Inspection on 23/02/09 for Fernbank Nursing Home

This inspection was carried out on 23rd February 2009.

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

The inspector found no outstanding requirements from the previous inspection report, but made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fernbank Nursing Home 19/05/08

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Fernbank Nursing Home Finchley Way Finchley London N3 1AB     The quality rating for this care home is:   one star adequate 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: Daniel Lim     Date: 2 4 0 2 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 31 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (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 31 Information about the care home Name of care home: Address: Fernbank Nursing Home Finchley Way Finchley London N3 1AB 02083493426 02083494748 fernbank@ECGhomes.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Karim Nizarali Bhanji,Rozita Heshmati-Bhanji care home 34 Number of places (if applicable): Under 65 Over 65 0 34 dementia old age, not falling within any other category Additional conditions: 34 0 The Registered Person may provide the following categrory 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 Date of last inspection Brief description of the care home Fernbank Nursing Home is a care home which has been registered to provide nursing care for a maximum of thirty four older people. The home changed ownership in December 2007. The current owners inform us that they also run other registered care homes in this country. 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 home provides care for a culturally diverse group of residents including a significant number from the Greek Cypriot community. The premises comprise of a large detached three storey period house. The ground floor Care Homes for Older People Page 4 of 31 Brief description of the care home contains ten single bedrooms and four double bedrooms. Four of the single bedrooms have ensuite facilities. The first floor contains eight single bedrooms and four double bedrooms. Four of the single bedrooms and one of the double bedrooms have ensuite facilities. The home has a large communal lounge on the ground floor and an additional smaller lounge on the first floor. There is a small front garden and a medium sized garden at the side of the house. There is also a small parking area at the side of the house. The home is situated in a residential area near to West Finchley tube station and close to shops, restaurants, bus routes and other community facilities located along the High Road and Ballards Lane. The scale of fees charged by the home can be obtained from the manager. The provider must make information about the service available, including reports to service users and other stakeholders. Care Homes for Older People Page 5 of 31 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: one star adequate 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: The quality rating for this service is One Star. This means the people who use this service experience ADEQUATE quality outcomes. This unannounced key inspection took place over two days on the 23rd and 24th of February 2009 and took a total of 10 hours. The CSCI pharmacy inspector inspected the arrangements for the administration of medication on 17 February 2009. We were assisted by the registered manager Mrs Rosemarie Tiano and one of the registered providers, Mr Karim Nizarali Bhanji Four residents and five relatives were interviewed. The feedback received from them was positive and indicated that they were satisfied with the care provided. Completed Care Homes for Older People Page 6 of 31 questionnaires were received from four residents, four staff and a health professional. These were on the whole positive and indicated that residents were well cared for. Statutory records were examined. These included four residents case records, the maintenance records, accident and incident records, complaints records and fire records of the home. The premises including residents bedrooms, communal bathrooms, laundry, kitchen, garden and other communal areas were inspected. Four staff were interviewed regarding the care of residents and other areas associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records including evidence of CRB disclosures, references, supervision and training records were examined. In addition, the minutes of residents meetings were examined. These indicated that residents had been consulted and informed of changes affecting the running of the home. The completed Annual Quality Assurance Assessment form was received by CSCI. Information provided in the assessment was used for this inspection. What the care home does well: What has improved since the last inspection? What they could do better: Further improvements are required in the administration of medication. All deficiencies identified in our pharmacist inspectors report must be complied with. Communication regarding changes in medication and dosage must be improved. The policy and procedures for homely remedies, disposal and as required medicines must be clarified and updated. Comprehensive and accurate audits must be carried out and include reasons why Care Homes for Older People Page 8 of 31 discrepancies occur and action taken in response. The storage and recording of controlled drugs must be improved to ensure compliance with the Misuse of Drugs Act. Lancets for use in the home must be of the professional type to prevent the risk of infection from blood borne diseases. There must be up to date and current protocols in place for residents who are fed by tube because of swallowing difficulties The minimum and maximum temperatures of the fridge must be recorded and the fridge kept locked when used to store prescription medicines. The homes contracted pharmacist should be requested to update the MAR charts so that discontinued items are removed from the MAR chart. This is to prevent errors in the administration of medication. A report following the analysis of service user surveys together with an action plan in response to any identified deficiencies must be prepared. This is required to ensure that the care provided is of a good quality. At least one of the fire drills organised in a twelve month period must be carried out after dark.This is to ensure that staff are familiar with fire safety procedures in the night. 