Inspection on 06/03/07 for Fernlea

This inspection was carried out on 6th March 2007.

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 6 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 11/07/06

Fernlea 14/02/06

Fernlea 17/10/05

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 Key Unannounced Inspection 6th March 2007 12:15 Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 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.V328447.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 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.V328447.R01.S.doc Version 5.2 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) www.st-annes.org.uk 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.V328447.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Seven service users with learning disabilities and four who also have physical disabilities. To provide accommodation and care for one named service user over 65 years 25th September 2006 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 over 65 years of age. St. Anne’s Community Services, 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 learning disabilities (red side), and the other providing care and accommodation to adults with physical and learning disabilities (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 three single bedrooms, a lounge, kitchen/diner, bathroom, shower room and an office. Accommodation on the blue side comprises four single bedrooms with wash hand basins, kitchen/diner, lounge, conservatory that is also used as a multisensory room, shower room and an adapted bathroom. The range of fees charged for this service is £202.30 - £457.29 per week. This does not include the nursing component which is paid directly by health. The pre-inspection questionnaire states that additional charges are made for the following: activities, hairdressing, toiletries/clothing, accessories, newspapers and transport (charged at £72 per month each). The service provider ensures that information about the service is available to Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 5 prospective service users and the current service users by way of the home’s Statement of Purpose, the Service User Guide and through CSCI inspection reports. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. As part of this key inspection, a visit was made to Fernlea by one inspector between the hours of 12.15 pm and 5.40 pm. In addition to the visit, information used to inform the inspection includes notifications received from the home about any accidents, incidents or events that affect the well being of residents, the pre-inspection questionnaire submitted to CSCI prior to the site visit, completed surveys from relatives giving views about the quality of the service. Three surveys were returned from relatives and gave generally positive feedback about the home with all stating that their relative gets the agreed or expected care and that staff usually have the right skills and experience to look after their relative. Comments received about what the care home does well include; “Treats everyone equally with respect”, “They create a safe, comfortable, loving home for people unable to care for themselves”, “Allow freedom of movement within the home, supervise constantly, security conscious”. Further comments are included in the main body of this report. The inspector had the opportunity to talk to the manager and staff on duty. Due to the nature of the service users’ disabilities, verbal feedback about what it is like to live at Fernlea is not possible. The inspector therefore spent time observing care practice and interaction between staff and service users. Communal areas and some service users’ bedrooms were seen. Records relating to service users, monies, staff training and staff rotas were examined as part of the site visit. Medication and records relating to medication were examined. At the key inspection conducted in July 2006, a number of concerns relating to the wellbeing and safety of service users were identified. In order to monitor the home’s progress with the requirements made regarding these matters, a further inspection visit was made to the home in September 2006. Areas inspected were accidents/incidents relating to service users, including service user to service user assaults, individual service user care plans, staff care practice, staff training and staffing levels. Good progress had been made in all areas inspected and no further requirements were made. Unfortunately, progress in all areas has not been sustained and requirements have been repeated regarding the protection of service users and the training of staff. The inspector would like to thank the service users and staff for their cooperation and hospitality during the site visit. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Effective action needs to be taken to protect all service users from being assaulted by other service users. Service users need to be supported to take part in appropriate and valued activities in and outside of the home. Healthcare checks need to be arranged as planned. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 8 Accurate medication records must be kept to make sure service users are given their medication as prescribed. So that this vulnerable group of service users are protected as far as possible, staff need to have training in adult protection and physical intervention. The home needs to let the appropriate people know if a service user has been harmed. Repairs need to be made to the water supply on the blue side and floor covering in the red side kitchen needs replacing. So that service users can build good relationships with staff and receive consistent care, a stable staff team needs to be established. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 9 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.V328447.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are assessed before they move into the home so that staff are aware of individuals’ needs and aspirations. EVIDENCE: Records relating to three service users were examined. All contained evidence that pre-admission assessments had been conducted. There have been no new admissions to the home since the last inspection. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ needs and identified risks are reflected in their individual plan and service users are supported to take some reasonable risks and make some choices, however action taken to minimize the risk of assault is not always effective and must be reviewed in order to protect vulnerable service users. EVIDENCE: Three service user individual plans were examined. Each provides clear information to staff about how to meet individual needs and is developed using information following a person centred planning meeting. Each service user has a named nurse and keyworker who take responsibility for the development and review of the care plans. A clinical psychologist has continued to support the home in writing behaviour management plans and clear guidance is in place about how staff should respond to individuals’ challenging behaviour. Staff spoken to were able to give a good account of how to protect a service Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 12 user from potential assaults by a fellow house mate and, whilst the service user in question has not been assaulted for some months, another service user has now become the victim of some assaults. This was discussed with the manager and she agreed to discuss this with the team and introduce clear guidance on the supervision requirements for the service user. There are a number of restrictions in place in order to protect service users from harm, however a clear rationale is recorded and evidence of regular review is in the records. There is evidence in the records, and this was confirmed through discussion with staff, that service users’ families or advocates are involved in the review process. Three relatives completed surveys as part of the key inspection and all indicated that they are kept informed of important issues affecting their relative. Staff were observed to encourage service users to make choices about what they would like to eat or drink and a service user was asked if the inspector could go into his bedroom. Photographs of different meals and food are used to support service users to make choices about the menu, and the manager reported that photographs of staff are to be introduced so that service users know who is on shift. Most service users living at Fernlea have regular contact with family, however those without family contact have access to advocacy services. Comprehensive risk assessments are in place giving staff clear information about identified risks and what steps to take to reduce the risks. In general, staff have a good understanding of what the risks are and how to minimize them, however staff must be vigilant in ensuring that particular service users are not left unsupervised to avoid any further assaults taking place. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users’ lifestyles are good in that good support is offered to maintain relationships, they enjoy a reasonable diet and have their rights respected, however the lack of stimulation and opportunities to engage in meaningful activities both in and outside of the home does not support service users to enjoy a good quality of life. EVIDENCE: Two service users receive an individualised day service package provided by external staff that come to Fernlea and support the individuals to access community based activities. The manager reported that, wherever possible, the two service users are out of the building at different times so as to limit the amount of time spent together at the home as there continues to be compatibility issues between them. Three other service users receive limited day care provision at day centres or college. For the remainder of the time, Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 14 and for those without any day service provision, staff at the home are responsible for providing occupation. Daily records were examined and it was concerning to note that a service user who receives day service two days per week, had only been out of the house on one other occasion since the beginning of 2007 up until the date of the site visit (6th March 2007). Daily records suggest that the service user spends days looking at books and playing with toys. Service users were observed to spend long periods of time with nothing to do and no engagement in meaningful activities. A service user with no day service provision had left the house on twenty four occasions in the eighty days prior to the inspection, however of these, thirteen were limited to being on the home’s transport to drop off or collect other service users without having the opportunity to get off the transport. The service user had had eleven opportunities to participate in community-based activities such as shopping or going out for a meal etc. Given that the service user is reported to enjoy getting out with staff, it is unsatisfactory that so few opportunities have been available to leave the home. Staff explained that staffing levels and a lack of drivers does not support more frequent opportunities to access community based activities. The manager reported that she continues to encourage staff to support service users to participate in activities in the home and there has been some improvement in this area. Some staff were observed to support service users to be present in the kitchen whilst the evening meal was being prepared and this is a positive improvement. The manager has introduced an additional recording system so that she can see at a glance what activities service users have taken part in during any month. Concerns about service users’ lifestyles and opportunities to participate in appropriate activities both in and outside of the home have been raised with the provider at the last four inspections. In order to improve the quality of life for service users, it is a requirement that the provider addresses this matter. Evidence in service user records and completed surveys from relatives indicates that good support is offered to service users to maintain contact with their families. One relative commented, “The staff go out of their way to make sure we keep in touch and enable us to see each other”. Care practice was observed on both sides of the home. In general, practice was good. Staff interacted positively with service users using their preferred method of communication. Staff asked permission to enter service users’ bedrooms and knocked before entering bathrooms and bedrooms. Some staff made efforts to interact with service users and demonstrated an awareness of their interests and likes/dislikes. A service user was supported and encouraged to be as independent as possible when mobilising around the home. The manager was observed to skilfully de-escalate a situation where a service user was anxious, using the agreed behaviour management plan. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 15 Menus were examined and demonstrate that a reasonably varied diet is offered although service users are not consistently offered sufficient portions of fresh fruit and vegetables. Staff have worked hard to meet the dietary requirements that have recently been introduced for a service user, and records showed that an improvement in the service user’s health has been achieved. The inspector observed the evening meal being served on the blue side and it was positive to see an improvement in practice since the last key inspection. Staff supported service users sensitively, and a member of staff was heard explaining to service users what the meal was and what was on each spoonful. The mealtime was relaxed and informal. The pre-inspection questionnaire states that service users are offered a choice of menu and staff on duty confirmed this. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users’ personal care needs and most of their healthcare needs are met, however inaccurate medication records and gaps in health checks could result in individuals’ healthcare needs not always being met. EVIDENCE: Excellent personal support plans are in place describing in detail how individuals prefer to be supported. This is particularly important for those service users unable to verbalise their preferences. Staff were observed to offer personal care sensitively, protecting individuals’ privacy and dignity. Some service users require support with mobility and staff demonstrated good movement and handling techniques, explaining to service users at each stage of a transfer. Service users looked clean and well cared for. There was evidence in individuals’ records that health care needs are met. There was evidence of routine health checks in relation to most service users whose records were examined. Health action plans and an ‘OK Health Check’ are in place, however it was noted that some of the agreed actions within one Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 17 ‘OK health check’ had not been followed through and it was incomplete. This needs to be addressed. The manager and staff explained how they had managed recent changes in health care needs of a service user and described the improvement in the individual’s health and well-being. Medication was checked in relation to two service users. One was accurate and all medicines tallied with records kept, however records relating to the second did not. After reviewing old Medication Administration Records (MAR), the manager was able to account for all the medication and explained that previous errors had continued to be recorded and not rectified. Whilst there are systems in place to check balances, these are not being implemented satisfactorily. The manager acknowledged this and agreed to address this matter with nursing staff in a qualified staff meeting. Clear guidelines are in place for the administration of ‘as required’ (prn) medication. Medication is stored securely. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Clear complaints and protection procedures are in place, however potential adult protection issues are not always managed satisfactorily and staff have not received necessary training, therefore service users are not always adequately protected from possible abuse. EVIDENCE: A satisfactory complaints procedure is in place. The pre-inspection questionnaire indicates that no complaints have been received at this home in the last twelve months and systems are in place for recording complaints. Two of the surveys completed by relatives state that they are aware of the complaints procedure and two indicate that they usually get an appropriate response to any concerns they have raised. One indicated that they always get an appropriate response. Since the last inspection, the manager has written to the relatives of all service users reminding them of the complaints procedure; a copy of this letter was seen at the time of the visit. Most of the service users at Fernlea are reliant on others to make a complaint on their behalf due to the nature of their learning disabilities. Procedures are in place in respect of protection of vulnerable adults, in addition to the Kirklees multi-agency policy and procedure. At the last key inspection in July 2006, the manager reported that staff had not received up to date training in adult protection and agreed to address this. However, the manager reported that, due to training being cancelled on two occasions, of fourteen Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 19 staff (including care staff and nursing staff) only three have received up to date training in adult protection. Given the protection issues at this home, it is vital that staff receive the relevant training and are able to demonstrate competence. The manager and staff have continued to work alongside a clinical psychologist to identify and develop behaviour management strategies and positive ways of working with two service users. Records show that this has been effective and there have been no further incidents of assault between the service users. The manager and staff did point out, however, that there remains a level of fear and anxiety for one service user when he is in the home at the same time as his housemate. Despite the vigilance of staff to prevent further assaults on a service user, upon examination of incident records, it was found that another of the service users has become the victim of some assaults. These had not been reported to the Commission for Social Care Inspection (CSCI) or under adult protection