Inspection on 21/12/09 for Fernbrook House

This inspection was carried out on 21st December 2009.

CQC 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

Fernbrook House 04/02/09

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 14/03/2010.

Key inspection report Care homes for older people Name: Address: Fernbrook House 37-47 Fernbrook Avenue Southend-On-Sea Essex SS1 2QW     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Vicky Dutton     Date: 2 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 32 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 32 Information about the care home Name of care home: Address: Fernbrook House 37-47 Fernbrook Avenue Southend-On-Sea Essex SS1 2QW 01702460364 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Fernbrook Care Homes Ltd care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 30 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 need on admission to the home are within the following categories: Old age not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Fernbrook House is a privately owned care home that provides thirty beds for both nursing and residential care. The home is also registered to provide care for people who have dementia. Fernbrook House is situated in the residential area of Southchurch which is close to Southend on Sea. Transport links and local amenities such as shops are close by. Accommodation is provided on two floors in three shared rooms with en suite, and twenty four single rooms, 21 of which have en suite facilities. The first floor can be Care Homes for Older People Page 4 of 32 0 4 0 2 2 0 0 9 30 0 Over 65 0 30 Brief description of the care home accessed by a lift. There is communal lounge on each floor, and a dining room on the ground floor. A garden is available to the rear of the building. There is no parking available at the home but on street parking is generally available close by. A Statement of Purpose and Service Users Guide were available. Previous inspection reports are made available to people. At the time of this site visit the fees charged by the home were stated as being from £399.00 to £600.00 per week. Fees charged depend upon level of needs and funding arrangements. Additional charges include chiropody, hairdressing, newspapers and other personal items. People are also charged at the normal care staff rate per hour if a member of staff needs to escort them to hospital for an planned appointment. People would also have to pay the cost of a taxi if other transport is not available. The provider said that the hourly rate would not be charged in an emergency situation. Care Homes for Older People Page 5 of 32 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: This was an unannounced key site visit. At this visit we (CQC), considered how well the home meets the needs of the people living there, how staff and management work to provide good outcomes for people, and how people are helped to have a lifestyle that is acceptable to them. We spent seven hours at Fernbrook House. We looked around the premises to see if it was pleasant and safe for people. We viewed some care records, staff records, medication records and other documentation to see how well these aspects of care and running the home are managed. Time was spent talking to, observing and interacting with people living at the home, and talking to management and staff. We also spoke to three visitors during the site visit. The homes Annual Quality Assurance Assessment (AQAA) was sent in to us when we asked for it. The AQAA is a self assessment tool that providers are required by Law to Care Homes for Older People Page 6 of 32 complete. The AQAA tells us how management feel they are performing against the National Minimum Standards and how they can evidence this. The AQAA for Fernbrook House was basically completed by the manager. It gave us the information that we asked for, and helped us in our assessment of the home. Before the site visit a selection of surveys had been sent to the home for distribution to residents, relatives, involved professionals and staff. We received responses from ten residents, three relatives, two visiting professionals and five staff. The views expressed at the site visit and in survey responses have been incorporated into this report where appropriate. We were assisted at the site visit by the acting manager at the home, (referred to as the manager throughout the report,) the provider and other members of the staff team. Feedback on findings was provided throughout the inspection. The opportunity for discussion or clarification was given. We would like to thank the staff team, residents, relatives and visiting professionals for their help throughout the inspection process. Care Homes for Older People Page 7 of 32 What the care home does well: What has improved since the last inspection? What they could do better: Although staff are aware of the need to support residents privacy, dignity and choice there is a need to monitor how staff work to ensure that these core principles are always carried out in practice. Although people generally receive good care, work is needed to make staff less task focused and institutional in their approach. Care planning is developing well in the home so that staff are aware of peoples needs. Care plans do however need to be put in place in a timely manner and continue to Care Homes for Older People Page 8 of 32 evolve a person centred approach that puts the person at the centre of the process. When the home are assessing the suitability of people considering moving into the home they need to ensure that staff have the knowledge and skills to meet their needs. 