Inspection on 10/08/07 for Fernihurst Nursing Home

This inspection was carried out on 10th August 2007.

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

Fernihurst Nursing Home 09/02/09

Fernihurst Nursing Home 22/06/06

Fernihurst Nursing Home 28/11/05

Fernihurst Nursing Home 14/04/05

Fernihurst Nursing Home 10/11/04

Fernihurst Nursing Home 27/07/04

Similar services:

Fairfields Country Rest Home

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Fairfax House

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

CARE HOMES FOR OLDER PEOPLE Fernihurst Care Home Fernihurst Care Home 19 Douglas Avenue Exmouth Devon EX8 2HA Lead Inspector Ms Rachel Fleet Unannounced Inspection 10 August 2007 10:00 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 Fernihurst Care Home DS0000061639.V340315.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. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernihurst Care Home Address Fernihurst Care Home 19 Douglas Avenue Exmouth Devon EX8 2HA 01395 224112 01395 224117 andym@sanctuary-housing.co.uk 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) Sanctuary Care Limited Mr Andrew Douglas Mack Care Home 50 Category(ies) of Dementia - over 65 years of age (50), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (50) Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The terms of the staffing level agreement made on 17/05/04 must be met. Registration allows for the admission of five people aged between 55 and 65 years of age The maximum number of placements, including that of the 5 people aged between 55 and 65 years, will be 50 Date of last inspection Brief Description of the Service: Fernihurst is a care home registered to provide accommodation for up to 50 people over the age of 65, but that has also successfully applied to accommodate up to five people over 55 years of age within the 50 beds. The homes service is for people whose main needs relate to their mental health, and whose needs are such that they require 24-hour supervision by nurses. The great majority of the people living at the home have dementiarelated care needs. The manager is a nurse trained in the mental health field, as are some of the other nurses, and one of them is usually on duty at the home or on call. The home does not offer intermediate care. The home was purpose built approximately six years ago, with an 11-bed extension added in April 2004. The 50 single bedrooms are spread over three floors, served by two passenger lifts. All rooms, except one, have an en suite lavatory. There is a lounge / dining area on each floor, with a ground floor conservatory and level garden at the rear of the home for anyone at the home to use. There are on-site parking facilities. At the time of the visit, fees were £625 - 675 per week. Fees do not include hairdressing, chiropody, toiletries, newspapers/magazines, telephone calls, relatives’/visitors’ meals, or routine hospital transport costs. Staff escort time for hospital appointments is charged for if more than two hours (at the hourly rate of pay for staff). And fees do not include other outings of any sort; people can pay for extra staff time (at the hourly rate of pay for staff) if they wish to go out accompanied by staff, by arrangement in advance, through the manager. The latest Commission for Social Care inspection (CSCI) report on the home is kept in the reception area, with copies available from the home on request or through CSCI’s website. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place as part of the usual programme of inspection. The unannounced site visit lasted just under 12 hours, taking place over two days (10 & 13 August 2007). We met at least 14 people who lived at the home during the visit, either individually or in groups, around the home. Several were unable to give their views, or give them in detail, because of mental health disabilities. Two spoke with us in some depth. Prior to the site visit, the manager Andy Mack had provided information about the management of the home, an assessment of what they do well, and their plans for improvement. The Commission had also sent surveys to 15 people who lived at the home, with four being returned, and to 10 relatives or supporters, with five returned. Four surveys were returned of 10 sent to health and social care professionals (including GPs, community psychiatric nurses and care managers). The visit included ‘case-tracking’ of five residents - looking into their care in more detail by meeting with them, checking their care records, talking with staff about their care needs, spending a period of time observing the general care they received. This group included men and women, people new to the home, someone who rarely had visitors, someone who used a wheelchair, people with more complex physical or mental health needs, and much more able people. General observation of the day’s events and reading documentation was also informative. We spoke with one visitor, five care staff (including two nurses), the activities facilitator, the cook and the deputy manager, and as well as discussing our findings with the manager. An additional inspection was carried out in February 2007 to ascertain whether requirements made at the last full inspection - on 22nd June 2006 - had been addressed, and to follow up issues relating to Adult Protection that had arisen since that inspection. The home was found to have taken appropriate action, and no requirements were made as a result of the February inspection. There has since been another allegation, against a staff member, which was also investigated and dealt with through multidisciplinary adult protection/ safeguarding procedures. The Commission has not received any other concerns or complaints about the home since the last inspection. Information gained from all these sources and from communication about the home since the last full inspection is included in this report. