Inspection on 19/10/05 for Ferndale Nursing Home

This inspection was carried out on 19th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Ferndale Nursing Home 23/07/07

Ferndale Nursing Home 13/06/06

Ferndale Nursing Home 09/11/04

Ferndale Nursing Home 06/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Ferndale Nursing Home 124 Malthouse Road Crawley West Sussex RH10 6BH Lead Inspector Mrs Kerry Leppard Unannounced Inspection 19th October 2005 16:15 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 Nursing Home DS0000024142.V256198.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 Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ferndale Nursing Home Address 124 Malthouse Road Crawley West Sussex RH10 6BH 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) 01293 520368 01293 528898 Ferndale Health Care Limited Mr Ishwurduth Mannick Care Home 28 Category(ies) of Dementia - over 65 years of age (28), Old age, registration, with number not falling within any other category (28) of places Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The total number of persons in the home should not exceed 28. Date of last inspection 18th May 2005 Brief Description of the Service: Ferndale is a care home providing nursing care and accommodation for twenty-eight older people with dementia. The home is owned by Ferndale Health Care Limited. The responsible individual on behalf of the organisation and registered manager of the service is Mr Ishwairduta Mannick. The home is in Crawley and close to the amenities offered by the town centre. The home was first registered in 1994 and consists of accommodation on three floors, all of which are accessed by a passenger lift. The home provides accommodation in eighteen single and five double rooms, one and three of which respectively provide en suite facilities. The home has a garden, which can be accessed by ramped pathways. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Requirements identified in the last report dated 18th May 2005 have not, to date, been complied with. These have therefore been reiterated here along with two further requirements identified at this visit for action by the Registered Provider to meet compliance with the Care Homes Regulations (2001). In addition four recommendations for good practice have been identified. It is reasonable for the Commission for Social Care Inspection to expect compliance with the requirements without formal recourse to legislation and the Registered Provider is advised that, if necessary, enforcement action will be initiated. This could include the serving of Statutory Notices and/or making application to restrict further admissions to the service until the legislation is complied with in full. The Registered Provider is therefore required to confirm in writing to the Commission for Social Care Inspection that compliance with all the legislative requirements has been achieved by the dates set out on page 22 of this report. This inspection was unannounced and was conducted on Wednesday 19th October 2005 between 4.15pm and 8.30pm and on Friday 21st October 2005 between 9.15am and 10.30am. On the first day, the inspector toured the premises and spent time with residents. The inspector was unable to obtain feedback from all residents due to their level of disability. Therefore, periods of observation were made and the residents who could provide some feedback were spoken with. The inspector also spoke with a visitor and members of staff on duty, two night staff spoke with the inspector individually. On the second day the inspector returned to check some records and was assisted by the registered manager. What the service does well: The redecoration of communal bathrooms has positively added to the homely environment created at Ferndale, resident’s bedrooms and the home in general has a welcoming atmosphere. Residents looked comfortable and relaxed in the company of staff, some spoke positively about the care provided to them. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 6 Feedback reflected positively on the standard of care provided and communication between the home and relatives. What has improved since the last inspection? What they could do better: Requirements for action are Care records must include pressure area care being provided to residents. Records must be made of incidents of aggression and challenging behaviour exhibited by residents. Recruitment records are consistently poor at Ferndale, they have been found to be unsatisfactory on the last six inspection reports. They show that the registered person does not carry out all of the necessary checks before care staff commence work. This breach of the regulations puts residents at risk and an immediate requirement has been issued. Systems for moving and handling residents must be updated to ensure the health, safety and well being of residents and staff. Recommendations that have been made are That residents food and fluid intake should be monitored to minimise the risk of poor nutrition. That recruitment and staffing arrangements ensure that the home is sufficiently staffed at all times. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 7 That the timescale for completion of the Skills for Care induction are met and that an assessment of the staff member’s competence is made to identify further training needs, including effective communication. That business and financial plans be produced. The registered provider has agreed to return these with his action plan in response to this report. 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 Nursing Home DS0000024142.V256198.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 Nursing Home DS0000024142.V256198.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): 3&6 Prospective residents needs are assessed before they come to live in the home. Intermediate care services are not provided at Ferndale. EVIDENCE: Care records relating to the two newest admissions to the home were sampled. These showed that a social worker and/or a representative of the home had carried out an assessment of need before each resident came to live in the home. Feedback indicates that staff at the home are helpful during the process of finding a placement at Ferndale and moving the resident into a safe environment. Ferndale Nursing Home DS0000024142.V256198.