Inspection on 19/05/08 for Fernbank Nursing Home

This inspection was carried out on 19th May 2008.

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

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 Nursing Home 23/02/09

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Fernbank Nursing Home Finchley Way Finchley London N3 1AB Lead Inspector Ffion Simmons Key Unannounced Inspection 09:20 19th & 20th May 2008 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 Nursing Home DS0000071245.V361089.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 Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernbank Nursing Home Address Finchley Way Finchley London N3 1AB 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) 020 8349 3426 020 8349 4748 fernbank@ECGhomes.co.uk Karim Nizarali Bhanji Rozita Heshmati-Bhanji Mrs Rosemarie Margaret Tiano Care Home 34 Category(ies) of Dementia (34), Old age, not falling within any registration, with number other category (34) of places Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE The maximum number of service users who can be accommodated is: 34 NA 2. Date of last inspection Brief Description of the Service: Fernbank Nursing Home is a private registered care home with nursing services for up to thirty- four older people. The home is situated in a quiet residential area close to West Finchley tube station and relatively close to Finchley Central and North Finchley shopping centre. The ground floor contains ten single bedrooms, four with en-suite facilities and four double bedrooms. The first floor contains eight single bedrooms, four with en-suite facilities and four double bedrooms, one with en-suite facilities. The home has a large communal room on the ground floor and an additional communal room on the first floor. The home provides care for a cultural mix of people with a significant number from the Greek Cypriot community. The stated aim of the home is To provide service users with a secure, relaxed and homely environment in which their care, well being and comfort are of prime importance. The cost of placements for Fernbank is £546.00 to £669.50 per week. Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The unannounced key inspection took place over two days on the 19th and 20th of May 2008 and lasted a total of 15 hours and 50 minutes. During the inspection, we spoke with residents and observed care practices. We tracked the care of three residents, and in doing so we checked their personal records. We met the home’s Registered Manager and the home’s Directors and spent time with staff. A number of records and documentation was checked during the inspection, including medication administration records, staff files, health and safety documentation, the home’s complaint records and quality assurance documentation. Questionnaires were sent to residents, relatives/carers and advocates, professionals and staff to comment on the service and we had a 20 return rate. We have used the information within these questionnaires to contribute to the content of the report. The Registered Manager (Matron) took time to complete and return the Annual Quality Assurance Assessment (AQAA), which has been used as evidence to inform this report. What the service does well: What has improved since the last inspection? What they could do better: Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 6 Care plans must be more person-centred and reflect residents’ choices and preferences and residents must be involved in the development of their care plans where possible. Residents (and their representatives where necessary) must be consulted with about their, social and leisure interests and arrangements must be made for them to take part in activities both within the home and in the community. The medication policy must be updated and made available for staff reference to ensure that they are up-to-date with their practices in the administration of medication. Staff must follow the correct procedures for handling and administering medication safely. This is to prevent error and ensure that medication is administered as prescribed. Robust recording and auditing of medication must take place to provide evidence of safe administration of medication. The practice of crushing of a resident’s tablets should be immediately reviewed as there are safety, legal and professional implications of administering medication in this way. Steps must be taken to ensure that staff are aware of the procedures for recording complaints/concerns and compliments and that they are effectively documented and investigated. Staff must receive formal one-to-one supervision so that they feel supported and to do their job to a high standard. The reports undertaken on behalf of the registered provider must be undertaken on a monthly basis. The reports must be forwarded to the home promptly so that any action from the visits can be implemented without delay. 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 Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 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 Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, Standard 6 is not applicable. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Personalised assessments are undertaken prior to a resident moving in. This ensures that the home understands their needs and can be confident that their needs can be met. EVIDENCE: During the inspection we checked the files of three residents. Each resident had a full needs assessment on their file. Where residents had been referred by the local authority, a full and comprehensive assessment of their needs and a care plan were available on their files. This was followed by a needs assessment carried out by the home’s Matron (Registered Manager). The Annual Quality Assurance Assessment (AQAA) confirmed that “pre-admission procedure is carried out as soon as possible at the clients home, hospital or residential home.” The assessment process enables the home to build a picture of their needs including their cultural and personal beliefs. The home does not offer intermediate care. Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are known and are outlined in their care plans and are regularly reviewed. The care plans could be more personcentred to better reflect residents’ wishes. Risk assessments are used to identify risk and to promote the health and safety of residents but they are not regularly updated. Improvements are needed in the management of medication in the home so that residents are fully protected in this area. EVIDENCE: We tracked the care of three residents and in doing so we checked their personal records including care plans and risk assessments. Each resident had care plans on their files, which were reviewed on a monthly basis to identify any change to their needs. Care plans could be improved to better reflect residents’ wishes and choices and to demonstrate their involvement in developing and reviewing the plan of care. The format of the care plans were at times difficult to follow and not accessible to the residents. The risk of residents developing a pressure ulcer is assessed using the Waterlow risk assessment. The files seen demonstrated that these risk assessments were not being reviewed on a regular basis. Equipment for the Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 10 prevention of pressure ulcers is in use in the home. Where residents require wound care, the home requests the input of the Tissue Viability Nurse who provides specialist advice on the management of the wounds. Other risk assessments in use in the home include manual handling risk assessment. Records showed that these needed updating also. At the time of the inspection, we could not see evidence that the risk of malnutrition was being assessed, although residents’ weight is monitored where possible. Residents have access to the multi-disciplinary team, which includes opticians, chiropody and General Practitioners. The AQAA, that was completed by the Matron, highlighted that the “GP service is excellent, they visit weekly, and one doctor is of Greek Cypriot origin”. The homes’ management of medication was assessed during the inspection. We found that the medication was securely stored. Staff record the temperature of the store room and the fridges where medication is stored to make sure that medication is stored within correct temperatures. Medication arrives into the home mainly in blister packs. Each resident had a medication profile illustrating the medication they are to take and there were good records of the receipt of medication into the home. We audited a sample of loose tablets to check if the quantity of the tablets could be reconciled against the number of signatures. We found that there were irregularities, for example the balance of calcium tablets for a resident was found to be incorrect with 8 tablets too many in the pack. A total number of tablets of a medication used for the cardiovascular system was not correct either against the signatures on the Medication Administration Records (MAR). If medication is not given as prescribed then the residents health can be adversely affected. At the time of the inspection, there were controlled drugs in use in the home. These were seen to be securely stored. The balances of the controlled drugs currently in use were correct. There were two examples within the controlled drug register where staff had not recorded and witnessed when Tamazepam was disposed of. Disposal records must be in place for all medication to ensure a full audit of the medication can be carried out. It became evident during the inspection that staff were unaware of the new arrangements for the safe disposal of controlled drugs. The need to ensure that the correct arrangements are followed was discussed with the Matron and the Deputy Manager who were present during the inspection. In view of the irregularities in the quantities of loose medication evidenced during the inspection, we also discussed the need for regular and robust auditing of the receipt, administration and disposal of medication. During the inspection, we noted that staff with the agreement of the GP and the next of kin were crushing a resident’s tablets and administering the medication in the residents’ porridge. We were told that this was necessary Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 11 because the resident had difficulty swallowing. We were assured that the resident was aware of this arrangement, although documentation around this did not clearly illustrate this. There are safety, legal and professional implications of administering medication in this way, and in consultation with a Pharmacist alternative ways for administering medication should be sought, i.e. through the administration of the drug in other forms such as drops, liquids or soluble form. The home had a medication policy in place but needs to be updated so that it is in line with current best practice and legislative requirements. Particular attention must be given within the policy to highlight the need for obtaining residents’ consent and respecting their capacity to make decisions. We observed that residents’ privacy and dignity was respected by staff during the inspection. Where residents share a bedroom, screening is provided to ensure their privacy. We saw that residents were asked whether they would prefer to be assisted with personal care by a male or female, and how they wished to be addressed. Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 12 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. