Inspection on 19/03/09 for Fernbank House

This inspection was carried out on 19th March 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fernbank House 21/03/07

Fernbank House 18/10/05

Fernbank House 27/04/05

Fernbank House 08/12/04

Fernbank House 01/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fernbank House Torrs Park Ilfracombe Devon EX34 8AZ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Joanne Walsh     Date: 1 9 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Fernbank House Torrs Park Ilfracombe Devon EX34 8AZ 01271866166 01271866166 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Trevor William Leek,Mrs Susan Lorraine Leek Name of registered manager (if applicable) Mrs Susan Lorraine Leek Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: 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 Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 25 care home 11 Over 65 11 11 11 0 0 0 Brief description of the care home 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. Care Homes for Older People Page 5 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a week day in March and centered around gaining the views of the people who live at the home and those of the staff. We also spent time talking to the registered manager and looking at some of the key documents including pre admission assessments, plans of care, medication records and staff files relating to recruitment and training. This helps us to make a judgment about how well the home is run. Prior to the inspection taking place we also sent surveys to people who live at the home, to some staff and to health care professionals. The results of these and comments from face to face interviews have been included in the main body of the report. Care Homes for Older People Page 6 of 25 The home are asked to complete an Annual Quality Assurance Assessment, which gives us information about how the home maintains a safe environment and tells us what checks, servicing and policies and procedures are in place to ensure safe working practices. This helps to inform the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –03000 616161. Care Homes for Older People Page 8 of 25 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are good systems in place for ensuring all needs are assessed prior to any new people moving into the home. Evidence: The pre admission information for two new people to the service was looked at and discussed with the registered manager. She stated that where possible she will visit the individual either in their own home or other care/ nursing setting and spend time talking to them, their family and any other care givers to ensure she can get a good picture of their needs, wishes and any diverse needs. This helps them to make an informed decision about whether the home can meet assessed needs. Where an individual is funded by a Local Authority, the care management assessment and care plan is always obtained to help the home plan for assessed needs. Care Homes for Older People Page 10 of 25 Evidence: One person spoken to said that they had visited the home prior to moving in and had spoken with the manager about what sort of care and support they needed. One person said in their survey that they had visited with their relative prior to moving into the home. Staff spoken to on the day of the inspection said that they were given good information about any potential new people moving in so that they could plan for their care. One staff member said as we are a small home and small group of carers, it does not take long to get to know the person really well and how best to provide any help. Care Homes for Older People Page 11 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal and health care needs are well met. Evidence: Six individuals were spoken to during this inspection and we received six surveys from people who live at the home. All face to face interviews and surveys gave a very positive view about the care and support provided at Fernbank House. Comments included I feel so lucky to come here, they are marvelous. I knew a few people who had already come here and it has a good reputation and I am happy here.I think the home is a beautiful place with lovely caring staff. All six people who completed surveys ticked always to the question do you receive the care and support you need. The plans of care were looked at for two people living at the home. They show that plans are reviewed usually on a monthly basis and any significant changes to care and support is recorded. Plans identify risks in respect of falls, mobility issues and nutritional screening. Where risks have been identified, clear instructions are in place as to what staff should do to minimise any risks. Care Homes for Older People Page 12 of 25 Evidence: Plans of care could be further developed by including a section on the individuals mental capacity and by including more detail about their preferred routines and preferences for being supported. This would ensure care and support is delivered in a person centered way. Plan should be developed and reviewed with the individual and/or their representative where possible. Health care needs are clearly identified and any visits to the doctor and visits from other health care professionals is well recorded. Two health care professionals completed surveys and gave positive feedback about the home. One said presents a homely and dignified approach to residents. Residents are always in a clean and well dressed condition and appear very happy in the circumstances. Another surveys commented provide a supportive, gently caring environment with a family feel to it. The residents are really well known, understood and respected as individuals. Individuals spoken to confirmed that they could see their doctor when they wished, that a chiropodist visited the home and that optician and district nurse visits were arranged as needed. Staff spoken to on the day of the inspection said that plans of care gave them a good picture of what support needs each person has and they treated people with respect and kindness. Medication records and storage was checked during this inspection. Medication records appeared up to date and accurately maintained. Staff have training in the safe handling, recording and administration of medications before they take on this role and individuals are able to self medicate only once they have been risk assessed to do so safely. Care Homes for Older People Page 13 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals social needs are well met. Evidence: People spoken to and those who returned surveys said that they were happy with the type and level of activities offered in the home. The staff said that they have time in the afternoons to spend quality one to one time talking to individuals and that they often played games and took people for walks if the weather was reasonable. The AQAA said that activities had been changed to incorporate new peoples wishes and needs. It also stated that some people were supported to continue to go to local social clubs and that entertainers are brought in for individuals birthdays and on special occasions. People spoken to felt that the level of activities were sufficient to meet their needs. The local clergy visit to offer communion and if individuals wish they could be taken to local churches or meeting venues as requested. People spoken to, including one visiting relative, confirmed that visitors could come at Care Homes for Older People