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 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 32 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 32 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. People considering moving into Fernbrook House can feel confident that staff will try to ensure that the home is suitable to meet their needs. Evidence: We saw that a Statement of Purpose and a Service Users Guide were available. Both had been recently updated in September/October 2009. The provider stated that they were making arrangements for the Service Users Guide to be available in a Braille and large print format. Neither document gave details of the type of service the home provides for example dementia care. We also noted that the Service Users Guide did not include details of fees and additional charges as is now required. The manager confirmed that when people are considering moving into Fernbrook House they are now given a copy of the homes Service Users Guide to provide them with good information about the service. A brief brochure is also provided and we saw that this did include the range of fees at the home. On surveys returned from people living at the home most felt that they had received enough information about the home. Care Homes for Older People Page 11 of 32 Evidence: To see how well the admission process is managed, and how peoples needs are assessed to ensure that the home will be suitable for them, we looked at the files of two people who had recently moved in. We saw that a satisfactory assessment identifying nursing and general care needs had been undertaken, with peoples needs clearly identified. One file also contained a very detailed assessment and information from the persons previous placement. This should ensure that peoples needs are recognised and met from the start of their stay. Management do however need to ensure that this is always the case, and that staff have the knowledge and skills to cope. We saw that recently two younger people with specific issues/conditions had been admitted to the home. Although the home had coped, and both people had settled, training records did not identify that staff had the knowledge or skills to deal with their specific issues. To encourage good practice an admissions record is in place. This seeks to ensure that people are settled in well and appropriate paperwork etc. is completed. Intermediate care is not provided at Fernbrook House, but the home has the facility and has previously provided care to people on a Stepdown basis. This is a service for people leaving hospital who may require some additional recuperation or rehabilitation time. The manager reported that they do not currently have anyone using this service. Care Homes for Older People Page 12 of 32 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. People living at Fernbrook House will receive basic care that seeks to recognise and meet their individual needs and preferences. Evidence: We received varying feedback about the care and support offered to people at Fernbrook House, but most was positive. For those living in the home most people were assisted in completing surveys by staff. On these five people said that they always received the care and support that they needed and five that they usually did. People living in the home told us, I am quite happy here, its really quite good, Its nice here, I am very happy and content with everything, Its alright but routines could be better for us. On four relatives surveys one person said that the service always met their relatives needs, two that the service usually did and one that it sometimes did. Relatives said: The home tries to meet the needs of my [relative], especially their specific needs, Generally we are very happy with the way my [relative] is treated. Their medical needs are met and they are always clean and dressed when we see them. We go in everyday and so far have not been disappointed. Relatives spoken with at the site visit felt that the service generally met Care Homes for Older People Page 13 of 32 Evidence: their expectations and were happy with the care their relatives were receiving. A visiting professional said, I believe the management and care staff are trying their best to meet all the service users needs. Our observations of care during the day showed that people received satisfactory care and support. We were concerned however at the number of people in bed who had no access to their call bell so that they could summon assistance if needed. While some people would not be able to use their call bells, this was certainly not the case in many instances. This issue needs to be addressed with staff as this is poor practice. During the day staff were task orientated but kind and attentive. Residents appeared well groomed and were appropriately dressed. When we were observing care, the approach felt quite routine orientated. People were brought into the lounge, sat in a one of a row of chairs, had a table placed in front of them and then were given a drink, often without much interaction or discussion. On surveys all five staff who completed these said that they were always given up to date information about the needs of the people that they support. They felt that ways of sharing information always, or usually worked well. We looked at a number of care files to see how well care is planned for and arranged. We wanted to see if people have a say in their care, how the home ensure that staff are made aware of peoples needs, and how they are helped to meet them in an individual way. A visiting professional said, Their paperwork is good i.e care plans and risk assessments. Since the previous inspection care planning has been reviewed. Care files in place now provide a more consistent and organised approach, with all the information relating to the care of the individual in one file. We saw that care plans in place provided sufficient information for staff to enable them to offer individual support. The manager and staff spoken with had an understanding of peoples needs. Care plans were devised from the pre-admission assessment and detailed the individual support needed relating to different aspects of care such as mobility, personal hygiene, continence, eating and drinking and so on. The AQAA said, Plans are developed and agreed in