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents’ cultural and religious needs are met but residents would benefit from more attention being given to their social and leisure needs. Residents are offered wholesome, varied and appealing meals, which meet their individual needs and preferences. EVIDENCE: The home had a programme of activities on display in the communal area on the ground floor. According to the activities programme, flower arranging and hand massages were due to be taking place during the inspection. We did not observe these activities taking place and these activities were not recorded as having taken place in the activities book. The home does not currently employ an activities co-ordinator to plan and facilitate the home’s programme of activities, although the Matron told us that a care worker is allocated to this task. The home would benefit from having an activities co-ordinator in post to make sure that residents are given the opportunity to take part in meaningful activities, which meet their individual needs. One of the residents did not have a social care plan in place and steps must be taken to ensure a plan is in place so that their social and leisure needs and preferences are known. Staff commented “it would be nice to spend more time with the residents for chats, Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 13 garden, games, music but its not always possible.” reviewed as the occupancy of the home increases. Staffing levels must be The home meets the religious and cultural needs of the residents living at the home. The AQAA, completed by the Matron informed us that, “residents wishing to attend Sunday service outside of the home have a car and carer to take them there and back. In-house services are provided by the Greek Orthodox Priest for our Greek residents”. During the inspection we observed that relatives and visitors were welcomed into the home. Residents can meet their relatives and visitors in the privacy of their rooms. We observed relatives being offered the opportunity to eat with residents and a residents told us that they were allowed to stay over the Christmas period in order to be with their relative. There are areas where the home can better enable residents to exercise choice and control in their lives, for example through facilitating residents’ meetings and the use of resident questionnaires. The home should also explore ways of involving residents in the care planning process. The food in the home is freshly cooked on the premises. The AQAA confirmed that there is now a choice of more vegetables and fruit on the menu. Greek food is served on the weekly menu about two or three times per week. We observed lunch time at the home and saw that there is insufficient space for all residents to eat at dining tables. Plans are in place to rectify this issue through the provision of new dinning tables and chairs, with the aim of making mealtimes more comfortable and a more social event. We observed that residents were given the choice of eating their meals in their rooms too and were given a choice of what they would like to eat. Residents’ dietary needs including their likes and dislikes are noted in their personal files. A resident told us that their breakfast is served between 07:30 and 08:00. Lunch is served at 12pm and dinner at 16:30. Comments about the food were generally positive and included “the lunch (main meal of the day) is excellent. The dinner (traditional) but that is what most elderly people love and it is well cooked and nicely balanced”. Other comments included “the food is very good. Served nice, cooked well, not many cups of tea a day, one for breakfast and afternoon tea that’s it, two cups a day, plenty of water and juice to drink” and “if the supper is improved the food is good, just need more on plate and more cups of tea if wanted more than two cups a day.” The should respond to these comments to make sure that residents’ wishes are met. Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 14 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. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has a well-publicised complaints policy. Complaints from individuals are not always fully recorded and outcomes and actions are not always being properly logged. EVIDENCE: The home has a complaints policy, which was seen on display in the hallways during the inspection. A record is kept of formal complaints received about the service, and we checked this during the inspection. On the whole, residents commented that they were aware of how to raise concerns about the service they receive. When asking relatives about the service’s response to any concerns raised, one relative commented, “we have never had a need to raise any concerns”. Another relative however commented that they had previously raised concerns about the laundry service and the food provision. We could not see that these concerns had been recorded and how these concerns had been dealt with and whether they were satisfied with this outcome. All complaints received must be recorded and investigated. The home has a policy in place for the protection of vulnerable adults from abuse. Copies of the local multi-agency policy were seen on display within the home for staff reference. Staff have received recent training on the protection of vulnerable adults from abuse. During the course of the inspection, we noticed that a resident had a bruise to the left side of their head. We checked the accident and incident book, and daily notes but could not find reference to Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 15 the possible cause of the bruising within these records. The daily notes made no reference to staff observing any bruising. We discussed our observations with staff on duty on the day, who could not offer an explanation for the cause of the bruising. Steps must be taken to note and report any observed bruising to residents so that the cause can be promptly investigated. Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 16 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, 20, 23 & 26. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is clean and hygienic and provides residents with a homely environment. The owners are committed to improving the home’s environment and upon completion of the refurbishment work, the home will provide a very good standard of accommodation to the residents. EVIDENCE: Fernbank Nursing Home is situated a short walk away from West Finchley tube station. The home is not purpose built, but provides a homely environment. The home has a well-maintained garden, which is accessible to wheelchair users. There are plans to landscape the garden in the near future. Residents’ bedrooms are situated on the ground and first floor and there is a lift in place for accessing the first floor. The home is under new ownership and since December 2007, the home is undergoing major refurbishment work. Some of this work has included plastering and painting the bedroom walls, the fitting of new wooden flooring Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 17 and the provision of new furniture, including new wardrobes, new side tables and electric beds and new curtains. During the inspection, the work to some rooms and corridors had not been completed and some of the windows had temporary covers to them, and some rooms required new furniture. The major refurbishment work is due to be completed at the end of June 2008 and once completed, will provide residents with very comfortable rooms. In addition to the refurbishment of the residents’ bedrooms, the shower rooms are being updated and one shower room is being converted into a bathroom, which will be fitted with an accessible bath so that residents can choose to have a bath instead of a shower if they wish. There is a large communal lounge/dining room on the ground floor. Currently there is insufficient space for all residents to eat at dining tables. The directors plan to rectify this issue through providing new dinning tables and chairs with the aim of making mealtimes more comfortable. In the communal areas, there is a television and music centre in place for residents to enjoy. The home was clean and fresh and the standard of hygiene throughout the home was good. There are suitable laundry facilities in the basement of the home and staff have received training in infection control. The home employs a domestic assistant to promote cleanliness of the home. Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 18 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. People using the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The service recognises the importance of training, and tries to deliver a programme relevant to the needs of the residents. Residents are protected by the home’s robust recruitment practices. Staffing levels meet the needs of the current residents living at the home but will need to be reviewed as the occupancy levels increase. EVIDENCE: The home is currently in the process of recruiting new staff to fill the four care assistant vacancies. We were told that the home rarely uses agency staff. This was also reflected within the AQAA that was completed by the Matron. The staffing rotas were checked during the inspection and reflected that there is one Registered Nurse, a Night Senior carer and a carer on duty during the night. During the day there is one Registered nurse on duty, supported by a senior carer and three carers. At the time of the inspection there were 19 residents receiving care. Whilst staffing levels were considered to be sufficient for meeting the needs of the current residents, staffing levels should be reviewed as the occupancy levels increase. The AQAA reflected that the residents have high care needs. Some comments that we received regarding staffing levels include “most of the time the home is very short of staff, when staff are sick there is usually no cover so the staff that are on over-work and they do not give the service user the proper attention and time” and “ I feel we are often short staffed. The clients needs are always met but it does put Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 19 pressure on the staff and lessens staff morale”. I think this home is ok, just short on staff.” Of the total care staff employed in the home. 38 have obtained the National Vocational Qualification (NVQ) in care at level 2 or above with a further 46 working towards this NVQ level 2 or above. The AQAA outlines that there are staff currently working towards NVQ level 3. The home’s recruitment procedures were assessed during the inspection by checking the files of three staff. All staff had completed application forms, and there was a record that they had attended an interview. There were two written references on their files, and an enhanced criminal record bureau disclosure had been obtained for each member of staff. Proof of identification was also evident on their files. A staff training matrix was on display in the Matron’s office, showing at a glance which training staff have attended. Records demonstrated that staff have received updates in their training in safe working practices, which include infection control, fire training, 1st aid, health and safety (which includes manual handling and food safety) and training in the Protection of Vulnerable Adults from Abuse. Staff have also received a training session by the Matron on caring for residents with Parkinson’s disease and staff have received training in dementia care. Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 20 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, 36 & 38. People using the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced and qualified person. The home’s quality assurance systems do not currently include seeking the views of residents. Staff supervision is infrequent and inconsistent. The health and safety of residents are not always protected as risk assessments are not reviewed regularly and gaps found in the recording of observed injuries to residents. EVIDENCE: The Registered Manager (Matron) is experienced at managing a nursing home and is a qualified and experienced Nurse. The Matron told us that she will be shortly completing the level 4 National Vocational Qualification. The Matron was observed to be present on the floors and was aware of residents’ needs. The Matron told us within the AQAA “I have an open door policy.” The Matron has the support of a Deputy Manager who is also an experienced Registered Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 21 Nurse. The Matron, the Deputy Manager and staff were helpful and