CARE HOMES FOR OLDER PEOPLE
Ferndale Easton Road Flitwick Bedfordshire MK45 1HB Lead Inspector
Dragan Cvejic Unannounced Inspection 25th January 2008 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.V358646.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 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 barnepen@bupa.com BUPA Care Homes (Bedfordshire) Ltd Mrs Penny Barnes 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.V358646.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th May 2007 Brief Description of the Service: Ferndale is a purpose built care home that is registered to provide care for thirty frail people over the age of sixty-five who may also have dementia and/or physical disabilities. The home had been operated for many years by the local authority and transferred to the current proprietor BUPA Care Homes (Bedfordshire) Ltd ten years ago. The home has got a new manager approximately a year ago. The building had been significantly upgraded after the transfer and provides single room accommodation on three floors. The communal accommodation of three lounges and a large dining room is located on the ground floor. All of the lounges overlook a well-stocked and maintained garden. Toilets and bathrooms are located for convenient access throughout the building. The home is located within walking distance of Flitwick’s town centre and its amenities. Fees for accommodation are available on request. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes.
This was an unannounced inspection of the service. The home submitted their self-assessment, AQAA, which was used in preparation for the site visit and for this report. The site visit was carried out during the morning hours and the manager, staff and residents were asked to provide their overview of the standard of service. Some visitors also commented on care and gave their views on how the home operated. Case tracked residents were asked for their comments and their files and documentation was checked. Other documentation related to residents, staff, training, safety and daily records were also checked. What the service does well:
Initial assessment carried out prior to admission holistically addressed all newly referred people. It means all areas of their life were assessed and their personality was considered, helping all to decide if the referred person would fit into the home. Very good records of initial assessment, in care plans and risk assessments, helped staff to get to know each individual and meet their needs. The detail went to the extent of “likes two sweeteners in his tea” and “likes reading novels” was recorded. A visitor commented to us during his visit: “This is by far the best home in the area. If I ever need care, I would come here.” How needs were met was confirmed in a number of thank you cards with comments: “Thank you for all you’ve done for my grandma. “ and “The compassion and care shown to my mum during her last few days of her life are a shining example to everyone working in care of the elderly.” Users’ autonomy and independence was not only respected but also promoted. A user who wanted to do some house chores was in charge of feeding the home’s pets: birds and cats. This was nicely recorded in her care plan and a risk assessment was drawn up related to these tasks. Set in the rural village of Flitwick, the home not only housed some local service users but also employed many staff from the local community. This helped the home create a warm, friendly atmosphere inside, but also maintain contacts with the local community, for example the local school; and including service users in local life. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 6 A responsible individual visited the home as a part of regular management monthly visits and found staff taking some service users out for a walk, making the most of the nice, sunny and warm winter day. The new manager brought better organisation and a user who was in the home for 4 years, commented: “The home went down in standard when the previous manager left, but has now nicely picked up with the new manager.” This comment agreed with the general feelings and findings of this inspection. 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. The summary of this inspection report can
Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 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.V358646.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supplied sufficient information allowing users to make an informed choice and the initial assessment sufficiently addressed users’ needs, ensuring that the needs could be met if individuals were admitted. The home did not provide intermediate care and this standard was not applicable. EVIDENCE: At the entrance to the home, in the recently updated Service user’s guide, there was the most recent inspection report, expanding information about the home to all interested people in an open, transparent and honest way. The introduction of QUEST forms with a detailed form for initial assessment improved the assessment and helped users and the home decide if the
Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 10 assessed needs could be met. Four service users recently admitted were assessed using this new form. Following their care planning from initial assessment, their risk assessments, and daily notes showing their progress in the home, it was visible that service users’ needs were met. Two of them spoken to, confirmed that they “felt at home” and “well supported”. The home’s self-assessment provided the same evidence for this group of standards: “All prospective residents undergo a comprehensive pre-admission assessment to ensure that the home can meet any identified need and the placement will be appropriate. They will then have a realistic idea of what we offer. This is so that all parties can make an informed choice about where they are to live, and are fully aware of the services we provide. We invite prospective service users to visit the home and have lunch or afternoon tea to give them an opportunity to chat with service users who already live here. We provide comprehensive written information for prospective clients, and ensure that they have full access to the service user guide. One of these is placed in every bedroom, as well as in the reception area.” Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users felt comfortable, respected and well cared for by the permanent staff, their care plans provided clear instructions to staff on how to help users in the way they agreed and liked. EVIDENCE: Personal and health care was assessed in the home’s self-assessment and stated: “All residents have comprehensive personal care plans individual to their identified needs. Self care is encouraged. Any case of pressure sores is recorded. The information is collated within BUPA Care Homes and the information is used to identify trends and inform the purchase of appropriate equipment. All residents have a nutritional screen using the MUST nutritional screening
Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 12 tool. Every resident is registered with a General Practitioner of their choice (within the constraints of access to G.P.s). The recently updated Medication policy meets the criteria of the National Minimum Standards and the guidance from the Nursing & Midwifery Council and the Royal Pharmaceutical Society. Privacy and Dignity feature highly in BUPA Care Homes customer service programme, Personal Best.” Four residents’ files were checked and contained detailed information in care plans and related risk assessments. Risk assessments were, in particular, very good, as they addressed a wide range of risks. For example one assessment stated: “keeps furniture polish in her room.” This was further elaborated with actions for staff to check the general health state of the resident in order to ensure that she was fully aware of the potential risks of overusing polish and being aware of COSHH instructions for this chemical. In another example, staff were alerted to observe skin condition for a user who preferred and was allowed to sleep half a night in her bed and the other half in her chair. The files contained records of contacts with visiting healthcare professionals. All four files had records of eye tests, chiropodist visits and interventions by GP’s. Both care plans and risk assessments were reviewed on a monthly basis. Medication process was observed, records for four users were checked, storage and the new medication room were checked and all medication related issues were addressed appropriately. One of the medication records contained an added risk assessment for a resident who wanted to and used her inhaler independently, thus self-medicating. The other records contained signed disclaimers that residents wanted staff to give them medication, rather than to self medicate. A resident spoken to stated: “ I feel so safe now when staff keep my medication. I cannot forget to take it now.” Privacy and dignity were respected. A resident wanted to spend daytime in a different lounge and this was recorded. The resident stated to us how happy she was with it. Respect for independence was visible around the home: a resident was “in charge” of feeding the home’s pets, birds and a cat. Another user helped with clearing mugs and cups, as she wanted to perform some of the general house chores that reminded her of her activities prior to admission to this home. A resident that moved in 3 years ago from another home, remembered both the inspector and the other home and discussed how much better she felt here. The new recording system included records of users wishes in case of death, as for example in one of these, a comment stated: “arranged with “X” funeral directors”. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents chose their normal daily routine and activities both through their meetings and individually planned support and care, but staff did not appropriately address potential delays in helping residents with ordinary tasks, although staff response to emergency calls was very good. EVIDENCE: The notice board in the hall contained a displayed list of weekly activities. It also gave information on a daily basis of what date and day it was and what the weather looked like, helping residents with confusion to stay in contact with reality. Residents spoken to confirmed that they had regular meetings and the minutes were displayed and showed how residents decided themselves about issues affecting their everyday life. A resident was very pleased with these meetings and explained: “when we decide something, it does happen, gradually.” Residents preferred activities were recorded in their care plans: “Likes reading novels”, the other “likes knitting” and the third “feeds cat”.
Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 14 Three residents spoke with a visitor and all four of them confirmed to us that organised activities were regular and were appropriate for users’ needs. Those that did not want to participate in a particular activity, as in the example of a resident who spoke to us, were allowed to opt out. Breakfast time was observed. The dining room was pleasantly arranged, with nice cutlery, with teapots rather than just mugs, for those that were able and preferred to have their morning tea in this traditional way. Staff were present and helped users feel comfortable. Staff spoke in a friendly way and patiently to residents creating a respectful and nice atmosphere. Later on, during the visit, a cook wrote individual choices for lunch in each lounge, checking with residents what each individual wanted. However, a resident was seen waiting for a staff member to return to her for 15 minutes, after being told: “I will see you in a minute”. Although staff responded immediately by running when the call bell rang and buzzers sounded, slightly more realistic responses in terms of when staff would come back to help individual as a part of their normal routine would improve respect and trust. The home’s self-assessment stated: “We have a structured activities programme tailored to the individual needs and preferences of our residents. Residents may handle their own finances should they wish to do so. We encourage the personalisation of residents’ individual space with their personal belongings. A full and varied menu is available in the home. The BUPA Menu Master helps us to ensure the menu meets the nutritional needs of the residents. We have started the BUPA Night Bite system to ensure that food is available 24 hours a day. We have started having a weekly shop that opens at a particular time. This stocks toiletries, sweets etc for the service users to buy and the service users have an input into what they like the shop to stock. This helps to empower them in their everyday life, by identifying their needs and making decisions of what to purchase.” Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were protected by the robust and thee tier process for dealing with complaint or allegations. EVIDENCE: The self-assessment explained the home’s approach to complaints and protection: “We have a clearly defined company complaints policy with agreed timescales for managing complaints. The information that accompanies the policy is prominently displayed in the home. The policy includes a three tier framework including the home, the regional management team and the national Quality and Compliance department. ‘BUPA Care Homes’ has robust policies for dealing with allegations of abuse or neglect. Staff can not only raise concerns within the home, they have access to senior staff outside the home too. There are well documented procedures for reporting under PoVA should the need arise. Most of the staff have undertaken PoVA training this year, and we will ensure that another session is arranged for those who could not attend.” Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 16 The home recorded 3 complaints and 2 referrrals to the Protection of Vulnerable Adults register, but no one was recorded on the register after thorough investigation. Residents spoken to confirmed that they felt confident to complain if they wished. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean, bright, arranged in a homely style and according to residents’ wishes and choices, demonstrating the objective to create a homely atmosphere for residents and allowing them to be involved in environmental issues. EVIDENCE: The home commented about their approach to the provision of a safe and comfortable environment that would meet the needs of residents in their selfassessment: “We use a specialist microfibre cleaning system that combined with effective cleaning regimes keeps the home clean and odour free. Our comprehensive policies and procedures include control of infection and handling clinical waste.
Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 18 Services and facilities comply with the Water Supply (Water Fittings) regulations. The home is supported in maintaining the environment by a central team of experts within BUPA Care Homes. We have a specialist property and estates department as well as a hotel services department. 2 lounges have been decorated this summer and the service users decided on the colour scheme themselves corporately.” The tour of the premises during the site visit confirmed that the home was clean, bright and well equipped to meet the needs of residents. Records of other inspections, such as Fire department and Environmental Health were checked and found to be appropriately recorded and without specific requirements. The manager pointed out proudly that the home was not affected by the recent outbreak of Noro virus that affected some communities and hospitals. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A sufficient number of well organised, well trained and committed staff helped the home achieve its objectives and consequently help residents enjoy life in the home. EVIDENCE: The staff working in the home were primarily from the local area and knew the local community quite well. Some staff knew several residents prior to their moving into the home and this helped create a friendly, respectful atmosphere. Out of 27 staff, 22 were working part time and were flexible when the rota was planned. This allowed the home to cover all shifts internally, without engaging agency staff. A resident stated: “Staff are very good. The two new staff members are excellent, they are always here to help.” A visitor said: “ I come regularly, about once or twice a week. Staff are excellent.” All carers at the time of site visit were female, but two male residents stated that they did not mind being helped by female staff. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 20 Twelve staff members were NVQ qualified and 4 more were currently completing this training programme. Upon completion, there would be 60 of NVQ trained staff. Recruitment procedure was set by BUPA, the organisation, and was rigorously followed when new staff were recruited. Two staff files were checked and showed that all checks were carried out prior to staff starting date. New training records were introduced since the last inspection, to improve not only the close monitoring of training but to ensure that records of staff training were accurate. This new matrix helped the senior team to identify any need for training updates and carefully plan training so that the rota and cover of care shifts were not affected when staff attended training. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,45,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were protected by safe working practices that were set in the policies and implemented in practice. EVIDENCE: The new manager brought her skills and experience to consolidate the home and ensure the home raised the standards of care after changes in management. She continued with her personal development, thus motivating all staff to work on self-development.
Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 22 In the home’s self-assessment it stated: “BUPA Care Homes has appointed a Director of Quality and Compliance and has developed a national Quality and Compliance team of experts. The home appointed a manager in April 2007 after a period without someone in post.” Quality assurance was effectively developed and cascaded in a timely manner, ensuring effectiveness of the process and using results from surveys to improve services and provisions. Residents could have support with their finances through BUPA’s organised and robust system that ensured full protection and prevention of financial abuse for residents. Two residents spoken to stated that their family members were helping them with their finances, but they: “always had a few pounds in their purses”, if they needed money for anything. The staff supervision record was displayed on the office notice board. Checked files also contained records of individual supervision sessions. Staff spoken to confirmed that they were supervised about every two months. Safe working practices were implemented within the home. Policies controlling safe working practices were in place. Risk assessments regarding premises were checked and were up to date. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 23 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 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 24 No 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. Standard Regulation Requirement Timescale for action 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 OP12 Good Practice Recommendations Staff should respect residents’ choice and time-planning when residents want staff to help them, and tell them openly how long they would they need to wait if staff needed to respond to an emergency elsewhere. Ferndale DS0000014901.V358646.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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