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): 7, 8 & 9 Residents needs are set out in a plan of care. Records in relation to health care needs and intervention could be improved. Action has been taken to minimise the risk associated with storing prescribed creams in resident’s bedrooms. EVIDENCE: A sample of three care plans were seen, all of which contained comprehensive details about the needs of each resident including a long term needs assessment and risk assessments. The more detailed care plans and a moving and handling risk assessment for the most recent admission had not yet been completed four days following admission to the home. The timescale for completing this work should be monitored to ensure staff have clear guidelines. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 11 Records are made of resident’s regular health checks by their GP. To improve health care monitoring the care records must include any actions being taken to provide pressure relief and the treatment and progress of any wounds. The inspector was pleased to note that risk assessments have been undertaken in relation to the storage of topical preparations in resident’s bedrooms. Records indicate the action that staff must take to minimise this risk and during the tour of the home the inspector observed that these actions were being carried out by staff. This is a positive step toward ensuring the environment is safe for residents. Ferndale Nursing Home DS0000024142.V256198.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): 14 & 15 Residents are supported to exercise choice. A balanced diet is offered, records could be improved to demonstrate action being taken to minimise the risk of poor nutrition. EVIDENCE: Care records indicate the level of communication and comprehension that residents have and their ability to express their wishes. Staff who spoke with the inspector demonstrated a good understanding of resident’s differing abilities. One staff member shared a good example with the inspector of how discussion with the resident’s relatives has supported staff to understand the resident’s needs and preferences. The inspector observed that although most residents spend most of their time in the lounge/dining area, those who are able to mobilize independently do move freely between communal areas and their own bedroom, if this is located on the ground floor. The inspector also observed that the home is well organized and clothes were laid out for residents for the following day. The registered person must ensure Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 13 that routines in the home do not impinge on resident’s choices, such as what they would like to wear. Nutritional risk assessments are completed and daily notes are used to record issues such as appetite, care staff also complete records of daily events that they feedback to the nurse in charge. The inspector observed a ‘handover’ and noted that food intake is included in this information exchange. However, specific food monitoring records are not made when a risk has been identified and this remains a recommendation. During this inspection residents had a light supper of sandwiches and a dessert followed by a hot drink. A hot drink was also provided when the night shift began and a care assistant on night duty said that an early morning hot drink is provided. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 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 the following standard(s): 16 & 18 The complaints procedure is made available to residents and their representatives. Action has been taken to minimise the risk of abuse to residents, monitoring and record keeping could further minimise the risk. EVIDENCE: The complaints procedure is posted in the main entrance hallway and is sent to resident’s representatives following their admission to the home. Feedback indicates that there is always someone in the home to talk to and the home’s staff are responsive to any issues that may arise. The registered person advised the inspector that no complaints have been recorded since the last inspection. Risk assessments in relation to the use of bed rails have been incorporated into care records, which is an improvement. These must demonstrate that alternatives have been explored and that the equipment is regularly maintained to minimise the risk of injury. The inspector noted that care records have also been improved in relation to the guidelines for staff to follow in response to aggressive and challenging behaviour exhibited by residents. Records must be made of such incidents and audited regularly as part of the review of care plans to identify trends and patterns, which may assist staff to minimise the risk of reoccurrence and/or respond to the behaviour appropriately. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 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 the following standard(s): 24, 25 & 26 Residents bedrooms are homely and comfortable. Precautions are taken to ensure safety. The home is clean and is a pleasant environment. EVIDENCE: Some redecoration has been undertaken to improve the tidiness of paintwork and communal bathrooms are currently being redecorated which has vastly improved the appearance of them. The change of colour and consideration to details has made the bathrooms homely and warm and fitting with the rest of the home. Following the last inspection the registered person confirmed that although radiator covers have been fitted he has identified some that pose a risk and have required further intervention to make them safe. This should be monitored on an ongoing basis. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 16 The home was clean and fresh to a satisfactory standard on the day of inspection. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 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 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, 29 & 30 The home’s recruitment and use of staff could be improved to ensure satisfactory staffing levels are achieved. Staff are trained to do their job. Systems of appraisal should be used to identify training needs and support needed by staff to meet resident’s needs. The home’s recruitment practises are consistently poor and put residents at risk. EVIDENCE: The home is staffed with nursing and care staff at all times to meet the needs of the residents. Two nurses cover the morning shift and one covers all other times, four care staff work during the day and two at night. Often the manager is one of the nurses on duty during the morning. On the second day of the inspection there was only one nurse on duty when the inspector arrived, the registered manager arrived later in the morning to cover sickness. The registered person must ensure that his recruitment and staffing