Inspection on 22/06/06 for Fernihurst Nursing Home

This inspection was carried out on 22nd June 2006.

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 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 10/08/07

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 Key Unannounced Inspection 22nd June 2006 09.10 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.V293643.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.V293643.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 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.V293643.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 28th November 2005 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 applied to be registered 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, with these needs being such that 24-hour supervision by nurses is required. Many residents in this home have dementia. 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 ensuite lavatory. There is a lounge and dining area on each floor, with a level garden at the rear of the home for all residents to use. A parking area is provided at the entrance to the home. At the time of the inspection, fees were £500 - £650 per week. Fees do not include hairdressing, chiropody, toiletries, newspapers/magazines, telephone calls, relatives’/visitors’ meals, or hospital transport costs. The latest CSCI report on the home is kept in the reception area, with copies available from the home on request. They are also discussed at the Relatives’ Support Group, which is held regularly. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspectors, Stephen Spratling and Rachel Fleet, met most of the 47 residents during this unannounced inspection, either individually or in groups, around the home. Some residents were in day rooms; others moved independently between areas, and a few preferred to spend time in their bedrooms. Several were unable to give their views, or give them in detail, because of mental health disabilities. One inspector had lunch with residents in one of the dining rooms. The inspection included ‘case-tracking’ of five residents - looking into their care in more detail by meeting with them, checking their care records, talking with staff, and observation of general care they receive. Observation of the day’s events and reading documentation was also informative. The inspectors spoke with five care staff (including two nurses), three visitors, and a cook. A CSCI pre-inspection questionnaire had been returned by the home. Completed CSCI comment cards from six relatives/supporters (completed on behalf of residents, who were unable to do this), seven staff and ten community-based health or social care professionals were also returned. The inspectors were at the home for seven hours before discussing their findings with the manager and his deputy. Information gained from all these sources and from communication with the service since the last inspection is included in this report. The Commission has received one complaint about the home since the last inspection, regarding various aspects of care of a resident. The provider Sanctuary Care Ltd. - was asked to investigate, and they found the complaint to be partially upheld. An action plan was drawn up to address issues identified, and the inspectors followed this up during this visit. What the service does well: Two surveys returned by health or social care professionals commended the home regarding their standards of care for residents with very complex, challenging needs. They felt this was achieved because of the home’s commitment to staff training, management of staff, and the co-operation of senior staff in working with community professionals. There is good access to information about the home, so that prospective residents, with their supporters, can make an informed choice about where they wish to live. Prospective residents’ needs are assessed well, helping ensure the home can meet the care needs of people who are admitted. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 6 Involvement of other professionals and regular review of planned care ensures residents receive good health care. Meals are of a good quality. There is generally good promotion of dignity and respect for residents, staff giving them choice and control where possible. Residents’ families and friends are able to remain part of residents’ lives, so they benefit from familiar and supportive relationships. The environment and facilities are generally spacious, light and homely, although some needed redecoration and refurbishment is due to take place in the next three months. This is to include features that will help people with dementia make better sense of their environment. There are good standards of cleanliness, protecting residents’ wellbeing. The manager has the knowledge and experience to ensure the home is run well, and run in the best interests of the residents. This includes having good systems that protect their financial affairs. Complaints are received well, and used to improve the service and care residents receive. Various policies and practices are used to try to protect residents from abuse, including good recruitment procedures. What has improved since the last inspection? What they could do better: Including good levels of detail in each care plan would help ensure residents consistently receive all the care they need, including for their social needs. Opportunities for fulfilment through occupation or recreation are limited, partly because of staffing arrangements, so residents’ social needs are not always met. However, steps are already being taken to try to improve matters. Unsafe aspects of medication management must be addressed so that residents’ wellbeing is not at risk. The diet provided is balanced and palatable, but aspects of mealtimes could be improved, to help promote residents’ enjoyment of mealtimes. Whilst most staff were considerate and respectful to residents, a minority of staff did not always maintain residents’ dignity or communicate sufficiently with them when assisting them. Although staff are trained and supervised enough to ensure residents’ safety, the service could be improved if staffing Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 7 levels were reviewed, and more staff had basic accredited care training as well as up-to-date knowledge and skills needed for caring for people with mental disabilities, to guide their practice. There are generally good systems to ensure health and safety matters are attended to, but two additional measures could be taken to further protect residents and staff. 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. Fernihurst Care Home DS0000061639.V293643.