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 –0870 240 7535. Care Homes for Older People Page 9 of 31 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 10 of 31 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. Admissions are not made to the home until a full needs assessment has been undertaken by the manager or a sufficiently skilled member of staff. This ensures that the home is able to meet the needs of residents. Evidence: The pre admission assessments which were examined were noted to be appropriate and comprehensive. These assessments included details of the personal, mental, cultural and spiritual needs of residents. Risk assessments had also been prepared for residents admitted to the home. These were appropriate. The homes AQAA stated that Residents are assessed prior to admission and clearly given information about the service that they will receive. A social workers comprehensive assessment is faxed to Care Homes for Older People Page 11 of 31 Evidence: matron prior to matrons own assessment. Residents are invited to spend a day in the home so that they can get a feel as to whether they will feel at home there. Residents in the home were noted to be clean and appropriately dressed. Residents and relatives who were interviewed by us indicated that residents were well cared for and their care needs had been attended to. Comments made by residents and their relatives included Staff are caring and helpful well cared for and no complaints The manager stated that the home does not currently have any contracts for intermediate care. Care Homes for Older People Page 12 of 31 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Arrangements are in place for meeting the healthcare and personal care needs of residents and these are recorded in residents care plans. However, there are serious deficiencies in the arrangements for the administration of medication. These put people who use the service at risk. Evidence: Comments made by residents and their relatives in interviews indicated that there is a friendly and caring atmosphere in the home. Residents interviewed stated that they were well cared for and they had been treated with respect by staff. Case records contained evidence that residents had access to healthcare professionals such as the chiropodist, dentist, optician and their GP. One completed questionnaire from a healthcare professional indicated that the healthcare needs of residents are usually being met and any concerns raised are always responded to. However, one completed questionnaire from a resident indicated that personal care was not always performed in a satisfactory manner. This was Care Homes for Older People Page 13 of 31 Evidence: discussed with the manager. The manager informed us that she regularly checks and ensures that the personal and healthcare needs of residents are met and that they are recorded in the daily notes and observation charts. This was evidenced in the case records examined. She also stated that one to one sessions with residents are provided and residents can raise their concerns during these sessions. She said she was unaware of any dissatisfaction. However, she agreed to remind staff to ensure that they are gentle, careful and thorough when providing personal care. The AQAA indicated that individual care plans had been prepared for residents following their assessment. It states Care plans in place which contain information about the individuals wishes, choices and decisions. As their health deteriorates we put in place information to monitor food or fluid intake, monitor pain, and monitoring of pressure ulcers. We liaise with other healthcare professionals to ensure dignity and comfort of the resident is maintained, that they are pain free. A sample of four care plans which was examined were on the whole well prepared and regular monthly care reviews had been carried out. The care plans were holistic and addressed the cultural and spiritual needs of residents. Nutritional monitoring and weight monitoring charts were evident. These had been completed monthly. Appropriate risks assessments had been prepared for residents. These were generally of a good standard. The care plan of a resident with dementia contained an appropriate and up to date dementia care plan. Staff interviewed were aware of how to care for such a resident. We observed that residents privacy and dignity was respected by staff during the inspection. Three relatives who were interviewed informed us that residents were well cared for. We observed that residents privacy and dignity were respected by staff during the inspection. Three relatives who were interviewed informed us that residents were well cared for. While interviewing one resident in his bedroom, the resident called a staff member to his room and informed us that he was extremely pleased with the care given by the staff member. We activated the call bell in the bedroom and noted that staff responded promptly. The CSCI pharmacy inspector visited on 17 February 2009 and made the following comments. Some