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: People have access to information about the home, but updating it must be managed properly to ensure people are correctly informed about the service the home offers. There are systems in place for identifying peoples’ care needs, although some care plans need more detail to avoid inconsistencies in care and to ensure people receive all the care they need. Action should be taken to help people Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 7 make their choice or preference known for meals or drinks, so they can enjoy their diet as much as possible. Some people have varied and interesting daily lives, with family, friends and the community around the home remaining part of their lives. But the diverse range of interests and abilities of individuals living at the home should be addressed, to ensure everyone has opportunities for fulfilment that take into account their needs and wishes - satisfying their interests through fulfilling activities in and outside the home. Staffing arrangements and staff training are adequate, having been improved in the last year, but further progress is necessary to meet the needs of all the people who live at the home and ensure their dignity. The home’s recruitment policies adequately protect people from unsuitable staff, but further evidence is needed to show that related procedures are fully robust. When asked what could be done better, a staff member said communication could be better sometimes, some nurses being better than others at ensuring everyone got a proper report at the start of their shift. 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 be made available in other formats on request. Fernihurst Care Home DS0000061639.V340315.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 Fernihurst Care Home DS0000061639.V340315.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. (The home does not offer intermediate care). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have access to information about the home that helps them decide where to live, but updating it has not always been managed properly to ensure people are adequately informed about the service the home offers. The people who come to live at the home can be assured that their needs will be assessed before they are invited to move in, promoting the success of any admission to the home. EVIDENCE: A relative of a new resident said they had been given written information about the home, when they looked around whilst choosing a home. The information had since proved to be a reliable guide to the home. They had also been given a contract on admission. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 10 One person quoted services offered in their copy of the Statement of Purpose that the home had not provided. It emerged that their copy was over two years old - given to the person when they first went to live at the home; the current version did not offer the services they referred to. They said they had not been notified of any changes to the Statement of Purpose, so were unaware that outings, for example, were no longer included in the fees. The current version does not include a breakdown of the weekly fee to the extent we require – to show nursing costs, accommodation costs, etc. The manager said Sanctuary Care is dealing this with, and a new version will be available later this year. Assessments of people’s needs were seen, carried out by senior staff at the home who went to meet them before they decided to move in. Information was also available from Social Services care plans for individuals who were not privately funded. In some cases, it was seen that less usual needs had been given particular thought, with agreement recorded as to how those needs were to be met, before the person went to live at the home. For example, where someone was unable to make some decisions safely for themselves, next-ofkin and relevant professionals were consulted about what should be done in a particular situation. Action was agreed in the person’s best interest. This was to be reviewed again once the person was living at the home, to see if it was still necessary or appropriate. Fernihurst Care Home DS0000061639.V340315.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 – 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place for identifying peoples’ care needs, although lack of detail in some care plans may lead to inconsistencies in care and a risk that some people may not receive all the care they need. Regular reassessment, safe management of medication, and multidisciplinary working ensure people receive good health care. Their dignity and privacy is generally respected and upheld, although one example of poor practice was seen. EVIDENCE: A visitor said their relative had a detailed care plan, which staff had gone through this with them. This involvement was reflected in other care plans seen. A new staff member said they had been able to read people’s life stories or personal histories in their care plan records, finding them very helpful in getting to know people who had communication difficulties due to dementia, etc. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 12 Some care plans said aspects of care should be carried out ‘regularly’. When asked how they defined ‘regularly’, one staff said this meant two-hourly, another said ‘every few hours’. It was seen that one person, whose care plan said they should be helped to the toilet regularly, remained in their armchair for at least three hours. Information in the entrance hall said the chiropodist visited 6-weekly. Care notes showed people had attended various hospital appointments, and had regular contact with a GP. Risks of falls, malnutrition and skin pressure damage were monitored regularly, with action taken to address any risk thus identified. In records checked, some people had progressively gained weight, and for others, their weight remained stable over time (losing and gaining weight at intervals). Various types of pressure-relieving mattresses and cushions were seen in use around the home. Wound care was recorded well. Care plans included strategies (such as diversion) staff should use to help certain people when they were distressed, for example. A relative involved in a care plan review was pleased with the outcome of staff action to help someone establish a better night/day pattern. People who were asked said they were satisfied with how the home managed their medication for them. Care records showed staff discussed medications with GPs regularly. We noted a number of people were on relatively little medication. Guidance for use of a sedating medication was seen in someone’s care plan, with other care strategies given for staff to use, before considering using medication, to reduce the person’s agitation. Temperature records showed refrigerated items were being stored properly, to maintain their effectiveness. No issues were found regarding monitoring of medicines’ shelflife after opening. Controlled drugs were stored properly and records were well kept, corresponding with balances checked. Photographs of individuals were on their medication records, to help ensure medicines were given to the right person. Staff were seen to engage with people in a kindly, patient manner. A female resident said a male care assistant helped them with their personal care sometimes, and she did not mind having help from this particular person. However, she felt a request for a female carer instead would be accepted without any problem. Bathroom facilities are being improved so that people have a suitable, adapted bathroom nearer to their bedroom, avoiding having to move so far around the home in their dressing gowns, etc. There was information in the entrance hall on how to book the visiting hairdresser. People were given individual attention, from the staff helping them to eat at lunchtime, with assistance given at a pace that suited them. The home has cordless phones which people who live at the home may use in private if they wish. One example of poor practice was seen (noted under ‘Staffing’). Fernihurst Care Home DS0000061639.V340315.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 – 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some people benefit from varied and interesting daily lives, with family, friends and the community around the home remaining part of their lives. However, the diverse range of interests and abilities of individuals living at the home have yet to be addressed adequately, to ensure everyone has opportunities for fulfilment that take into account their needs and wishes. There are various practices that promote peoples’ choice and control in their lives, although more could be done to enable them to exercise such rights. People enjoy a balanced and palatable diet. EVIDENCE: Several people appeared to enjoy being part of a quiz held in one part of the home during our visit. The manager said people living at the home, as part of recreational activities, had made the hanging baskets around the home. Raised flower beds have been created in the garden since the last inspection. We saw the activities facilitator spend some considerable time encouraging someone with drawing; she also spent time in the garden with someone who Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 14 wanted to walk outside. One person thought the home did not provide enough opportunities for exercise for one individual. When asked about this generally, the activities facilitator said that exercise sessions had not proved popular, so she used games (throwing a ball or bean bags, etc.) to encourage movement, which were more successful. The manager said fees do not include outings because of staffing implications (including costs), which she confirmed, although she said she had taken people occasionally to weddings or evening functions. The manager said the home had been working with care assistants to develop their role in providing meaningful interactions with individuals. This was reflected by a carer who said they had played table games with two people earlier in the day, and tried to make the most of opportunities to talk to people during care-giving, etc. However, one survey said the home did not meet the needs of a more mentally and physically able person. Care records did not evidence the quality of individualised attention – the length of time spent talking with people, etc. - and did not reflect well that individual’s hobbies or interests identified on admission to the home were followed up with them after admission. For example, flower arranging and gardening were arranged at the home; but care notes for two people interested in these things in the past did not show they had done these things. A visitor said visiting times were flexible, and that they had enjoyed the recent garden party. This had also been open to the public, and was done with the involvement of the local Alzheimer’s Society. Local schools or Brownies visit at Christmas to sing carols. Care records showed a number of people attended the church service held at the home almost monthly. The manager confirmed that attending church services elsewhere would have cost implications for individuals if transport or escort were needed. Peoples’ rooms were personalised with their own possessions. A workman was asked to return later in the day because the person occupying the room he needed access to did not like getting up until later in the morning. Staff were clear that some people liked going to bed early (also getting up earlier), whilst others went at more usual times - later in the evening. A member of staff was heard having some difficulty making themselves understood when offering someone options at tea; they did not show the person the choices available, which might have better helped the individual decide what they wanted. One person asked for a teaspoon so they could stir their tea; a staff member told them they had already stirred it for them, persisting with this response even when the person did not initially understand the situation and repeated their request. There was a list of peoples’ dietary preferences and dislikes in the kitchen. Staff said they offer alternatives if someone declines the meal they are offered, and at the lunchtime seen people were asked if they wanted any more to eat. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 15 A visitor said their relative enjoyed the food provided. People in the dining room at lunchtime seemed to enjoy their meal, most getting individualised help as needed, from staff. One person said the food was ‘okay’, adding the tea was too milky, and it was better where they used to live. Menus seen were varied and included at least two options at meals, with lunch being the main meal of the day. One person felt teatime menus were less appealing, tending to be drier foods and of a lesser quality. Teatime menus seen for one week included fishfingers and tomatoes, vegetable bake, cauliflower cheese, scrambled eggs, gala pie, and sandwiches. The cook confirmed he is asked to make snacks for people who have missed a meal for various reasons or who are hungry between meals. He also bakes cakes for afternoon tea. Crockery of a particular design has been bought, since the last inspection, to help people with dementia be more independent at mealtimes. Fresh fruit and vegetables were seen in the food stores. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 16 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. Individuals feel their views or concerns are listened to, with good promotion of peoples’ welfare through the range of safeguarding policies and practices in use. EVIDENCE: A visitor said there was always someone available if they had any concerns or requests to voice, and these were always followed up. The manager had a large file of letters of thanks. The last entry in the complaints log was dated November 2006, and entries had a timely letter of response, from the manager to the complainant, attached. The written complaints procedure, available in the entrance hall, had required information. Staff spoken with were able to describe unacceptable practices (including behaviours as well as actions that would affect peoples’ mental and physical wellbeing). They knew they had a responsibility to report these things if they saw them occur, and they felt the manager would respond appropriately. Two allegations of abusive practice, made since the last main inspection, were investigated through multidisciplinary procedures in line with Devon County Council’s safeguarding policies. The home subsequently took appropriate action to address issues identified (which related to poor care practice rather than abuse). Some staff had more recently raised concerns, which the manager had taken seriously and again dealt with in line with local safeguarding policies. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 17 Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 18 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. There has been good investment in the environment in recent months, which has provided people with nicer, fresh and clean accommodation that is better adapted for their needs. EVIDENCE: People who were asked said they liked their bedrooms, and confirmed that there was sufficient hot water, ventilation, etc. One person who took a newspaper said the lighting was sufficient for reading. Someone who used a wheelchair said the home was accessible so they could get about easily, although they thought the tyres weren’t fully inflated and they were going to ask the handyman to check this. The footplates were in place, and the chair was clean. A staff member felt some people would benefit from more grabrails in their bathrooms, and said they would speak to the manager about this or raise it at the next staff meeting. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 19 The home has been redecorated using good practice guidance on supporting people with dementia. Different colours for each area of the home and for doors have been used, and signs on doors are at a lower level, to help people find their way around. A specialist bath is being provided on the top floor, so people there do not have to go to another floor for baths. The home also has shower facilities that are wheelchair-accessible. People who were asked thought the home was kept sufficiently clean, with one person adding there was prompt attention to any problems found. The home looked clean on this visit, with cleaning staff at work for much of the time; no lasting malodours were noted. Staff confirmed there were always ample supplies of disposable gloves and aprons, towels, flannels, etc. Laundry facilities have been improved, with creation of a separate room for ironing and sorting clean laundry. Washing machines had recommended programmes for disinfecting laundry, with one such programme seen in use. Handwash facilities were available for staff. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 20 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 – 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements and staff training are adequate, having been improved since the last inspection, but further progress is necessary to meet the needs of all the people who live at the home. People living at the home are adequately protected from unsuitable staff by the home’s policies, but further evidence is needed to show that recruitment procedures are sufficiently robust. EVIDENCE: When we first arrived, there were two nurses and eight care assistants caring for 47 people. They were supported that morning by two kitchen staff, three domestic staff, two administrators, a handyman and the activities facilitator. The deputy manager who was on a day off came in to assist us. Later in the day, there were seven care assistants, and four rostered overnight, with two nurses always on duty. Not all the nurses have a mental health qualification, but there is usually at least one such qualified person on duty, or one on call as a minimum. One person living at the home said they got on with all the staff, but identified some they found particularly helpful. They felt staff were always busy, and ‘quite often pushed’, so they sometimes had to wait ‘quite a while’ for staff. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 21 Another person, who was more independent, said care staff were good and they were there if they wanted them. The manager said there is an extra six hours of care staff time and three hours domestic time each day, compared to the last inspection. The extra care staffing hours were used to cover busier times of day (before breakfast and over lunchtime). The domestic hours enabled checks on cleanliness around the home in the second half of each day. One staff member, when asked what the home could do better, spoke about staffing shortages. In particular, they felt they were called away to help colleagues too often when already helping someone themselves, wanting more uninterrupted time with people. We heard staff discretely discussing assisting one person to the toilet but extra help they needed was not available; lunch then arrived and the person was not helped to the toilet, thus remaining seated in their chair for at least three hours. Their care plan said they needed regular assistance to the toilet. We brought this to the manager’s attention. Another part-time staff felt staffing levels were adequate except when someone went sick at short notice and no replacement could be found; they also confirmed few agency staff are used now. One person said the home’s policies and practices for managing sickness absences, implemented since the last inspection, had had a positive effect and stabilised staffing levels. A regular visitor felt there were enough staff to care for people, with only the occasional staff shortage affecting this. Another said staff were not in the lounges as often as they felt necessary to look after someone at risk of falling who kept trying to get up from their chair. The manager said all staff monitor lounge areas through their shift; if other priorities take them away from the area, they return at intervals to check on peoples’ wellbeing. A member of staff was found in lounges whenever we went to them during our visit. During two hours we spent in one lounge, no staff were there permanently, but someone came in at least once every five minutes apart from one ten-minute period when no staff came in. A visitor said staff were friendly. We spoke with staff from overseas whose first language was not English. They had some difficulty conversing with us, but someone who lived at the home specifically praised them for their efficiency and attention. The manager said the home is supporting some overseas staff to undertake care qualifications. A new staff member said they were still on induction, their training taking the form of videos with questionnaires, and supervision by or working with nursing staff. They didn’t have any previous care experience, but had other relevant experience and were undertaking a care-related qualification. Four personnel files were checked and found to have most of the information required before individuals start working at a home. However, there were gaps in the employment history of two of these people, which the manager was able Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 22 to explain, but a record of these had not been kept. He said he would ensure this was done in future. Some staff entering one lounge did not speak to or acknowledge the people sitting there. When some staff sat down to help individuals at mealtimes, they did not acknowledge other people eating in the same area. Staff training records showed videos with questionnaires were used. It was not clear, however, that completed questionnaires were checked to judge the person’s responses and understanding of the subject. The deputy manager said she went over them with individuals, but would record this in future. She also said she worked with staff in care-giving to new people, to ensure their needs were properly identified and they received appropriate care. A senior carer had had training on person-centred care in the last year, but not on dementia care or other topics relevant to individuals’ particular needs. However, they felt training at the home in general had improved ‘100 ’ during that time. They had experience of working in other types of care settings and had been able to share their knowledge at staff meetings to try to improve general care. Other staff said they had learnt how to care for people with dementia by working with colleagues. The manager has obtained leaning materials to develop this area of training. And there are plans that a number of staff will begin an accredited care course in September 2007, with the aim that half of the staff will then have achieved a basic care qualification. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 23 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, 35 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from living in a well managed home that works hard, in a variety of ways, to make sure it is run in their best interests. EVIDENCE: The registered manager is a Registered Mental Nurse who has also completed the Registered manager’s award. He has many years experience in the care sector. Staff and peoples’ relatives felt the manager and deputy manager were approachable, staff noting that senior staff took the time to meet peoples’ families and other supporters. Some staff felt the manager was sorting out issues at the home – ‘getting things done’, including action about unreliable colleagues, an issue staff raised at the last inspection – with positive results for the running of the home. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 24 The deputy manager had recently carried out a 4am visit to the home, without forewarning staff, to monitor standards (as part of the home’s actions to address safeguarding issues raised earlier in the year). Either she or the manager carry out these night visits every 1-2 months, which also enables them to give training more specific to night work. One person who felt the food provided could be better, said there were no residents’ meetings where they could raise such matters. The manager said there had been very low attendance for residents’/relatives’ meetings in recent months (noted also from minutes kept), despite holding them at different times of the day or week, so he hadn’t held one recently. He intends to produce a regular newsletter as a means of passing on information. Surveys have just been distributed by the home to relatives of the people living at the home. Responses will be analysed by Sanctuary’s head office staff and passed to the manager, who produces the action plan to deal with any issues raised. A Suggestions book seen in the entrance hall had two entries for this year. We looked at personal monies, and associated records, which were kept securely by the home at peoples’ request. We checked these for three people. Receipts and two verifying signatures were available for transactions that were checked at random. These included money left with the home for safekeeping as well as money spent - shopping done by staff on people’s behalf, hairdressing, chiropody, etc. Cash held for each person matched the balance shown in their records. Staff felt there were enough equipment (hoists, etc.) to do what was expected in their job, and they had a safe working environment, with repairs attended to quickly. Accident forms were with the manager for auditing, during our visit. He confirmed he checks them to look for ‘accident blackspots’, for example, to identify any particular causative factors. All nurses have taken a first aid course, ensuring first aider cover at all times. The fire procedure for visitors is displayed in the lift. Records showed fire safety checks had usually been carried out at recommended intervals in recent months, with very occasional omissions; the manager agreed to monitor that the regularity was maintained over time. The handyman had records of various other safety checks he regularly undertook (bedrails, water temperatures, cleaning of shower heads, etc.). Kitchen facilities were organised, and clean. Temperature records for kitchen fridges and freezers were seen to be within recommended levels, showing food was stored appropriately for safe consumption. Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 25 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 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 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 6 Requirement You must a) Keep the statement of purpose and the service users guide under review, where appropriate, revising them; and (b) Notify the Commission and service users of any such revision within 28 days, to ensure that people have accurate and required information about the service & facilities being offered by the home. 2. OP29 19 & Schedule 2 You must have thorough recruitment procedures that include a satisfactory written explanation of any gaps in individuals’ employment histories, to ensure that people living at the home are protected from unsuitable staff. 30/09/07 Timescale for action 31/10/07 Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 27 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 OP7 Good Practice Recommendations It is recommended each individual’s care plan sets out in detail the action which care staff need to take to ensure that all aspects of health, personal and especially social care needs of people living at the home are met. You should ensure that the care home is run in a manner that ensures the dignity of each person living there, with regard to meeting needs such as promotion of continence. It is recommended that person-centred care is further developed so that the lifestyle of the home matches individuals’ expectations or preferences, with particular consideration given to ensure arrangements suit the needs and capacities of people with varying levels of cognitive impairments, satisfying their social, religious and recreational interests and needs, through leisure and recreational activities in and outside the home. It is recommended that there is a menu offering a choice of meals in formats suited to the capacities of all people living at the home, which is given, read or explained to them. It is recommended staffing numbers are appropriate to the assessed needs of people living at the home (including social needs). It is recommended a minimum ratio of 50 trained members of care staff (NVQ level 2 or equivalent) be achieved, excluding the registered manager & registered nurses. It is recommended that the staff training and development programme ensures that staff fulfil the aims of the home and meet the changing needs of people living at the home. 2 OP10 3 OP12 4 OP15 5 OP27 6 OP28 7 OP30 Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Devon Area Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 © 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 Fernihurst Care Home DS0000061639.V340315.R01.S.doc Version 5.2 Page 29 - 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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