partnership with the resident in each case, and with their families or representatives where appropriate. We did not see any evidence of this involvement on the care files sampled, so this aspect may need to be better documented. Care plans are kept under regular review to identify any changes in peoples needs. Risk assessments were in place relating to appropriate areas of care such as moving and handling. Areas where care planning could be improved were discussed with the manager. For example one person with complex needs had moved into the home two weeks prior to the site visit. Although they were not expected to stay long, only a care plan relating to personal hygiene needs was in place. This would not provide sufficient information for staff to meet the persons needs. There was little personal information in care files that would give staff a feel for the person, their history, background and so on and provide opportunities for individualised Care Homes for Older People Page 14 of 32 Evidence: interactions. Social History sheets were blank or not well completed on files sampled. Daily care records are maintained. These were generally detailed and informative. However there is not always good follow through. For example one resident told us that their leg was sore as staff had accidentally caught it on a chair. When we looked at records it was recorded that this skin flap injury had been discovered and a dressing applied. No further mention was made of the injury. Only one dressing record had been made, no accident report had been completed. The manager said that the injury had been discovered, but it had not been clear how it had occurred. A visiting professional thought that records could be improved and that the home could do better in, Recording of daily notes, especially when there are major concerns with the service users wellbeing. i.e concerns with behaviour. Care staff should be recording every incident to allow social workers and other professionals to ascertain the complexity etc. The minutes of a recent staff meeting said, Not all staff are documenting accurately. All staff are reminded of their responsibilities in proper documentation. Records showed that people access appropriate health care to meet their needs. On surveys people said that they always received the medical care that they needed. A relative said, The manager always consults me on issues such as medical treatment. We saw that a range of different professionals such as doctors, district nurses, opticians, chiropodists and specialists are involved in ensuring people keep as well as possible. One relative told us, The home have on two occasions called in a doctor to see our relative. The manager said that dental care was arranged as required. Assessments were in place in relation to peoples heath care needs such as nutrition, falls and risk of developing pressure sores. Nutrition records are maintained and peoples weight is monitored so that any potential issues might be identified. Since the previous inspection some nursing staff have undertaken relevant training such as catheter care, nutritional care of the elderly, diabetes and pressure area care. This will help to improve and keep their knowledge and skills up to date. A visiting professional said, What I find excellent about this home is the management of medication, and ordering and requesting of repeats promptly. As part of this inspection we looked at how peoples medication is managed. Medication at the home is generally well managed but some areas were practice could be improved were discussed with the manager. This included the disposal of refused medication, the use of lotions, and the need to date boxed/bottled medication when commenced to provide a good audit trail. Medication at the home is always administered by qualified nursing staff. Staff training records showed that only two out of five trained staff had undertaken specific training in administering medicines. This should be improved to ensure knowledge and practice remain up to date. During the day staff treated residents with kindness and respect. Doors were kept Care Homes for Older People Page 15 of 32 Evidence: shut when personal care was being undertaken. Shared rooms had privacy curtains in place. A member of staff said, All residents dignity and choice are respected always. Staff practice does however need to be monitored to ensure that people are always treated with suitable attention, respect and dignity. One member of staff was observed to enter a residents room without first knocking, and did not initially greet the person. At lunch time bibs were put on people often without any acknowledgement or discussion. Two people in their rooms were observed to be being assisted to eat by staff who were paying little attention, not engaging, and purely carrying out the task. The homes brochure states that basic toiletries are provided as part of the fee. We saw large containers of shaving foam, shampoo and bath foam with no names on in the homes bathroom. The manager needs to monitor staff practice and ensure that these products are not being used communally. This would be poor practice that does not support an individual person centred approach. Fernbrook House provides nursing care so many people living there are very frail and nearing the end of their life. At the moment care planning does not fully recognise the needs of people at this stage of their life in terms of emotional support and comfort. Aftercare arrangements forms were completed on some files. These might record some wishes, and relatives views about if the person should go to hospital or not should a crisis arise. The AQAA recognised that this was an area for development and said: Although we feel we provide a good service for dying residents and their families it is an area where we especially feel that continuous improvements should be made to make services even better. For this reason we intend to implement the Liverpool Care Pathway for end of life residents. Within