Inspection on 21/03/07 for Fernbank House

This inspection was carried out on 21st March 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fernbank House 19/03/09

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fernbank House Fernbank House Torrs Park Ilfracombe Devon EX34 8AZ Lead Inspector Susan Taylor Key Unannounced Inspection 21st March 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 Fernbank House DS0000055784.V328619.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. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernbank House Address Fernbank House Torrs Park Ilfracombe Devon EX34 8AZ 01271 866166 F/P 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.V328619.R01.S.doc Version 5.2 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 18th October 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. The current fees range from £306 - £400 per week. Additional charges are made for hairdressing (dependent upon individual requirements), chiropody (£10 per session), toiletries and newspapers (dependent upon individual requirements) Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Fernbank House is a care home for older people, some of who may have dementia or mental health problems. A key unannounced inspection took place on the 21st March 2007 beginning at 09:30 a.m. lasting approximately 7.5 hours. The inspection included a full tour of the home and discussion with the manager and care staff. The inspector also spoke to a number of residents and who gave their opinions on the care, activities, food, environment and staff. The inspector also observed care that two residents received. Surveys were sent to three residents, three relatives, three staff and five health and social care professionals. Comments from the people who responded are incorporated within the report. What the service does well: Fernbank House is a homely place to live. The home obtains important information about residents prior to agreeing to their moving to the home. This helps to reduce the risk of an inappropriate admission to the home and ensures that the team can meet peoples’ needs. The manager is excellent at assessing people’s needs and putting in place aids and equipment to improve their care. Care plans centre on the needs of the person living at the home and give the team good information about how they should care for that person. The team of staff maintain good links with other healthcare professionals that are of benefit to residents. People think that the care is very good and are “very lucky to have a place” at Fernbank House. People living at the home say that there are plenty of planned and spontaneous activities that they can choose to take part in. Comments like “There’s plenty to do if you want to. I say order me a taxi and they do” and “we can go out to church if we want to” were typical of what people said. The activities and outings are tailored to meet people’s needs and are suitable for older people, some of who have dementia or other mental health problems. Meals are home cooked and plentiful. At lunch, people said things like “it’s lovely” and “I really enjoyed it” and “I can’t eat another thing, I’m so full” when asked if they would like more. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 6 There are policies and procedures that protect vulnerable people, including dealing with complaints. Residents say that they can voice their concerns and feel that staff listen them to. Residents said that staff were kind and very caring. The manager encourages staff to do training so that they all keep up to date and understand how to care for older people and people with dementia or mental health problems. In terms of health and safety, residents say that they feel safe at Fernbank House. The home is clean, comfortable and well maintained. The manager and staff follow very high standards to prevent people from becoming ill through infection. What has improved since the last inspection? What they could do better: Records about tablets that people take need to show when people are doing this for themselves as opposed to when staff give help to take them. A recommendation has been made. The home needs to have up to date information about protecting vulnerable people. Devon County Council has guidance on it’s website that the manager can read and download about this. A recommendation has been made. The manager has not followed the procedure when employing new staff, which ensures that they have the right people to care for residents’. The shortfalls seen would put residents at risk. A legal requirement has been made. The registered manager said that they would prioritise this. The Commission has guidance on it’s website that will help the manager to do this. Important views from residents, relatives, other visitors and health and social care professionals have been listened to. However, the home hasn’t written Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 7 these down so that everyone knows when the home is improving or when something needs to be done to improve. A recommendation has been made. The manager needs to record when staff receive induction training and are supervised so that they can show that they have helped staff to work safely been given support and guidance to care for residents. A recommendation has been made. 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. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 8 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.V328619.R01.S.doc Version 5.2 Page 9 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): 3&6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective residents are given comprehensive information about Fernbank House that enables them to make a decision about whether it is the right home for them. The home has an excellent admission procedure. It is risk based and completely person centred so the team are clear about exactly what the resident wants from them. A judgement is not made about intermediate care as this is not provided. EVIDENCE: The inspector observed that every resident had a copy of the statement of purpose and service user’s guide in their room. These documents document are laid out in large print, and provide detailed information about: Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 10 accommodation, facilities, admission criteria, organisational structure and terms & conditions of residency. In a survey, a resident verified that they had received enough information about the home that enabled them to decide to move in. A resident said we consider ourselves very lucky to have a place here. Three care files were examined and people’s needs were tracked to establish whether the care delivered was appropriate. The manager told the inspector that they assessed prospective residents prior to admission to ensure that their needs could be met at the home. The inspector spoke to three residents who verified that this had been the case. Detailed assessments were seen on all the files, which gave a really clear picture of each person. Risks covering nutrition, tissue viability, falls, manual handling, and continence had been assessed and there was a comprehensive plan setting out how each of these would be minimised. All of the assessments had been regularly reviewed. The manager verified that the home does not offer intermediate care. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 11 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 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Fernbank House has a good care planning process that provides clear information about the needs of the residents and how they are to be met. The home maintains good professional relationships with specialist people and implements their advice to the benefit of the residents. Good risk management was seen that ensures residents are cared for safely. Procedures are followed so that residents receive the right medication, as prescribed, at the right time. Following assessment, the home needs to ensure records reflect decisions made that enable people to self administer certain medicines so that individuals receive continuity of care from the staff. EVIDENCE: Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 12 A resident verified in writing that the always received the care and support they need. Additionally that medical support was always available. Two staff in surveys verified that they were given clear instructions about how they should work with residents and what their individual needs were. The inspector examined three care files and saw that the home uses a template to identify needs for each resident. All of the care plans included good details about the people’s preferred personal care routines that had been obtained at assessment and encouraged their independence and participation in the process. Additionally, all of the care plans contained clear summaries of individuals’ needs and actions and goals. The Commission had been notified of an incident earlier in the year in which a resident with dementia had fallen down an external fire exit. The inspector tracked the care of a person with dementia by observing how the staff interacted with them and also spoke to their relative. The individual’s care plan stated that staff needed to be aware of the person’s whereabouts at all times, that they needed prompting at mealtimes and needed help with personal care. Additionally, the person’s social history included important information about their past life and occupation, which gave a sense of who they were. The manager had encouraged the person’s family to assist the home in gathering relevant information about the individual to improve the planning and delivery of care. In terms of care outcomes for the individual, the inspector saw that staff were attentive and regularly checked on their whereabouts. Staff communicated appropriately with the person, in a calm and patient manner that allowed the person sufficient time to process what was being said. The inspector observed them speaking simply and slowly, using touch appropriately to reinforce what had been said. Accommodation was discussed with the person’s relative. The inspector was told that although they had freedom to go wherever they chose to, staff were “very strict” about not letting them go upstairs on their own in case of falls. The relative felt that this was completely appropriate and said, “this is a very safe place” to live. Staff verified that a pressure mat was used to alert them if the resident left their bedroom at night so that they could encourage the person to go back to bed or stay with them until they settled. The inspector saw evidence on the person’s care file verifying that the home was in regular contact with the GP, consultant psychiatrist and community psychiatric nurse about the individual’s care. In other files that the inspector examined letters seen demonstrated that the home has a professional relationship with the general practitioner with whom all the residents are registered. In addition to this there are good links with the mental health and social services teams. The home had clear policies and procedures about risk assessment and management, which had been implemented. All of the care files had guidance on action to be taken to minimise identified risks with regard to nutrition, tissue viability, falls, manual handling, and continence. All of the assessments Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 13 had been regularly reviewed. The inspector particularly looked at the decision making process linked to the use of bedsides. Detailed records were seen in an individual’s care file that were explicit and clarified why bedsides were being used for that individual. It was apparent; that the team had carefully considered the risks and had outlined measures to ensure that bedsides were used safely for the individual concerned. Two out of three staff files examined had evidence to verify that person had been assessed as competent to handle medicines safely. This was further verified when the inspector spoke to one of the staff that said that the manager “had worked alongside [them] to ensure that I do it safely”. Another person had attended a ‘Safe handling of medicines’ course and a certificate was seen in their file. The inspector observed the manager administering medication after lunch. Good practice was seen. The home uses a monitored dosage system. Secure storage facilities are used, which meet legal requirements. The manager verified that she is responsible for stock taking and the inspector examined records that demonstrated that this is done on a monthly basis. At the same time, the manager told the inspector that when she was on duty she tended to do the medication round. Records of ordered medication and a register of controlled drugs were seen and tallied with what was stored. The system was easy to audit and the inspector tracked medication administered to three residents. Records accurately reflected medication having been administered as prescribed by the GP. However, records did not record the fact that one person was self administering an inhaler (salbutamol). This was discussed with the manager who told the inspector that she would rectify this. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 14 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 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has increased access for residents to a wide range of social, cultural and recreational interests. Routines and activities are flexible and suited to individual residents needs in terms of their age, gender, culture and abilities. Residents are enabled to exercise choice and control over their lives whilst at the same time encouraged to maintain contact with friends and family in the community. Nutritional and personal preferences of residents are well met. EVIDENCE: The inspector was shown a diary of events, outings and activities that demonstrated that residents had access to a wide range of social, cultural and recreational interests. The manager told the inspector that the team had worked hard to increase the level of outings and activities for people living at the home and had ensured that records were kept to demonstrate this since the last inspection. Social, cultural and recreational interests that people had Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 15 been involved in included visits to the local theatre and places of interest such as Tapley Gardens, aromatherapy, celebratory events such as birthday and Christmas parties, and shopping trips. These had taken place in groups or 1:1 with the individual’s key worker. The inspector saw that the home has a large supply of videos and library books in large print. A resident who had partial sight told the inspector that the library books were changed regularly by the library service. In a survey, a resident wrote that there are usually activities arranged by the home that they could take part in. The inspector spoke to four residents who said things like, “there’s plenty to do if you want to. I say order me a taxi and they do” and “we can go out to church if we want to”. Speaking about the activities for a relation with dementia, a relative said, “carers take her out”. On entering the home, the inspector signed the visitor’s book and saw that a lot of people visit the home for all manner of reasons. The inspector felt that there was an open feel to the home as residents were observed answering the door to visitors and welcoming them in. Relatives told the inspector that they were welcome to visit whenever they wished to and did so often without notice to the home. Lunch was served during the inspection, which was a well balanced, appetising meal of three courses. The meal incorporated plenty of fruit and vegetables. Informal feedback was obtained from residents throughout the meal who made comments like “it’s lovely” and “I really enjoyed it” and “I can’t eat another thing, I’m so full” when asked if they would like more. The inspector observed the care of two particular residents during lunch. One person needed encouragement in the form of prompting to eat their meal. The other person needed to be fed. The inspector observed that this was done by a carer who focussed all their attention on the individual concerned chatting with them, gently explaining what was on the plate and at a pace that suited the resident. Equipment such as plate guards were used, which enabled one resident to continue feeding themselves without assistance and so promoting their independence and dignity. A record of meals provided was seen and demonstrated that people living at the home have a varied menu. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 16 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 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Fernbank House’s arrangements for the protection of vulnerable adults, including dealing with complaints generally ensure that residents are protected and able to voice their concerns. The manager should obtain a copy of the revised guidance and procedure for protection of vulnerable adults. EVIDENCE: A service user verified in writing that they knew who to speak to if they were unhappy and also that they knew how to make a complaint if they needed to. On a tour of the building the inspector saw that there was a copy of the brochure and guide in every persons bedroom that covered the complaints procedure. The procedure had been reviewed and was easy to understand giving clear information about the stages and timescales of complaint investigation. The manager verified that no complaints had been received in the last twelve months and showed the inspector how previous complaints had been investigated and recorded. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 17 During the inspection the inspector met several residents who made comments like, we have wonderful carers. Two staff who responded in a survey verified that they had received adult protection training. Other staff met on the day, had a clear understanding of how to recognise abusive practice and the steps they should take to prevent it. The vulnerable adults procedure was seen in the office and is accessible to staff. However, this has recently been revised and the manager should obtain a copy. In the pre-inspection questionnaire, the manager had verified that no referrals had been made to the Protection of Vulnerable Adults list in the previous twelve months. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 18 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents at Fernbank House live in comfortable accommodation that is suitable for their needs and is maintained to a high standard. Staff have received training and implement good practice to minimise the risk of cross infection to residents. EVIDENCE: A survey from a resident verified that the home was always clean and fresh. The inspector toured the building and met domestic staff and other residents. People told the inspector that the home was kept “beautifully clean” and “so clean and tidy”. Additionally, people said that the owner does “all the manual Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 19 jobs to keep the place ship shape”. Records examined verified that maintenance is carried out in a timely manner. The home was spotlessly clean and free from odours. The grounds were tidy and attractive with herbaceous perennials and shrubs. The inspector was shown a maintenance and renewal plan by the manager who went on to say that the ground floor of the building was in the process of being decorated. The inspector interviewed two staff that understood good practice principles to minimise the risk of cross infection. Staff told the inspector that the manager had worked alongside them to ensure that they understood what they had to do. A ‘no touch’ technique was observed as staff dealt with soiled linen. The inspector observed staff using alcohol gel after giving personal care to a resident. During a tour of the building the inspector saw that there was a plentiful supply of gloves and aprons for staff to use for protection. The manager told the inspector that she implemented a higher standard of practice than was recommended by infection control specialists and did so to ensure that there was never an outbreak of infection in the home. Residents told the inspector that clean clothes were delivered to them every day from the laundry. Staff told the inspector that infection control training had been provided for them. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 20 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 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has robust recruitment procedures to ensure that the right people are employed to care for vulnerable people. The manager needs to ensure that this is followed consistently to ensure that residents are fully protected. Fernbank House is committed to training and developing it’s staff ensuring that residents are cared for by properly qualified and experienced staff. EVIDENCE: Duty rosters for the weeks beginning 12th & 19th January 2007 and 9th February to 2nd March 2007 were examined. The owner/manager works six out of seven days, two of which are as the cook. The inspector saw that there had always been two staff on duty twenty-four hours a day. In addition to this, a cleaner is employed for 17½ hours per week. Staff and people living at the home verified that the provider carries out general maintenance. Staff were observed throughout the home to be relaxed and seen to respond to people’s needs in a timely and appropriate way. In a survey a service user verified that the staff at Fernbank House always listen and act upon their wishes. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 21 In surveys two staff verified that references had been obtained prior to their employment, including a CRB check. The home had a robust recruitment procedure that is based on equal opportunities. The manager told the inspector that disabled staff are employed at the home and that reasonable adjustments are made to enable them to do their jobs well. The inspector examined three staff files. Since the last inspection, the manager had improved the application form used for recruitment so that a full working history is obtained and appropriate references are undertaken. Written references [two] had been obtained for all the staff. Records of a verbal reference was seen on one file. With exception of one file, criminal records bureau certificates had been obtained by the home long after the individuals had started work there. One member of staff had commenced employment on 18/7/06 and the CRB certificate was dated 11/10/06 (verified by pre-inspection questionnaire, duty rosters and staff record). Another member of staff started their employment on 20/11/06 and the CRB certificate was dated 5/12/06 (verified by pre-inspection questionnaire, duty rosters and staff record). The inspector was shown records that demonstrated that the CRB checks had been sent off for prior to the first day of employment. However, in both cases the provider had not obtained a POVA First check that would enable the employees to work with residents until such time as the full criminal records bureau certificate had been obtained. This shortfall was discussed with the registered provider. The inspector showed the provider the Commission’s publication ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’ [available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf] and clarified what constitutes good practice in relation to recruitment procedures. The provider told the inspector that they would address the shortfall as a priority. Two staff that responded in a survey verified that they had good access to training. Staff also echoed this that the inspector met during the inspection. At the time of completing the pre-inspection questionnaire 35 of the staff working at Fernbank House had a national vocational qualification in care. In addition to this, the manager verified that they had one unit left to do on the Registered Managers Award and told the inspector that they aimed to complete the qualification by the Summer 2007. The manager clarified that recent turnover of staff due to ill health and natural wastage had meant that the team had lost three staff with NVQs or other social care qualifications. Staff spoken to at the inspection told the inspector that NVQs had been discussed and that there were plans for them to start these soon. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 22 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): 31,33,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager/provider is experienced and qualified to run the home and does so effectively for the people who live there. Quality assurance systems are both informal and formal and it is evident that resident’s, staff and visitor’s views are respected in this home. However, comments from people who use the service need to be collated and reported upon so that there is evidence of a continuous cycle of improvement. Financial procedures safeguard residents’ interests. Access to records for people who regulate and those who live in the home has been improved by the setting up of a designated key holder position. Legislation covering the storage and safekeeping of records are adhered to and ensure that resident’s rights in terms of data protection are met. However, some aspects of record keeping relating to the induction and supervision of staff are poor. Although staff say that they receive induction and supervision so that they feel well supported Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 23 whilst caring for residents, gaps in records fail to provide evidence of this and could leave the home vulnerable in respect of employment legislation. Health and safety is managed effectively and minimises any potential risks for residents, staff and visitors to the home. EVIDENCE: The registered manager is a qualified nurse with management experience. The Commission examined the certificates and professional portfolio of the manager as part of the registration process. The manager told the inspector that she had nearly finished the Registered Managers Award and hoped to do so by the Summer 2007. The inspector explained that her progress with this would be monitored at the inspection. In surveys staff felt that the home was well run. Staff wrote that what the home does well is the support you get, from working with the staff and working as a team and residents receive a very high standard of care and it is a pleasure working for [the owners]. The home has a very high standard of care. I would have no hesitation in recommending Fernbank to anyone. The inspector was shown a survey that had been done in 2006 since the last inspection, which demonstrated that the manager had taken further steps to improve quality assurance procedures in the home. Residents