Inspection on 10/10/06 for Fernlea Care Home

This inspection was carried out on 10th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fernlea Care Home 22/04/08

Fernlea Care Home 10/04/07

Fernlea Care Home 09/01/06

Fernlea Care Home 12/07/05

Fernlea Care Home 21/02/05

Fernlea Care Home 28/06/04

Fernlea Care Home 13/01/04

Fernlea Care Home 10/02/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Pinta

Kestrel House, St Anne`s Opportunity Centre,

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Fernlea Care Home Sway Road Brockenhurst Hampshire SO42 7SG Lead Inspector Marilyn Lewis Unannounced Inspection 10th October 2006 10:00 Fernlea Care Home DS0000037572.V311817.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 Care Home DS0000037572.V311817.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 Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernlea Care Home Address Sway Road Brockenhurst Hampshire SO42 7SG 01905 795088 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) fernlea@craegmoor.co.uk Park Care Homes (No 2) Ltd Care Home 10 Category(ies) of Learning disability (10), Mental disorder, registration, with number excluding learning disability or dementia (10) of places Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th January 2006 Brief Description of the Service: Fernlea is managed by Parkcare Homes No: 2, which is a trading subsidiary of Craegmoor Group Ltd, a national company providing residential and nursing care. The property is a large detached house set in a large garden. It is located in the New Forest village of Brockenhurst, within walking distance of local amenities. Fernlea provides care for up to 10 residents with a learning disability and/or a mental disorder. All residents are accommodated in single bedrooms. The age range of the current service users (ten males) is 22-62 years. The fees as stated in the pre inspection questionnaire dated 5th June 2006 range from £901.53 to £2000 per week. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days the 10th and 16th October 2006. The inspector toured the home and met with three service users, three staff members, the acting manager and the organisation’s area manager. Care plans were sampled for four service users and records seen included those for medication, fire safety and fire drills, complaints, accidents, staff training and staff recruitment. Since the last inspection the registered manager has left the service and the manager who took over had also just resigned. An acting manager is running the home until a new permanent manager is recruited. On the first visit it was only the acting manager’s second day in the home and she did not have access to some records required. The second visit was to look at those records and meet with other staff members and the area manager. During the second visit it was noted that the acting manager was addressing areas requiring attention discussed during the first visit, including rewriting and reviewing care plans and risk assessments, the menus and the activity programmes. What the service does well: A full care needs assessment is undertaken for all service users before they are offered a place at the home to ensure the home can meet their care needs and they are able to visit, with their relatives, before they make a decision about living there. Service users are supported to make decisions about their lives, their rights are respected and they are treated with respect. One service user attends a local college to gain basic educational skills and two others are involved in the ‘garden project’, which with support from the activities worker enables them to undertake gardening tasks in the locality. Staff had received training in the protection of vulnerable adults and were aware of the procedures to be followed should abuse be suspected. The home provides clean, homely accommodation for service users. Service users said that they liked their rooms and staff respected their right to privacy and did not enter rooms against the service users wishes. The interior of the property is well maintained. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 6 Records seen indicated that service user’s safety was protected by the robust procedures used when recruiting new staff. What has improved since the last inspection? What they could do better: Care plans seen for four service users had not been personalised to include the wishes of the service users and had not been kept under regular review to ensure the changing needs of the service users were met. Risk assessments were also in a general format and did not provide information on how the risks could be minimised while still allowing the service users as much independence as possible. A staff member spoken with said that he had not realised risk assessments were to detailed to provide assessment on all the risks when undertaking an activity. Although some service users have a structured activities programme others do not and appeared during the visits to sit around in the communal rooms with little to do. Service users said that they enjoyed the food provided but records seen indicated that they were not offered a varied menu at lunch times. One service user said that it was usually sandwiches. Advice had not been sought for one service user who ate only fish fingers or sausages and chips for the main meal. Records seen indicated that some service users were not receiving the one to one support they required and a new appointment had not been made for one service user who had not attended an outpatient appointment at a local hospital. A staff member said that this was due to staff shortages. The acting manager was addressing issues regarding staff not dealing with medicines in an appropriate manner such as not dating, when opened, containers of eye ointment that are to be discarded after a limited time once opened. Although the interior of the property was well maintained attention was still required to the exterior of the building including the paintwork to facia boards, window frames and masonry. The changes to management of the home have resulted in staff feeling there is a lack of consistent leadership. Staff members said that when only two care Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 7 staff members are on duty for a day shift there is insufficient time to fully support the service users. The area manager said that new staff were being recruited and staffing levels would be monitored. Three carers were on duty at the time of the second visit. Training records were not up to date and it was therefore not possible to confirm if all staff had received the training required to do their job. The acting manager was undertaking an audit of staff training requirements and had arranged for training sessions in mandatory subjects such as moving and handling for those staff who required it. Fire records seen had also not been kept up to date and it was not possible to confirm that all staff had attended fire drills. The acting manager arranged for a fire drill to take place on the 12th October and said that she would organise further drills until all staff had attended one. 