the next twelve months we intend to complete this implementation and have the necessary training and support in place. The manager and provider said that in the new year staff from Basildon Hospital were coming to undertake training with staff. Care Homes for Older People Page 16 of 32 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People will have some opportunities to lead a fulfilling lifestyle in line with their personal preferences. Evidence: On surveys only two people felt that the home always arranged activities that they could take part in. Five people felt that they usually did and three that there were sometimes activities available. Relatives said, We think they could maybe have a few more activities or entertainment, and, There are no activities or stimulation. In some care files we saw that Activities Assessments had been undertaken. These identified what people might like to do and what their abilities were. This information was not carried forward into care planning for social care on those files viewed. Individual activities records are maintained. These showed that where people are cared for in their rooms they are offered some one to one time. Other activities include, music, shooting game, and art work. We saw that when individuals have specific interests or hobbies this is supported. For example one person enjoys drawing all the time, and another person enjoys puzzle books and computer games. Activities in the home are mainly focused in the afternoon when an activities person works from 14.00 to 16.00 each weekday. We saw that there was plenty of activity equipment available, and that the activity co-ordinator encouraged people to take part in different Care Homes for Older People Page 17 of 32 Evidence: activities. An aromatherapist visits the home twice a month, and outside entertainers also visit. In the lobby area there were photographs that show people enjoying parties and other activities. During the morning of the site visit people were observed to be left largely to their own devices in their rooms, or in the homes two lounges. Staff were however attentive and popping in and out. This caused some confusion as within a short timescale people were asked three times if they wanted the television or music on. It was agreed that they would have music on for an hour, and then soon after another member of staff had gone in and the television was put on again. In discussion and on the AQAA the manager recognised that activities are an area for continual development, particularly for those people with dementia. The AQAA said, The home is planning to implement full internet access for those residents who wish to use the facilities. As some residents now come into the home with laptops, access to the internet will be most beneficial to them in keeping in contact with what is happening in the world outside the home. The implementation of Wii games is also planned so that the activities co-ordinator can play team games or individual games with the residents as required. The home is planning to purchase a minibus during the next 12 months so that residents can go on trips outside the home. Care staff also need to be trained and encouraged to see activity and occupation as integral to all aspects of daily life and very much part of their role. Although the homes brochure stated that there are monthly church visits to provide communion and a hymn service this has not happened for some time. The manager said that this is soon to start again and arrangements have been made with a local church that attends the sister home to Fernbrook House. A relative felt that people were encouraged to make choices in their daily lives and said, The carers are always patient and cheerful and allow my [relative] to make decisions about food, clothing etc. as far as they are able. During the day People spent time where they wished. Some people felt that routines of daily life were not consistent or to their liking. One person said, Sometimes we are got up early, then the other day it was about 11.00 which is far too late. On a survey a relative said, X is woken very early but then waits for a couple of hours for breakfast. They are only allowed one shower a week. The manager said that people could have baths or showers as they wished. People living at Fernbrook House are able to have visitors at any time. During the site visit when visitors came they were made welcome by staff. We noticed that some people have their own telephones, so are able to keep in contact with friends and family. A pay phone was also available in the entrance area. Information on advocacy services and a Relatives and Residents Association was available. This will help people to know where they can go for independent support and advice. A tour of the premises showed that although some rooms are quite bare, Care Homes for Older People Page 18 of 32 Evidence: people are able to bring in their own possessions in order to make their rooms homely. On surveys only four people said that they always enjoyed meals at the home. Two people said that they usually did and four that they sometimes did. People spoken with during the site visit seemed happy with the food provided, and said that it was, very nice, Usually the food is quite good, and, Its alright. A member of staff was seen to go round to people during the morning to see what they wanted for lunch, with a choice of liver and bacon or sausages for lunch and soup and sandwich or chicken nuggets and beans for tea. The AQAA said, Following requests made by residents and their families from quality questionnaires for a more varied menu, changes have been put in place regarding the menus. These changes include new menu items, more choices and more variety. We have also introduced a simple satisfaction system in which the residents can rate their meals. Meals that receive a low scoring will be either changed or improved. When we visited, the home were still operating a two weekly rotating menu that provides