Inspection on 25/07/06 for Fernlea

This inspection was carried out on 25th July 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fernlea 16/07/08

Fernlea 18/12/07

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 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 25th July 2006 10:00 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.V304556.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.V304556.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) 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.V304556.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 19.12.05 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 stairlift. The home is spacious and centrally heated. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Key unannounced inspection took place with 2 inspectors over one day and was measuring all of the core standards.. A detailed tour of the premises took place. The inspectors spoke to 7 Residents and 1 Visitor and 5 Staff. The inspectors followed an inspection plan written before the start of the inspection to ensure that all areas that needed covering were done so. All areas of the inspection and findings were discussed with the manager and the provider at the end of this inspection. A number of questionnaires were sent to the home for residents or their families to complete. Details from these are included within the report. What the service does well: What has improved since the last inspection? Care plans and risk assessments were clear and comprehensive- residents are now being involved in this process A large amount of redecoration has been carried out at the home The home have had a recent inspection by environmental health which was very positive Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 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.V304556.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.V304556.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality outcome in this area is good. This judgement has been made using available evidence including a visit to the service. Information gathered by the home before resident moves in, ensures that they can care for residents appropriately. EVIDENCE: Five residents were case tracked as part of the inspection process. All had pre admission assessments within their files, which are done before they move into the home. The purpose of these assessments are to make sure that the home can provide the necessary care an individual needs. Details were recorded of what a resident can and cant do for themselves as well as their past medical history .One record had not been signed, but was thought to be an oversight by the manager. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 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 10 Quality outcome in this area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans detail how staff are to care for residents. Medication practices need improvement to ensure residents safety is maintained at all times. Residents feel they have their dignity and privacy maintained by staff that care for them. EVIDENCE: Those Residents who spoke to the inspectors were very complimentary about the staff and stated, “the staff here are lovely we have everything we want.” One person stated, “we are very happy with the care here.” The staff observed during the inspection were attentive and polite to the residents at all times. An example of good practice was observed and discussed with Staff regarding their recent implementation of offering all Resident drinks/fluids on the hour, one Residents explained they only have to ask staff for a drink when they fancied one and they always provided them with a drink on request. Staff were also seen using fluid balance charts for those Residents considered poorly and care for in bed so that their intake could be monitored at all times. Staff spoke openly of staffing levels and in their opinion how they felt the levels helped them provide individualised care, especially in supporting people when they wanted to get up in the mornings. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 Page 10 One point discussed with the manager was the large window areas which would benefit from coverings to promote further privacy to those Residents who sat in these smaller sitting areas and one bathroom window that had frosted glass but no window covering. Another point would be to remove any posters or notes relating to care or Residents from all areas accessed by visitors and Residents. Some rooms were also noted to have had their doors wedged open, this was discussed in full as it presented as a safety and privacy issue especially for those Residents still in bed with their bedrooms doors wedged open. The care plans that were case tracked during the inspection were clear and showed that they were kept under review, however April 2006 had been missed out. It was clearly recorded that the home involves a variety of other health professionals in caring for residents such as speech therapists, tissue viability nurses and opticians. Risk assessments were in place for those residents who need them in relation to falls, moving and handling, nutrition and waterlow scores (which show if a resident is at risk of developing pressure sores). A social assessment and profile were also in place for all residents. Very detailed communications sheets are recorded which showed that the families and individual residents are kept informed of their care, which is an example of good practice. Medication administration records (MAR charts) and medication storage areas were checked. Some areas of concern were noted. MAR charts showed that a number of instructions and dose changes had been made by staff but that they had not be signed or dated. Medications that have variable doses were not always accounted for and handwritten entries were not always double signed and dated, to ensure they were correct. A lady who self medicates her own asthma inhailer did not have a risk assessment in place and one medication that had been prescribed to be given twice a day, had only been given once per day. The room where medications are kept was found to be extremely hot at 89 degrees; this needs to be addressed urgently as most medications need to be stored at lower temperatures to ensure they work correctly. The home needs to monitor these temperatures on a daily basis. 5 boxes of eye drops were sampled and found not to be dated as to when they were opened and two boxes were past their expiry dates. Dressings were kept in the medication room in very large numbers, but must only be kept for those who are prescribed them. Some boxes did not have a prescription label on them to show they were being used for individuals who had them prescribed. These excess stocks must be disposed of as soon as possible. The home have a waste disposal contract for when they need to dispose of old medications, however they are not recording what medications leave the home. The manager also acknowledged that the home do not always see prescriptions before they go to the pharmacy. Advice was given on the importance of this. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 Page 11 Fernlea DS0000025101.V304556.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. Residents are stimulated with a variety of activities, however these need to be reviewed. Residents are encouraged to make personal choices and meals provided are wholesome and nutritious. EVIDENCE: Staff confirmed that activities generally take place including the organisation of visiting entertainers and monthly events like the summer fair, However there was no display of daily organised events, this should be developed to evidence how the national minimum standards are to be met and Residents should have their opinions and requests taken into account so that this programme is reflective of their needs. A full review of activities needs to address the Residents needs and request to meet their social needs and aspirations and the care documentation needs to reflect the national minimum standards. Currently the home employs 1 person for 10 hours a week to organise activities although they currently do a lot of work voluntary in their own time. A review of the homes staffing structure highlighted that they had previously acknowledged an activities organiser for Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 Page 13 at least 22 hours a week which highlighted a staffing vacancy, which once implemented may then be developed to further evidence a regular structured approach to social support. Residents have contact with family, friends and the community and this is appropriately supported by the staff. Residents stated that they were happy with the food provided and commented that it was, “very nice”. As an example of good practice the chef was knowledgeable about all of his Residents needs and made a point to visit the Residents regularly and had built up a very personalised rapport in which he knew all the Residents names. It was noted that the chef provided a lot of home made meals including the dessert during the day of this visit. A copy of the homes menus were viewed which showed that a choice was available, the dining room was attractively maintained and well presented with matching linen and table clothes which added to a high standard of presentation. Residents were able to give examples on how they take ownership of their daily lives such as choosing when to go to bed and what clothes they wear. Fernlea DS0000025101.V304556.