Inspection on 17/10/05 for Fernlea

This inspection was carried out on 17th October 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 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 7 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 11/07/06

Fernlea 14/02/06

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 Unannounced Inspection 17th October 2005 10:45 Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 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.V259830.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 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.V259830.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fernlea Address 59 Fort Ann Road Soothill Batley West Yorkshire WF17 6LS 01924 470176 01924 470176 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.V259830.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Seven service users with learning disabilities and four who also have physical disabilities. To provide accommodate and care for one named service user over 65 years 31st January 2005 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 65 years of age. St. Anne’s Shelter and Housing Action, 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 leaning 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 of three single bedrooms, a lounge, kitchen/diner, bathroom, shower room and an office. Accommodation on the blue side comprises of 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. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place between 10.45am and 3.34pm. One inspector conducted the inspection. As part of this inspection, a tour of the communal areas was conducted, care and staff training records examined and discussion with the acting manager, nursing and care staff took place. Due to their complex needs, discussion between the inspector and service users was limited. The registered manager commenced her maternity leave on the day of inspection. One of the existing nurses has taken up the position of acting manager in her absence. What the service does well: What has improved since the last inspection? Records are stored in an area that can be kept locked. The lighting in the corridor on the red side has been improved. Additional cushion covers have been purchased for a service user’s chair. Doors to communal areas and bedroom in the red side are no longer kept locked. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 6 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. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 7 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.V259830.R01.S.doc Version 5.0 Page 8 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): EVIDENCE: Not examined at this inspection. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 9 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): 6,9,10 Elements of individual care plans and risk assessments do not adequately address all the needs of service users and need to be reviewed. Service users’ care plans are not always implemented consistently and this needs to be addressed. EVIDENCE: Two individual care plans were examined as part of the inspection. Some areas of the individual plan provided excellent detail about how to support service users with personal care routines, however some elements of the plans require further development, for example, the advice from a physiotherapist had not been transferred into a service user’s care plan. It was noted that, once again, a number of agreed elements of the care plans were not being implemented. This is the fourth consecutive inspection where this has been the case and the provider must address this as a matter of urgency. The inspector was concerned that a service user that had moved into Fernlea in August 2005 from another service within St Anne’s did not have a current care plan; the care plan had been transferred from the service user’s previous home. The inspector was informed that, as the service user was due to have a person centred planning meeting in November, it had been decided that the care plan would be updated following this meeting. A number of elements of the Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 10 transferred care plan were not being implemented, for example, snacks/drinks were not available to a service user in their bedroom, photographs to support communication were not available or used. The care plans examined did not adequately describe all agreed restrictions on choice and freedom and were not all reviewed six monthly. Upon discussion with staff it was clear that not all staff are familiar with the individuals’ care plans and this must be addressed. The inspector examined risk assessments in relation to two service users. Most of the risk assessments examined were detailed and clear, further clarity is recommended within a risk assessment where physical intervention may be required. Some of the agreed control measures to reduce identified risks are not adhered to. For example, a movement and handling risk assessment for a service users states that two staff are required for all transfers; staff said that this is not always possible. Since the last inspection, service users’ records have been transferred to an area that can be kept locked. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 11 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 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. Good support is offered to service users to enable them to have a holiday away from the home. Staff support service users to maintain contact with their families. EVIDENCE: Whilst there was evidence in service users’ records that the frequency of community based activities had increased for some service users since the last inspection, there are still a number of service users who have few opportunities to participate in activities outside of the home. An objective in a service user’s care plan to have an outing weekly had been changed to monthly as a weekly outing could not be achieved. The records showed that in the last six months, this had been achieved on three occasions; one of these outings was the service user going in the transport to drop off and pick up other service users from their day placement. Clearly the revised objective is not being met; the provider must take steps to ensure that service user plans Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 12 are implemented as agreed. Staff on duty explained that, although the home has its own transport, there is a shortage of staff that are able and available to drive. The home is also still heavily reliant on agency staff which impacts upon the service. Agency staff are used most days at the home although, wherever possible, the same staff are used. Three of the seven service users have regular, though limited, day services and one service user has additional staff employed three days per week to provide an individual day service from the home. Staff at the home are responsible for the daytime occupation of the remaining service users. It was observed that, whilst staff attempt to spend time with service users who are at home during the day, this time is limited due to the number of other tasks that must be completed, for example, cooking and cleaning. Service users were observed to spend lengthy periods of time unsupervised when staff were busy with cleaning and housekeeping tasks. The acting manager explained, that in order to avoid service users becoming bored, those on the ‘red’ side have three scheduled in-house activities each day. These include activities such as sandwich making and putting away their laundry. The acting manager reported that all service users had had a holiday this year that was individually planned to meet service users’ needs and particular interests. A range of leisure equipment is available to service users including TV, videos, DVDs, stereo, multi sensory equipment. There was evidence in records that service users are supported to maintain contact with their families; staff confirmed this. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 13 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 Service users do not always receive personal support in the way they prefer or require. Service users’ healthcare needs are met most of the time. EVIDENCE: Most staff were observed to offer personal support to service users in a respectful and positive manner. There were however a number of occasions where the manner and approach of some staff was negative and did not maximise service users’ dignity, independence and control over their lives. Some personal support plans contained excellent detail describing service users’ preferred and required routines, likes and dislikes. Some plans however did not contain sufficient detail and must be further developed. This is particularly important for service users who cannot easily communicate their needs in order to ensure that consistency and continuity of support is achieved. A range of equipment for moving and handling service users is available and staff were observed to use this equipment appropriately. Evidence that service users receive additional specialist support and advice from physiotherapists, occupational therapists, speech therapists etc was seen in service user records. It was noted however that advice given had not been transferred to the care Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 14 plan in respect of one service user and staff were not aware of the advice. See standard 6. There was evidence in service users’ records that staff support service users to attend healthcare appointments where necessary. It was noted that a service user had an identified healthcare need in May 2004. This has still not been achieved although there was some evidence that staff had made attempts to access the relevant service. Further exploration and advice must be sought in respect of this service user’s healthcare need. This was discussed with the acting manager at the time of inspection. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 15 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): EVIDENCE: Not assessed on this occasion. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 16 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. EVIDENCE: The home was found to be clean and comfortable. Requirements made at the previous inspection in respect of the environment have been addressed and this is positive. It was noted that the curtains in one service user’s bedroom were too small for the window. The acting manager explained that these were due to be replaced. Since the last inspection, the number of restrictions placed upon service users living on the ‘red’ side has significantly reduced. The bathroom, lounge, kitchen and bedrooms were unlocked and service users had access to these areas, although supervision was required in the kitchen. The acting manager reported that this has had a positive effect on the quality of life for service users and that the atmosphere was less stressful. The inspector noted that the atmosphere at the home was more relaxed than at previous inspections. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 17 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): 32,33,35 Staff working at the home have relevant qualifications and experience. Relevant training is provided to staff. The home does not have a stable staff team. EVIDENCE: Staff working at the home have a range of skills and experience. Training records were examined as part of this inspection and there was evidence that relevant training is attended on a regular basis. Most of the care practice observed was positive and staff were approachable and comfortable with service users. As previously mentioned, there were some occasions where staff could have improved their practice in this area. Not all staff were able to demonstrate an awareness of service users’ needs as described in their care plans and this must be addressed. The acting manager reported that the home has not yet met the standard of 50 of all care staff, including agency staff, to have achieved NVQ level 2 or above. New care staff complete the Learning Disability Award Framework induction and foundation training. There is a comprehensive training and development plan in place. Training that staff have received includes movement and handling, first aid, food hygiene, adult protection, health and safety, autism awareness, managing violence and aggression and equality/diversity/rights. This is in addition to NVQ training, which is ongoing. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 18 Since the last inspection, there has been an improvement in sickness levels in that no staff are currently on long-term sick leave. However, the number of staffing vacancies has increased since the last inspection therefore a stable staff team has still not been achieved at the home. At the time of inspection there were vacancies for three support staff and one qualified nurse, although there is an additional nurse vacancy as one of the existing nurses has taken up position of acting manager whilst the registered manager is on maternity leave. The acting manager explained that an advert had been placed for the support staff and there had been a good response. In the interim, agency staff are used on most days in order to cover the rota although, wherever possible, the same agency staff are used. The staffing ratios are 2:3 on the red side and 2:4 on the blue side. Staff on duty reported that this ratio is maintained most of the time although there are occasions when the minimum levels have not been achieved. The inspector noted from the rota that, on the day before the inspection, there had been insufficient staff on duty. A member of staff commented that staff are often very busy completing domestic or administration tasks leaving limited time to spend on leisure, educational or recreational activities with service users. This was observed at the time of inspection. The acting manager explained that, as far as possible, domestic tasks are completed by staff in the morning so that afternoon staff have more time to spend with service users. It is recommended that the provider consider the employment of cleaning staff so that care staff and nursing staff have more time available to spend with the service users throughout the day. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 19 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): 41,42 Record keeping needs to improve in some areas. The health, safety and welfare of service users are protected at this home. EVIDENCE: Records required by regulation that require further development or improvement are mentioned previously in this report. In service users’ files that were examined, it was not always clear what was current information and what was no longer relevant. The requirement made at the previous inspection regarding this matter has therefore been repeated. Records regarding health and safety matters were in good order. There was evidence in the records that the required checks and maintenance of safety and specialist equipment is carried out. Evidence that regular fire drills are carried out to ensure that service users and staff are aware of the procedure was seen in the records. All staff receive training in health and safety. No unsafe practices were observed at the time of inspection. Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 X X 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 1 13 1 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X 3 1 X 3 x CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Fernlea Score 1 2 X X Standard No 37 38 39 40 41 42 43 Score X X X X 1 3 x DS0000001081.V259830.R01.S.doc Version 5.0 Page 21 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 YA6 YA18 YA41 Regulation 15(1)(2)bcd 12(1)(b) Requirement A current individual care plan that includes personal support plans must be in place for all service users accommodated at the home. This must be kept under review and must be implemented as agreed. Timescale of 15/4/05 unmet. 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. Timescale of 15/4/05 unmet. The registered person shall ensure that service user records are kept up to date. Records must be dated so that it can be established which records are current. It must be made clear within records, those that are no longer current. Timescale of 30/4/05 unmet. DS0000001081.V259830.R01.S.doc Timescale for action 15/01/05 2 YA12 YA13 16(2)(m)(n) 12(1)(b) 15/12/05 3 YA41 17(3)(a) 15/12/05 Fernlea Version 5.0 Page 22 4 YA33 12(1)b,18(1)a The registered person must ensure that at all times 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. 31/12/05 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 Service user records should be reorganised clearly to ensure staff are working to current care plans and that the care plans are presented in an easily accessible format. Records in relation to service users should be signed and dated. Risk assessments in relation to physical intervention should give clear instructions to staff about when physical intervention should be implemented. There should be further exploration about how the health care needs of an individual service user can be met. 50 of care staff should have achieved NVQ level 2 by 2005. This should be considered when appointing new staff. 2 3 4 YA9 YA19 YA32 Fernlea DS0000001081.V259830.R01.S.doc Version 5.0 Page 23 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. 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