progress has been made is ensuring the safe handling of medication. However, there are still areas of serious concern where the people who use the service could be Care Homes for Older People Page 14 of 31 Evidence: placed at risk. The medication policy had been updated in December 2008 as requested and covered all areas for safe administration including the disposal, giving as required medication, covert administration and crushing. The disposal of medication procedure still requires clarification to ensure that medication is not returned to the community pharmacist. The prn or as required policy also needed clarification so as not to confuse with the administration of homely remedies. It would be also be good practice to obtain the GP approval to use homely remedies to prevent the risk of drug interactions with regular medication. Residents in the home were able to administer their own medication if they wished to, subject to risk assessments and giving consent. We met one gentleman who had decided that he wanted nurses to give him his tablets and he explained to us that this was because he was prescribed a lot and sometimes he forgot that he had already taken them. He told us that when he was in pain he always told the nurses and they gave him his painkillers earlier if necessary. We inspected the Medication Administration Records or MAR. There were no omissions in the records for receipts and a separate record book was used for records of disposal. Overall records of administration were accurate. We did notice that there was a gap for simvastatin the evening before the inspection, but when we looked at the blister pack the tablet was not there so we assumed it had been given but not signed for. One resident was very ill and not able to take any medicines. The nurse recorded this at the time of the inspection as the MAR had been left blank. We counted several medicines supplied in the original packs including a complex medicine with a variable dose and on all occasions were able to reconcile the quantities with signatures for administration. The home was carrying regular audits and we looked at these. We could see that frequently it was recorded that there was one too many tablets and that it was destroyed. We suggested that it would be good practice to record why there was one too many tablet or the other reason for the discrepancy. We inspected the storage and recording of controlled drugs. The homes cupboard did not comply with the Misuse of Drugs Act. Records were muddled because a new controlled register had been started and the transfer of records not completed. We were able to check all balances eventually and they were correct. There was confusion over the buprenorphine patches for one resident. The GP had reduced the dosage but the pharmacy had supplied the previous dose with wrong instructions. There had been a delay of two weeks in obtaining the correct strength and staff did not seem to know which strength was prescribed.The MAR listed 3 strengths and none had been deleted. It was recorded in the CD register that the old strength had been applied on 17 February 2009 but this was not recorded on the MAR. We noticed that there was a record of the dose reduction in the GP book but not in the individuals care plan. When Care Homes for Older People Page 15 of 31 Evidence: we looked at the daily notes we read that the resident had complained of pain on two occasions during this period. Nurses had responded by giving two other prescribed painkillers and it was recorded that he was comfortable. We noticed that the home had a Doom kit so that they could legally dispose of controlled drugs. We looked at the fridge and noted that it was not locked and only the actual temperature was being recorded rather than the minimum and maximum temperature. Currently only a sip food and a cream were stored in the fridge. We looked at the lancets used for testing blood glucose in residents who are diabetic and noticed that they were not of the professional type. Using the incorrect lancets can be a cause of transmission of Hepatitis. We looked at medication on the first floor and recording and audits could all be reconciled. We noticed again that frequently, discontinued medication was not deleted by the supplier on the MAR and it was difficult to know whether the medication was current or not. One resident was prescribed a feed to be given by tube because of swallowing difficulties. We noted that there was a fluid balance chart and the feed was recorded on the MAR but we were not able to find the current protocol for flow rate and maintenance of the site of the tube. We looked at the care plan for this resident and noticed that although the speech therapist and chiropodist and GP all visited regularly there had been no visits by the dietician recorded. We were pleased to see a PCT pharmacist in the home at the time of the inspection carrying out a training session. The home was taking steps to improve medication management but further work is needed to raise standards. Following the inspection the manager stated that she had carried out investigations into the dissatisfaction regarding personal care expressed by a resident. She stated that the said resident was washed with a hand towel instead of a flannel because the residents flannels were in the wash. She added that she had also placed the carer concerned on different shifts to ensure supervision. She was of the opinion that the carer had used his initiative and improvised, rather than leave the resident unwashed. Care Homes for Older People Page 16 of 31 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. The daily life, meal arrangements and routines of residents are well organised. The views of residents and their relatives are