Inspection on 16/07/08 for Fernlea

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Good service.

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

Fernlea 18/12/07

Fernlea 25/07/06

Fernlea 19/12/05

Fernlea 18/07/05

Fernlea 22/02/05

Fernlea 04/06/04

Fernlea 19/03/04

Fernlea 09/10/03

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Fernlea North Mossley Hill Road Mossley Hill Liverpool Merseyside L18 8BP Lead Inspector Mrs Lynn Paterson Key Unannounced Inspection 16th July 2008 09:30 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 Fernlea DS0000025101.V363898.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. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernlea Address North Mossley Hill Road Mossley Hill Liverpool Merseyside L18 8BP 0151 724 6435 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) No email Flightcare Limited Therese Ryall Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 40 Nursing and 10 Personal Care within the overall of 40 beds (male and female) To accommodate one named person under the age of 65 years within the overall number of 40 residents 18th December 2007 Date of last inspection Brief Description of the Service: Fernlea is a care home providing nursing care for thirty residents and personal care for up to ten. It is part of the Flightcare Limited group, who have several homes in the Merseyside area. It is set in a quiet residential part of the city, close to shops, parks, churches and places to eat. There is a fairly reliable bus service and a railway station is within a few minutes drive. The home provides care mainly in single rooms within a Victorian building with a modern extension. All floors are accessed by a passenger lift and a stair lift. The home is spacious and centrally heated. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. The inspection of Fernlea Care Home was unannounced and was carried out over a one-day period. During the site visit a number of documents were examined including care files, staff files, maintenance logs and medication records. Discussions were held with staff, people living in the home and their representatives and a tour of the premises was undertaken. Observations were made of staff carrying out their duties and their interactions with people living in the home. Fieldwork included case tracking five residents, which involved reading all documentation relating to the residents daily living and speaking with the residents and staff who were associated with their care. The deputy home manager was in attendance throughout the site visit and provided information about policies and practices and detailed the changes that had happened in the home since the previous inspection. The manager completed the Annual Quality Assurance Assessment (AQAA) and returned it before the inspection visit was carried out. The information contained in the AQAA is referred to in this report. Fees are £322.00 - £423.00 per week. What the service does well: People who use the service said the staff are kind and caring and look after them well. Comments included: “The staff work very hard to make sure we are all well looked after. I don’t know how they do it though as there are only a few of them on each shift” “The staff are very good they provide us with good care and they never complain and always have a smile for us”. “Staff are treasures, they are good, kind and compassionate”. Staff said they are well supported by their line managers and feel that the staff group works well together. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 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 Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3.6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are only provided with a service after their needs are assessed and they have been assured these needs will be met. EVIDENCE: 5 care files viewed held information to show that a full assessment of need had been carried out by qualified nursing staff prior to a placement at the home being offered. Staff advised that this pre placement assessment enabled them to gain full information about the person who was requesting a service and plan care as appropriate to assessed need. The deputy manager said that all issues relating to equality and diversity, such as residents age, disability, heritage, religion or belief and sexuality were explicitly addressed during the assessment process to ensure that a holistic package of care could be provided. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 9 Files held risk assessments to ensure residents safety and welfare and review dates were in place to ensure information could be monitored and reviewed as the placement progressed. Intermediate care is not provided at Fernlea. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7.8.9.10. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents’ social and health care needs are monitored and met. EVIDENCE: 5 care files viewed held clear care plans that followed on from the pre admission assessment. The care plans reflected the changing need of the people living in the home through the staged review systems in place. The review of care meetings were recorded on file and any changes in health or social care needs were discussed with the person living in the home, their family and other people who were involved in their lives. The documented care plans detailed resident’s needs and gave staff guidance as to how these needs should be met. Staff said the care plans identified what levels of care and support was needed, however staff revealed that although Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 11 the plans were recorded they still asked residents what support they wanted to enable them to keep control of their lives wherever possible. Comments from staff included: “At the change of every shift staff meet and give verbal and written updates about each resident’s support needs and any significant events that may have occurred” “Care plans are always accessible for staff to read and obtain relevant information” “A good standard of care is given to every resident, which considers his or her preferences, culture and disability. Privacy and dignity are always maintained”. People living in the home said they liked the staff and felt