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. The home has a complaints procedure, which is easy for residents or families to use. Staff have a good knowledge of adult protection procedures, which protects residents from abuse. EVIDENCE: No complaints have been recorded since the last inspection. The home has an up to date complaint procedure in place, details of which are displayed around the home for residents to read. Policies are also in place to protect staff including a policy on equal opportunities. Staff and residents spoken to stated that they knew how to make a complaint if they needed to and staff demonstrated that they knew where to access adult protection policies. Fernlea DS0000025101.V304556.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality outcomes in this area are adequate. This judgement has been made using available evidence including a visit to the service. The home is suitable for the residents who live there, creating a homely environment. All areas are clean and tidy. EVIDENCE: A tour of the home took place and a sample of areas seen showed evidence of a well maintained building including large attractive garden areas. Residents bedrooms viewed were well presented and the residents had been supported to personalise their bedrooms with pictures, ornaments and furniture. Residents were appreciative of these. Most liked their bedrooms and were positive about the way that they were kept clean. Windows must be checked all over the home as one was found to open quite wide. All radiator guards must be checked as one was found to be loose. The maintenance men reported that they had repaired both areas during this inspection. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 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): 27, 28, 29 and 30 Quality outcomes in this area are adequate. This judgement has been made using available evidence including a visit to the service. Staff are competent to provide care to residents and have been trained on a variety of subjects. Staffing levels are sufficient to operate a safe home. EVIDENCE: Staff have a caring attitude and are confident that they take care of the residents properly. The staff said that there is sufficient staff at the home. Most staff that spoke to the inspector explained that they had attended a varied amount of training however it was also acknowledged that some staff were in need of their basic mandatory training to be up to date especially for all staff employed at the home to be included in “ abuse awareness and the protection of vulnerable adult’s.” All staff must have all necessary training to assist them in their role and all mandatory training must be up to date for all Staff and evidence of in-house training should be formalised and included in staff records. The development plan should identify what actions will be taken to ensure the home’ has 50 of staff with NVQ (National Vocational Qualification) qualifications. Evidence was seen that trained nurses employed at the home have had their qualifications checked with the NMC (Nursing and Midwifery Council). No evidence was available to demonstrate the training undertaken by the home manager, however she was able to verbally inform the inspectors. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 Page 17 Staff files showed that all staff receive appropriate checks before starting work at the home. Staff also confirmed that they receive a full induction from one of the senior members of staff. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 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): 31,33, 35 and 38 Quality outcomes in this area are good. This judgement has been made using available evidence including a visit to the service. Management of the home is clear and effective, quality monitoring is developing well. Financial arrangements safeguard residents. Health and safety checks are in place. EVIDENCE: Residents and Staff were complimentary about the matron and comments included “the matron is lovely and always listens.” The rapport and relationship was obvious and observed as being very friendly and warm with genuine caring attitudes promoted throughout the home. It was also acknowledged though general discussions with staff and in review of staff files that supervision needs further planning and development to eventually meet the national minimum standards of at least 6 sessions each year for every single member of staff employed at the home. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 Page 19 Health and safety arrangements are well managed just some issues were noted to need further attention including e.g. fire doors wedged open, which is an unsafe practice. Accident records are stored confidentially. One record recorded in the care file was crossed referenced with the accident book. It was found that no record had been made, which is a legal requirement. Pre inspection information showed all health and safety certificates were up to date. Financial information and records kept by the home ensures that residents are safeguarded. Clear records and receipts are in place. The manager explained about the new company system to audit care. This is going to be implemented in the future and will involve other home managers visiting Fernlea and checking standards. The home also use an external quality assurance system and have sent a set of questionnaires to residents and relatives. The manager stated that there was a poor response to this, but that the results were held in head office. No information was available to show how the home were going to use the information from these surveys to improve care. Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 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 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES 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 13(2) Requirement The registered person must ensure that: 1. The medication storage room is kept at a safe temperature at all times. 2. That all medications are given as prescribed 3. That handwritten instructions are double signed and dated 4. That dressings are removed that are no longer required 5. That eye drops are recorded when opened and deposed of when expired 6. That records are kept of all medication disposed of 7. That residents who self medicate have appropriate risk assessments in place 8. That all variable does are correctly recorded 9. That the home always see prescriptions before they go to the chemist The registered person must ensure that activities are reviewed to suit then needs of individuals and that staff hours DS0000025101.V304556.R01.S.doc Timescale for action 30/07/06 2 OP12 16(2)(m) 01/10/06 Fernlea Version 5.2 Page 22 3 OP19 23(2) 4 OP28 18(1)(a) 5 OP38 17(1) are also reviewed in this area. The registered person must review the window restrictors at the home to ensure they are safe. All radiator guard covers must also be checked and made safe. The registered person must ensure all staff has 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. Remains outstanding from previous report The registered person must ensure that all accidents that happen at the home are recorded in the correct way. The practice of wedging fire doors must cease, the home must look into providing specialist door closure systems. 01/08/06 01/12/06 01/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP10 OP28 Good Practice Recommendations The inspector recommends that the home put blinds up on the window that looks onto the hallway in the sitting area, to ensure privacy is maintained The inspector recommends that the home implement a plan to demonstrate how they are to meet the 50 target of staff trained to NVQ level 2 or above Fernlea DS0000025101.V304556.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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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