Inspection on 19/12/05 for Fernlea

This inspection was carried out on 19th December 2005.

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

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

Other inspections for this house

Fernlea 16/07/08

Fernlea 18/12/07

Fernlea 25/07/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Fernlea North Mossley Hill Road Mossley Hill Liverpool Merseyside L18 8BP Lead Inspector Natalie Charnley Unannounced Inspection 19th December 2005 10:15 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.V274338.R01.S.doc Version 5.1 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.V274338.R01.S.doc Version 5.1 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) Flightcare Limited Mrs Susan Gabbutt Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 40 Nursing and 10 Personal Care within the overall of 40 beds (male and female) To accommodate one named person under the age of 60 years within the overall number of 40 residents To accommodate one named service user under 65 years for regular planned respite One named service user under 65 on short term placement Date of last inspection 18th July 2005 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. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day The inspector arrived at the home at 10.15 and left at 16.30.The inspector spoke with 5 staff, the home manager, 4 visitors and 10 residents. The inspector completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas that needed covering were done so. Feedback was given to the manager during and at the end of the inspection. No requirements or recommendations were outstanding from the last inspection. All core standards have been assessed over the last 12-month inspection period What the service does well: What has improved since the last inspection? The home have redecorated the dining room and put up new curtains. A new television and DVD player have been purchased. Care assistants are now allocated a ‘floor’ from which to work on a daily basis. This has helped staff have clear roles and responsibilities. Meal times have changed which are suiting residents better. They now have a light lunch and a larger meal at teatime. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 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 DS0000025101.V274338.R01.S.doc Version 5.1 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.V274338.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The home carries out a full assessment before a resident moves to the home to ensure they can meet their individual needs. EVIDENCE: Five care plans were sampled during the inspection, including one for a resident who had been admitted a few days earlier. All had a detailed pre admission assessment in place that formed the basis of the care plan. The home manager is usually responsible for undertaking these assessments, however the home do also use information provided by social services when this is sent. The home has received two ‘variations’ from the Commission for Social Care Inspection in recent months. This means that the home have admitted a resident who has different needs than the home holds registration for. These admissions have been managed well by the home. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 11 Care planning at the home is based on the individual and details how care is to be given, however residents themselves are not involved in this process. Residents health care needs are well managed and promote quality of life. The issue of death and dying is sensitively handled. Medications are generally well managed, however a small number of improvements must be made to protect residents. EVIDENCE: Care plans sampled were detailed and showed that the assessment form had been used to plan and action care. Residents have their weight, blood pressure and pulse recorded on a regular basis and plans showed that the home work closely with a range of other health professionals. Records of GP (General Practitioner) visits were very detailed and good records are kept of any investigations that a resident receives, either at the home or at hospital. The home manager discussed how the home has accessed a new team of nurses called the ‘IV therapy team’. These specialist nurses visit the home if a resident needs blood or fluid supplements. Residents living at the home, who have any type of wounds, have these recorded and photographed. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 10 From discussion with residents, relatives and staff and from care plan documentation, it was clear that residents or their next of kin have limited involvement in planning their care. One relative stated, “I had no idea that these plans were in place” another stated “ my mum hasn’t been involved in this process”. None of the residents interviewed had been involved in this process, but do recall an ‘assessment’ taking place. This needs to be addressed by the home. Residents have a variety of risk assessments in place within their care plans which cover areas such as manual handling and pressure sores. There are currently no assessments in place at present to look at nutrition and falls. This was discussed with the home manager during the inspection. The medication storage area at the home is small but adequate. The drugs fridge was not locked and the home were not recording the maximum/minimum temperature of this fridge, which is important when storing medications. Medication administration records were of a good standard, except one prescription had been covered by s sticky label, leaving the original information unable to be read. All controlled drugs stored at the home were also well recorded. Medications are only given out by trained nurses. The home works closely with residents and their families on the difficult subject of death and dying. Residents and their families are asked for any wishes they may have to be given to the home in case of an emergency. Relatives can also stay over if a bedroom is vacant. The home has ‘significant conversation’ record where such details are recorded. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 15 Activities at the home are varied to suit the needs of individual residents. Dietary needs of residents are well catered for with a balanced selection of food that meets the tastes of residents. EVIDENCE: The home have a designated activity co-ordinator who works 16-24 hours per week, this member of staff is also employed in the home laundry. On the day of the inspection, the residents choir where holding their Christmas carol concert, which was also attended by family and friends of their residents. Residents and visitors were given sherry and a buffet tea after the concert. The home had been visited by the church and local scout group and a local school had visited over the Christmas holidays. Residents confirmed that they go out of the home on trips such as to Chester and Southport. A trip to the panto is planned for the New Year. Residents commented “ we do a lot of things here to keep us busy”, “I enjoy the trips out on the bus” and “staff help us do the activities we want to “ when asked about what the activities are like at the home. The home offers a 4-week rotating menu. This includes a cooked breakfast daily and a large range of alternative meals. Residents spoke highly of the food Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 12 offered making comments such as “ the food is great”, “ food is always hot and tasty” and “I can chose what I want to eat”. The home also caters for many special diets such as for diabetics and residents who have difficulty swallowing. The home offer residents the large dinner at nighttime, which is approved of by the residents. During the inspection, it was identified that a list was on display in the dining room naming specific residents and the reason that the needed special diets. This shows information that is confidential and should not be on display for other residents and visitors to read. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Staff have a poor knowledge of adult protection procedures which leaves residents from risk of harm. EVIDENCE: The home has a variety of policies in place that ensure that residents are protected from abuse including a ‘whistle blowing’ policy and local adult protection policy, however staff interviewed commented “I’ve not read the abuse policies” and “I don’t know what is in the abuse policy”.4 out of the 5 staff interviewed had not received training on abuse and did not know what to do if an allegation was made. The home needs to urgently address this. No staff have been referred to be included in the POVA list (Protection of vulnerable adults) since the last inspection. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The layout, facilities and location of the home are suitable for the residents who live there. Infection control methods must be tightened to protect both staff and residents. EVIDENCE: A tour of the home was undertaken as part of the inspection. Despite being an old building, the home is accessible for the residents who live there and inside and outside parts of the home are well maintained, with a rolling plan of maintenance and redecoration in place. The home has a resident cat called Henry and a rabbit and guinea pig that live in the summerhouse during the winter months. The home was clean and tidy and residents and visitors commented that this was a normal practice. The home has a contract with a clinical waste company and are currently awaiting for information regarding disposal of controlled drugs. Two residents are MRSA positive. The home is storing soiled Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 15 clothes/linen in a yellow clinical waste bags and are not using a red infectious material bag which would dissolve in the wash. These need to be used to protect staff and protect the spread of the MRSA infection. The home are using medicated washes to clean which is good practice. Infection control policies are in place at the home and available for staff to read, however not all staff have had infection control training. One member of staff stated “ I haven’t had infection control training but the deputy matron has given me an explanation on it”, the member of staff also commented “ we have a good supply of gloves and aprons at the home”. The home must address this areas as a matter of urgency. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 and 30 Staff do not have the necessary skills and training to care for residents appropriately, however residents were all happy with the care they received. Recruitment practices need to be tightened to ensure residents are protected EVIDENCE: Staff files are held at the homes head office, however the Director was able to bring them to the home on the day of the inspection. 4 staff files were sampled, including the 2 most recent members of the staff team. These showed that staff had completed an induction, received conditions of employment and a contract and had 2 satisfactory references. Staff interviews and files also showed that all new staff undergo a Police check. One staff file showed that a new member of staff had a Police check carried out by a local PCT (Primary Care Trust) in 2004, and was awaiting a check to come back that had been carried out by the home. Police checks cannot now be ‘transported’ from one job to another; this was discussed with the home manager during the inspection. The home has records to show that all registered nurses working at the home are registered with the NMC (Nursing and Midwifery council). Staff training records were also checked. The home manager acknowledged that these records were not up to date, records showed that not all care staff had received training in mandatory subjects. Staff in the kitchen and laundry were also not updated in all subject areas. No training records were available for the trained nurses. The home must urgently address this. Staff interviews Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 17 also confirmed that training needs addressing, however staff commented on the fact that they are paid to attend training sessions. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,and 38 The home does not formally seek the views of residents and relatives regarding the care they receive. The home maintains the health and safety of staff and residents at all times, protecting them from harm. EVIDENCE: The home have a quality assurance check under ISO9002, this looks at the standards of paperwork at the home. Records regarding this are held at head office. Currently there are no systems in place to monitor and review the quality if the care given to residents. The home manager stated that this is because she has “an open door policy”, however a formal process must be put in place. Visitor confirmed that the manager is very approachable, but would welcome a more formal approach. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 19 Records relating to the health and safety of the home were checked. Checks were in place for gas, electric, annual fire tests, nurse call bells and lifts. Records relating to checking water temperatures and some fire checks were not able to be located during the inspection as the maintenance man was not on duty. The home manager must ensure she is able to access all of these records. Accidents occurring at the home were well recorded and monitored by the home manager. Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 X 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 2 Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 15(1) Requirement The registered person must ensure that residents and their relatives are involved in the care planning process The registered person must ensure that 1. A maximum and minimum temperature reading is obtained and recorded daily for the medication fridge 2. Stickers are not placed over original printed prescriptions The registered person must ensure that residents privacy is maintained at all times and that information displayed in the dining room with residents names on is removed The registered person must ensure all staff are aware of the homes abuse policy and receive appropriate training on this subject The registered person must ensure that correct procedure is followed when dealing with infectious linen/clothes. Staff must receive training on infection control DS0000025101.V274338.R01.S.doc Timescale for action 01/03/06 2 OP9 13(2) 01/02/06 3 OP10 12(4)(a) 01/02/06 4 OP18 18(1)(a) 01/03/06 5 OP26 16(2)(j) 01/02/06 Fernlea Version 5.1 Page 22 6 OP29 13(6) 7 OP30 18(1)(a) 8 OP33 12(3) 9 OP38 23(1)(a) The registered person must ensure that portable Police checks are not used and that all staff have a check carried out by the home The registered person must ensure all staff have training in manual handling, infection control, first aid, health and safety and fire awareness. Training records must be maintained for all staff including trained nurses. The registered person must ensure that a formal quality monitoring process is put in place to review quality of care at the home The registered person must have access to all health and safety checks that are carried out at the home 01/02/06 31/03/06 31/03/06 01/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fernlea DS0000025101.V274338.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 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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