being sought when planning the homes activities and routine. People using the service are given the opportunity to take part in activities that are imaginative, appropriate and varied. They also have opportunity to maintain important family relationships. Residents are offered wholesome and varied meals which meet their needs and preferences. Evidence: The homes AQAA made the following statement Residents are now being encouraged to make choices about their lifestyle and are being supported to develop their skills. The activities person is ensuring that social, educational, cultural and recreational activities meet individual expectations. The residents appear to be enjoying the new karaoke, monthly live entertainment, One to one sessions and many more. And staff enjoy joining in. The home has a part time activities organiser. She provided us with details of activities that residents could participate in. The programme of weekly social and therapeutic Care Homes for Older People Page 17 of 31 Evidence: activities included exercise sessions, music therapy, hand massage, bingo, exercise, entertainment sessions and art and crafts. There was documented evidence that residents had been consulted regarding activities they would like to engage in. Details of residents personal preferences were also documented. A record of acitvities that residents had engaged in was kept by the activities organiser and available for inspection. The manager informed us that care staff were also involved in providing social activities. An example of good practice was provided by the activities organiser. She informed us that residents with mobility problems who chose to remain in their bedrooms were also assessed and provided with one to one sessions and appropriate activities. These included hand massage, reminiscence sessions and books being read to them. This was confirmed by one such resident. Residents and relatives interviewed were able to confirm that the home has a range of activities which residents can participate in if they wanted to. In addition, arrangements had been made to ensure that residents from various cultures can celebrate and observe their religious and cultural events. Clerics from the Orthodox and Catholic church regularly visit the home. Inhouse services are provided by the Greek Orthodox Priest for Greek residents. The home had a visit the previous year from the local environmental health officer and was awarded 4 stars. The kitchen was clean and well equipped. A record of fridge and freezer temperatures had been kept. These were satisfactory. The chef who was interviewed was knowledgeable regarding his responsibilities and the special dietary needs of residents. The menu examined was varied, balanced and there was a choice of main dish. Traditional English food and various cultural meals were noted on the menu. We interviewed a resident of Greek origin and another of African origin. Both stated that their ethnic meal preferences had been responded to. Two of the completed residents survey forms received by us indicated that the respondents were not fully satisfied with the meals provided. They indicated that the portions were too small and the meals were not well cooked. However, we could not find evidence of this during the inspection. Residents interviewed were generally satisfied with the meals provided. One stated that he had been given large portions. The chef reassured us that residents had been consulted daily regarding their meal preferences. Although this was not documented, three of the residents were able to confirm that they had been consulted. Care Homes for Older People Page 18 of 31 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. The arrangements for responding to complaints and for adult protection are satisfactory. The required policies and procedures for safeguarding residents were in place and give the required guidance to staff. Evidence: The homes AQAA made the following comments People who use the service are encouraged to express their concerns verbally or in writing. All staff on induction are informed about POVA and whistle blowing. Mandatory training on POVA is delivered by a qualified person. Staff are aware of where to access the policies and procedures Residents and their relatives who were interviewed by us indicated that they were well treated and satisfied with the care provided to residents. The home has an adult protection procedure. It included examples of abuse and guidance to staff on reporting allegations of abuse to Social Services and The CSCI. The local authority guidelines were also available. The manager and her staff who were interviewed were aware of the homes policy and procedures for the protection of vulnerable adults. There was evidence that staff had been provided with the required training. The home has a record of complaints received. There was documented evidence that Care Homes for Older People Page 19 of 31 Evidence: they had been promptly responded to within the required timescale of 28 days. Residents stated that they were on the whole, satisfied with the services provided. When asked, they said they know who to complaint to if they wanted to make a complaint. During the second day of inspection, two relatives came to see the manager and thanked her for the care given to their relative who was no longer resident in the home. They also took the opportunity to inform us that staff had been caring and provided a very good quality of care for their relative. The home has a record of compliments received. Comments made included the following We are extremely grateful to all the staff I wanted to thank you and all your staff for the support and kindness and love shown to my mum. Care Homes for Older People Page 20 of 31 