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.V293643.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is good access to information about the home, so that prospective residents, with their supporters, can make an informed choice about where they wish to live. Good systems are in place to ensure prospective residents’ needs are fully assessed, promoting the success of any admission to the home. The home does not offer intermediate care. EVIDENCE: Prospective residents are sent the Service User Guide, which informs them how to get further information about the home. This is being updated to include recently required information on fees. It is available in a clearer format than standard print. A resident confirmed they had obtained sufficient written information about the home before they came to live there. A relative Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 10 confirmed that they had received a Service User Guide, and that staff had visited their parent to discuss their needs before admission to the home. Pre-admission assessments were comprehensive, including areas identified in the National Minimum Standards as well as weight, nutritional and pressure sore risk scores. They also had information from other professionals and family members. A staff said that sometimes the needs of prospective residents were discussed with staff before the person was accepted for admission, ensuring as much as possible that their needs could be met by the service. Further assessment of one resident covering their first 72 hours after admission was being built up, which is seen as good practice. Fernihurst Care Home DS0000061639.V293643.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 - 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are adequate systems in place for informing staff about residents’ care needs, although lack of detail in some care plans may lead to inconsistencies in care and a risk that some residents may not receive all the care they need. Regular reassessment and multidisciplinary working ensures residents receive good health care. Management of medication is adequate, but certain aspects must be addressed to avoid risk to residents’ welfare. There is generally good promotion of dignity and respect for residents, although two examples of poor practice were seen. EVIDENCE: Needs identified in pre-admission assessments were reflected in care plans, which were put into practice with some positive effect. For example, directions to use particular equipment to try to reduce the risk of falling for one resident, Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 12 which the inspector saw was being used. Another resident’s care plan reflected concerns that they were losing weight, with strategies for stopping this; their records indicated that they had gained some weight since the plan was implemented. Care plans were comprehensive and generally satisfactory, including mental health/psychological needs as well as physical and personal care needs, with basic guidance as to how these need should be met. Community-based health or social care professionals felt their specialist advice was included in care plans. Some plans were less detailed than others (particularly social histories, etc.), or did not always reflect information gained from risk assessment tools – risks of falling, etc. Staff were therefore less well informed through care plans about these residents’ needs. However, one staff said they got very good information at verbal ‘handovers’ at the start of their shift. A problem affecting one resident was attributed by staff to a specific diagnosis, but this diagnosis was not included on care records; and it was not clear whether positive interventions had been tried, to prevent the problem occurring. One resident called out regularly during the inspection, and this behaviour was described as attention seeking by one staff. However, the resident had no call bell available, and asked the inspector to ask staff about this. Staff felt the resident would not use one if it was provided, but there were no alternative arrangements included in the care plan – such as checks by staff at specific intervals – so that the resident could make it known if they wanted anything. A relative thought personal care was attended to adequately. Residents felt the home got medical advice or attention in a timely way, and records seen confirmed this. Community-based professionals (opticians, chiropodists, etc.) had also visited residents, systems being in place for access to such services. Survey cards from health or social care professionals said they were satisfied, overall, with the care provided. Care plans were reviewed regularly and also updated when changes in a resident’s condition occurred, although occasionally parts of care plans were crossed out but not signed or dated (to indicate when the change in care had occurred). Weights were recorded regularly. Professionally recognised assessments are used, regarding nutrition, falls and vulnerability for developing pressure injuries. Suitable equipment, including pressure-relieving equipment on beds and chairs, was in use around the home. Residents who were asked said they were satisfied with how staff gave out medication. Medication reviews by GPs were shown. However, some medication requiring refrigeration was not being stored at the right temperature, according to daily records. This can damage them, potentially reducing their effect. The medication policy included checking fridge temperatures, but no guidance on correct temperatures and what to do if medications have been stored outside these recommended temperatures. Nurses seen administering medications made sure that the medications trolley was secure or observed at all times, took medications to residents individually and observed them taking the medications. However, signatures were not always written straight after administration, and in one case, dosage given was Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 13 not being recorded where a variable dose was prescribed. One person’s medication allergy had not been noted on their administration sheet, although it was noted in their care plan. These issues could lead to administration errors. One liquid medication seen had not been dated when opened as the label instructed, so staff would not know when it should be discarded. Staff had appropriately recorded when one resident was asleep at night and thus did not take prescribed medication. However, this happened for some days, but had not been discussed with the resident’s GP, to consider other ways of ensuring the resident got any required medication. Residents moved around the home as they wished. A resident said staff were discrete when assisting them with an aspect of personal care. Care plans included how staff were to maintain privacy and dignity in specific ways for some residents. There was evidence that a small minority of staff did not promote residents’ dignity as well as others. The manager immediately spoke with one staff regarding a resident’s clothing, when an inspector brought a matter to his attention. And poor practice shown by two staff assisting residents at lunch was also discussed. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 14 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): 12 - 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are only adequate opportunities for fulfilment, although steps are being taken to improve matters. Good efforts are made to ensure residents’ families and friends remain part of residents’ lives, so they benefit from continuity of supportive relationships. There are good practices to promote residents’ choice and control in their lives where possible. The diet offered is adequate - with menus being balanced and meals palatable, but aspects of provision needing improvement. EVIDENCE: Of areas given for comment on survey cards, ‘activities’ was the one rated lowest (as ‘sometimes’ or ‘usually’ sufficient). The home has an “activities coordinator” employed for 30 hours per week; on the day of the inspection there were 49 residents at the home. Two residents said they would like more to do; others were unable to comment. Three care records showed residents having one-to-one or group time, with the activities coordinator, every third day on Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 15 average. This usually appeared to involve a short chat, a game, or looking at newspapers. A relative felt perhaps more entertainment was needed, as opposed to ‘activities’. Residents’ interests were noted in care records, but it was not clear that these were followed up since they were not always included in care plans or referred to in daily notes. One resident was restless and was found on the floor at least three times during the inspection. No diversional occupation was offered during this time, staff being otherwise occupied; the resident’s activities record had five entries for the last three weeks. A comment in their care notes suggested the resident was perceived as ‘demanding’. Care staff said they rarely have time to spend socialising or doing activities with residents. One said they felt that this was definitely an area where there is “room for improvement”. The manager has recently requested extra activities co-ordinator hours, as well as extra care assistants’ hours for social time with residents. A notice in the lift informed about spiritual care offered by local clergy, who visit the home regularly. A visitor who was next-of-kin to a resident said they were kept informed appropriately about their relative’s condition. Three visitors spoke positively about the care provided at the home and the welcome they receive. But two expressed disappointment that trips out, particularly to the sea, never happen unless initiated by visitors. A garden party had been held for the Queen’s birthday, and support meetings are held regularly for relatives. When the weather improved during the inspection, doors were opened to the enclosed garden so residents and visitors could freely go out if they wished. Some staff checked if residents had had enough to eat, offering them more, before removing their plates at lunch. One staff checked their understanding of a resident’s confused speech with the resident, before continuing the conversation. Some residents had their own possessions, furniture, etc. in their bedrooms. Some aids and adaptations were seen around the home, giving residents more control through independence in their daily lives. Signs, familiar pictures and photos were used to inform residents about the function of rooms or which their bedroom was. Toilet frames and grab rails were seen. Twohandled cups were given to some residents. Some dining chairs had arms and ‘sliders’, making it easier to pull them to or push away from dining tables. A visitor said that they regularly eat at the home and two spoke highly of the food provided. One inspector ate with residents on the top floor. The lunch was pleasant and hot, though nobody was offered a choice of meal and staff were not aware of an alternative being available. One resident who did not eat their meal was not offered an alternative. A cook was aware of special diets; they also said they would always make an alternative on request, though alternatives are not routinely prepared/offered. Menus in the kitchen did not state an alternative. Fresh fruit and vegetables were seen in kitchen stores. The meal happened in effectively two sittings, with those needing help being assisted first. Staff knew what help each resident needed at lunch. Most care Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 16 staff feeding residents did so appropriately - sitting with them and speaking with them - although one person, when interrupted, got up and walked away without comment to the resident. One staff fed a resident without any interaction, however, and another stood, whilst talking to a colleague. Meals were served in bowls to residents needing a pureed diet, so that although parts of the meal had initially been pureed individually, the meal did not look very appetising. There was evidence of good practice at mealtimes – drinks were offered regularly and when one resident spilt their drink, staff got them another immediately, without being asked; residents were politely offered serviettes to wipe their mouth at the end of the meal, rather than staff just doing this for them. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good response to complaints, ensuring they promote improvement of the service residents receive. There is a good range of safeguarding policies and practices in use, to try to protect residents from abuse. EVIDENCE: Visitors’ comments included staff were always busy but quick to remedy any issues raised with them; that they were confident complaints would be addressed, if discussed with staff; and that staff were always helpful and supportive individually. The Comments book was said to be a useful way to get matters dealt with. Steps have been taken to address issues raised in a complaint made since the last inspection. No complaints were raised on this occasion. Health or social care professionals felt the home made appropriate decisions when they could no longer manage the care needs of residents, ensuring residents’ longer term welfare. Surveys indicated it was thought most residents had received a contract, protecting their rights. The safeguarding policy has been updated to include reference to guidance on local reporting procedures, although the guidance was still to be included. Care staff asked were aware of their responsibilities to report abuse; they had received some training to help them recognise abuse and to ensure they know Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 18 how to report it. A cue card was on display in the medications room reminding staff of their responsibility to report abuse and how to do so. Non-care staff also have training on abuse awareness. Allegations into unprofessional behaviour by staff are taken seriously by the manager, and investigated appropriately. Use of bedrails was a considered decision, with records kept and reviewed for each resident concerned, rails being removed in one case since considered no longer necessary. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 19 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): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a generally good, safe and homely environment, although planned redecoration will improve the home further. Systems are in place to promote good standards of hygiene, protecting residents’ wellbeing. EVIDENCE: Residents able to comment, relatives, and staff also, said they thought the home is generally kept clean and they were happy with standards of daily maintenance. The pre-inspection questionnaire showed maintenance checks and servicing had been carried out within recommended timescales, to try to avoid breakdowns, etc. All areas seen were clean and appropriately furnished. Several residents’ rooms were personalised with pictures and soft furnishings. Specialist information is being sought before redecorating parts of the home (being done within the next three months) to ensure it incorporates good Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 20 practice with regard to creating an environment helpful to people with dementia. Certain lounges will be redecorated and bedrooms recarpeted as a priority. Bathrooms will be made safer to use and more homely. The laundry machines had recommended programmes for disinfecting laundry, with the laundry staff aware of appropriate temperatures to use. Handwashing facilities were not easily accessible during the inspection because of laundry placed in front of the sink. This was discussed with the staff on duty. The kitchen was clean, with records kept daily of fridge, freezer and cooked food temperatures. One area of concern was a resident sitting in a lounge chair with food spilt down its sides; staff said chairs were cleaned nightly. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 21 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 - 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing is adequate to meet residents’ general needs. However, there are inadequate arrangements to ensure their social needs are met at all times. Staff have adequate knowledge and skills to ensure residents’ safety. However, the service could be improved if more staff had accredited training to guide their practice. Residents are protected by the home’s good recruitment policies and practices. Training and support for staff act is adequate, but residents would benefit if all staff had up-to-date knowledge and skills needed for caring for people with mental disabilities. EVIDENCE: Surveys completed by next-of-kin described staff as friendly, approachable, professional, very caring. One commented about staff shortages. One was very grateful for the care given to their parent. Residents said of staff, they were ‘friendly’, ‘kind’, ‘generally okay although a couple are off-hand’, and ‘difficult to get hold off’. There are usually two nurses rostered on duty at all times, with eight care assistants rostered in the morning, seven in the afternoon and evening, and four overnight. This is in addition to the manager and deputy manager, who are both nurses. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 22 Staff were continually occupied in one part of the home, with care-giving or related tasks, so they were unable to speak with the inspector. There was little time for them to engage with residents other than when physical care was being given. One resident was distressed that another resident often wandered into his room, which staff could help prevent, although otherwise felt there were usually enough staff on duty. Staff on one floor reported that 15 of the 19 residents there needed two staff to help with their personal care, and were still getting residents up at 11.45 am. They felt that there are generally enough of them on duty to meet residents’ basic care needs, but none felt they have much time to spend with residents otherwise. An inspector saw staff regularly checked on residents in one lounge, but were not able to stay and chat with them unless they were expressing a particular physical need. One staff noted shortages were felt when staff had to escort residents to appointments, as was observed during the inspection. Others commented about colleagues with poor attendance causing shortages; the manager has dealt with this issue appropriately. Staff rotas confirm there are always nurses on duty, in charge of care. Of 28 care assistants, eight have a recognised care qualification, and six are undertaking the course. New staff undertake mandatory health and safety training before actually working at the home. A previous requirement relating to recruitment has been met, with staff surveys and employment files showing police checks and other required information were obtained by the home, in a timely way. A recent inspection of the home by the provider had identified that gaps in employment history were not being discussed at interview, so this is now done. Induction programmes for care staff are based on accredited standards (devised by ‘Skills for Care’, a recognised organisation), and records were seen, although a newer accompanying learning package on dementia care is not yet used. An induction programme is being developed for ancillary staff. There was evidence in staff files that performance issues, including sickness absences, are discussed at supervision sessions or addressed more formally. Staff spoken with and all but one survey reported receiving 1 to 1 supervision with a senior colleague. All surveys from the health or social care professionals said staff demonstrated clear understanding of residents’ needs. The Alzheimer Society has given training recently, and person-centred care is the next training topic. One staff has a special role regarding wound care. Some staff attended a catheterization update. Of three staff asked, one had learnt about dementia while doing a care qualification in a previous job, but two said they had not attended any training about caring for people with mental health or dementia related problems; two were aware they had missed training/updates run at the home. Fernihurst Care Home DS0000061639.V293643.