also told the inspector that they had completed a survey and were regularly asked whether they were satisfied and was there anything that could be improved for them. At lunchtime, the inspector observed this in practice as residents were asked for feedback about the meal. A couple of people said that they would like dripping sometime and were told you can have it at tea time if you would like, we have two lots types - pork and beef - in the fridge at moment. Other people told the inspector that the home is marvellous and that the manager is a genuine carer and has an infectious laugh. At the same time they said that the staff are wonderful carers and they felt lucky to have a place here. The inspector told the manager that the completed surveys should be collated into a report so that the Commission, the provider, staff and people who live at the home are able to see recognition of what the home is good at, what needs to be improved and how this will be done. The manager had already recognised this and showed the inspector the work they were in the process of doing to analyse the results. The manager/registered provider had verified in the pre-inspection questionnaire that they did not act as an appointee for any resident at the home. During the inspection, the manager told the inspector that relatives chose to leave small amounts of money for their relation for safekeeping so that personal items such as hairdressing and newspapers could be paid for. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 24 Records showing how such money was managed on behalf of three residents were inspected. These were well kept and accurately recorded the correct balance seen. Entries had been signed for and where appropriate two signatures seen. Receipts corresponded with entries for items such as chiropody, hairdressing and newspapers. Secure facilities were being used to safeguard resident’s money. Three staff files were examined to establish whether new staff had received an induction that met national minimum standards. None of the files had a record of induction training that met Care for Skills Induction Standards. The inspector was told that a new induction based on ‘Care for Skills’ induction standards was being followed. Two staff told the inspector that they had been given an induction to the home, which consisted of shadowing senior staff and being assessed as being competent to undertake certain tasks. Two staff in surveys verified that the manager of the home met with them regularly. However, one person commented that they had not received one to one supervision or been observed whilst carrying out care as part of this process. One out of three staff files had recorded evidence that supervision had regularly taken place. Throughout the inspection the inspector examined a number of records pertaining to the people who live at the home. These were kept safe in the office and were accessible to staff. Since the last inspection, the manager had written a policy and set up arrangements to ensure that there was designated as a ‘key holder’ with access to all records that might need to be inspected on duty at all times. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed stated who was responsible for implementing and reviewing these. Certificates seen in three personnel files examined verified that staff had attended infection control and manual handling training in the past 12 months. The inspector observed hand sanitizer being used by staff to minimise the risk of cross infection. The fire log was examined and demonstrated that fire drills, had taken place regularly. Two out of five staff had certificates on their personnel file verifying that they had completed fire training. All of the residents, relatives and staff told the inspector that the alarm was regularly checked. Certificated evidence verified that the hoists had been regularly maintained. First aid equipment was clearly labelled. Some of the staff on duty verified that they held a current first aid qualification having completed the National Vocational Qualification in Care. Good manual handling practice was observed as carers transferred residents from wheelchairs to chairs in the dining room at lunchtime. Electrical appliance checks and risk assessments had been done in the last six months. Data sheets were in place and staff spoken to understood the risks and how to minimise these in respect of chemicals used in the building mainly for cleaning and infection control purposes. The accident procedure had been followed. Entries tracked by the inspector established that appropriate action had been taken following Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 25 reported accidents. The manager told the inspector that she regularly audited accidents and incidents occurring in the home to ensure that these were kept to a minimum. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 26 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 3 x 4 4 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x x x 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 2 3 Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No 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 OP29 Regulation 19 (1)(b)(i) Requirement The registered person shall not employ a person to work at the care home unless - subject to paragraph (6), (8), (9) her has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 9 of schedule 2. This relates to two out of three files that were examined and discussed with the registered provider and to future recruitment practice forthwith. Timescale for action 22/06/07 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. 2. Refer to Standard OP9 OP18 Good Practice Recommendations Ensure that records accurately reflect when people have been assessed to self-administer medications such as salbutamol inhalers. Obtain a copy of the revised Safeguarding adults/Adult DS0000055784.V328619.R01.S.doc Version 5.2 Page 28 Fernbank House 3. OP29 4. 5. OP33 OP37 protection policy and guidance. (Feb 2007) Available at: http:/www.devon.gov.uk Use the CSCI publication ‘Safe and sound? Checking the suitability of new care staff in regulated social care services’ (available at http:/www.csci.org.uk/pdf/safe_sound_tagged.pdf) as good practice guidance for recruitment practices. The results of the survey conducted in 2006 should be published and made available to current and prospective residents, other service users and the Commission. Induction training and supervision of staff should be recorded in personnel files. Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Fernbank House DS0000055784.V328619.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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