Page 14 of 25 Evidence: any time and that they were always made welcome. People spoken to expressed a high level of satisfaction with the meals provided. Comments included at lunch we have two choices and staff usually ask us what we would like, I like everything, I do not have a bad word to say about the meals. One survey returned stated a tasty and varied menu. Five out of six people ticked always to he question do you like the meals at the home, one person ticked usually. Meals are served in the dinning room or people can choose to eat them in their room. Support with eating is offered in a kind and respectful way and the lunchtime meal was seen top be relaxed and unhurried. The registered manager said that as they only had 10 people, they could accommodate everyones likes and dislikes within the menu choices. Special diets can be catered for and drinks and snacks are offered though out the day. Fresh fruit was available in the dinning room area and people said that although drinks were offered at set times, extra drinks and snacks could be asked for. Care Homes for Older People Page 15 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views are listened to and acted upon Evidence: All six people spoken to during the inspection and those who returned surveys said that they could make any concerns known to the registered manager. One person said Sue is very good, she always listens to any concerns we have, but there is really nothing to complain about, everything is good here. The home have sated complaints procedure and this is given to people as part of the information they receive when they first come to live at the home. The home keeps a record of any concerns raised and what actions have been taken to resolve issues. Staff spoken to were aware of what they should do should they suspect any form of abuse and said that training in this area had been covered. Staff said that their views were listened to and that they could make suggestions to improve the care and support offered in the home. Staff who returned surveys said they knew what to do if an individual, relative or advocate had concerns about the home. One staff member commented all the staff communicate well with each other and we have a very good team and our managers are very supportive and listen to us. Care Homes for Older People Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Fernbank House provides people with a clean, comfortable and safe environment. Evidence: During this inspection all communal areas and most of the individual bedrooms were looked at. The home is cleaned to a high standard and the domestic staff are commended for their efforts to keep the home clean and free from odour. The registered manager explained that since purchasing the home they have had a systematic programme of refurbishing all the bedrooms and this work is almost complete. Some people have chosen at this stage not to have their rooms redecorated, but those completed have been done to a high standard and provide people with their own comfortable rooms that are personalised. The registered manager explained that they have purchased air flow mattresses so that individuals who are potential risk of pressure areas can have immediate access to this type of equipment instead of having to wait until mattresses can be ordered from community resources. Individuals spoken to and those who returned surveys expressed a high level of satisfaction with the environment. One person did comment if only this sun lunge was Care Homes for Older People Page 17 of 25 Evidence: bigger. Staff spoken to said that there are always plenty of gloves and aprons and that there are clear policies and procedures in respect of infection control. Care Homes for Older People Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are reasonably well trained and supported although recruitment needs to be more robust to help protect individuals who live at Fernbank House Evidence: The staffing levels are sufficient for the number and needs of the current people living at the home. There are normally two care staff on per shift, a cook and a cleaner. The night time is covered with one waking night carer and one sleep in person. Staff spoken to and those who returned surveys said that the staff team worked well together and that they had good training and support from the registered manager. Staff are encouraged to complete National Vocational Qualification training in care and they have 50 or more who have achieved this. Other training that helps people to do their job safely and competently is organised on an as need basis. It would be helpful if the home developed a matrix of training needs to help them plan for training and what updates are required. Three staff recruitment files were looked at. One had no references or details of who the individuals referees were and one had not had their checks completed in respect of them being suitable to work with vulnerable people, prior to them commencing employment. This could potentially place people at risk and the registered manager is Care Homes for Older People Page 19 of 25 Evidence: aware that we will look to take enforcement action if they do not comply with requirement made in respect of this. Care Homes for Older People Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run and in the best interests of the people who live there. Evidence: The registered manager is also the owner of the home. She has experienced and is qualified to run the home. People who live at Fernbank and staff who were spoken to and those who returned surveys all said they were confident in the manager, that she listened to views and opinions. One staff said Any concerns, no matter how small can be discussed with the manager. The views of the people who live at the home are sought via formal questionnaires on an annual basis but also via less formal means, chatting and spending time with the people who live at Fernbank. One person said Sue always finds time to have a chat, make sure I am okay and have no complaints. The home does not have responsibility for anyone personal finances but hold small Care Homes for Older People Page 21 of 25 Evidence: amounts of monies on behalf of individuals for items such as toilets, hairdressing etc. The money is kept secure and records kept of all transactions. The AQAA provided us with information about how the home ensures a safe environment with regular servicing of equipment and maintenance of the building, as well as polices and procedures relating to health and safety in work. Plans of care evidenced that risks for individuals are identified and risks in respect of the environment is also recorded. The registered manager stated that induction covers all key areas as detailed via Skills for care guidelines, but this was not checked as no completed checklists were available. Care Homes for Older People Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 17 The home must ensure that all relevant checks and references are in place before employment of new staff begins To ensure that individuals who live at the home are protected 30/04/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 Plans of care should include an assessment of the individuals mental capacity and should document that plans are developed, shared and reviewed with the individual and/or their representative where possible. Care Homes for Older People Page 24 of 25 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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