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 Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 8 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 Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 4 and 5 Quality in this outcome area is good. The judgement has been made using available evidence including visits to the service. No one is admitted to the home without a care needs assessment to ensure the home can meet their care needs. Service users are able to visit the home before making a decision and are provided with a written contract giving the home’s terms and conditions for residency. EVIDENCE: The home’s service user guide is provided in a symbol format suitable for the service group. Since the last inspection three new service users have been admitted to the home. Prior to admission a full care needs assessment was undertaken for each person. The assessments covered all aspects of care needs including personal care and health needs. The service user’s likes and dislikes for food items, social activities and participation in daily living activities were included in the document. The records seen indicated that service users and their relatives were able to visit the home to view their room, meet the permanent service users and the staff before making a decision about living there. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 10 Each service user had been issued with a written contract giving the terms and conditions for residency. Fernlea Care Home DS0000037572.V311817.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is adequate. The judgment has been made using available evidence including visits to the service. Service users are supported to make decisions about their daily lives and their personal information is kept confidential. The acting manager is addressing the need for care plans and risk assessments need to be personalised and kept up to date to ensure the changing needs of the service users are met. EVIDENCE: On the first visit to the home care plans were seen for the three new service users and for one service user who had been resident in the home for some time. Some care plans seen were in a generic format and had not been personalised to take into account the wishes of the service users. Care plans for one service user had not been dated or signed by the staff member responsible for writing them. Risk assessments contained in the care plans were also generic. One service user who regularly goes into the local village alone had a risk assessment that Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 12 stated the service user must be made aware of safe practices when out alone but did not state what they were. No mention was made of where the person went, how they got there or how long they were likely to be away from the home. A staff member spoken with said that he did not realise the risk assessment was meant to be detailed to cover all aspects of the risks when undertaking an activity. Some risk assessments had not been dated or signed. Care plans and risk assessments for the three new service users had not been reviewed since they were put in place even though one had been resident since March 2006. Although information in the care plans had not been updated in writing, a staff member spoken with was aware of the current care needs of service users and said that verbal communication during handover meetings between shifts was good. On the second visit to the home the acting manager showed the inspector revised care plans for a service user. The plans were very good and gave detailed information about the service users care needs and the actions required to meet those needs. The service user had been involved in the review of his care plans and his wishes had been documented. Risk assessments were included in the plans for all daily living and social activities. The acting manager said that she intended to review all the care plans in the next few days with the service users and that meetings to discuss care planning had been arranged with staff. During the inspection visits staff were observed supporting and encouraging service users to make their own decisions. A staff member said that one service user had expressed a wish not to use a method of communication that used a large picture book. Staff had discussed this with him and had developed a small book that he was more comfortable using. Care plans seen for one service user indicated that an advocate was involved in their care. Service users were able to choose to spend time with others in the communal rooms or in the privacy of their own room. Staff were seen to knock on doors and wait before entering and respected the wishes of two service users who opened their doors but did not want staff to enter their rooms. A member of staff said that any changes to the daily running of the home such as redecoration of rooms were discussed during service users meetings. Service users had been involved in choosing colour schemes and furniture for the home. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 13 A staff member spoken with was aware of the need to treat information regarding service users as confidential unless this posed a risk to the service user. