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Inspection on 14/04/05 for Fernihurst Nursing Home

Also see our care home review for Fernihurst Nursing Home for more information

This inspection was carried out on 14th April 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

This large purpose built home provides comfortable, well-maintained accommodation for residents. Many residents have personalised their own private rooms with the help of staff and families. The variety of lounge areas is comfortable and well used. The level gardens are now accessible and recent planting will make them nice places to spend time. Many residents have difficulty speaking for themselves; staff work hard to try to ensure that these people get care they would wish by observing them/ helping them to communicate in other ways and through talking to relatives. Most relatives said they have confidence in the home and leave their loved ones knowing they are well cared for and safe. Staff are kind and residents are treated with respect. Staff mostly have the skills they need to their job well. Where problems arise staff and managers act professionally in trying to find solutions.

What has improved since the last inspection?

The atmosphere in the home is more relaxed with residents now being helped to access all parts of the shared accommodation. The gardens have been made safe for residents to use with minimal supervision and new planting done to make the garden more attractive.

What the care home could do better:

The activities for residents need to be developed. Systems for monitoring medication administration must be followed to protect residents. All pre-employment checks must be done before staff start work.

CARE HOMES FOR OLDER PEOPLE Fernihurst 19 Douglas Avenue Exmouth Devon EX8 2HA Lead Inspector Stephen Spratling Announced 14 April 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 Crispin’s, 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 Version 1.00 Page 3 SERVICE INFORMATION Name of service Fernihurst Care Home Address 19 Douglas Avenue, Exmouth, Devon, EX8 2HA 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) 01395 224112 01395 224117 Sanctuary Care Ltd Mr Andrew Douglas Mack Care Home 50 Category (ies) of DE(E) Dementia - over 65 (50), registration, with number MD(E) Mental Disorder - over 65 (50) of places Conditions of registration Date of last inspection YES 10 November 2004 Brief Description of the Service: Fernihurst is a care home registered to provide accommodation and care for up to 50 people over the age of 65 and has applied to be registered to accommodate up to 5 people over 55 years of age. Registered nurses supervise care. The home’s service is aimed at people whose main needs relate to their mental health. Many residents in this home have dementia. The home was purpose built approximately 6 years ago, with an 11 bed extension having been completed in April 2004. The 50 single bedrooms are spread over 3 floors and served by 2 passenger lifts. All rooms, except one, have ensuite lavatory. There is a lounge and dining area on each floor. Fernihurst Version 1.00 Page 4 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out by two inspectors (Stephen Spratling and Michelle Oliver) from 9 am until 4 pm on Thursday 14th April 2005. During the day the inspectors spoke with the manager, nine members of staff, ten of the people living at the home and 5 visitors to the home. They also looked around all the shared areas of the home, the garden and some of residents’ private rooms. The inspectors looked at the assessments and care plans for four residents; they also looked at some other policies and records kept by the home. What the service does well: What has improved since the last inspection? The atmosphere in the home is more relaxed with residents now being helped to access all parts of the shared accommodation. The gardens have been made safe for residents to use with minimal supervision and new planting done to make the garden more attractive. Fernihurst Version 1.00 Page 5 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fernihurst Version 1.00 Page 6 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 Fernihurst Version 1.00 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12-month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 Clear information about the service is made available to prospective residents and other interested people, to help ensure people can make an informed choice about where to live. Residents benefit from good admission and assessment practice, which ensures that the home is able to meet their needs. EVIDENCE: The statement of purpose has been updated since the last inspection and provides all the required information. This is made available to residents and relatives. Residents and relatives have access to relevant information about the home at all times as it is available in public areas and given to interested parties. Pre-admission needs assessments were seen in all four of the resident’s records looked at. These were dated as having been completed before admission with review since admission. Most visitors spoken with said that their relatives are well cared for; one persons family were less happy though their assessments showed evidence of all needs being recognised and they acknowledged that they are involved in the assessment of their relative. Fernihurst Version 1.00 Page 8 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, 9 & 10 Residents benefit from clear plans of care which are developed to help ensure all identified needs are met. The home operates clear procedures for the management and administration of medication; these are not always followed potentially placing residents at risk. Residents are treated kindly and with respect. EVIDENCE: Of the four residents’ care records seen all contained clear detailed care plans which reflected residents needs identified through assessments. All showed evidence of regular review and update. Medications are securely stored. The home uses a monitored dosage administration system. Though most medication administration had been properly recorded the inspector saw that on one occasion a medication had not been administered from a pack but the record sheet indicated it had been given. Other charts seen did not properly indicate the receipt of medications. Fernihurst Version 1.00 Page 9 Residents who were able to comment said the staff are kind and helpful. Visitors spoken with indicated that they always see staff being polite and patient