limited choice. This is disappointing as we raised this as an issue at our last visit. However management have been consulting with residents and a new four weekly menu plan is to be implemented in the new year. We saw that the new menus will provide greater choice for people. Meals at Fernbrook House are not a special or social occasion. People did not have the opportunity to move around or have a change of scene. Ten people remained in the upstairs lounge, and two people in the downstairs lounge and had their lunch from over-bed style tables. In the upstairs lounge people had been in the same position with the tables in front of them all morning, and remained so after lunch. Some people had to share a table giving them an awkward eating angle. The television remained on. Meals were individually labelled but served ready plated with gravy applied. A number of people ate in their rooms. One person had no table so was leaning awkwardly from their chair to the tray that had been placed on the bed. The provider said that this is the position they prefer to eat in, even when offered assistance or alternatives. Another person had not been assisted to sit up properly and could therefore not see their meal properly or eat easily. Another person had been left with their meal in front of them which they were not interested in or eating. They had no staff support or encouragement and their meal was getting cold. Some people who were confused had been served with their lunch and pudding at the same time. This may mean that they are confused about what to eat. We have already commented on staff skills in assisting people. The manager said that it is peoples individual choice to remain in the lounges, but staff did not encourage anything different. The manager said that when people are asked what they want to eat they are also asked where they would like to eat, however this did not happen when we observed this process. At Care Homes for Older People Page 19 of 32 Evidence: tea and coffee times people were offered choices, but at other times staff just filled up glasses with juice or water without asking people if they wanted more or what they wanted. Care Homes for Older People Page 20 of 32 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. People are able to raise concerns and feel safe in the home. Evidence: There was a clear complaints process in place that was on display for people and briefly mentioned as part of the Service Users Guide. On surveys everyone said that they knew who to talk to if they were not happy with anything, but four said that they did not know how to make a complaint. Since the previous inspection two complaints have been recorded by the home. These were well documented. No complaints have been raised with us (CQC) since the previous inspection. Over the past year we have however had to intervene to ensure that proper safeguarding procedures were followed. We received two notifications, sometime after the events had occurred in the home. Both should have been reported to the safeguarding team without delay. This was subsequently done and events looked into by in one case social services and the other the health authority. The manager at the time said that they were working reduced hours and were not always aware of what was happening to ensure that things were reported and documented properly. Other senior staff had clearly not understood or followed procedures. This left people at risk. Since that time a new manager and other senior staff are in post. We saw that there were up to date local authority guidelines, and local procedures available to give staff understanding and guide their practice in relation to safeguarding. A flowchart was available showing actions to be taken in the event of an incident. According to training Care Homes for Older People Page 21 of 32 Evidence: records all but one member of staff have undertaken training in safeguarding. On the care plans sampled one viewed showed that where the persons behaviour could be difficult this was identified and advice given to staff. For another person however where there were potentially serious behavioural issues, although a risk assessment was in place, no care plan arose from this. The manager confirmed that no staff have undertaken any specific training in managing challenging behaviour. Care Homes for Older People Page 22 of 32 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. People live in a pleasant home Evidence: Fernbrook House provides a generally comfortable and homely environment for people. When the current provider took over the home an extensive refurbishment programme took place to improve the environment. Some further works would be of benefit for example some corridor areas are looking tired and would be improved by redecoration. At this visit people were happy with the accommodation and said that they liked their rooms. As at previous inspections we saw that one shared room still had obscured glass fitted to the window, so that the occupants could not see out. People should be able to see out of their bedroom windows. Most bedrooms were reasonably homely and been personalised. Some however were quite bare. A general hand is available to undertake repairs and decorations. At the site visit we noticed some things in need of repair and these were immediately attended to. In one case it was a chest of drawers where all the drawers were broken or not fitting properly. It was not known how long it had been like this. Staff may therefore need reminding that they must report any issues such as this so that they are dealt with in a timely manner. The provider said that he monitors the fabric of the building. There is a garden area at the back of the home for people to use. One person said, Care Homes for Older People Page 23 of 32 Evidence: There is a small garden which could be made pleasant for people to sit in in good weather. It is overgrown and neglected. Management recognise this and have plans to improve the area. The