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. The home is clean, tidy and well furnished. The manager and providers have ensured that the physical environment of the home provides for the requirements of people who live there. The necessary equipment and adaptations for supporting residents are available. Residents are allowed to personalise their bedrooms. Overall, the home provides a comfortable and homely environment to live in. Evidence: Residents interviewed by us indicated that they were happy with the accommodation provided and their bedrooms had been kept clean. The home employs a full time maintenance person on site. Following the last key inspection the home has undergone renovation and redecoration. The homes AQAA stated that The home has been refurbished to a very high standard. Evidence is recognised by visiting the home and seeing the changes throughout. Residents see Fernbank Nursing Home as their own home and feel that they are part of a family. Residents were involved in choosing the pictures to be hung around the home. They are encouraged to personalise their rooms and, prior to admission, encouraged to visit the home and choose their own room. They can use their own furniture and television if they wish, as long as they comply with the required regulations. All old beds have been replaced by new electric nursing beds. All furniture in bedrooms has been replaced, including Care Homes for Older People Page 21 of 31 Evidence: wardrobes, chests of drawers and armchairs. A new kitchenette has been fitted with facilities for relatives to make beverages and a microwave is available. We note that beautiful oil paintings depicting scenes of bygone days were displayed in the reception area and along the corridors. The bathrooms, toilets and hand basins were clean. Bedrooms inspected by us had been personalised by residents with their own pictures and ornaments. The manager stated that the furnishings in some bedrooms had been changed to suit the needs and preferences of residents. Various specialist equipment for the care of residents was available. These included portable hoists, walk in showers and baths, air mattresses, wheelchairs, and a call bell system. New beds with electric controls had been purchased. The laundry was inspected and we note that laundry staff reported that care staff followed procedures for ensuring that soiled linen and clothes are put into the appropriate bags. The manager was aware that soiled laundry items are subject to a special high temperature wash. This ensures effective infection control and protects the health of residents. The required safety inspection had been carried out on the gas, electrical installations and portable appliances and documented evidence was kept in the homes maintenance folder. The home has a medium sized garden. Seating is provided. The manager stated that there are plans to landscape the garden in the near future and make it more accessible to residents. Care Homes for Older People Page 22 of 31 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a good recruitment procedure that is followed in practice. The manager recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Residents and their representatives are satisfied with the staffing arrangements. Evidence: Residents and relatives who were interviewed spoke positively of staff and indicated that staff were caring, responsive to their needs and had treated with respect and dignity. The duty rota was examined. It indicated that in addition to the manager, there was normally a minimum of one nurse and four care staff during the day shifts and one nurse and two care staff on waking night duty during the night shifts. The manager is supernumerary. Ancillary staff working at the home comprise two kitchen staff a cleaner a maintenance person and one part time admin staff. During this inspection the home had twenty residents. The manager is aware of the need to keep staffing numbers under review to ensure that the home can continue to meet the changing needs of the people living there. She stated that there were occasions when two nurses instead of one were on duty. Care Homes for Older People Page 23 of 31 Evidence: Four staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. There was documented evidence in staff records to indicate that staff had been provided with essential training relevant to their area of work. These included topics such as the management of residents with dementia and pressure sores. A staff training matrix was on display in the managers office showing at a glance which training staff have attended. The manager further stated that training profiles of staff were also available on computer. Staff stated that there is a good team spirit and they worked well together. The records of four staff were examined. These indicated that the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. Proof of identification was also evident on their files. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss any work related problems, issues related to the care of residents and their training. The issue of equalities and diversity was discussed with the manager and her staff. Staff demonstrated an understanding of the need to treat all residents sensitively and with respect regardless of disability gender race religion or sexual orientation. They were aware that they must not discriminate against residents and they indicated that this was stressed to them during their induction. Care Homes for Older People Page 24 of 31 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. People living in the home can be assured that the home is well run and the manager has the skills and ability to manage the home and meet its stated aims and objectives. Equality and Diversity issues are given priority by the manager. Records are on the whole, well maintained. There is an effective system for maintaining health and safety. Staff are regularly supervised. Residents and their representatives are consulted regarding the care provided and the management of the home. Evidence: Feedback received from residents and their representatives indicated that the manager had been successful in fostering a caring and welcoming environment where residents are cared for with respect and dignity regardless of their background race religion disability or sexual orientation. The AQAA stated The home manager has completed her NVQ level 4 and Registered Managers Award. We design and implement new policies according to statutory and operational need. Care Homes for Older People Page 25 of 31 Evidence: The manager looks at areas where change is necessary in order to prevent errors and makes improvements to policy and operations. The manager was found to be knowledgeable regarding her role and responsibilities. She is a registered nurse with extensive experience in the care field. She is supported by a deputy manager and an administrator who works part time. There was evidence that residents are consulted regarding the management of the home. Residents and relatives meetings had been held. The minutes of the latest residents meeting were examined. It indicated that residents and relatives were informed of progress in the home. The home has a development plan. This includes refurbishment of certain areas of the home and further staff training. A consumer survey had been carried out recently. However, a report following the analysis of these surveys together with an action plan in response to any identified deficiencies had not yet been prepared. This is required to ensure that any concerns raised regarding the care of residents is responded to and the care provided is of a good quality. Weekly fire alarm checks and regular fire drills had been documented. The home had an up to date fire risk assessment. Staff had been provided with training in fire safety and Health and Safety. No night fire drill had been organised in the past twelve months. At least one of the fire drills in any twelve months must be carried out during the night. This is to ensure that staff are familiar with fire safety procedures in the night. The accident records were appropriately filled in. On a tour of the premises it was noted that one of the window restrictors was not in place in a bedroom visited. This was brought to the attention of the manager and was rectified the following day. The home has a current certificate of insurance. The manager and administrator informed us that the home does not keep any money on behalf of residents or manage their finances for them. The AQAA outlined that regular staff supervision is carried out. There was documented evidence of this in the staff records. Care Homes for Older People Page 26 of 31 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 27 of 31 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 9 13 The minimum and maximum 10/04/2009 temperatures of the fridge must be recorded and the fridge kept locked when used to store prescription medicines. This is necessary for the welfare and safety of residents. There must be up to date and current protocols in place for residents who are fed by tube because of swallowing difficulties This is necessary for the welfare and safety of residents. Lancets for use in the home must be of the professional type to prevent the risk of infection from blood borne diseases. This is necessary for the welfare and safety of residents. 10/04/2009 2 9 13 3 9 13 10/04/2009 Care Homes for Older People Page 28 of 31 4 9 13 The storage and recording of 10/04/2009 controlled drugs must be improved to ensure compliance with the Misuse of Drugs Act. Records must be made at the time of administration or receipt and must correlate with recording on the MAR chart. This is necessary for the welfare and safety of residents. Comprehensive and accurate 10/04/2009 audits must be carried out and must include reasons why discrepancies occur and action taken in response. These audits must include tracking dosage changes to ensure that the prescribers instructions are followed This is necessary for the welfare and safety of residents. The policy and procedure for 10/04/2009 homely remedies, disposal and as required medicines must be clarified and updated. This is necessary for the welfare and safety of residents. Communication regarding changes in medication and dosage must be improved. This must include appropriate recording in the care plan, the Medication Administration Records and obtaining supplies of 10/04/2009 5 9 13 6 9 13 7 9 13 Care Homes for Older People Page 29 of 31 medication in a time for administration to the resident concerned. This is necessary for maintaining the health and well being of the resident. 8 33 24 A report following the analysis of service user surveys together with an action plan in response to any identified deficiencies must be prepared. This is required to ensure that the care provided is of a good quality. 9 38 23 At least one of the fire drills organised in a twelve month period must be carried out after dark. This is to ensure that staff are familiar with fire safety procedures in the night. 10/04/2009 11/05/2009 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 9 The homes contracted pharmacist should be requested to update the MAR charts so that discontinued items are removed from the MAR chart. This is to prevent errors in the administration of medication. Care Homes for Older People Page 30 of 31 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). 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