Inspection on 11/07/06 for Fernlea

This inspection was carried out on 11th July 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fernlea 16/09/08

Fernlea 19/09/07

Fernlea 06/03/07

Fernlea 14/02/06

Fernlea 17/10/05

Fernlea 31/01/05

Fernlea 13/07/04

Fernlea 15/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Fernlea 59 Fort Ann Road Soothill Batley West Yorkshire WF17 6LS Lead Inspector Alison McCabe Key Unannounced Inspection 11th July 2006 10:30 Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 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 Fernlea DS0000001081.V296160.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 Adults 18-65. 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. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernlea Address 59 Fort Ann Road Soothill Batley West Yorkshire WF17 6LS 01924 470176 F/P 01924470176 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) St Anne’s Community Services Mrs Sarah Grogan-Evans Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Seven service users with learning disabilities and four who also have physical disabilities. To provide accommodation and care for one named service user over 65 years 14th February 2006 Date of last inspection Brief Description of the Service: Fernlea is a care home registered to provide nursing care and accommodation for three adults with learning disabilities and four adults with learning and physical disabilities. The registration category also includes one named service user who is over 65 years of age. St. Anne’s Community Services, a charitable organisation, operate the home. The home is located in a residential area close to the centre of Batley. There are shops, a post office and community facilities within 5 minutes’ drive of the home. The property is a brick built, detached bungalow which was purpose built for use as a care home. Internally, the home is separated into two discrete units, one providing care and accommodation to adults with severe learning disabilities, and the other providing care and accommodation to adults with physical and learning disabilities. The former is referred to by the staff as the “red side” and the latter, the “blue side”. All the service users have complex needs. The property has small, secure sheltered gardens on either side of the home and parking space on a drive. Internally, there is a central area where there is staff sleeping in accommodation, the laundry, macerator room and a storeroom. Accommodation on the red side comprises three single bedrooms, a lounge, kitchen/diner, bathroom, shower room and an office. Accommodation on the blue side comprises four single bedrooms with wash hand basins, kitchen/diner, lounge, conservatory that is also used as a snoezelen room, shower room and an adapted bathroom. The range of fees charged for this service are between £202.35 - £457.29 per week. This does not include the nursing component which is paid directly by health. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this key inspection, an unannounced visit was conducted at Fernlea by one inspector between the hours of 11 am and 6.45 pm. In addition to the site visit, information used to inform the inspection includes notifications received from the home about any accidents, incidents or events that affect the well being of residents; provider monthly visit reports submitted to CSCI; the pre-inspection questionnaire submitted to CSCI prior to the site visit; completed questionnaires from one service user, visiting professionals and relatives of service users giving views about the quality of the service. The manager has explained that six of the seven service users were unable to complete the questionnaires due to their level of learning disability. Questionnaires were also sent to six relatives - four have been returned; three visiting professionals - one has been returned; two GPs – none have been returned. Comments and feedback have been included within the main body of this report although the general feedback from all has been positive with all respondents expressing satisfaction with the service provided at Fernlea. As part of the visit, the inspector had the opportunity to talk to six members of staff including nursing care officers and support workers (including agency staff) and the registered manager. Communal areas and some service users’ bedrooms were seen. Records relating to service users, staff meeting minutes, staff training, quality assurance, menus and staff rotas were examined as part of the site visit. Medication and records relating to medication were examined. The inspector also had the opportunity to observe care practice and the evening meal being served. Since the last inspection visit to the home, the registered manager has returned from maternity leave and there has been a change of deputy manager. Of four requirements made at the previous inspection, two have been positively addressed and two remain outstanding. A further two requirements have been made as a result of the findings at this site visit. Findings of this key inspection are mixed. Some areas of good practice have been identified where outcomes for service users are good. However, a number of areas have also been identified where improvements are required in order to improve the quality of life for service users. The inspector would like to thank the service users and staff for their cooperation and hospitality during the site visit. What the service does well: Before service users move into the home, their needs are properly assessed. Service users are given information about the home before they move in. This helps to make a decision about whether or not to live at Fernlea. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 6 Some service users have regular access to community-based activities. Staff offer good support to service users to enable them to maintain contact with their families and friends. Good food is provided at this home. Service users are supported to make some choices. There are clear care plans for some service users describing how needs should be met. The home has a good range of equipment, aids and adaptations to meet the needs of service users with physical disabilities. The home has a complaints procedure; no complaints have been received in the last twelve months. Service users live in a clean and comfortable home. Good infection control procedures are implemented. A qualified, competent manager runs the home. Some staff are very skilled at communicating with service users using their preferred method of communication. What has improved since the last inspection? What they could do better: Some care plans need to be revised to ensure that a positive approach is always implemented. Staff need to ensure that care plans are implemented as intended and agreed. More support should be offered to some service users to help them to be engaged in meaningful and fulfilling activities both inside the home and in the community on a regular basis. Care practice in some areas needs to improve. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 7 Record keeping in some areas needs to improve. A stable staff team needs to be established to ensure consistent care is delivered to service users. Training relevant to the needs of the service users must be delivered to staff as required. All service users must be protected from harm. The kitchen on the red side needs to be replaced. 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. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Prospective residents are given the information they need to make an informed decision about where to live. Adequate assessments are completed prior to service users being admitted to the home. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: One service user was able to complete a satisfaction questionnaire with staff support as part of the key inspection of Fernlea. The service user indicated that they were asked if they wanted to move to Fernlea and that they were given enough information about the home before moving in to help in deciding if it was the right place. Records of three service users were examined as part of this visit. A completed Community Care Assessment was in place in each of the records seen. It was noted in one of the service user’s records that it had been identified that they be accommodated in a supported living environment. The manager explained that this was a temporary placement and gave a clear explanation about this. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Detailed care plans are in place for some service users informing staff how to meet individuals’ assessed needs. Further development is necessary in some areas. Service users are supported to make choices about their lives. Action is being taken to minimize identified risks to service users. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Individual care plans for two service users were examined as part of this site visit. Some parts contained excellent detail about how care should be delivered to service users. Guidance and protocols about how a service user should be supervised had been introduced a few days before the site visit due to concerns about the service user’s safety. These gave clear guidance to staff about how to meet the service user’s needs and keep them safe. Some parts of an individual plan and behaviour management guidelines that were seen appeared to be quite negative. The home’s manager was able to explain the Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 11 rationale for some interventions in a positive manner, although acknowledged that the way in which the guidance had been written did not promote a positive approach. It was agreed that these would be reviewed. There was evidence in the records that reviews are conducted periodically. Evidence of this was also seen in the provider’s monthly reports that are submitted to the CSCI. Feedback received by CSCI from relatives of service users confirms that they are consulted about the care of their relative at Fernlea and this is positive. Through examination of daily records, it was noted that agreed care plans are not always implemented consistently. This was discussed with the manager at the time of the visit. All service users have an identified keyworker and named nurse who take responsibility for ensuring care plans are up to date. Risk assessments were in place in those records that were checked. These provide useful information to staff about identified risks and strategies for minimizing risks. A number of incidents of service user to service user assaults have taken place at this home, resulting in the home’s manager conducting risk assessments in relation to the management of challenging behaviour and the supervision of vulnerable service users. At the time of the site visit, these had only just been introduced therefore it is not possible to comment on whether the risks to particular service users have been reduced satisfactorily. Staff have been asked to read the new risk assessments and sign to say that they have done so. The manager was observed to ensure that a new member of staff did this. Some examples of good practice were observed in staff supporting service users to make informed choices. During the visit, a service user was supported to go through pictures of different meals in order to plan the following week’s menu and shopping list. The member of staff demonstrated a good understanding of the service user’s way of communicating. An agency staff member on duty was observed to support a service user with a meal ensuring that opportunities to make choices were given. Feedback from a service user survey completed as part of this key inspection stated that the service user always makes decisions about what they do each day. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Some service users have access to daytime occupation whilst some service users have limited opportunities to take part in valued or fulfilling activities, education or training. Service users are supported to maintain contact with friends and family. Staff respect service users’ rights some of the time; care practice needs to improve in some areas. Food provided is generally nutritious and varied. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Three of the seven service users have regular, though limited, day services and two service users have additional staff employed to provide an individual day service from the home. The manager explained that, wherever possible, the two service users receiving individualised day provision do so at different Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 13 times in order to reduce the amount of time they spend in the home together as there are compatibility issues between them. Staff at the home are responsible for ensuring that the remaining service users are kept occupied. It was noted that there was very little occupation or engagement with service users at home during the day. Staff were often busy with domestic tasks leaving service users unsupervised for lengthy periods of time. For example, two staff members were busy in the kitchen with food preparation and clearing up while the service users were sitting in the lounge. Whilst it is acknowledged that domestic tasks are essential, it is suggested that more attention be paid to including service users in these tasks where possible. A range of activities was available in both communal areas of the home and in service users’ bedrooms. These included TV, stereo, multi-sensory equipment, DVDs and videos. A range of children’s toys were available in the lounge on the blue side and a service user was observed sitting with an inset puzzle in front of him for some time, although was not engaged in this activity. It is recommended that more adult activities be explored that are functionally equivalent to the existing range, and that staff engage in activities with service users more often. For two service users living on the red side of the home, the frequency of community based activities has remained at a good level due to having one to one staffing for a number of hours per week. The remaining service users do not have the same opportunities to access community based activities due to a lack of staff that are able to drive, and several staff vacancies. A number of service users on the blue side require specialist transport provided by the home due to the nature of their physical disabilities. The manager anticipates that the frequency of community based activities will increase in the near future as two staff due to start at the end of July are both drivers. A requirement regarding service users having regular opportunities for community activities and daytime occupation has been made at the previous three inspections. The action plan following the last inspection stated that staffing difficulties had impacted on progress in this area. Some service users have been on holiday and others are due to go away soon. Holidays have been arranged on an individual basis, involving service users in choosing and planning wherever possible. This is good practice. There was evidence in records that service users are supported to maintain contact with family and friends. Staff spoken to confirmed this. Relatives of four service users completed comment cards as part of the inspection process. Both stated that they were made to feel welcome at the home and were able to visit their relative in private. The inspector had the opportunity to talk to a relative during the site visit. She expressed her satisfaction with the care her relative received and reported that there had been positive changes for her Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 14 relative since moving to Fernlea. The pre-inspection questionnaire indicates that a service user at the home uses advocacy services. Some staff were observed to respect service users’ rights, for example knocking on bedroom and bathroom doors before entering, encouraging independence with meals and choice of drinks. Several staff were observed to address service users by their name and in a respectful manner, however some forms of address used seemed less appropriate, for example, “good girl”, “good boy”, “that man”. Whilst it is recognised that such forms of address are often used as terms of endearment, care should be taken to ensure that service users are spoken to with respect and as adults. The inspector was particularly concerned about this issue because of the cumulative effect of care practice/activities etc that did not appear to value service users as adults. Evidence of this was observed and seen in some service users’ records. Service users spent lengthy periods of time with no interaction from staff, despite staff being in the same room or seemingly not engaged in other tasks. Improvement in this area is necessary. Service users are offered a reasonably healthy diet. Records on the blue side indicated that service users are offered the recommended five portions of fruit and vegetables most days. Records on the red side showed that progress in this area had slipped since the last inspection visit; there were a number of days where service users did not appear to have had any fruit or vegetables. The manager acknowledged that, on the red side, the food offered was not as healthy as it had been but thought it may also be a lack of accurate recording. Service users are supported to plan menus and a member of staff was observed to encourage a service user to choose healthy, balanced meals. The evening meals on both sides of the home were observed being prepared and served. Service users on the red side were offered cheesy vegetable bake, and service users on the blue side were offered fish, vegetables and potatoes. It was noted that none of the service users were offered condiments and these were not available on the table. Care practice