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 at least once during a 12 month period. 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. The manager has good knowledge, skills and experience to ensure the home is run well. There are a good variety of strategies in place to ensure the home is run in the best interests of the residents. Good systems and practices used by the home protect residents’ financial affairs. There is adequate attention to health and safety matters, but additional measures could be taken to further protect residents and staff. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 24 EVIDENCE: The registered manager is a Registered Mental Nurse and has also completed the Registered manager’s award. He has many years experience in the health service and private care sector. He has recently attended a 2-day conference on dementia care. And has consulted with Oxford Dementia Care Centre staff, who have recently carried out an audit at the home to inform future development of the service. Staff surveys indicated a majority felt managers were supportive, although some wanted stronger action about unreliable colleagues. Staff spoken with indicated that the home managers are approachable and generally responsive to their ideas and concerns. Two community professionals commented positively about the management of the home and how it has benefited residents. A relative confirmed they had received a questionnaire about the home, and said the manager often asks them if everything is all right. Results of residents’ surveys are discussed at relatives’ meetings, and a report made available. A relatives’ meeting was being held at the weekend; the home’s manager attends these. Monthly audits on different matters are carried out – how well the home cares for people at the end of their life, for example. A recent audit had identified that policies were not in a user-friendly format for residents, and this is now being addressed. Findings of the provider’s own unannounced monthly visits to the home are discussed at supervision and staff meetings. Money held for residents by the home is looked after by the administrator. Records looked at were easily audited, with receipts kept, deposits and withdrawals signed for, and accounts matching amounts held in wallets. The home does not act as appointee for any residents. Three care staff reported having training within the past year on manual handling, food hygiene, infection control, fire safety; two had done first aid training. One of the staff has had particular training on manual handling that enables them to train and advise other staff. An issue raised at a fire officer’s recent visit was being addressed. No fire doors were seen wedged open or obstructed. Staff were asked what they should do in the event of a fire and were generally clear on how they should respond to keep residents safe. Fire drills were held regularly, but no attendance record was kept; the manager was going to do this in future. He was not aware of new food safety legislation, but was going to look into this before revising the home’s food safety policy. Kitchen temperature records showed fridges running above 8ºC on several occasions, which is higher than recommended for ensuring safe food storage and had not been reported to senior staff. Other than this, good practices were evident – food in fridges Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 25 being covered and dated, fly screens at windows, etc. Safety information on cleaning products was available. Checks on window restrictors were recorded, ensuring they were still in place. A thermometer was not available for checking bath water temperatures, and staff were unaware of procedures for doing this. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Timescale for action The registered person shall make 31/07/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is especially regarding: Safekeeping of medication through guidance in the medication policy & by following manufacturers’ instructions, especially regarding storage temperatures & timescale for use after opening; Safe administration, including signing for medication & recording variable doses at the time of administration, noting allergies on medication sheets, ensuring ongoing omission of prescribed medication is discussed with the resident’s GP. Requirement Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 28 2. OP38 13(4)(c) The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. This is especially regarding food storage & safe bath water. 15/08/06 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 the service user’s plan sets out in detail the action which needs to be taken by care staff to ensure that all aspects of the health, personal and especially the social care needs of the service user are met. It is recommended the arrangements for health and personal care ensure that service users’ privacy and dignity are respected at all times, with particular regard to personal care-giving. It is recommended that service users should be given opportunities for stimulation through leisure and recreational activities in and outside the home, with particular consideration given to ensure arrangements suit the needs, preferences and capacities of those with Dementia and other cognitive impairments. It is recommended that there is a menu offering a choice of meals in written or other formats to suit the capacities of all service users, which is given, read or explained to them. And that staff offer assistance in eating, where necessary, sensitively and individually. It is recommended staffing numbers are appropriate to the assessed needs of the service users (including social needs & taking into account escort duties, etc.). 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. 2. OP10 3. OP12 4. OP15 5. 6. OP27 OP28 Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 29 7. OP30 It is recommended that the staff training and development programme includes the ‘Skills for Care’ dementia care learning module, and ensures staff fulfill the aims of the home and meet the changing needs of service users. Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Exeter 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. Extracts may not be used or reproduced without the express permission of CSCI Fernihurst Care Home DS0000061639.V293643.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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