CARE HOMES FOR OLDER PEOPLE
Ferndale Easton Road Flitwick Bedfordshire MK45 1HB Lead Inspector
Dragan Cvejic Unannounced Inspection 17th November 2005 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Ferndale Address Easton Road Flitwick Bedfordshire MK45 1HB Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01525 712650 01525 714169 BUPA Care Homes (Bedfordshire) Ltd Ms Joan Bradshaw Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23rd June 2005 Brief Description of the Service: Ferndale was a residential home in a quiet side street in the village in Flitwick. Location of the home in the small community had an impact on the operation of the home. Many service users came from the same area and the staff working in the home were mainly from the same locality. The home offered accommodation to elderly frail people in general. The communal areas were mainly on the ground floor, and service users bedrooms on the first and second floor in this three storey building. The home was appropriately equipped to meet the needs of service users, with grab rails, special baths and other supportive equipment. It still preserved its homely environment and atmosphere. Staff were professional, but still friendly, and showed respect and commitment to their work. The home offered a very good standard of care. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out during 2.1/2 hours in the morning. Only some key standards were inspected and this report should be read together with the previous when most standards were inspected. This inspection was carried out using a case tracking methodology. One service user was case tracked and the home’s fire safety and procedure were case tracked. Four service users were spoken to in detail, although brief comments were collected form 4 more. Three staff members were consulted, as well as a student nurse on a placement and a hairdresser. Moving and handling process was observed, as well as getting up and breakfast. Four users’ bedrooms, a laundry room, communal areas, family rooms, two lounges, corridors and the staff room were inspected. The home was temporary managed by a new deputy while the registered manager was seconded to another home, but was coming in at least once a week to stay up to date with the home’s life. Her absence did not affect standards in the home. The home continued to offer a very good level of care in a pleasant and comfortable environment. What the service does well:
Much useful information was provided in the entrance foyer: information about the home, about the advocacy services, local events, many tailored services to help older people, such as financial protection, funding explanation, help with their potential health issues and some of the home’s procedures that included a fire procedure. The atmosphere in the home was very friendly, open and positive. Staff listened to and talked to service users. They discussed the weather, a daily politics, anything that is a part of normal every-day discussion. Service users who were unable to walk unaided were helped with dignity and respect. One of them said: “This is lovely, I feel much safer”, when staff used the hoist to help her move. “It’s your turn Mrs X”, a staff member explained to service user who waited to be moved next from her wheelchair to a comfortable armchair. The home displayed the fire procedure in all major areas within the home. The procedure at the entrance made all aware. Each bedroom had a fire procedure displayed. Service users knew the procedure. Staff explained clearly their actions in case of fire. A hairdresser also knew the procedure and included potential customers in her salon. The fire fighting equipment in the home consisted of a combination of fire extinguishers and fire hoses. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 6 An engineer was in the home during the inspection to carry out regular yearly lift maintenance. The manager explained that the home planned all maintenance tasks for the time when they would cause minimal disturbance to service users. Breakfast time was a pleasant, social event in the dining room. It looked and sounded like in a nice tea shop. Tea was served in teapots and staff helped users who needed help filling their cups. A choice of cereals, toast and sandwiches were offered from table to table and demonstrated how service users were treated with dignity. Service users that needed help with their finances used an established BUPA system that ensured protection from abuse. The home benefited from the stable, experienced, committed and flexible staff team that provided all cover themselves and successfully avoided use the of agency staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection.
Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 7 The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,4 The home provided written information about the services and provisions not only in this home, but by the organisation, BUPA, too. Service users could make an informed choice of home from the information provided. EVIDENCE: The home displayed its aims and objectives in the entrance foyer. A number of other leaflets and information were provided allowing service users, relatives and visitors to learn about the home, the local area, other services and general help in care settings. Service users confirmed that: “Staff are very good. They are always here when we need them and they help us with everything we need. They help me get up from my chair when I want. They are so understanding.” Observing staff while using the hoist to help two service users move demonstrated how they managed to keep service users so happy. Responding to users’ wishes and preferences also demonstrated how the home met the needs of service users. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9,10,11 The home had introduced improvements in the medication handling process making it safe, easy to monitor and ensuring the protection of service users. The home continued to respect the dignity of service users above the minimum level and users felt respected as individuals. EVIDENCE: Medication records were accurate. The amount of medication prescribed on a “when needed” basis was transferred from sheet to sheet allowing easy monitoring and audit. A syringe was used to accurately measure amounts of liquidised medication. A service user confirmed that she knew her medication and that it was always given to her correctly. A senior staff member was observed administering morning medication and the process was appropriate. The person in charge was helping a service user when the inspection started and stayed to complete this task before seeing the inspector. Two staff knocked on the doors before entering bedrooms. Cleaners were taking commodes away for cleaning when service users were not in the rooms, to show respect and promote dignity. Service users were happy with the laundry service. A laundry staff member stated that she was sorting out any potentially mixed clothes each weekday,
Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 11 ensuring service users wore their own clothes. Dignity was highly respected as demonstrated in staff contacts with service users and from users comments: “the staff did more than they could”. Death was sensibly discussed, so that service users were not distracted from their positive approach to life. Information about death and bereavement was displayed in the visitors’ room. The home had a procedure on how to deal sensibly with service users with terminal conditions. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 Service users enjoyed the flexibility and homes’ style of management of everyday life in the home. They took part and greatly influenced the daily routine that promoted their independence, rights and choice. EVIDENCE: A list of activities, created monthly, was displayed on the main notice board and was accessible for all service users. The same board was used to display the minutes of service users’ meetings. They contributed to the setting of a daily routine in the home’s life. These minutes were produced in large print so that most users could easily read them. Relatives were invited to attend these meetings and the last attendance list showed that one relative attended. The list of activities contained the visits by the church representatives and the hairdresser’s sessions were also planned and presented on this list. The home established contacts with a local school and was expecting a visit from them. Two family rooms were designated for visitors and service users that wanted to meet in private. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): none These standards were met and were not inspected on this occasion. EVIDENCE: Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,24,26 The location and facilities provided in the home matched the needs of service users and an appropriate and effective maintenance programme ensured that service users had a nice, homely and pleasant place to live in. Some internal doors did not seem to meet fire safety standards. EVIDENCE: The home was clean and bright in one half of it, and the cleaning team was working on the other half. The standard of cleaning was appropriate and two service users spoken to stated: “The home is clean and pleasant to live in.” The home was accessible to all service users except for a short time, whilst the basic maintenance took place. The lift was out of use during the inspection, but all service users were downstairs while the engineer carried out regular yearly servicing. This was carefully planned and organised to cause the littlest possible impact on service users. Some internal double doors, sealed by an intuminance strip to ensure smoke retention in case of fire, did not close properly and presented a serious risk to health and safety. The manager was made aware and stated that the matter would be reported immediately to the BUPA maintenance department.
Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 15 Service users commented that communal areas were comfortable and homely. Their personal bedrooms, 4 were inspected; were clean, homely and attractive with personal pieces of furniture. A laundry room had the appropriate flooring, all equipment was operational and individual clothing baskets ensured the least mistakes and mixing of users’ clothes. Infection control measures were implemented in the home. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 One of the main advantages in this home was the staff team. Their commitment, flexibility, number, skills and experience and caring attitude determined a very good standard of care and satisfaction of service users. EVIDENCE: The home continued to benefit from the flexibility of the staff team. Many staff worked part time hours and were able to cover internally for absences. This way, the continuity of care and stability of the processes were ensured. Staff rota indicated who was working specified hours and was created weekly. Staff were observed helping service users and presented a good practical knowledge of techniques used in the home. A student on a placement was allocated specific tasks with named staff members and was working always supervised. The home encouraged all new staff to undertake the NVQ programme and 4 staff were planned to start. The ratio of qualified staff was around the required percentage of 50 , fluctuating around the acceptable range when new staff start and the number falls under 50 . Staff training plan was displayed in the staff room showing who was due for refresher mandatory training and ensuring the training was available to all staff that wanted to attend a specific session. BUPA’s Personal Best programme was also well promoted and given appropriate attention. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36, 38 The home was well managed which ensured service users’ safety, welfare and rights were protected and their voice was taken into account when the management of the home was planned and organised. EVIDENCE: Although the registered manager was working only one day in the home, while on a temporary secondment, her influence, style and philosophy were respected and followed by the staff team and the deputy manager who ensured that stability was maintained. The atmosphere in the home continued to be the main element that determined judgement about the home: working to very high standards of care. Results of the 2005 service users survey were on the notice board. Insurance certificate and registration certificate were displayed. The business plan took into account the temporary engagement of the manager elsewhere and provided direction of the home for the future. The deputy was given more responsibility in relation to everyday running of the home.
Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 18 An administrator stated that all service users who needed help with their finances were using the established and effective BUPA financial arrangement by which service users financial interests were protected. The home did not handle anyone’s personal allowances. The staff supervision programme had started to fall behind schedule due to the manager and a previous senior staff member being away, the manager on secondment and a senior staff member who was promoted and moved to her new position in another home. The deputy stated that she was aware and the staff were consulted about this temporary difficulty. Staff were encouraged to approach her and ask for extra support if they needed, until the current recruitment process brings new seniors in and the supervision plan continues as planned. Fire procedure and safety were inspected in detail. Two different directions were given in written form and some internal doors needed immediate attention, but the rest of the fire safety measures, procedures and knowledge were in place. Equipment was tested in May this year. Fire training for all staff was carried out in October. Service users were aware of the procedure. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X X 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 3 3 X X X 3 X 3 STAFFING Standard No Score 27 4 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 4 3 X 3 3 X 1 Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP38 Regulation 23 Requirement Timescale for action 12/12/05 2 OP38 23 All internal fire doors must be inspected and any discrepancy with the fire regulation must be dealt with immediately. The doors that do not prevent smoke coming through are not appropriate and endanger service users and staff. 12/12/05 All written fire procedure in the home must be the same wherever displayed, and the potentially left old procedure would cause confusion and seriously endanger service users, staff and visitors and must be removed and replaced with the current procedure to be displayed in all areas in the home. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No.
Ferndale Refer to Good Practice Recommendations
DS0000014901.V267165.R01.S.doc Version 5.0 Page 21 1 Standard OP36 The deputy manager should arrange as soon as possible for a supervision process that will ensure staff are regularly supervised, especially during a vulnerable time such as this when the manager is on secondment. Ferndale DS0000014901.V267165.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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