with residents. During the day of the inspection staff were seen addressing service users politely and warmly. Staff were observed explaining and seeking permission to give care for example when moving a service user from a chair to wheelchair. Fernihurst Version 1.00 Page 10 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, 14 & 15 Social activities are provided at the home and provide daily variation and interest for some people, however they lack focus on individuals needs. Residents are encouraged and helped to exercise control and choice over their lives. They benefit from the contact with family and friends, which is encouraged by the home. A varied balanced diet is provided, served in a pleasant atmosphere, with individual support given discreetly as needed. EVIDENCE: The home has a dedicated activities organiser who spoke with the inspector and described plans to find out about peoples life histories to help her plan more individualised activities, which she acknowledged are not yet being provided in all cases. She was seen involving residents in gentle physical exercise. Visitors spoken with confirmed that they are made to feel welcome when visiting at any reasonable time and that they visit without prior appointment. Fernihurst Version 1.00 Page 11 People were seen moving freely around the home, some people were seen to choose to take meals and spend time in their rooms, others chose to stay in bed until they wanted to get up and staff worked around this. One inspector ate with residents; residents indicated that they like the food; the atmosphere was pleasant with some residents sitting around tables together and others being discreetly helped to eat by staff. Fernihurst Version 1.00 Page 12 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 Arrangements for responding to concerns are satisfactory and help to improve the quality of care for residents. EVIDENCE: A clear complaints procedure is on display in the homes reception. Most visitors spoken with expressed confidence that their concerns are listened to and acted upon. One person’s relatives were less confident, though the complaints they raised with inspectors had been addressed by the manager and their relatives care plan amended to reflect them. Fernihurst Version 1.00 Page 13 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 & 26 The home is safe, well maintained and kept clean, providing a comfortable homely environment for residents. EVIDENCE: The inspectors walked all around the shared areas of the home and went to some private rooms; all areas were clean and well maintained. Visitors spoken with confirmed that the home is always clean and tidy. Since the last inspection new fencing has been erected in the garden, which means it is now safe for residents to use with minimal assistance. The laundry floor has been properly sealed since the last inspection which will help reduce the risk of cross infection. The inspectors spoke to two of the cleaning staff and the staff member who runs the laundry; all indicated that they have the time and tools to do their jobs properly. Fernihurst Version 1.00 Page 14 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 & 29 Staff are employed in sufficient numbers to meet the needs of residents. Recruitment procedures are in place but are not sufficiently robust to maximise protection of residents. EVIDENCE: The staff rota showed that the allocation of staff on each shift was adequate to meet the needs of the current residents. Staff spoken with said there are generally enough staff on duty to provide care in an unhurried manner. Visitors spoken to also indicated that enough staff are available to properly care for their relatives. Staff said that when a manager is not in the home there is always someone available to contact for support and guidance. Recruitment files for three staff members were seen. One file was complete. Of the other two, one contained only one reference and the other indicated that the staff member had started before their Criminal Records Bureau check had been received. Fernihurst Version 1.00 Page 15 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) 33 The home is well run and improvements to building/grounds and the standard of care for residents are ongoing. EVIDENCE: The inspectors were supplied with results of a questionnaire completed by some residents’ relatives in October 2004 where they are asked to comment on different aspects of the service. Minutes from regular relatives meetings were shown to the inspector where they are invited to comment on the service and suggest improvements. Since the last inspection the atmosphere has improved, residents appeared more relaxed and staff reported being happy working at the home. A relative of one resident who had been at the home a long time said they felt the care was better and staff happier than when they first came to the home. The manager showed the inspectors a monthly audit tool, which is being introduced to monitor and help improve standards. Fernihurst Version 1.00 Page 16 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x x Fernihurst Version 1.00 Page 17 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 OP29 Regulation 19 Requirement The registered person must not employ a person to work in a care home unless…(b) he has obtained in respect of that person the information and documents specified in Schedule 2 of these regulations; (you must ensure that you have 2 written references and a CRB checks before staff are employed. Exceptions to this (re POVA first) are outlined in the Department of Health Document “protection of Vulnerable Adults A Practical Guide” published 26/07/04.) Timescale for action 13/06/05 Fernihurst Version 1.00 Page 18 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 OP9 Good Practice Recommendations The registered person should ensure that there is a policy and staff adhere to procedures, for the receipt, recording, storage, handling administration and disposal of medicines… Service users’ interests should be recorded and they should be given opportunities for stimulation through leisure and recreational activities in and outside the home which suit their needs, preferences and capacities; particular consideration should be given to people with Dementia and other cognitive impairments… 2. OP12 Fernihurst Version 1.00 Page 19 Commission for Social Care Inspection Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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. 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