager and told the inspector “We’ve all had abuse training. We have a zero tolerance here for abuse and have a whistle blowing policy.” The home Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 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): None EVIDENCE: Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 14 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): 27, 29, 30 The home has a competent team of staff that are in sufficient numbers to meet the needs of residents. Recruitment procedures have improved since the last inspection, and therefore protect residents. There is a training and development culture that ensures that residents are cared for by properly qualified and experienced staff. EVIDENCE: Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 15 Residents verified that their needs were well met. Throughout the day staff were observed to have time to carry out their duties. The duty rosters accurately recorded the names of staff, and duties that had been worked. The inspector saw that since the last inspection new staff had been recruited, and was told “We’re fully staffed now”. Staff said that they enjoyed their work and felt well supported. Standard 29 was not fully inspected. The inspector intended to read personnel files for a selection of staff. However, the person in charge of the home did not have access to these whilst the registered persons were away on holiday. Two staff who had been recruited in 2005 were interviewed and verified that references, including CRB and POVA list, had been taken up prior to them commencing employment at the home. The pre-inspection questionnaire received by the Commission earlier in the year verified that a wide range of training had been provided. Two of the care staff on duty had completed the NVQ level 2 award in care. Another member of staff told the inspector that their training needs had been discussed during supervision and that they would be shortly starting the NVQ level 2. The inspector was told that individual training files existed. However, the person in charge of the home did not have access to these. Staff told the inspector that they felt well supported, and had been appraised. New staff verified that the induction course had included care values, health and safety matters, being supernumerary and shadowing the registered manager. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 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): 33,35, 38 Some progress had been made towards the development of quality assurance systems in the home. It was evident that resident’s, staff and visitor’s views are respected in this home. However, the outcome of these measures need to be collated and reported upon to meet the current legal requirements. Whilst one resident was satisfied, the inspector is unable to make an overall judgement about whether the financial interests are safeguarded by accurate procedures and record keeping because these were not accessible on the day of the inspection. This will be followed up with the registered persons. The health and safety of residents, staff and visitors is promoted at Fernbank House. EVIDENCE: A group of residents told the inspector that they had recently completed a survey that asked them for their views about the home. Staff comments included: “I’ve never come across two people who really care like [The
Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 17 registered persons] do” and “they are open to suggestions”. “We’re regularly asked our opinion about the home”. The Commission had not received a copy of the annual quality assurance report since the last inspection. A requirement made at the last two inspections is repeated therefore in this report. One resident told the inspector “[the registered persons] are always asking whether everything’s ok. I couldn’t fault it at all.” The inspector intended to see documentation showing how resident’s personal allowances had been managed. However, the person in charge did not have access to this information. The person in charge told the inspector “most resident’s families take care of their finances”. Touring the building followed up a requirement made at the last inspection relating to health and safety. Windows above ground floor level have restricted opening that meets the Health and Safety Executive guidelines. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 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 x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 x x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 2 x x 3 Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 19 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 12 Regulation 16(2)(n) Requirement Timescale for action 31/01/06 2 33 24(2) 3 35 17(3)(b) The registered person shall having regard to the size of the care home and the number and needs of service users— consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. The registered person shall 17/02/05 supply to the Commission a report in respect of any review conducted by him for the purposes of paragraph (1), and make a copy available to service users. (Previous timescales of 31/1/05 and 30/6/05 not met) 31/01/06 The registered person shall ensure that the records referred to in paragraphs (1) and (2)— are at all times available for inspection in the care home by any person authorised by the Commission to enter and inspect the care home. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 20 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 9 Good Practice Recommendations All staff administering medicines should be regularly assessed for competence as part of the regular supervision process in the home. Fernbank House DS0000055784.V255129.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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