AQAA said, The garden area could be more pleasing to the eye and it is for this reason and because of comments made on a questionnaire that patio furniture and a barbecue is to be purchased on time for the better weather so that residents and their families can enjoy the benefits of sitting outside. Limited signage is provided to assist peoples orientation. As the home is registered to provide care for people with dementia this would benefit from being reviewed. The homes bathrooms and toilets were not part of the initial refurbishment programme and would benefit from de-cluttering and brightening up. Two bathrooms are used for storage showing that this is an issue at the home that reduces the facilities available to people. As at the previous inspection assisted bathing facilities are only available on the first floor, with a shower area and an unused non assisted bath on the ground floor. This means that people living downstairs do not have bathing facilities close to their rooms. On the day of inspection the home seemed adequately clean and there were no unpleasant odours. A relative however felt that this area could be improved and said, My relatives room is not always as clean as I would like and I sometimes do the dusting myself. Minutes of a recent staff meeting said, It has been reported that cleaning is not up to standard. Domestic staff to be more vigilant and make sure all rooms, toilets and lounges are clean and tidy. The home has a laundry area where there was adequate equipment to meet the needs of people. Training records showed us that staff have undertaken training in infection control, which should assist them in maintaining good practice. Practice may need monitoring however. In one room we saw that dirty linen had been put on the floor. When staff realised that we were around a container was fetched from the laundry area. Care Homes for Older People Page 24 of 32 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. People are cared for by kind and adequatly trained staff. Evidence: We received some positive comments about staff working at Fernbrook House. Residents said: I like all the staff, The staff are always friendly, They are always kind and considerate, and, They look after you alright. One person spoken with however felt that there was sometimes a communication issue. They said, Sometimes they cant understand me or I cant understand them. We have to keep repeating things to each other. They often jabber away in their own language to each other. This has been an ongoing issue in the home. The persons comments were relayed to the manager. Although the homes brochure states that staff turnover at the home is low, this is not the case. At the previous inspection 12 staff had left. This year the AQAA reported that 10 staff had left over the last year. This will not help in providing people with consistent support from people that they are familiar with. It is positive however that the home do not use agency staff. Staffing levels are maintained at a trained nurse and five carers in the morning, a trained nurse and four carers during the afternoon and evening and a trained nurse and two care staff night. During weekdays the manager and a director of the Company are in the home as supernumerary to these numbers. The AQAA and observations at the site visit indicated quite high levels of dependency in the home. For example 12 people requiring help or supervision to eat meals, eight people being cared for in bed and 14 Care Homes for Older People Page 25 of 32 Evidence: people requiring two or more people to assist with their care during the day. At the site visit the manager and provider said that they were happy with current staffing levels, which had been worked out using the Residential Forum guidance. This is a system for working out what staff are required based on peoples level of dependency, layout of the building and so on. On surveys and in discussion people felt that staff were generally available when they were needed. At the site visit staff were kind but busy at all times. Although they popped in and out of the lounge area, they did not have time to spend any quality time interacting with residents. One survey said, Staff are friendly and caring but feel things could be better if there were more staff. Rotas showed us that both trained and care staff commonly work twelve hour shifts on up to four days each week, with shorter shifts on other days. This is not good practice as staff practice and competence may become compromised if they are tired. We also saw that staff may on their days off be on standby to cover shifts at the sister home to Fernbrook House, this means, in one persons case, that they are potentially working for three weeks without a day off. The manager said that they do monitor peoples hours. A cook is provided each day from 08.00 to 17.00. Rotas showed us that housekeeping hours are also provided each day. So that people receive care from a well trained workforce it is recommended that at least 50 of a homes care staff achieve a National Vocational Qualification (NVQ) in care at level two or above. Fernbrook House has exceeded this target. A training matrix showed that apart from two staff who are currently undertaking NVQ at level two, all staff have already achieved an NVQ at level two or three or both. To see how well people are protected by the homes recruitment procedures we looked at the files of the two most recently recruited staff. We saw that a good process had been followed, and appropriate checks such as references, identification, and ISA first checks had been carried out. Criminal Records Bureau checks were in place. As staff recruited and working at the home are from overseas the home sometimes finds it difficult to get good references. For example one persons second reference had been supplied by a member of staff working in the home who they were living with and who was also recorded as their next of kin. This is not ideal. A new member of staff spoken with, and