CARE HOMES FOR OLDER PEOPLE
Ferndale Easton Road Flitwick Beds MK45 1HB Lead Inspector
Dragan Cvejic Announced 23June 2005 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 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 I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Ferndale Address Easton Road Flitwick Beds MK45 1HB 01525 712650 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) BUPA Care Homes (Bedfordshire) Ltd Joan Bradshaw care home 30 (30) (30) (30) Category(ies) of OP - Older People registration, with number DE(E) - Dementia over 65 of places PD(E) - Physical Disability over 65 Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14/12/04 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 I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out during one working day. The home supplied pre-inspection questionnaire and basic statistical information. The other methodologies used were reading documents, talking to the management, 4 staff members and 7 service users. An informal tour through the home was made and the inspector was invited into two service users’ rooms. The home, staff and service users welcomed the inspector and provided the information necessary for this report. The manager explained that the home offered care to elderly frail people, some with physical disabilities and small number of users with mild dementia. What the service does well:
“I am 93”, said a service user spoken to, “I came in first to stay here for my daughter’s holiday, but than decided to stay permanently. It’s homely; they make me a cup of tea even at night. Everything is clean. All the carers are very nice and food is all right. I have my private phone, I am happy with my room. I have everything I need. It only took me 2 or 3 days to settle in, you could not have a nicer place to live in.” Other comments from service users confirmed that the home offered very good care in a nice environment. “What they do for us is wonderful. There are no restrictions, food is great, we have a choice, and our washing and ironing is done for us.” A service user that wanted to do washing up after morning tea commented: “I don’t want to make my tea, here, no thank you. I did it at home, but not here. I prefer staff to make it for me. I help with washing up.” This choice was repeated in many cases, when recorded preferences in care plans were actually respected in everyday life. Records were clear, detailed and concentrated on the main issues and needs. Documents were dated and signed and regularly reviewed, with service users’ input. An updated care plan was discussed with the care assistant and she confirmed that a service user’s plan stated that “wheelchair should be used when service user becomes tired of walking with her Zimmer frame”. Daily records showed that this had actually happened and the service user was more than happy with the arrangement. Both the comments and the observation demonstrated that the atmosphere in the home was very positive, supportive at all levels, friendly and professional. All but one service users spoken to commented that they felt at home and that they were well looked after in a comfortable and pleasant environment. A hairdresser that works at the home said: “I will put my mum here. It is a lovely home.” The manager stated that many staff working short, part time hours provided an excellent flexibility for easy management of staff deployment.
Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 6 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. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4,5 Clear and complete written information was provided in a statement of purpose, a service user’s guide and a home’ “welcome pack. The appropriate pre-admission assessment and with a good admission procedure ensured that service users could make a really informed choice of the home that would be able to meet their needs. EVIDENCE: The home had a reviewed statement of purpose and an extract from it, with the aims and objectives, was displayed in the staff room. A copy of the document was also available in the main hall. Minutes from the service users’ meeting demonstrated that they were involved in the review process, as the agenda contained: menus, activities, Personal best, care plans and laundry. The home used a new form for the assessment process that ensured all relevant information was collated prior to admission. The comments from family members were included in users’ files. Risk assessments were related to admission details and care plans and appropriately addressed identified risk areas. Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 9 Service users’ comments confirmed that their needs were met. Trial visits were used by users and staff to determine suitability of the home for each individual, potential service user. Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 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 standard(s) 7-11 The home had a very good working practice, ensuring that service users’ health care needs were seen and acted upon individually. This approach was demonstratively effective and service users benefited from well organised monitoring system that was in place. A holistic approach to each individual ensured preventative and timely actions were taken when it was necessary. EVIDENCE: The care plans and risk assessment were related and demonstrated personalised and respective approach to each individual. A service user’s deteriorating mobility was addressed in the care plan that stated “she is using a wheelchair now for longer distances”. A risk assessment was drawn up for the use of lift for the same service user. A daily routine was very flexible and service users’ wishes and preferences were respected and promoted by engaging the allocated staff to work with individuals when service users wanted them on duty. A visiting district nurse sat in a service user’s room to offer her treatment in private. The personal care giving was individualised. A service user stated that she wanted her care worker to help her with a bath and that staff was planned to work during the hours when the service user stated she wanted to have a bath.
Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 11 The plans and regular reviews were clear, up to date and were dated and signed by service users demonstrating their involvement in care planning process. An holistic approach ensured all health care needs were addressed including dental, podiatric and mental health care needs. Medication records did not accurately correspond to the amount of tablets in the home and monitoring system was not effective. There were more tablets than recorded in one case and less in another. Privacy and dignity were highly respected and many service users confirmed that their rights and privacy were respected. The files contained users’ preferences, ability to hold the key, to open their post and to make decisions on their daily life. The appointments with external health professionals were accurately recorded. Service users were consulted about their needs and their wishes were recorded and respected. The arrangements in case of death were recorded. Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 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 standard(s) 12-15 Service users enjoyed the flexibility and home style management of everyday life in the home. They took part and greatly influenced the daily routine that promoted their independence, rights and choice. EVIDENCE: The home offered a variety of activities both in and outside the home. A service user who greeted the inspector started by saying: “the girls took me out to the pub for a drink the other night. It was great.” A list of activities was on the notice board in the home. Autonomy and choice were very well respected and promoted. Families supplied additional information about service users’ habits, hobbies and preferences. A service user proudly showed her box production work and explained that a handyman was supplying her with materials for her hobby. She donated her hand made small jewellery boxes for humanitarian purposes. Meal times were particularly relaxed and friendly and a cook respected individual preferences and knew the likes dislikes and dietary needs of service users. She also recorded all “special orders”, usually made at the last minute by individuals. A service user stated: “I can change my mind about the food when they serve it and choose something different”. Menus were discussed and chosen by service users in their meetings and all comments about food were very positive. A cook commented on her satisfaction and very good relationship with service users.
Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 13 Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home ensured the protection of service users through safe working practices, a good, clear and simple complaints procedure and through an open and inclusive management style. EVIDENCE: The home had a simple and clear complaints procedure that was accessible in the main hall. The home received one complaint that was resolved within the set time scale and to the complainant’s satisfaction. A whistle blowing policy was displayed in the staff room reminding anyone that they could use it at any time. The policy was concise and clear. The staff knew how the procedure would be conducted if there were allegations of abuse. There were no referrals to POVA at the time of the inspection. Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 15 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 standard(s) 19,20,21,22,24 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. EVIDENCE: The home was well maintained with set programme of cyclical maintenance. The cook confirmed that identified equipment for replacement was replaced since the last inspection. Service users were proud of the environment, comfort it offered and homely style that they liked. The dining tables in the dining room were due for replacement and the manager confirmed that the order has already been placed. The home was bright, clean and well ventilated. A conservatory was very popular and well used by service users. Each floor had sufficient number of bathing facilities. Bathrooms had grab rails, a Malibu bath was installed and used by many service users and this preference was also recorded in care plans.
Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 16 Several service users used a lift autonomously and the home drew up risk assessments for those who enjoyed this facility independently. All service users spoken to confirmed that they had all they needed in their rooms. Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 One of the main advantages in this home was a 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 employed sufficient and competent staff. Many staff members were working part time, short hours, allowing for flexibility and accommodated meeting the service users’ preferences regarding their daily routine. It also provided more opportunities for staff to take service users out from the home to the local amenities. The rota was clear and indicated capacity of workers on duty. All staff had completed the TOPSS induction training and used the programme to up date their knowledge. They were also doing BUPA’s Personal Best programme that concentrated and emphasised individuality of service users. The home had a very low ratio of the NVQ qualified staff, but the recruitment programme required new staff to enrol on this training as soon as they were ready. The staff were up to date with mandatory training. Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,37,38 The home was well managed that 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: The home was managed by the skilled, experienced and qualified manager. She created open, transparent and inclusive atmosphere where service users and staff felt empowered and respected to voice their opinions and give suggestions. A minutes from service users’ meeting displayed in the hall demonstrated their discussion on replacement and renewals in the home. A service user stated that she suggested a colour for re-decorating her room. The service users meeting’s minutes contained a discussion on a new way of operating laundry that was introduced and improved this provision. These examples showed service users’ involvement in management of the home.
Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 19 A quality assurance review was carried out and the results were used to analyse and improve services and provisions. Service users that needed support to deal with their finances, including their personal allowances were directed to use an independent representative or use the BUPA’s system. Records inspected were accurate, up to date and well organised, apart from those related and addressed under medication. The home ensured safe working practices were in place. Staff received mandatory training on a regular basis. Records demonstrated that all staff were recently trained in first aid and manual handling and all staff completed TOPSS induction programme, as a part of their in-house regular training. Accidents/incidents were accurately recorded and reviewed in order to reduce re-occurrence. Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 4 15 4
COMPLAINTS AND PROTECTION 3 3 3 3 x 3 x x STAFFING Standard No Score 27 4 28 2 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 4 3 x 3 x 3 3 Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13 Requirement The medication process must be reviewed and arranged in a way to ensure accuracy and allow for monitoring process. Timescale for action 31/08/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 28 Good Practice Recommendations The manager should promote the NVQ so that the staff ratio raises to the expected level of 50 . Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 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
© 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 Ferndale I51 s14901 FERNDALE v226808 230605 stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
