Inspection on 28/11/05 for Fernihurst Nursing Home

This inspection was carried out on 28th November 2005.

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

The inspector 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 22/06/06

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 Stephen Spratling Unannounced Inspection 28th November 2005 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.V259395.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 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.V259395.R01.S.doc Version 5.0 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 people, will be 50 14th April 2005 Date of last inspection 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 but can also 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 7 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 Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors; Stephen Spratling and Teresa Anderson. On the day of the inspection 49 people were living at the home. During the inspection the inspectors spoke with eleven residents (all of whom had communication problems), with nine members of staff; four carers, one registered nurse, two of the housekeeping staff, the home administrator, the deputy manager and two visitors. They also looked at a variety of the homes records including those kept in relation to care planning, risk assessment, medication, staff recruitment and building maintenance. What the service does well: What has improved since the last inspection? What they could do better: Care planning needs to be improved to contain more description of resident’s needs (particularly social and recreational) and how they should be met. Staffing levels need to be reviewed to ensure that residents receive the stimulation and support they need and to ensure that confused and disorientated residents do not compromise the privacy and dignity of other residents. There needs to be better monitoring of what residents eat to ensure they are getting the food they like and need. The systems for administering medication should be more strictly observed to ensure residents are safe and to ensure they get full benefit from receiving medications as prescribed. Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 6 The policy about reporting incidents of suspected abuse needs to be improved. Recruitment procedures need to be further tightened up. 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.V259395.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed during this inspection. Please see previous reports for more information. EVIDENCE: Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Resident’s care and the consistency of that care is compromised through a lack of detail in individual care plans. More attention needs to be paid to resident’s nutritional needs however there is good evidence that other health needs are well met within the home and through appropriate referrals. Failure to follow established rules and systems for administering of medication puts residents at risk. Staff treat residents kindly and with respect, however residents rights to privacy are not fully upheld. EVIDENCE: All residents who live at Fernihurst have a care plan and the inspectors examined four of these. The information in these files is clear and accessible, however they did lack a level of depth and detail. For example, reference had been made to the vulnerability of some residents to poor nutritional intake, but the care plans did not provide information on the type of foods preferred and/or which foods would usually tempt the resident to eat and did not direct care staff in relation to what to do if someone is not eating (see standard 15). Also care plans asked that residents be encouraged to ‘join in’, however there was no reference to what had/might work to facilitate this for individual Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 10 residents. Care plans did not demonstrate that management strategies are in place for those people who exhibit challenging behaviour. Care plans did contain many references to the provision of health related care. They demonstrated that timely referrals are made to health care professionals such as GP’s, psychiatrists, audiology, chiropody and opticians and that actions are taken to meet health care needs. Record was seen of staff working with a GP to overcome the distress experienced by one resident through the appropriate administration of prescribed medication. As this resident was refusing to take this medication, a plan was agreed with the family and with the GP to overcome this. Unfortunately records demonstrated that not all staff were complying with this agreed strategy, limiting the extent to which this strategy can relieve this resident’s distress. The home has clear and satisfactory systems for management of medication however, it was noted during this inspection that the medicines trolley was left unlocked, open and unsupervised for long periods of time. Residents were seen moving freely around the home at Fernihurst as they should be able to if they wish. However some residents were seen wandering into others bedrooms uninvited, this on occasion caused annoyance/invasion of privacy to the occupants of these rooms. For example one male resident was seen entering the bedroom and sitting in the bed of a female resident who was in bed, on a number of occasions. Another male resident was observed in the room, of a different female resident, who clearly did not appreciate him being there. At these times staff were not visible and therefore did not intervene to protect these ladies privacy and provide the gentlemen with alternative focus (see standard 27). Staff were seen speaking with residents politely and kindly, explaining what they were doing when offering care. Residents able to comment indicated that staff are kind and polite to them. Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 11 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, 13 and 15. Current arrangements in relation to recreation and activities are not adequate. Arrangements for residents to meet with family and friends enhance their daily lives. Good food is provided but inadequate monitoring of what residents eat increases the risk that some residents do not receive the food they need. EVIDENCE: Some important information relating to residents life story was seen in daily recording and activities information but this had not been used to plan care in relation to meaningfully activities for/engagement with residents (see standard 7). Aside from having personal care attended to staff were not seen engaging residents in any social/recreational activities during the period of the inspection. The deputy manager explained that the activities co-ordinator was on leave and arrangements were not in place to cover this. Some staff demonstrated a real depth of knowledge about residents as individuals others did not. Staff said that the activities coordinator works a lot with residents on a one to one indicating residents get a lot from this but that generally carers do not have time to get involved in engaging residents in social activities. The Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 12 activities coordinator is employed for 40 hours per week and there are 50 residents at the home. Visitors are encouraged to come and visit their friends and relatives throughout the day and evening. As the home has a number of different communal areas, a large number of visitors can be accommodated and still have a degree of privacy. Residents can also choose to receive their visitors in their bedrooms and staff were observed helping some residents to their bedrooms when visitors arrived. Two visitors spoken with said they were always made welcome by staff and always given help if needed. The lunch provided on the day of inspection was chilli-con-carni with a large and varied selection of vegetables and mashed potatoes. The meal was hot, well presented and looked very appetising. There did not appear to be an alternative although some residents had cheese sandwiches. Some residents were observed obviously enjoying their meals. Those that did not appear to be enjoying it were not offered an alternative. Records were not kept if a resident had not eaten the meal. Care records and fit of clothes indicated that some residents are loosing weight. (see standard 8) It is commendable that one member of staff ate her lunch with a resident whose care plan stated that he needed supervision during meals. Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 13 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): 18 Residents can be confident that staff would recognise and report if they suspected abuse; however the lack of clarity in the homes policy means that there is a risk that concerns would not be addressed in the correct way. EVIDENCE: An inspector read the homes policy which staff are meant to follow if they have a concern that a resident may be being abused; it provided useful guidance in many respects though did not tell the reader that they should report all concerns to the commission and the local Social Services, which they should. The document also implies that staff should investigate concerns which they should not do until they have consulted with Social Services who take the lead in allegations of abuse. Three staff were given a scenario about alleged abuse of a resident and all were clear about their responsibilities to report this to the home manager. Staff said and records confirmed that they are routinely given training on how to recognise and report abuse. Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 14 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): None of these standards were assessed during this inspection. Please see previous reports for more information. EVIDENCE: Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Staffing levels are not sufficient to ensure that resident’s needs are fully met. Residents benefit from being cared for by staff that receive ongoing training to help them do their job well. Recruitment practices are in place but are not sufficiently robust to maximise protection for residents. EVIDENCE: The deputy manager reported that staffing numbers on the day of inspection were up to full strength and to the minimum agreed with the commission. Twenty residents are accommodated on the second floor and there were three carers allocated to this area supported by a registered nurse who was also working on the ground floor. Throughout the morning they were engaged helping residents to attend their personal care. Staff told the inspector that most residents need the help of two carers to support them with their personal care. One said that this made it difficult to provide adequate supervision, two people said that three carers on this floor does not leave them time sit and engage with residents. Two carers said staffing levels on the second floor are usually fine allowing them time to do their jobs properly; one of these carers said that they do not see activities with residents as their responsibility. On the day of inspection, some residents were observed unsupported for long periods of time, for example during the morning an inspector sat in the homes 1st floor lounge area with 13 residents many of whom were disorientated, it was 10 minutes before a carer came into the room looked around but did not Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 16 engage with any of the residents and left to continue assisting a resident in the bathroom. (see standards 10 and 12) New staff confirmed that they felt well supported when first working at the home, working with colleagues and following an induction program which helped them to understand their responsibilities. An inspector was shown the induction record completed in relation to one recently employed carer; it confirmed to national Training Organisation guidelines. All staff spoken with had received basic training to help them do their job safely and most had received more in-depth training e.g. several staff had been on a two day course about caring for people with dementia. Staff confirmed that they are supported to follow NVQ courses. An inspector looked at the recruitment records for three recently employed staff; they demonstrated that a thorough process is being followed which conforms with regulations in all but one area: All three staff had started work before receipt of full Criminal Records Disclosure (CRB). Protection of Vulnerable Adults First Checks had been completed prior to them starting but in the intervening period these staff were not being supervised according to Published Guidance. The inspector spoke to one of the staff who’s full CRB was awaited and they were not aware that they should have a named supervisor until their full CRB had been returned. Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 17 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): 33, 35 & 38 Resident’s benefit from the home being managed by a person who is experienced and suitably qualified. Service users are protected from financial abuse by a sound system of banking. Maintenance systems help to protect the health and safety of resident, though they are not as well protected from the potential effects of a fire as they should be. EVIDENCE: The registered manager is a Registered Mental Nurse with many years experience in the health service and private sector. He has completed the Registered manager’s award. Staff asked indicated that he is approachable and supportive. Significant improvements to the systems of the home have been seen by inspectors since he has been manager. Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 18 Resident’s personal allowances are kept in a safe within a locked cupboard. Each residents account is kept separate and good auditable records are kept including receipts for all monies spent and received. Three accounts were checked and found to be in order. Maintenance records were viewed including evidence that, portable electrical appliance safety tests had been conducted, water temperatures are regularly monitored and that showerheads are regularly cleaned to prevent legionella. Records showed that fire alarms and fire fighting equipment are regularly checked. Generally the home appeared well maintained though on walking around the home inspectors found two fire doors wedged open and a fire exit by the kitchen obstructed. Staff and records confirmed that staff receive training to help them to respond in case of fire and to help keep the home safe. Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X X X X X X X X STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 2 Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 20 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) Requirement The registered person must ensure the safekeeping of medicines at all times. (This relates to the times when medicines in the medication trolley are left unsupervised and accessible to service users). The registered person must not employ a person to work at the care home untilA full and satisfactory CRB check has been received. (Exceptions to this are permissible but must be done in line with Department of Health Guidance: “Protection of Vulnerable Adults Scheme- A Practical guide – ref paragraphs 37 to 46 & Annex C) Timescale for action 31/12/05 2 OP29 19 28/01/06 Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 21 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 The registered person should ensure that each residents care plan sets out in detail the actions which need to be taken by care staff to ensure that all aspects of the health, personal and social care needs of the residents are met. A record of nutrition, including weight gain or loss, and appropriate action taken should be kept. The registered person should ensure that staff medication is given as directed by a residents Doctor. The registered person should ensure that resident’s interests are recorded and opportunities for stimulation offered in line with these interests and their preferences. The registered person should ensure that diets are suited to individual assessed and recorded needs and that choice of meals is offered in a way that suits the capacity of residents. The homes adult protection policy needs to be reviewed to ensure it reflects local reporting procedures. Staffing numbers should be appropriate to the assessed needs of service users, the size layout and purpose of the home, at all times. The registered manager should ensure safe working practices including fire safety. (Fire doors should not be wedged open and fire exits should not be obstructed at any time) 2 3 4 OP8 OP9 OP12 5 OP15 6 7 OP18 OP27 8 OP38 Fernihurst Care Home DS0000061639.V259395.R01.S.doc Version 5.0 Page 22 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.V259395.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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