Inspection on 22/07/05 for Ferndale Mews

This inspection was carried out on 22nd July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Ferndale Mews 14/11/07

Ferndale Mews 06/02/07

Ferndale Mews 11/11/05

Ferndale Mews 25/01/05

Ferndale Mews 06/08/04

Ferndale Mews 23/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE FERNDALE MEWS St Michaels Road Ditton Widnes WA8 8TD Lead Inspector Anthony Cliffe Announced 22 July 2005 09:00 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 MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ferndale Mews Address St Michaels Road Ditton Widnes Cheshire WA8 8TD 0151-495-1367 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) Southern Cross Healthcare Services Limited Mrs Carrol Cunningham (Proposed) Care Home 34 Category(ies) of DE(E) Dementia - over 65 (34) registration, with number MD(E) Mental Disorder - over 65 (2) of places FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 This home is registered for a maximum of 34 service users to include :* Up to 34 service users in the category DE(E) (Dementia over 65 years of age) * Up to 2 service users in the category MD(E) (Mental disorder excluding learning disability or dementia over 65 years of age) 2 The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance whci may be issued through the Commission for Social Care Inspection 3 Date of last inspection 25 January 2005 Brief Description of the Service: Ferndale Mews is a care home providing personal care for 32 older people with dementia who may also have physical disabilities and 2 people diagnosed with mental disorder.The home is located in the Ditton area of Widnes, close to local shops, pubs and St. Michael’s church. The building is a storey purpose built home on the same site as Ferndale Court Care Home. All the bedrooms are single with en-suite facilities. There is a passenger lift. The home has a large secure rear garden. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on 22nd July 2005 following the employment of a new manager. It was arranged following liaison with the regional manager. The inspection lasted seven and a half hours. The format of the inspection was jointly agreed with the manager. A pharmacist inspector visited the home on the 27th July and the findings of the visit are incorporated into this report. The inspection was carried out using a process of cross referencing the documentation of identified residents following discussion with them, and following the delivery of care and support to them. A tour of the building, including a number of bedrooms, was completed. What the service does well: What has improved since the last inspection? The management of the home has improved since the recruitment of an experienced manager who was previously registered under the Care Standards Act 2000. The staff team have leadership, guidance and supervision. Pre admission assessment has improved with the introduction of a new format and dementia assessment. Medication, management, administration and recording have improved with no errors found. The provision of activities has improved with the employment of an activities organiser who is developing a programme of activities based on residents’ choices. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 6 Internally the building has improved with the decoration of the ground floor conservatory area, and dining facilities painted in lighter colours. In the conservatory and dining areas lighter curtains have been provided and wall murals have been added. In bathrooms shower curtains have been replaced and wall murals added to give a more domestic appearance. Residents’ bedrooms have been redecorated to their choice with matching curtains and bedspreads. Externally the gardens have had large potted plants added and the handyman has built a raised fountain area and flowerbed. Staff training has improved with nine staff registered for an NVQ level 2 qualification. 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 MEWS F51 F01 S5188 Ferndale Mews V230869 220705 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 MEWS F51 F01 S5188 Ferndale Mews V230869 220705 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) 3. Ferndale Mews does not provide intermediate care facilities and this standard is not applicable. Assessments of needs are completed, before residents move into the home, to ascertain if their needs can be met. EVIDENCE: The records of two residents who had recently moved into the home were examined. A new standard pre-admission form is completed as part of the preadmission assessment and this was supplemented by a dementia assessment. The manager and regional manager confirmed that the new pre admission assessment and care plan documentation introduced with the merger of Southern Cross Healthcare and Highfield Care is yet to be used in full. This will be done following training for home managers on the use of the documentation The pre admission information includes the resident’s previous mental health history and history of physical illness and current medication. It incorporates a number of assessments to determine the residents’ level of dependency, risk to developing pressure ulcers, nutritional needs and risk of falling. Incorporating the dementia assessment this document provides information from which a care plan to meet residents’ can be developed prior to moving in. Both residents had care plans to meet their needs. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 9 The care plans were supported by a detailed social assessment. Care plans identified the areas of need where residents needed support from staff to maintain their independence. Care plans reflected positive aspects of residents’ social needs for example in identifying the importance of residents wishing to look presentable, or having a visit from the clergy. Choices about residents’ daily routines were recorded. The manager or two senior care staff had assessed the residents before they moved into the home. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 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) 7,8,9 and 10. Residents’ plans ensure that health and social care needs are identified and met, but need to be revised by staff currently employed at the home. Care plan evaluation needs to improve to reflect the observations by staff of the triggers to challenging behaviour and best practice management of residents who present challenging behaviour. Medicine management and administration are safe and promote residents’ health and welfare. Residents are treated with dignity and respect and their rights as individuals upheld. EVIDENCE: The care plans of three residents were examined. The plans had a range of assessment documents to support the healthcare of residents, with a care plan to address the identified needs of the residents. Examples were the use of moving and handling assessments to promote the safety of a resident who liked to walk around the home and used a walking aid. The use of a bath hoist to help the resident get in and out of the bath safely. Otherwise the resident was independent in meeting their personal hygiene needs. A care plan was in place to ensure staff weighed a resident when there were no concerns about her eating and drinking. Staff identified that a resident remained continent with prompting as to the whereabouts of the toilet. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 11 In discussion with a senior carer and examination of a resident’s care plan, the senior carer described the situations when a resident became anxious and agitated which led to incidents of challenging behaviour. She described how these incidents were positively managed. The care plan review for the management of this behaviour did not include the observations by staff on the triggers to these episodes. Monitoring of the behaviour was not done to inform staff on the good practices described in managing them. Records detailed that their general practitioner reviewed the health of two of the residents and one of the resident’s had received NHS treatment as a result of the GP visits requested by staff. Several care plans though relevant to meeting the needs of residents were written by staff no longer employed at the care home, and these needed to be revised by the residents current key worker. Residents’ medicines were properly stored in an organised way. Records were kept to a good standard showing that residents were being given their medicines correctly and keeping good accounts of medicine use. The manager provided information to confirm that staff had attended training on medicine use and the benefits could be seen in the improvements. Residents commented on staff treating them with dignity and respect. A resident said ‘Staff know I am independent and help me when needed. If I have a bath, they keep a discreet eye on me, but make sure that the door is closed or the curtain is closed over, they stay with me and operate the seat’. Another resident said ‘I have only been here a few weeks but staff have helped me settle in, they are friendly and that has helped. I can find my bedroom, as staff kept reminding me where it was, or they asked if I was looking for it and gave me directions’. See recommendations 1 and 2. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 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, 13 and 14. Residents are supported to make choices in their lifestyle and in meeting their social needs. Families and friends are welcomed into the home at any reasonable time. EVIDENCE: The home has employed an activities coordinator for thirty hours a week. The activities coordinator said ‘ the job was advertised and I was aware of it by word of mouth. I am employed for thirty hours a week and I am happy here’. My induction programme was about getting to know the residents and working with the previous activities coordinator. The programme I have developed is trial and error. I have asked residents what they would like to do. We have had a variety of activities. We went to Knowlsey Safari Park and everybody enjoyed it. I am not sure what the budget is, but I know that residents benefit from community activities. I recently took three residents shopping. I really got to know them better it was a good experience. I also take residents out on a one to one and can see the benefit of this’. The activities on offer for the day were displayed on a notice board, along with a weekly plan of activities. Cake decoration was an activity that took place. A summer fate to raise money for a residents fund has been arranged for 30th July 2005. Staff and relatives had donated items for sale. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 13 The manager had written a notice to relatives requesting family support and volunteers for the setting up of an activity programme, and help in starting a residents and families committee for September. There were a number of visitors throughout the day. A visitor said ‘ dad moved in eighteen months ago. The place used to be tacky but friendly, but rooms have been decorated and it’s now like a good hotel. The manager has made a difference, the place is better organised, no odours. Staff are friendly and approachable, they are helpful and ring me when there is a problem with dad or if he needs anything. I take him out regularly and we have shared experience. Staff encourage him to join in activities. They took him to the Blue Planet aquarium and I know he would have enjoyed that. I always feel welcome here, things have definitely improved for the better. I would like to see the manager stay as this would provide stability’. A resident at the home talked about how she chose what she did during the day and how she was able to make choices. ‘I am very independent and staff help me when needed. I like to stay in my bedroom and listen to my favourite music or read. Becky the activities girl is very good. I join in things she arranges. I make my own bed and keep myself clean and tidy. I rely on other people for information. I get frustrated with my memory, when I don’t remember what I ordered to eat but staff remind me or I am offered an alternative. I have lived here for six years, and we have had six managers. I have met the new manager we had a welcome party for her. Things have definitely improved over the last two years and lately staff are more friendly’. I don’t like to be disturbed at night. I used to be disturbed every two hours with staff doing checks on me. I have requested that staff don’t check on me at night I lock my door and have my own key’. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 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 and 18. Residents and relatives have access to a satisfactory complaints procedure. The management of physical intervention policy needs to be clear and training provided for staff so residents are not at risk of being harmed. EVIDENCE: The complaints procedure was displayed in the main entrance to the home. A resident and relative both said they were aware of the complaints procedure. A relative said ‘ any thing I have asked them to do has been done so quickly without any fuss’. A resident said ‘ A while ago a carer spoke to me and was very rude. I wrote to the manager and the carer left. I would tell the manager if I was not happy with anything. I’m not backward at coming forward’. Comment cards were received from five relatives/visitors. Three of these said they were not aware of the complaints procedure but had not made a complaint. The other two said they were aware of the complaints procedure and had not made a complaint. A comment card said ‘we are pleased with the care my mother receives and we know she is very content at Ferndale Mews. Thank you to the staff’. Two general practitioners and a social worker returned comment cards and said they had never received or dealt with a complaint about the home. In interview with staff a staff member said ‘ the aggressive side of people causes anxiety, we try to get it under control or need staff help. Sometimes we have to hold their hands as they become resistive. I am clear this is a form of restraint and when we should use the holding of hands. I can’t remember if I have read the policy on restraint. When someone becomes aggressive we distract them or divert them if possible, but always call for assistance’. See recommendation 3. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 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 and 26. Residents live in a safe and well-maintained home, which is clean and hygienic. There is a commitment to improving the standard of accommodation for the benefit of residents. EVIDENCE: Internally the building has improved with the decoration of the ground floor conservatory area, and ground and first floor dining areas painted in lighter colours. In the conservatory and dining areas lighter curtains have been provided and wall murals have been added. In bathrooms shower curtains have been replaced and wall murals added to give a more domestic appearance. Residents’ bedrooms have been redecorated to their choice with matching curtains and bedspreads. Bedrooms contained residents’ personal items of furniture and electrical equipment. Two resident said they had chosen the décor of their bedroom. One said ‘I chose them for myself they are all right’. Another resident said ‘yes I chose the colours’. A visitor said ‘ dad moved in eighteen months ago. The place used to be tacky but friendly, but rooms have been decorated and it’s now like a good hotel. The manager has made a difference, the place is better organised, no odours. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 16 Externally the gardens have had large potted plants added and the handyman has built a raised fountain area and flowerbed. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 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, 29 and 30. Ferndale Mews provides sufficient staff to meet residents’ needs. Their recruitment policies were complete, ensuring residents are protected. Investment in training has been provided to maintain a skilled workforce. EVIDENCE: Information from the staff rota showed that sufficient senior staff and care assistants were employed to meet the residents` needs. The home uses regular agency staff to cover gaps on the duty rota. Additional professional support is available to residents from PCT and local authority staff with referrals made when necessary. The records of two recently employed care staff were looked at. All had the relevant POVA and Criminal Records Bureau (CRB) checks in place. Staff did not commence employment until the CRB check had been issued to them. Recruitment records for two staff were completed in full. Staff had received training on basic food hygiene, moving and handling and drug administration and fire training. Care staff verified during interview they had received training and one clarified they had registered for an NVQ level 2. The manager provided information that nine care assistants had registered for an NVQ level 2 in June 2005. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 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 and 36. The manager is competent and has made significant improvements. EVIDENCE: An experienced manager who was previously registered under the care Standards act 2000 manages Ferndale mews. The manager has not yet completed the registration process for manager, with the Commission for Social Care Inspection. Staff said there had been positive changes in the home and they had been consulted about them. A staff member who was interviewed said that she had completed an induction of six weeks supervised by the manager. She said she had regular one to one meetings. In the meetings she said ’I meet with Carol and discuss how I am getting on with residents and staff. We discuss how I care for residents and if I am having any difficulties or struggling. Records of these meetings are kept’. FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 2 x x x x 3 x x FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 20 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. 1. 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. 2. Refer to Standard OP7 OP7 Good Practice Recommendations Residents care plans needs to be revised by residents current key workers. Care plan evaluation needs to improve to reflect the observations by staff of the triggers to challenging behaviour and best practice management of residents who present challenging behaviour. The management of physical intervention policy should be read by all staff and staff need to be clear on the accepted methods used in the home. Relevant training needs to be provided for staff. 3. OP7 FERNDALE MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire, CW9 7LT 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 MEWS F51 F01 S5188 Ferndale Mews V230869 220705 Stage 4.doc Version 1.30 Page 22 - 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. 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