procedures. Not all staff spoken to were aware of the revised risk assessment stating the supervision requirements of the service users. Following another incident since the site visit, the manager has informed the CSCI of her intention to extend the supervision protocol currently in place for one service user, to all service users living on the red side of the home. It is essential that all service users living at Fernlea be protected from harm or abuse or the risk of harm or abuse. A physical intervention plan is in place for a service user, however the manager reported that all staff members require refresher training, and some have not received any training in physical intervention. It is essential that all staff expected to physically intervene with service users have received appropriate training. The pre-inspection questionnaire states that, in the eight weeks prior to the site visit, agency staff covered ninety-seven shifts. When planning the rota, the competence and training of agency staff must be taken into account where there is a possibility that they will have to physically intervene with service users. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a clean and comfortable home, although some repairs are necessary to improve the environment and facilities. EVIDENCE: All communal areas and two service users’ bedrooms were seen during this visit. All parts of the home were clean and free from unpleasant odour. Since the last visit, a new kitchen has been installed in the red side. The floor covering needs to be replaced as it is damaged and not sealed where old units have been removed. The corridor in the red side has been decorated and pictures and curtains hung, creating a much more homely environment. Staff have worked hard to introduce new items gradually so that service users do not become distressed by the changes. This focus on the specific needs of the individuals living at the home is good practice. Bedrooms seen were comfortably furnished and individualised to reflect service users’ interests. The Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 21 manager reported that damaged furniture in a service user’s bedroom was to be repaired. Staff reported that the water flow in the blue side was faulty. There was no hot water from the kitchen sink and the flow was poor, and staff reported that there was no cold water in a service user’s bedroom. The service user would not give permission for the inspector to look around his bedroom. A laundry is available in the corridor that joins the two sides of the home. A commercial washing machine and tumble drier is available and there is direct access to the garden so that laundry can be hung out in the summer months. Good infection control procedures and practice is in place. Antiseptic hand rub is available in the entrance to the home and bathrooms as a precaution against infection. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35,36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by a well supervised staff team that receive most of the training required to do the job, however in order to ensure staff have all the necessary skills for the job and consistent care is provided, NVQ qualifications need to be achieved and a stable staff team developed. EVIDENCE: Care practice has improved since the last key inspection. Most staff interacted positively with service users and demonstrated an understanding of their needs. The manager reported that training in values and attitudes has been delivered to the staff team and this is revisited regularly at staff meetings. Evidence of this was seen in records. There are six care staff working at the home, and none have achieved an NVQ qualification in care. The manager explained that one member of staff had two units to complete, one had completed the Learning Disability Award Framework (LDAF) and three are working towards LDAF. One support assistant is due to commence NVQ training soon, and the manager reported that upon completion of the LDAF, the remaining staff team will be put forward to start NVQ training. Of three Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 23 completed relatives surveys, two said that care staff usually have the right skills and experience to look after people properly, and one said “always”. A relative commented, “because of staff shortages, temporary staff sometimes work with my relative. If they do not know him and his particular needs, it can be frustrating for him, which can upset him”. The pre-inspection questionnaire indicates that two staff have left the home since the last inspection. The manager reported that there are vacancies for two support assistants but that all nursing posts are filled. Support assistants have been recruited and they are due to commence upon receipt of satisfactory pre-employment checks. Fernlea has had ongoing difficulties in recruiting and retaining staff so it is positive that all vacant posts have now been filled. Service users have not had the benefit of a stable staff team for a significant period of time, and the home continues to use agency staff on a frequent basis. A relative of a service user commented on a survey in response to the question ‘how do you think the care home can improve?’ “By making sure the staff have good working conditions and pay thereby encouraging them to stay at work and avoid the use of temporary staff”. Rotas submitted with the pre-inspection questionnaire show that agency or bank staff are used almost every day. The manager said that, wherever possible, the same staff are used and this was noted on the rota. Regular staff will also cover extra shifts where possible, and this is reported to be helpful in providing consistent care to service users. Evidence of this was seen on the staff rota. When all the service users are at home, there are four staff on duty, two on blue and two on red side. There is always a qualified nurse on duty. Four staff, including the manager, are able to drive the home’s transport. It was reported that the lack of drivers impacts upon the amount of opportunities service users have to go out. Staff recruitment records are stored centrally and the Provider Relationship Manager from CSCI examines these. A training and