Inspection on 18/07/05 for Fernlea

This inspection was carried out on 18th July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fernlea 16/07/08

Fernlea 18/12/07

Fernlea 25/07/06

Fernlea 19/12/05

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fernlea North Mossley Hill Road Mossley Hill Liverpool L18 8BP Lead Inspector Les Hill Unannounced 18 July 2005 9:15 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 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 F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Fernlea Address North Mossley Hill Road Mossley Hill Liverpool L18 8BP 0151 724 6435 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Flightcare Limited Mrs Susan Gabbut CRH Nursing 40 Category(ies) of OP - 40 registration, with number of places Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 40 Nursing and 10 personal Care within the overall of 40 beds (male and female) Date of last inspection 22 February 2005 Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 5 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 stairlift. the home is spacious and centrally heated. There are qualified nurses and adequate numbers of care staff on duty at all times. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection of Fernlea took place on Monday 18th July 2005, over a period of four hours. It involved the examination of some records, a tour of the building and discussions with five residents and four visitors. The inspection was part of the Commission’s requirement to visit and report on each registered care home on two occasions each year. What the service does well: The home has good pre-admission assessment procedures in place and prospective residents and their relatives are invited to visit and spend time in the home before making a decision to stay. Care plans were comprehensive, detailed and well documented with evidence that they were being reviewed regularly. Both residents and visitors spoke positively about the standards of care provided at the home. The home has a good range of individual and group activities on offer. Food prepared and served in the home was regarded as being well prepared and nourishing with a good range of choices available. Residents and their visitors were complimentary about both the activities and the food provided at the home. Fernlea is well presented and maintained to a good standard of furnishing and decoration. An ongoing programme of refurbishment was in place. The home benefits from strong management. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 7 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. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4, 5 and 6 Good pre-admission assessments were being undertaken and prospective residents and their families were supported through the initial settling in processes. EVIDENCE: The home’s statement of purpose and service users guide were examined on previous inspections and found to be satisfactory. There have been no changes to the document or to the running of the home. Contract between the home, the placing authority and the resident will be examined at the next announced inspection. Three residents files were examined during the inspection. All of them contained a full pre-admission assessment that identified the medical, family and social history of the resident concerned. The assessment formed the basis for care planning arrangements in the home. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 10 The home has been providing nursing care and support for older people for some time and has an experienced staff team. The manager said she would not admit anyone whose care needs could not be met by the home. All admissions are carefully considered and additional information is sought from relatives or other professionals where this is felt to be necessary. Prospective residents and their families are encouraged to visit the home before making a decision to move in and are offered a trial period of four weeks before they make a decision to stay. The home does not provide Intermediate Care. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and10. A sample of care plans was found to be comprehensive, detailed and well documented. Health and social care needs were being given appropriate priority. EVIDENCE: Completed pre-admission assessments were located on the three residents files examined and formed the basis for care planning and review. Care plans were comprehensive, detailed and well documented. They contained relevant and useful information that was also being reviewed on a regular basis. Residents who cannot retain the services of their own GP are listed with a local GP Practice. The manager told the inspector that the home receives good support from the GP’s, district nurses, the Pharmacist Advisor at the PCT, the optician, a local dentist and a visiting chiropodist. They also get good advice from the Tissue Viability Nurse. Continence advice and equipment is provided but the manager is in discussion with the Continence Advisor about the quantity of supplies for some residents with specific care needs. Records of a visit by health care professionals are maintained on the individual resident’s file. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 12 The administration, storage and disposal of medicines in the home was examined and found to be satisfactory. The inspector observed the medicines being given out at lunchtime on the day of the inspection and found the process to be safe. A minor matter regarding pharmacy instructions was identified and the manager said she would speak with the pharmacist. Residents who spoke with the inspector confirmed that staff in the home were hard working and kind. They said that nothing was too much trouble and they felt cared for and safe. They said that all personal care needs were being met in privacy. The inspector observed staff moving residents to the dining room at lunchtime. Hoists and standing aids were being used appropriately and staff were talking with the resident to explain what was happening. Visitors in the home at the time of the inspection also spoke positively about the staff group and supported the resident’s claims that they were doing their job well, with courtesy and kindness. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15. A full and interesting range of activity is offered at the home. A full, varied, appetising and well-prepared range of meals is also provided. EVIDENCE: The home’s activities organiser spends time with individual or small groups of residents each morning she is in the home and will organise similar or larger group activities in the afternoons. On the day of this inspection she had arranged for a group of singers to entertain the residents. A record of all the activities provided is maintained. Residents who spoke with the inspector were complimentary about the activities organiser and appreciated both the individual and group events that she arranged. Visitors to the home are welcomed at any time. On the day of this inspection the inspector spoke with four visitors who expressed their appreciation of the services provided at Fernlea and the ways in which they were welcomed. Contacts with the local community are maintained through the activities organiser and staff taking resident’s out to the local shops or to local pubs for a meal and through contacts with schools and other entertainers who go into the home from time to time. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 14 Resident’s told the inspector that they feel they are able to make choices about their own lives. They can make decisions about what time they get up and go to bed and are free to use their own rooms whenever they wish. There is always a choice of meals and they are free to choose whether or not they join in the activities provided. Al of the residents and visitors who spoke with the inspector were complimentary about the food served in the home. At breakfast time there is a choice of cereals, toast and a hot meal and at lunchtime the chef serves soup with a hot snack meal, salad or choice of sandwiches and a pudding. The main meal of the day is served in the evening and again there is a choice of meals available. Special diets are catered for and the chef uses fresh meat and vegetables wherever possible. The manager and the chef review the choice of meals being offered to ensure that they are still appropriate for the group of residents living at Fernlea. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 The home has a thorough and robust complaints procedure and the protection of residents is given appropriate priority. EVIDENCE: The home has a thorough and robust complaints policy in place that meets registration standards and identifies CSCI as the inspecting agency. There have been no complaints made to the home or to CSCI, about the home, during the past twelve months. The home’s manager confirmed that all residents are referred for inclusion of the Electoral Register and have the right to vote in national and local elections. The home has a “Whistle blowing” policy in place based on the “No Secrets” document and a copy of Liverpool’s adult protection procedures. An ex member of staff has been referred for inclusion on the POVA list but the home had not received confirmation of the inclusion at the time of this inspection. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21, 22, 23 24, 25 and 26. Service users are supported in a safe, well-maintained environment. EVIDENCE: Fernlea is situated in a residential area of Mossley Hill Liverpool. It is a large Victorian house that has been extended to provide appropriate standards of care for up to 40 residents. The private rear gardens are well kept and offer a peaceful place to sit. A bird table has been sited close to lounge windows and residents can watch a variety of birds as well as squirrels feed from it. The home also has a pet rabbit. Communal rooms are light, well decorated and furnished to a good standard. Resident’s bedrooms are well presented. Residents can bring small items of furniture (fire regulations permitting) and special belongings to personalise their rooms. Each of the bedrooms has a wash hand-basin. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 17 A rolling programme of re-decoration is in place and bedrooms and lounge areas in the home have benefited from painting and new carpets/floor coverings where appropriate. The manager told the inspector that plans are in place to redecorate and carpet the hallways and landings in the home. A new “wet room” has been created from one of the first floor bathrooms. Staff now have the opportunity to assist resident’s with showering in a more appropriate facility. Being an adapted older property, the home has high ceilings, large windows and has “character” to the feel of its communal spaces. A passenger lift takes residents to the first floor and a wheelchair sized stair lift accesses a second level to the first floor facilities. The home has six hoists/standing frames and assisted bathing facilities. A ramped access to the outside of the building is achieved through a side entrance to the home. Special beds/mattresses are provided where appropriate and some of the residents had specially adapted chairs. The home employs separate domestic and laundry staff. The standards of hygiene on the day of this inspection were high and the home appeared clean and generally odour free. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 Resident’s needs are met by the numbers and skill mix of staff on duty. Staff training is given appropriate priority. EVIDENCE: The home is staffed by qualified nurses and experienced and newly recruited care staff. The home recently lost a number of experienced care staff at the same time through legitimate reasons. Three had gone on to do nurse training and two others had moved away from the area. New staff were appointed and have settled in. The manager told the inspector that she is able to maintain the agreed staffing levels at all times. Occasionally the home uses some agency workers. One ex-member of staff was recently referred for inclusion on the POVA list. Five of the current team of care staff have an award at NVQ level 2. Seven other care staff are in the process of completing the appropriate course of study for an award at NVQ level 2 and three other care staff have yet to be enrolled. It is expected that the seven care staff will be credited with the award, thereby ensuring that the home meets the standard 0f 50 trained care staff by the end of 2005. In addition to NVQ training, the manager maintains a matrix of basic training provided for all staff. First aid, fire prevention, moving and handling, and food hygiene are all listed and the names of the staff who attended are recorded. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 19 Training in adult protection awareness is provided on induction and is included in the NVQ training. Qualified nurses are encouraged to maintain an up to date knowledge of nursing procedures and training has recently been provided in palliative care and the use of syringe drivers. The home’s recruitment and selection procedures will be examined at the next announced inspection. However the inspector was given an assurance that the portable CRB arrangements identified at the CSCI inspection in February 2005 have been reviewed and the home is now operating the proper procedures. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33 and 35. Residents live in a home that has strong management and is backed by safe procedures. EVIDENCE: The registered manager is a qualified Registered General Nurse with many years experience of working with older people. She has recently completed the NVQ level 4 in management, is a trained assessor in care and updates her own knowledge through attendance at workshops and study days. The manager operates an “open door” policy whereby residents, visitors and staff are welcomed to call into her office at any time to discuss concerns or to share important information. Staff are expected to discuss matters relating to the health and well being of residents at hand-over meetings between shifts. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 21 Both residents and visitors who spoke with the inspector confirmed that the manager is approachable and they would feel confident in raising any matters with her. The homeowner visits on a regular basis and since the CSCI inspection in February 2005 has been completing Regulation 26 visits and submitting a monthly report to CSCI. Residents or their relatives are encouraged to manage their own finances wherever possible but the manager holds small amounts of savings on behalf of some residents without family support and some money on behalf of residents to pay for hairdressing, chiropody etc. Sample records of these transactions were seen and found to be in order. Where residents have larger amounts of savings the home is experiencing difficulties in opening a separate savings account. Consequently the money is not able to earn interest. This matter is becoming increasingly frustrating for a number of homeowners in the area. Staff have access to the staff handbook and they are provided with formal oneto-one supervision. The home’s policies and procedures and records of safety checks will be examined at the next announced inspection. Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 N/A 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 4 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x 3 x x x Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 23 No 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 Regulation None 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. Refer to Standard None Good Practice Recommendations Fernlea F52_F02_s25101_Fernlea_v239447_180705_Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection Liverpool Area Office 3rd Floor 10 Duke Street Liverpool, L1 5AS 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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