accommodating during the inspection process. As part of the home’s quality assurance system, the Matron records the incidence of infection in the home for the month. The number of accidents/incidents in the home are reviewed also as part of the home’s quality assurance system. Dependency audits are also undertaken. We were not able to find evidence that residents’ meetings are taking place in the home and that residents are involved in the quality assurance process for example through the use of questionnaires or by any other means which meet their communication needs. Steps must be taken to involve residents in the quality assurance process to ensure that their views are sought. The AQAA identifies this as an area for improvement. In view of the shortfalls identified in the management of medication in the home, it is recommended that regular audits are undertaken to assess standards in this area and to identify errors quickly. Since December 2007, the home is under new ownership. The directors were present on both days of the inspection and visit regularly to oversee the running of the service. Both directors are experienced and were very receptive to the comments we made during the inspection. Steps must be taken however to make sure that visits on behalf of the registered provider take place on a monthly basis. A report of their visit must be made available to staff at the home so that any action as a result of the visits can be implemented promptly. The home does not manage any money for the residents, but one resident has money in the safe for safe-keeping. The AQAA confirmed that the home has a policy for the management of residents’ money, valuable and financial affairs. When touring the building we noted that residents have a lockable drawer in which they can keep their belongings safe. The AQAA outlined that staff supervision is held two monthly or more regularly if required. Staff files that were checked during the inspection however did not demonstrate that staff are receiving regular supervision as per the standards. Steps must be taken to make sure that staff receive regular supervision and that these sessions are formally documented. The home’s health and safety documentation was checked and was seen to be in order. The home recently had a visit from the food safety officer and was awarded 4 stars. Accidents and incidents are recorded but steps must be taken to note and report any observed bruising to residents. Steps must also be taken to make sure that risk assessments are updated regularly so that any risk can be identified and managed. Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 22 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 X X 2 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 23 NA Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2. 3. Standard OP7 & OP14 OP7 OP9 Regulation 12 (2); 15 13 13 (2) Timescale for action Residents must be involved in 01/08/08 the development of their care plans where possible. Risk to residents’ health and 01/07/08 safety must be regularly reviewed The arrangements for the 21/06/08 disposal of controlled medication must be in line with current legislative requirements. Medication must be administered 21/06/08 as prescribed and recorded accordingly. If not given, the correct endorsement must be used so it is known why it has not been given. Disposal records must be in 21/06/08 place for all medication to ensure a full audit of the medication can me carried out. The practice of crushing of a 21/05/08 resident’s tablets should be immediately reviewed as there are safety, legal and professional implications of administering medication in this way. The medication policy must be 21/07/08 updated and made available for staff reference to ensure that DS0000071245.V361089.R01.S.doc Version 5.2 Page 24 Requirement 4. OP9 13 (2) 5. OP9 13 (2) 6. OP9 13 (2) 7. OP9 13 (2) Fernbank Nursing Home 8. OP12 16(2)(m) (n) 9. OP14 12 (2); 15 22 17(2) 23 10. 11. 12. OP16 OP18 OP23 13. OP27 18 14. OP33 24 15. OP33 26 16. OP36 18 (2) they are up-to-date with their practices in the administration of medication. Residents (and their representatives where necessary) must be consulted with about their social and leisure interests and arrangements must be made for them to take part in activities both within the home and in the community. Care plans must be more person-centred and reflect residents’ choices and preferences. All complaints received must be recorded and investigated. Steps must be taken to immediately note and report any observed bruising to residents. Steps must be taken to complete the refurbishment work so that residents can enjoy accommodation of good quality Staffing levels must be reviewed as the occupancy levels increase to make sure that residents’ needs are met. Steps must be taken to involve residents in the quality assurance process to ensure that their views are sought. Steps must be taken to make sure that visits on behalf of the registered provider take place on a monthly basis. A report of their visit must be made available to staff at the home so that any action as a result of the visits can be implemented promptly. Steps must be taken to make sure that staff receive regular supervision and that these sessions are formally documented. DS0000071245.V361089.R01.S.doc 01/08/08 01/08/08 01/08/08 21/05/08 01/08/08 01/08/08 01/08/08 01/07/08 01/08/08 Fernbank Nursing Home Version 5.2 Page 25 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 OP7 OP9 Good Practice Recommendations Consideration should be given into ways of making the care plan format more accessible to residents. In view of the shortfalls identified in the management of medication in the home, it is recommended that regular audits are undertaken to assess standards in this area and to identify errors quickly. Comments raised by residents about the food should be responded to. 3. OP15 Fernbank Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Nursing Home DS0000071245.V361089.R01.S.doc Version 5.2 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!