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. The judgement has been made using available evidence including visits to the service. Service users rights are respected and they are able to maintain contact with relatives and friends. Some service users would benefit from a more structured approach to providing suitable activities and by being offered a more varied choice of meals. EVIDENCE: During the inspection visit service users were observed making decisions as to whether they wished to stay in their rooms or meet with others in the communal areas. One service user attended a local college to obtain basic educational skills. Two other service users were involved in a garden project, which is supervised by the home’s activities worker and included service users doing gardening in the locality. The activities worker also supports service users to make items of woodwork in the workshop situated in the grounds of the home. During the Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 15 first inspection visit a service user returned to the home following time spent on the gardening project. The service user said that he had enjoyed his day. One service user visits shops in the village as he wishes and records seen indicate that staff support other service users to access the community for shopping and visits to local pubs and cafes. However as previously stated in standard 9, risk assessments had not been undertaken for individuals accessing the community. Records indicated that one service user, supported by a staff member, attends services at a local church. However activity programmes seen in the files for the four service users case tracked had not been completed and there appeared to be no structure to the activities provided for them. During the inspection visits some service users appeared to be sitting around with little to do. One service user said that he was waiting for a staff member to play a board game. A staff member said that at times, due to the shortage of staff, it was not possible to provide one to one support for activities. Records seen indicated that service users were able to maintain contact with their relatives and friends. During the visits one service user spoke of enjoying making telephone calls to a relative. Service users said that they enjoyed the food provided. However records seen indicated that the choice at lunchtime was limited and service user said that it was usually sandwiches each day. One service user received one of two main meals each day, fish fingers or sausages and chips. A staff member said that this was what the service user wanted. There were no records for other options offered to the service user, although the staff member did say that the service user had on occasion been offered another item such as peas. Records seen did not indicate that advice had been sought to assist in developing a more nutritious diet. The acting manager had started to address the issue regarding the dietary needs of the service users by the second visit to the home. Staff had been asked by the acting manager, to develop picture books and cards of food items to support service users to choose meals and to produce a more varied choice of menu. The acting manager also said that staff had been asked to try a variety of different food items for the one service user who chose the same meals and to record what had been offered and the reactions of the service user so that they were able to monitor the service users wishes. Fernlea Care Home DS0000037572.V311817.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is poor. The judgement has been made using available evidence including visits to the service. Some service users are not receiving the amount of support required and are missing appointments with health professionals. The acting manager is addressing the issue of staff not following the appropriate procedures for dealing with medicines. EVIDENCE: Records seen for four service users indicated that one to one time had been agreed with adult services for a varying amount of time per day/week. However the one to one time recorded was not what had been agreed. One service user who required 6 hours per week had received between 1 hour and 2 hours 40 minutes a week for the previous three weeks. Another service user due to receive 2 hours a day received 1 hour or less for 7 of the previous 10 days. Staff spoken with said it was thought that not all the one to one time had been recorded but that also the number of staff on duty at times did not allow for one to one sessions. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 17 Visits by GPs and other health professionals including the district nurse and psychiatrist were documented in the service users care plans. The chiropodist also visited Service users. Records for one service user indicated that visits to an orthopaedic clinic had been cancelled. A staff member said that the appointment had been missed, as there were no staff members free to go with the service user. Although a note in the care plan said that the appointment should be rearranged there was no record of this happening. The acting manager said that she would speak with staff to see if an appointment had been made and if not would arrange one. Individual medication records seen had been completed appropriately. However the recording of the number of tablets remaining stated in the controlled medicines book did not match the number held, with one more held than accounted for. A staff member said that this had been the case for sometime but staff were still writing down the number of tablets that should be there and not the number actually there. A container of eye cream seen for one service user had not been dated when opened although it was to be discarded after four weeks from opening. The staff member spoken with, who was responsible for the administration of medicines on the first day of the inspection visit, was unaware of the requirement to date the product and did not know when the container had been opened but thought it was only for a few days. On the second visit to the home the acting manager had addressed the issues regarding medication by undertaking an audit of the medicines held in the controlled medicines cupboard and speaking with staff about dating eye drop containers when opened. Records seen confirmed that the acting manager had audited the medication records. A staff member said that they had been told to date containers when opened and why. Fernlea Care Home DS0000037572.V311817.