staff surveys, said that induction had covered what they needed to know. On the two staff files looked at a good initial four day induction had been undertaken. Currently people recruited are students undertaking NVQs in health and social care, so Skills for Care foundation standards are not being worked on. The manager was however aware of these and when they would be used. Staff spoken with and on surveys were positive about their role and felt that the home Care Homes for Older People Page 26 of 32 Evidence: offered good opportunities for training. We saw that details of up and coming courses were on display. The manager recognises that the home could do better in monitoring that staff put learning into practice and intends to introduce this element into their supervision. The AQAA said, We are very good at ensuring that staff attend appropriate training courses but we are not so effective in obtaining feedback from staff on training courses that they have attended to ensure that best practice is cascaded throughout the home. To address this the home will be putting training feedback as a permanent agenda item for staff meetings. A director of the Company who is working at the home to help is currently undertaking a ten week lifelong learning course that will equip them to deliver training to staff in a number of different areas. From training records all staff have now undertaken training in dementia care. The manager said that some of this has been in house training and some through the local authority. It is also planned that all staff will attend a more in depth distance learning training package in dementia care. Both the manager and provider are committed to having a well trained workforce. Care Homes for Older People Page 27 of 32 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 live in a well managed home where there are opportunities for them to express their views about the service. Evidence: The current acting manager at Fernbrook House has stepped in to cover the management of the home following the departure of the previous manager. They are the deputy manager of the sister home to Fernbrook House and do not intend to take over the management of Fernbrook House on a permanent basis. The provider is trying to recruit to this role. The acting manager had a good awareness of individual residents, and demonstrated an understanding of the National Minimum Standards and the expectations of home management. Staff spoke well of the manager and management of the home: The manager is always available and very supportive and approachable, There is openness and good communication, since the new employer took over there has been very good changes generally that makes residents staff and visitors happy, and, The manager is very supportive and caring for all staff as well as residents. We saw that regular staff meetings take place. Since the Care Homes for Older People Page 28 of 32 Evidence: previous inspection better processes have been put in place to ensure that people have the opportunity to express their views about the service. A quality assurance exercise using surveys was carried out in September this year, and reports from findings produced. From comments on the AQAA peoples views have been listened to and changes made to accommodate what people say. We saw that the provider is undertaking the regular monthly visit that is required by Regulation to ensure that the home is being properly run. The home have started to hold relatives/residents meetings. The first of these was held in September and it is planned that they will take place about every three months. The minutes said that, The aim of these meetings is to improve and develop the care and environment of the home. The AQAA was completed by the acting manager. It was very briefly completed and did not give us a very detailed picture of how the home was operating. The need to provide more detail was discussed. The AQAA was good however in recognising the areas where improvement is still needed. This shows that management are constantly seeking to improve the service offered to people. People can feel confident that if they or their families ask the home to help them look after their personal monies, this will be done in a way that safeguards their interests. Monies checked were correct, with receipts in place for all transactions. The fire service visited the home on 13/12/09 and found everything to be satisfactory. We saw that a fire risk assessment is in place, and that staff undertake regular fire drills. Weekly checks are carried out on all fire equipment. The home had an inspection from an Environmental Health officer on 18/11/09. The previous inspection in June 08 had awarded the home five stars and said that excellent standards were maintained. The manager said that this had remained the same. A tour of the premises did not reveal any major health and safety issues. The training matrix provided showed that most staff are up to date in core areas such as moving and handling and food hygiene. A number of staff however are not identified as having training in health and safety. This should be addressed to ensure that all staff maintain safe practice and recognise potential hazards. Care Homes for Older People Page 29 of 32 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 30 of 32 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 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 1 The homes Statement of Purpose and Service Users Guide should be reviewed. The information provided should be in line with regulatory requirements and provide people with full information about the service. Arrangements for mealtimes should be reviewed to ensure that people have the opportunity for socialise and have a change of position and scene. People need to be properly supported at mealtimes. 2 15 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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. 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