arrangements ensure that the home is sufficiently staffed at all times. Two recruitment records were sampled including the most recently recruited member of staff. These demonstrate that that the registered person has not improved the home’s recruitment process and that all of the necessary checks are not carried out before care staff commence work. This breach of the Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 18 regulations puts residents at risk and an immediate requirement has been issued. The home has a comprehensive training programme including health and safety topics and specialist training for staff. Staff who spoke with the inspector said that they attend regular training sessions in mandatory topics such as fire and manual handling and specialist sessions relating to residents with dementia. Staff said they found training and staff meetings helpful. Following the last inspection a food hygiene training session was provided and staff, including the chef attended this. The home also operates an in house induction and the most recently employed member of staff was working through a Skills for Care (formerly TOPSS) induction workbook. The registered manager should ensure that the timescale for completion of the Skills for Care induction are met and that an assessment of the staff member’s competence is made to identify further training needs. In relation to this, the inspector discussed with the registered person the need for effective communication between staff and residents. Seven staff have been identified as NVQ (National Vocation Qualification) award candidates with an external training organisation, the registered person is aware of the target of 50 of care staff trained to Level 2 and currently the home has achieved 11 . Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 19 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): 31, 34, 35, 37 & 38 The registered manager has yet to complete his training to meet the National Minimum Standard. The registered person has not demonstrated the financial viability of the home and a commitment to develop the service. Procedures and record keeping demonstrate that residents money and valuables and safeguarded. Record keeping is satisfactory. Moving and handling techniques being used by staff do not protect residents and promote health and safety. EVIDENCE: Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 20 The registered manager/provider is a registered mental nurse and has significant experience in the field and as an owner/manager. The registered manager has yet to complete his management award to meet the standard and is aware that the date at which the standard will be applied is 31st December 2005. Business and financial plans must be produced to demonstrate a commitment to improving the service for the benefit of residents. The registered person should take account of quality assurance feedback, professional reports and his own plans for the home. The registered person has agreed to provide copies of his business and financial plans with his action plan in response to this report. The home stores money belonging to residents and this is stored safely with records of transactions and the current balance. Records are well maintained and accurate for the most part, accidents are audited monthly and care plans are reviewed The health and safety of staff and residents is promoted and protected through the servicing of equipment and the recording of accidents. However, the inspector observed that under arm manual handling manoeuvres are still in use in the home. This is out of date and dangerous, handling belts should be used in accordance with advice sought from the home’s manual handling advisor. It has been noted previously that manual handling risk assessments in individual care plans do not contain specific guidance on what action should be taken to minimise risks to the resident and staff. These must be used to identify the manoeuvres and equipment staff must use to support residents safely with their mobility. Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 X X X X X 3 3 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X 2 3 X 3 1 Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP8 Regulation 12(1) Requirement The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users. Timescale for action 21/11/05 2 OP18 17 (1) Schedule 3(j) 3 OP29 19(1) The incidence of pressure sores, their treatment and outcome, are recorded in the service user’s individual plan of care and reviewed on a continuing basis. The registered person shall 21/11/05 maintain in respect of each service user a record, which includes the information, documents and other records specified in Schedule 3 relating to the service user. Including a record of any incident in the care home which is detrimental to the health or welfare of the service user. The records shall include the nature, date and time of the incident, whether medical treatment was required and the name of the persons who were respectively in charge of the care home and the service user. Staff records must include the 21/10/05 DS0000024142.V256198.R01.S.doc Version 5.0 Page 23 Ferndale Nursing Home 4 OP38 13 (4&5) information and documents specified within Schedule 2. (Previous timescale of 18 June 2005 not met) The registered person shall ensure that-unnecessary risks to the health or safety of service users are identified and so far as possible eliminated; the registered person shall make suitable arrangements to provide a safe system for moving and handling service users. (Previous timescale of 18 June 2005 not met) 21/11/05 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 2 3 Refer to Standard OP15 OP27 OP30 Good Practice Recommendations It is recommended that records be made of food and fluid intake of those service users who have eating difficulties to ensure that residents are not at risk of poor nutrition. It is recommended that recruitment and staffing arrangements ensure that the home is sufficiently staffed at all times It is recommended that the timescale for completion of the Skills for Care induction are met and that an assessment of the staff member’s competence is made to identify further training needs, including effective communication. It is recommended that business and financial plans be produced and made available. 4 OP34 Ferndale Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Nursing Home DS0000024142.V256198.R01.S.doc Version 5.0 Page 25 - 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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