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. The judgement has been made using available evidence including visits to the home. Service users feel that staff would listen to their concerns and they are protected from abuse by staff awareness in the protection of vulnerable adults. EVIDENCE: The home has a complaints policy in place that states who will investigate the complaint and timescales for the process. Records seen indicated that there had been no complaints received since the last inspection. The acting manager said that service users were encouraged to raise any concerns during discussions and service user meetings. One service user said that if he were worried about anything he would talk to a member of staff. The home has procedures for the prevention of abuse, including Hampshire County Council’s Protection of Vulnerable Adults and Whistle Blowing. The acting manager said that staff attended training sessions in abuse awareness and two staff members spoken with confirmed that they had received training in the prevention of abuse. Staff spoken with knew the procedures to follow should abuse be suspected. The home holds the service user’s personal monies. The monies are stored individually in a locked filing cabinet. Receipts are kept for all transactions. Money checked for three service users did not correspond to the records, with each service user having more money in their container than was recorded, Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 19 indicating that records and the amounts of money held had not been checked each time money was taken out for the service user. Two service users spoken with said that they knew they had money in the office but did not know how much. Staff gave the money they needed when they wanted and they were not interested in keeping the money themselves. The acting manager did not know why the discrepancies had arisen and said that she would conduct an audit of the records and money held. Fernlea Care Home DS0000037572.V311817.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is adequate. The judgement has been made using available evidence including visits to the service. Fernlea provides a clean, homely environment that is well maintained internally, but previous requirements for attention to the exterior of the property to be completed have not yet been met. EVIDENCE: Fernlea is a detached house situated in a residential area of Brockenhurst, in the New Forest. Visitors to the home are admitted by a staff member and are asked to sign the visitor’s book. The visitor’s book contained times when visitors had signed on arrival at the home but there were many gaps for when they left the premises. Service users are accommodated in single rooms. All the rooms have a toilet and washbasin and two also have a bath and another a shower. There are also two separate bathrooms and a shower room. The inspector respected the rights of the service users who did not wish to receive visitors into their rooms but did view the rooms of service users in agreement. The rooms had all been personalised by the service users and Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 21 contained many items such as televisions, DVD players, posters and pictures. Two service users said that they liked their rooms. A monitor system was in place for staff to be alerted for one service user who could possibly have an epileptic seizure at night. The home has a lounge with dining area, a dining room, that is not often used by service users, but is used by staff for handover meetings and is where the medicines are stored, a kitchen that is domestic in type and a laundry room. Hazardous substances such as cleaning fluids were locked in a cupboard. Rooms seen looked clean and homely. The exterior of the building, however, looked in need of attention with some windowsills in a poor state of repair and the walls needing a coat of paint. This has been an outstanding requirement from the last two inspections. The date for completion of the work from the last inspection is the end of December 2006 so has not yet been reached. Staff were however unaware of any work due to take place. The provider has been required to forward an action plan to include timescales for the work to be completed to the commission. Two staff members said that there were issues with space for the two staff members who ‘slept in’ each night. One staff member used the dining room and the other the lounge resulting in these areas being unavailable should a service user wish to use these rooms during the night. Staff also said that it was not possible to sleep well as there were no suitable beds available. A staff member also said that one service user liked to stay up late watching television in the lounge and that staff respected his wishes to remain in the lounge. During the second visit to the home the inspector met with the area manager for the organisation who said that the sleeping arrangements would be discussed with staff and service users to ensure they were agreeable to all. At the time of the first visit to the home there were no paper towels available for the communal toilet, bathroom or kitchen. A staff member said that they had run out of stock and that kitchen towel was being used in the kitchen and terry towels in the bathrooms and toilets. The use of material towels in communal rooms was not recommended, as it was a risk to the spread of infection. On the second visit paper towels were available. There is a large garden to the rear of the property with parking space and there is also a small parking area at the front of the home. A service user said that he had enjoyed a barbeque held in the garden in the summer. Fernlea Care Home DS0000037572.V311817.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. The judgement has been made using available evidence including visits to the service. Service users are protected by the home’s robust recruitment procedures but may not be fully supported when staff are not on duty in sufficient numbers. The acting manager is addressing the need to undertake an audit of staff training requirements to ensure staff receive the training required to do their jobs. EVIDENCE: There have been many changes to the staff employed at the home since the last inspection. The registered manager had left and the next manager has just resigned. An acting manager has been asked to run the home and on the first inspection day, it was her second day at the home. A staff member spoken with said that when only two staff members were allocated for a shift it was not possible to fully support the service users. This was noted in standard 18. On the first visit to the home two care staff were on duty plus the acting manager. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 23 At the time of the second visit three care staff and the acting manager were on duty. Rotas seen indicated that two care staff members had been on duty during shifts on a regular basis. The area manager said that new staff had been recruited for the home and that they were due to start as soon as their Criminal Records Bureau (CRB) and Protection of Vulnerable Adult (POVA) checks had been completed. There were no records or induction plans available to confirm this. The area manager also said that staffing at night would change from two ‘sleep in’ carers to one awake and one ‘sleep in’ staff members. Recruitment records seen for two staff members contained all the information required including two written references and proof of identity. CRB and POVA checks had been completed before they commenced work in the home. Two of the eight care staff members employed at the home were in the process of obtaining a National Vocational Qualification (NVQ) level 3 in care. The acting manager and area manager were aware of the requirement for fifty percent of care staff to have obtained or be working towards the qualifications. The area manager said that the lack of staff with the qualification was due to the recent staff changes. Staff training records had not been kept up to date. Staff said that they had attended training sessions that were not recorded. The records indicated that only three staff members had attended training in the administration of medicines but other staff members said that they had received the training. The area manager and the acting manager were aware of the issues regarding staff training. The area manager said that a training programme was being arranged for staff at the home and the acting manager said that she had asked staff to bring in any certificates they had for training sessions so that training could be confirmed. The acting manager said that she was organising supervision sessions with staff for the next two weeks and would be including training requirements in the discussions. A staff member said that the area manager had held group supervision meetings and that they had also received one to one supervision. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Quality in this outcome area is adequate. The judgement has been made using available evidence including visits to the service. The lack of a permanent manager has resulted in staff feeling there is a lack of leadership at the home. Service users are supported and encouraged to give their opinions on the quality of care provided at the home. Service user’s safety could be at risk if all staff have not attended fire drills. EVIDENCE: The registered manager left the home in March 2006 and the new manager has just resigned following some weeks away from the service. Two staff members spoken with commented on the lack of consistent leadership with one saying that they ‘just had to get on with things’. On the second visit to the home staff said that the situation had improved since the acting manager had taken up her position. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 25 The acting manager holds NVQ level 4 in care and the Registered Managers Award. She is an experienced team leader in another of the organisation’s homes situated in the locality. The area manager said that she had held group meetings with staff to discuss the issues surrounding the change of manager. A staff member said that service users were encouraged to give their opinions about life at the home as they wished and were supported to participate in decision making during service user meetings. The staff member said that meetings were usually held monthly but had not been held for the last few months, while the manager was away from the home. One service user said that they talked with a carer if they did not like the way things were done in the home. The organisation conducts a survey to obtain the views of service user and their relatives on the quality of care provided in their homes annually. The area manager said that the survey questionnaires had been forwarded to the director of the organisation and that feedback would be given to service users at the home and letters would be sent to relatives. No copies of questionnaires were available to confirm the survey had taken place. Training records were not up to date and it was therefore not possible to confirm that all staff had received training in mandatory sessions such as moving and handling and food hygiene. As stated in standard 35 the acting manager was undertaking an audit of training needed and arrangements were in place for training sessions for moving and handling, food hygiene, health and safety and first aid to be held at the end of October and through November for those staff members who needed to attend. Fire records seen were not up to date and it was not possible to confirm that all staff had attended fire drills. On the second visit the acting manager showed the inspector records for a fire drill that had taken place on the 12th October 2006 and said that a further drill would be held to ensure all staff had attended. A staff member confirmed that they had attended the recent fire drill. Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 26 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 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 3 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 2 3 3 2 3 LIFESTYLES Standard No Score 11 3 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 2 3 x x 2 x Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 (2) Requirement The registered person must ensure service user’s care plans are kept under review to reflect the changing needs of the service user. The registered person must ensure risk assessments are undertaken for all service user’s daily living and social activities. The registered person must ensure service user’s health care needs are not missed due to staffing issues. The registered person must ensure service users are offered a choice of varied and nutritious meals. The registered person must ensure staffing levels are sufficient to meet the care needs of the service users. The registered person must ensure staff receive the training required to do their jobs. The registered person must ensure that all staff attend fire drills and records of their attendance are kept up to date. Timescale for action 30/11/06 2. YA9 13 (4) 30/11/06 3 YA19 13 (1)(b) 30/11/06 4 YA17 16 (2)(i) 30/11/06 5. YA33 18 (1)(a) 17/10/06 6 7 YA35 YA42 18 (1)(c) 23 (4)(e) 31/12/06 30/11/06 Fernlea Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 28 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 Care Home DS0000037572.V311817.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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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