they worked very hard to ensure the residents were well cared for. However residents said that staffing levels were barely adequate to enable staff to stop and chat with them or have much social interaction. Comments included: “The staff are very good and work so hard but it is difficult for them to talk to us when they are providing lifting or something as they are always on the run” “If I want to go to the toilet I sometimes have to wait until staff have the time to take me, but they do their very best” “Staff are wonderful, always cheerful and kind to us all but they could do with more of them”. “No matter how busy the staff are they always treat us with the utmost respect” Staff said that residents meetings and reviews took place frequently to obtain their views about the standard of care provided. Systems are in place to ensure residents receive their medication as prescribed by their GP and only qualified nursing staff are allowed to handle residents medication. Residents spoken with confirmed they received their medication on time and revealed that the nurse who was responsible for the medication administration always wore a red tabard during the medication round. Staff confirmed this and said it identified that the medication round was under way and enabled the staff member to carry out this duty without disruption. Appropriate storage facilities are utilised and all medication record sheets were up to date. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12.13.14.15. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home utilises flexible routines so the residents can exercise choice in their daily lives. EVIDENCE: A range of social activities are provided at Fernlea and an activity co-ordinator is employed to ensure all the residents’ social needs can be met, wherever possible. Residents have the opportunity to go out into the community and various religious ministers visit the home as required. Discussions with residents revealed that they go about their day as they wish with little restriction in place. They said they can have visitors whenever and they are always made welcome. Visitors were observed coming and going from the home throughout my visit and all appeared to have excellent interaction with staff and residents of the home. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 13 Comments from visitors included: “We are very happy with the atmosphere here, we know mum is being well cared for and we know we are always welcome” “Staff are always cheerful and welcoming and we get offered drinks and things, it is good here”. The activities board showed that various activities take place to include Bingo, quizzes, gentle exercise, pampering, arts and craft and entertainment. An entertainer was performing in the home during my visit and observations of the residents confirmed that they were really enjoying the occasion. One resident said that the music brought back many happy memories of her childhood and teenage years and she recalled dancing on the stage to some of the music played. Other comments from residents included: “I love it when we have entertainment, it makes us all feel happy” “The entertainment is very good, we all sing along and are happy” “The lady who arranges the activities is wonderful. She finds out what we like and makes sure that we all are able to do something we like. She even makes sure that the people who are not able to leave their bedrooms have some interests. She will go to their rooms and do crosswords or just talk with them. Isn’t that good”. Records show that a varied menu is in place and residents spoken with said the food was good and they always had plenty to eat and drink. Lunchtime was observed and it was noted that residents were offered various meals, which appeared appetising and well presented. The dining room presented as welcoming and had benefited from some refurbishment since the last inspection visit. A number of residents needed assistance to eat and staff were seen helping them in a polite and discreet manner. Observations identified that the meals are provided in a way that demonstrates respect and dignity for all the residents of Fernlea. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16.18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems in place for the protection of residents from harm are robust EVIDENCE: Records show that the home has received 2 complaints in the past six months, both of which were dealt with as per the home complaints policy and procedures. The complaints procedure is provided to all residents and their representative and is on show in the main entrance to the premises. All residents spoken with said they knew about the complaints process but none spoken with said they had needed to use it. Staff said they had full knowledge of the complaints procedures and actions they should take if a complaint was made. Staff records show that they have all received training in the protection of vulnerable adults. During discussion with staff they demonstrated good understanding of the different types of abuse that can occur and of the actions they should take in the event of them knowing or suspecting an incident of abuse had taken place. The staff-training programme identified that adult protection training is an ongoing process in the home. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19.26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environmental standards would benefit from ongoing refurbishment to ensure residents comfort and safety is maintained. EVIDENCE: The overall standards of the building have improved since the last site visit and staff advised that carpets, curtains and bedding have been replaced in some areas of the home and new dining room furniture has been purchased. It is recommended that the home implement an ongoing refurbishment programme to ensure the home does not become institutional in appearance. There is a large garden area at the back of the home, which residents can use to sit in and/or entertain their family and friends. This area appeared to be easily accessible and well maintained. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 16 Bedrooms. Some of the bedrooms are comfortably furnished whilst others are stark with little being done to make them homely. Bathrooms and Toilets. There are sufficient bathing facilities for the registered number of people in the home. Some work has been carried out to the downstairs shower room to enhance the comfort and safety of the residents. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27.28.29.30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are trained and competent to carry out their role. However staffing levels could be improved to ensure sufficient care and support is provided at all times. EVIDENCE: Records show that staff training has improved and the company Flightcare who have overall responsibility of the home have employed a designated trainer who provides in house training for staff of Fernlea. During discussions staff advised that they felt their ongoing training and personal development was good and comments included: “Courses are often available for staff to gain effective knowledge and experience” “The training we have had this year has been excellent” “We have been provided with specialised training in dementia care, which is good for us as many of the people we care for experience some kind of Dementia or memory loss”. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 18 Staff said that the company have acknowledged that staff training needs to concentrate on resident’s specific care needs to ensure that all staff are fully competent in their role and residents know they will be well looked after. Staff revealed that issues of equality and diversity are included in staff training to ensure staff have information and guidance on how to address this sometimes-complex issue. 4 staff files viewed held all the necessary information to include Criminal Records Bureau (CRB) checks, employment history and references. However 1 file held 2 references one of which was not signed by the person the reference was requested from. It is recommended that the company change the format of the reference request to ensure that the return reference format includes full details of who has provided the reference and in what capacity they have been involved with the applicant. All staff spoken with said they enjoyed their work and felt well supported by each other. Comments included: “The staff group are really good and we work so well together” “Everybody pulls their weight and we work together in everything” “It’s a nice place to work in. Everyone is friendly and all staff care about the people who live here”. The staff rota showed that staff numbers on each shift are just about adequate to provide needs led care and support to people who have medium to high dependency levels. People who live in the home said that all staff were kind and caring and worked extremely hard. However they said that they were aware that staff sometimes had to rush about to provide care and support to all that needed it. Residents said that for example they sometimes had to wait to be assisted to the toilet, they were sometimes rushed with hoisting and transferring manoeuvres because staff just did not have the time to “go slow”. Residents said they would like the staff to have time to talk to them but this is not possible with the amount of work they have to do. Staff, when asked about their workload and staffing levels, revealed that on occasions they find that the dependency levels of the residents requires high staffing ratio which leaves other people having to wait for assistance. Staff, were in agreement that the service would function much more efficiently with a greater number of care staff. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31.33.35.38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed to ensure residents’ comfort and welfare. EVIDENCE: The home manager has vast experience in the care of older people and is awaiting registration with CSCI as registered manager of Fernlea. She is qualified to NVQ level 4 managers award. Staff said there are clear lines of accountability within the home and they receive regular pre-arranged supervision within their line management structure. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 20 The AQAA indicated that a range of policies and procedures relating to the care of residents and the running of the home are in place and have been reviewed and updated as required. Systems are in place to monitor and review services. The systems include staff supervision, registered provider twice-monthly visits and home managers carrying out audits on a regular basis. The company have a central administration office to take responsibility for the management of resident’s daily money. A selection of financial records were inspected and noted to be in good order. It was noted that resident’s money is individually banked and any interest is added to each individual account. Records show that the health safety and welfare of the residents are promoted in the home. The AQAA` indicated that the equipment in the home to include fire system, hoists, electrics, water temperatures are checked and serviced regularly and certificates are in place to validate this. Staff advised that they have completed a range of training in health and safety and discussion with staff confirmed they had full knowledge and understanding in this area. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 21 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 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 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 22 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. Standard Regulation Requirement Timescale for action 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 2 3 Refer to Standard OP19 OP27 OP29 Good Practice Recommendations The home would benefit form an ongoing refurbishment to ensure the residents live in safe and comfortable environment. The care and support services provided would be enhanced by the provision of extra staff. Request for references for staff who apply for employment at the home should clarify whom the request is to and in what capacity they know the applicant. Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Regional Contact Team 3rd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fernlea DS0000025101.V363898.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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