development programme is in place and records show that training needs are discussed in supervision meetings. Evidence that staff have attended a range of relevant training was seen in records, including makaton, epilepsy, autism awareness, oral health and LDAF induction and foundation training. Since the last key inspection, a number of training days have been attended regarding the management of challenging behaviour, de-escalation techniques and the promotion of non-challenging behaviour. The manager reported that this has increased staff awareness of individuals’ behaviours. As discussed under standard 23, staff require training in adult protection and physical intervention. Staff receive regular supervision on a one to one basis from the manager. Records of these meetings are kept. Staff spoken to said that they found supervision useful and supportive. The manager currently supervises all staff, Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 24 however anticipates that the deputy manager will soon take responsibility for supervising some of the staff. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 25 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well run home that is maintained to a good standard and where the quality of the service is monitored, however service users’ health and safety is not always adequately protected in that effective supervision is not always implemented and service user to service user assaults are not always reported appropriately. EVIDENCE: An experienced, well qualified manager, who is a registered nurse for people with learning disabilities, runs the home. The manager regularly updates her knowledge and skills by attending relevant training; evidence of this was seen in the records. Staff reported that the manager is supportive and approachable and a member of staff commented that she is a “good manager”. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 26 The manager demonstrates a clear sense of direction and her approach is open and positive. There was evidence in records that the manager has developed close links with the Community Assessment Team and psychology services in order to improve service delivery at Fernlea. Satisfaction questionnaires are sent to relatives or advocates annually to seek their views about the quality of the service offered. All but one of the service users at this home would be unable to contribute to this due to the level of learning disability. No formal quality audit systems are in place, however the manager reported that she checks care plans, risk assessments etc to ensure they are up to date and complete. The home has an annual development plan that is available in the home and the service manager makes monthly visits to the home to monitor the quality of the service. A report of the visit is available at the home. The pre-inspection questionnaire indicates that health and safety checks are carried out at the required intervals. The manager reported that, following advice from the fire officer, fire risk assessments were reviewed and floor plans developed. Staff spoken to were aware of the fire procedures and a bank staff on duty said that the fire procedures had been explained to her. Staff use good moving and handling techniques and regular training is provided in this area. Evidence of this was seen in records. Improved supervision is necessary on the red side to ensure the safety of all service users and improved reporting of incidents of service user to service user assaults is required. It is acknowledged that the manager has stated that steps have already been taken to improve practice in this area. Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 27 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 3 3 3 X X 2 X Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 28 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 YA9 YA23 Regulation 13(4) Requirement Timescale for action 10/04/07 2. YA12 YA13 16(2) m,n In order to protect the safety of service users, steps must be taken to reduce the risk of assaults from other service users. The home must be conducted in 21/04/07 such a way that enables all service users to maintain appropriate and fulfilling lifestyles. Arrangements must be made so that all service users have regular access to community based activities and recreational and daytime occupation/education opportunities consistent with their interests and wishes. Previous timescales of 15/4/05, 15/12/05, 31/03/06 and 26/09/06 unmet. In order to ensure the safety and wellbeing of service users and protect them from harm, staff must receive training in protection of vulnerable adults. Any staff expected to physically DS0000001081.V328447.R01.S.doc 3. YA23 13(6) 15/05/07 Fernlea Version 5.2 Page 29 4. YA42 37 c,e intervene with service user must have received the appropriate training. Where necessary, and in line with adult protection policies and procedures, assaults on service users must be reported so that service users’ health and safety is protected. This must include notifying CSCI. 10/04/07 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 YA14 YA19 Good Practice Recommendations So that service users are enabled to have fulfilling lifestyles, they should have access to a range of appropriate leisure activities. To ensure that service users’ healthcare needs are met, routine health checks should be kept up to date. OK health checks should be reviewed where necessary and completed in full. So that staff can be sure that service users have received their medication as prescribed, systems in place for ensuring that medication records and stock is correct should be implemented with care. The water outlets in the kitchen and a service user’s bedroom must be repaired so that good hygiene standards are maintained. In order to keep the home clean and hygienic, the floor covering in the kitchen on the red side should be replaced. To ensure that service users are supported by suitably qualified staff, fifty per cent of care staff should have at least an NVQ level two in care. 3. YA20 4. 5. 6. YA24 YA30 YA32 Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fernlea DS0000001081.V328447.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!