across the two units was mixed. Some examples of discreet and sensitive support being offered was observed, for example service users being told what was on their plate, drinks being offered between mouthfuls of food, meals that were liquidized were done so separately to ensure that service users could experience different tastes and textures. There were, however, some examples of less positive practice observed, for example, a service user being supported with their meal by more that one staff member due to a telephone call being taken, some service users not offered drinks with their meal, a member of staff standing over a service user whilst supporting them with their meal. It was noted that none of the service users were offered the opportunity to participate in, or observe staff in, the preparation or serving of meals although staff reported that service users participate in food shopping. It is recommended that service users be offered more opportunities in this area. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 15 The mealtime on the blue side was observed to be a relaxed and unhurried time, however the atmosphere on the red side was less relaxed. This appeared to be due to a difficult relationship between two service users. Staff reported that meal times are flexible depending upon the wishes of service users and activities planned for the day. Guidelines about how service users prefer to be supported with their meals were available. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Some staff offer personal support in the way that service users prefer and require; some care practice needs to improve in this area. Service users are supported to have most of their healthcare needs met although some record keeping needs to improve in this area. Medicine management is generally good at this home; robust auditing systems would improve practice in this area. Quality in this outcome area is poor. This judgement has been made from evidence gathered during the visit to this service. EVIDENCE: Some staff provide personal support in a way that maximises independence, privacy and dignity. Some examples of good moving and handling practice were observed. A personal support plan contained excellent detail about the service user’s preferences and needs, giving clear instructions to staff about the best way of supporting the service user. In one individual care plan it was noted that not all areas of personal support needs had been documented; this was discussed with the manager at the time of the visit. Personal support is not always provided in private and this must be addressed to ensure that service users’ dignity and privacy is protected at all times. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 17 It was observed, on a number of occasions, that staff delivered personal care to service users without explaining what was happening, in some instances in total silence, and in ways that did not protect service users’ dignity. Staff were not always responsive to service users’ needs, for example, a service user indicating distress was not attended to for over fifteen minutes. The home manager reported that further training in values and attitudes would be delivered to staff. Technical aids and equipment are available and were used appropriately by staff. Communication with agency staff about service users’ current personal support needs was inconsistent. Through observation of practice, it was apparent that not all agency staff had been provided with up to date information and this must be addressed. There was evidence in care records that regular healthcare checks are conducted. According to the records, some of these checks were overdue and relevant appointments should therefore be made. Health concerns regarding a service user have been addressed and good support has been offered to the individual to improve their state of health. Service users have health action plans in place and ‘OK health checks’ are completed annually. It was concerning to note that a recently completed OK health check was incomplete, unclear and unsigned. There was also an entry that suggested that the way in which staff were caring for the service user was causing stress to them. This was discussed with the manager during feedback and she agreed to look into this matter. It was positive to note that the manager had taken steps to ensure the health of service users during the very hot weather and was aware of Department of Health guidance regarding the heatwave. Fans have been purchased and bottles of water were available in all bedrooms with a mist spray attachment to assist in keeping service users cool. The manager reported that she had requested air conditioning units. Systems in place for the storage, administration and recording of medications are generally good. All medication checked tallied with the records kept. It is good practice that a record has been made on all service users’ records about how they prefer to take their medication. Clear guidelines are in place for most service users advising staff as to when ‘as required’ or ‘prn’ medication should be given. However, an error in the ordering and recording a prn medication for a service user could have resulted in the service user being given twice the prescribed dose. Fortunately, upon examination of records, it was clear that this had not occurred. The manager assured the inspector that this matter would be addressed immediately and medication of the wrong strength would be returned and records corrected. Greater care must be taken in this area. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 The home has a clear complaints procedure, although staff need to ensure that service users and their relatives are aware of this. No complaints have been received since in the past twelve months. Service users are not always adequately protected from harm or abuse. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: A satisfactory complaints procedure is in place. No complaints have been received at this home in the last twelve months and systems are in place for recording complaints. Two comment cards received from relatives of service users at Fernlea indicated that they had made a complaint about the service although no details were included. Two indicated that they were unaware of the home’s complaints procedure. One service user completed a comment card and it was indicated that they did not know who to talk to if they were not happy, and did not know how to make a complaint. It is a recommendation of this inspection that the home takes steps to ensure that service users and relatives are aware of the complaints procedure. A comment card received from a care manager confirms that they have not had to deal with any complaints about the service. Robust procedures are in place for the protection of vulnerable adults. The manager explained that she was aware that staff training was not up to date and that some staff require training in adult protection; she is in the process of Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 19 addressing this. Concerns about the safety and protection of a service user were discussed with the manager. The CSCI have been notified of a number of service user to service user physical assaults, unexplained injuries and attempted physical assaults. This has been occurring over a period of several months. The manager discussed areas that she had identified that need to improve in respect of the management of challenging behaviour. In an attempt to reduce the number of incidents of service user to service user assaults, behavioural management guidelines and risk assessments have been reviewed. These were examined and gave clear guidance to staff. In addition to this, protocols have been put into place to increase levels of supervision of individual service users. Systems are in place to ensure that all staff are aware of the revised guidance and understand it and a strategy meeting has been arranged to discuss the concerns. The inspector was concerned to observe the fear and anxiety exhibited by a service user in the home. Feedback from a care manager raises concerns about the potential bullying and intimidation of a service user at the home; this is also reflected in daily record entries made by staff. It is essential that all service users living at Fernlea are protected from harm or abuse or the risk of harm or abuse. Close monitoring of the situation is required. St Anne’s are in the process of having senior staff within the organisation trained to become physical intervention trainers accredited by the British Institute of Learning Disabilities and this is a positive step. One of the trainers notified the inspector during the visit that it is anticipated that the accreditation will be achieved by June 2007 and that, until then, no further training in this area will be provided. It is essential that all staff expected to physically intervene with service users have received appropriate training. If there are staff that require training in this area before June 2007, alternative arrangements must be made so that all staff are equipped with the required skills to intervene with service users safely. The manager reported that St Anne’s provide basic training about the management of challenging behaviour as part of the induction, although more in depth training is also necessary to support some of the service users living at Fernlea. The manager has identified that some staff require support to improve their skills and confidence when dealing with incidents of challenging behaviour. She reported that discussion and training would take place in staff meetings. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Service users live in a clean and comfortable home although some refurbishment is required to the kitchen on the red side of the home. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: All communal areas of the home and four service users’ bedrooms were seen. The home is comfortably furnished and was clean and free from unpleasant odours. The service user comment card that was completed indicates that the service user always find the home to be clean and fresh. Since the last inspection the corridor, shower room and a service user’s bedroom on the red side have been re-decorated. The gardens on both sides were well kept and were used by service users. A swing has been purchased for a service user since the last inspection, and they were observed enjoying using this. The kitchen on the red side is in need of replacement as it is worn and damaged in areas. The manager reported that she has requested this and it is documented in several provider visit reports that this is necessary. A laundry is sited on the corridor that links the two sides of the home. Adequate Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 21 laundering facilities are provided, and there is door from the laundry to the garden; soiled laundry is not transported through communal areas of the home. The manager reported that the organisation is considering employing a cleaner for a few hours a week as care staff are currently responsible for cleaning and domestic tasks in the home. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 Care practice at this home needs to improve in some areas. Although relevant training is provided, not all staff have had the opportunity to attend the necessary training events. Qualified nurses support service users, however support staff are not qualified in NVQ level two in care or above. Staffing levels are adequate to meet the needs of the residents although a stable staff team needs to be established. Quality in this outcome area is poor. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: Fernlea has had ongoing difficulties in recruiting and retaining staff. At the time of the site visit there were vacancies for three full time nurses and 1 full time support assistant. The manager reported that two nurses have been recruited from another St Anne’s home and are due to commence working at the home at the end of July, and a newly qualified nurse has been recruited from university and is due to start at the end of September. The staffing difficulties, including staff being on long term sick leave and maternity leave, has resulted in high levels of agency staff being used at the home. Wherever Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 23 possible the same agency staff are used, and evidence of this was seen on staff rotas. Although it is anticipated that the staffing difficulties will soon be resolved, it has had an impact of the service delivered. The manager reported that, due to the needs of the service users, it is essential that staff who know service users are on duty, although it is acknowledged that this is not always achieved. It was reported that at times, even though there are sufficient numbers of staff on duty, due to some staff being inexperienced or not confident with service users, opportunities to go out are limited. In order to improve the quality of service provided, a consistent staff team needs to be established. Feedback from two relatives of service users stated that, in their opinion, there are always enough staff on duty, although one relative did not agree that there are always sufficient numbers of staff on duty. They added that, due to a high turnover of staff, bank or agency staff are used frequently and they do not always know the needs of the service users. They also said that this did not appear to affect the care given. The manager reported that, when all the service users are at home, there are a minimum of four staff on duty, including at least one qualified member of staff. Staffing levels are sometimes less than this depending upon which service users are in the building. One waking night staff and one member of staff who sleeps cover nights. There is always a qualified member of staff on duty and evidence of staffing levels and positions was seen on the staff rota. The staff team is made up of both men and women, which is positive, as the service user group is both men and women. Since the last inspection, a new deputy manager has started at the home; this was an internal transfer from another St Anne’s home. Records of staff meetings were seen and it was noted that a wide range of relevant areas are discussed. Staff training has not been kept up to date, often due to staff not being able to be released from the home because of staff shortages. The manager has completed a training analysis and has identified training that each member of staff requires. The training plan was seen during the site visit, and the inspector was satisfied that the manager has identified priority training needs for staff. None of the six support assistants have an NVQ level 2 or above, although one member of staff is currently working towards NVQ level 3 in care. The manager reported that the remaining staff, with the exception of one, are completing the Learning Disabilities Award Framework induction and foundation training. During the site visit, a number of examples of positive care practice were observed where staff presented as approachable and respectful of service users. A member of staff was observed to communicate extremely well with a service user using Makaton signing. The staff member said that she and two other staff members would be attending further training in Makaton with a Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 24 view to cascading this to the rest of the team. Some staff spoken to demonstrated a good understanding of the needs of the service users, including a good understanding of why some challenging behaviours might be presented. There were, however, a number of examples of less positive practice. Some staff members were observed to interact with service users in a rather sharp manner and a ‘parent’ style of approach was used. There were some instances where there was little or no engagement with service users and, on some occasions, this included when staff were supporting service users with care or moving position etc. This was discussed with the manager during feedback. The manager has since informed the CSCI that, in order to improve the quality of service in this area, further training in values and attitudes will be delivered during staff meetings. The service user comment card completed as part of this key inspection indicated that the service user considered that the staff always treated him well and this is positive. Staff recruitment records are stored centrally and the Provider Relationship Manager from CSCI examines these. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 A suitably qualified manager with a clear sense of direction is running the home. Satisfactory quality assurance and monitoring systems are in place at this home. The health and safety of staff and service users is protected in many areas. Improved practice in the management of challenging behaviour is necessary in order to improve outcomes for service users in this area. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. EVIDENCE: The registered manager is a qualified learning disabilities nurse with several years’ post qualification experience. She has extensive experience of working within a care setting with people with learning disabilities and this was apparent during the site visit. At the last inspection visit, the registered Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 26 manager was on maternity leave; she returned to work at Fernlea at the end of April, therefore is still in the process updating herself on changes that occurred in her absence and prioritising matters that require addressing. The manager has a clear sense of direction and is open and transparent in her management approach. Staff spoken to said that they found the manager approachable and supportive. During the visit, the manager was observed to act as a positive role model for the staff team in her approach with service users. The manager reported her intention to work alongside staff in order to monitor care practice more closely and coach staff where necessary. It is hoped that this will improve some elements of service delivery. Questionnaires are sent to relatives/friends of service users seeking their views about the quality of service offered; all but one of the service users at this home would be unable to contribute to this due to the level of learning disability. The most recent surveys were sent out in May 2006 and all were returned. All surveys expressed satisfaction with the service; evidence of this was seen in the records examined. The manager reported that the results of the questionnaires are discussed at staff meetings and feedback is then given to the families of service users. Following the requirement made at the previous inspection visit to make available the results of surveys, it was stated in the action plan received by the CSCI that a file containing the completed surveys would be set up. If requested, families can view these, although this was not examined at the site visit. The home has an annual development plan that is available in the home. The service manager or a registered manager from another of St Anne’s homes conducts the monthly provider visits that are required under the Care Homes Regulations. A copy of the report of these visits is sent to the CSCI. It is not always clear from the reports what the opinion of the person carrying out the visit is with regard to the conduct of the care home or the standard of service provided. For example, in addition to a number of standard questions that are asked on the form, is a section asking ‘what areas were inspected on this visit?’ Several subjects may be listed such as service users’ money, petty cash, menus etc, however there is no further information about the findings. It is recommended that more detailed information be included in the reports of monthly visits by the provider. Feedback from four relatives and one care manager received in comment cards all stated that they were satisfied with the overall care provided at Fernlea and this is positive. The pre-inspection questionnaire indicates that health and safety checks are conducted at the required intervals. Whilst touring the premises, it was noted that hazardous substances were stored securely with the exception of the medication box in the fridge; this was unlocked although only contained eye drops at the time. The manager dealt with this immediately. Hot water temperatures were checked and were close to 43°C. Food storage was generally good although a small number of items were not labelled Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 27 appropriately; staff discarded these at the time. Good infection control procedures and practice is in place. Antiseptic hand rub is available in the entrance to the home and bathrooms as a precaution against infection. Improved practice in the management of challenging behaviours is necessary in order to keep all service users safe. This has been discussed earlier in the report. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 2 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 3 3 3 X X 2 X Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 29 Yes 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 YA12 YA13 Regulation 16(2)(m)(n) 12(1)(b) Requirement The registered person must make arrangements for all service users living at the home to have regular access to community activities and recreational and daytime occupation/education opportunities consistent with their interests and wishes. Previous timescale of 15/4/05, 15/12/05 and 31/03/06 unmet. Timescale for action 31/08/06 2. YA16 YA18 12 3. YA23 YA42 13(6) 4. YA33 YA32 12(1)b,18(1) The registered person must ensure that service users are cared for in a way that respects their privacy and dignity. Care practice must improve. The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The registered person must ensure that at all times DS0000001081.V296160.R01.S.doc 07/08/06 07/08/06 15/09/06 Fernlea Version 5.2 Page 30 YA35 suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of service users. Staff vacancies must be filled. Previous timescale of 31/12/05 and 30/04/06 unmet. Staff must receive appropriate training. The use of temporary staff must not prevent service users from receiving continuity of care. 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 YA6 Good Practice Recommendations Staff should ensure that all service user care plans clearly describe how individuals’ needs should be met. Behavioural management plans should focus on positive behaviour, ability and willingness. Staff should ensure that service users have access to a range of appropriate leisure activities. Staff should offer service users more opportunities to participate in the preparation and serving of food. Service users should be offered the opportunity to observe this process if they are unable to participate due to their disability. Routine health checks should be kept up to date for all service users. OK health checks should be reviewed where necessary and completed in full. Systems should be in place for ensuring that medication records and stock is correct. Where possible service users and relatives of service users should be made aware of how to make a complaint. DS0000001081.V296160.R01.S.doc Version 5.2 Page 31 2. 3. YA14 YA17 4. 5. 6. YA19 YA20 YA22 Fernlea 7. 8. 9. YA24 YA32 YA39 The kitchen on the red side should be replaced. The registered person should continue working towards 50 of all care staff achieving NVQ level 2 or above. Regulation 26 reports should contain more detail. Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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 Fernlea DS0000001081.V296160.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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