Inspection on 22/04/08 for Fernlea Care Home

This inspection was carried out on 22nd April 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fernlea Care Home 10/04/07

Fernlea Care Home 10/10/06

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 27/09/2008.

CARE HOME ADULTS 18-65 Fernlea Care Home Sway Road Brockenhurst Hampshire SO42 7SG Lead Inspector Joy Bingham Unannounced Inspection 22/04/08 09:15 Fernlea Care Home DS0000037572.V361169.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.V361169.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.V361169.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 www.craegmoor.co.uk Park Care Homes (No 2) Ltd Position Vacant 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.V361169.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th April 2007 Brief Description of the Service: Fernlea is owned by Parkcare Homes No: 2 Ltd, which is a trading subsidiary of Craegmoor Group Ltd, a national organisation providing residential care and support to individuals within the social and health care sector. The manager has been in post just over a year and is on the point of applying to be registered with the Commission for Social Care Inspection. The house is a large detached property 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 current fees range from £693 to £2495 per week. The manager provided this information on the day of the site visit. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The purpose of the inspection was to find out how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included the Annual Quality Assurance Assessment (AQAA) completed by the home, and survey comments from residents and staff. An unannounced visit to the home was carried out on 22 April, lasting 8 hours. During this time we were able to have a partial tour of the premises, including two bedrooms, the lounge, kitchen, dining room, and a bathroom and have discussions with the staff and contact with some of the residents of the home. We sampled staff and care records, policies and procedures that relate to the running of the home. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection (CSCI). There were fourteen requirements made at the conclusion of the last inspection in April 2007. The action taken by the home was reviewed and we found each requirement had been completed. Craegmoor appointed a new manager in January 2007 but application has not yet been made to the Commission for Social care Inspection (CSCI) for her to be registered. What the service does well: The manager and staff team demonstrated a high level of commitment and a good understanding of the residents’ needs. Records show the analysis of care needs has involved service users and their families and has been well thought through. The interaction observed between the staff and residents indicated that staff provide support in an attentive and respectful way. The opportunity to engage in relevant training is given to the whole staff team, and this is significantly valued. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 7 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.V361169.R01.S.doc Version 5.2 Page 8 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 adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users’ needs and aspirations are assessed. However, to ensure that the support needs of new service users are met and are compatible with other residents, a more comprehensive assessment should be conducted. EVIDENCE: The assessment records for four residents, including the most recent admission, were inspected. The Manager had recently visited one prospective service user, accompanied by an experienced care manager from a sister home of Craegmoor, as she said she felt she had not been trained to undertake pre-admission assessments and was not confident in this role. We were told that at the time of the assessment there was no-one in upper management within the organisation who was available to visit with her. The manager appears not to have been supplied with a detailed care management assessment integrated with the Care Programme Approach (CPA) for people with mental health problems, and therefore relied on what she was told. The service user’s needs have proved to be far higher than anticipated before admission, and due to the extent of demand placed on the staff team the Manager subsequently called a safeguarding meeting. There have been a high number of notifications of incidents reported to the CSCI. A review took place and an increase in funding for 1:1 support and 2:1 support for the service user Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 9 when he is in the community was agreed. The manager gave 28 days notice to find an alternative placement. At the time of the inspection the notice period had expired but no firm alternative placement was forthcoming. We looked at the records relating to this and we felt the assessment team had missed some clues about the extent of this person’s challenging behaviour from indicators in the clinical background and noted behavioural difficulties. The manager said that the resident had not visited the home prior to admission as she was led to believe that doing so might raise his anxiety levels. A comprehensive care plan had been developed, agreed with a family member, the service user and the care manager. However we were told the impact this person has on the staff team and their availability to support other residents means the arrangements cannot continue indefinitely. In the written survey nine residents said they were given adequate information and opportunity to see the home. One resident said he was not asked if he wanted to come to this home. The other comments made were: • ‘ it’s a nice home in the country with fresh air’ • ‘my room was the office. They made it into a bedroom for me’. A statement of purpose was available for inspection and was found to be upto-date. This was a requirement from the last inspection and is now met. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 10 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 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are involved in creating a care plan; they know their needs and wishes are reflected in this and they are supported in making decisions and taking appropriate risks in order to live as independent a life as possible. EVIDENCE: Each of the ten residents had a very comprehensive care plan which had been drawn up with the involvement of the residents together with their family and relevant agency. Four of these plans were inspected and it was noted that all staff were part of the care plan/key working process. There was evidence of the involvement of service users at each stage by their signing agreement to the content. The format of the completed plans were wide ranging and comprehensive including detail of ‘important people in my life, what I do, what makes me happy, how I express happiness/unhappiness, and what helps me when I’m Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 11 angry, what I like/enjoy right now’. Pictorial aids were in use where appropriate. Separate sections clearly devote to risk assessments; some are generic and some specific to the individual person e.g. getting ‘stuck’ in public places, personal space, epilepsy. These were all reviewed and the date of review recorded each month. The Annual Quality Assurance Assessment (AQAA) submitted by the home referred to the ‘Your Voice’ project which is an effective means of ensuring service user views and opinions are listened to and acted upon where possible. It states that a range of communication aids are used to enable service users to make an informed choice about various aspects of their day to day lives. The preferred method of communication used by each service user is care planned and all staff are made aware of the method and encouraged to use it wherever possible. The surveys from the residents informed us that in relation to making decisions themselves the home scored 75 positive, and in relation to what to do in the day, evening and weekend the home scored 29 out of 30 with one comment—‘sometimes if there is enough staff on.’ All ten of the residents completed a form, all with the help of their key worker or a member of staff of their choice. We took the opportunity to speak with family members who visited during the day. Positive comments were received such as ‘he’s always happy to come back here, which is reassuring for me’, ‘they keep me in touch’, ‘they do a good job here’. Staff views were also collected through surveys. Staff members said: • • • • • • The home is good at promoting independence of the individual residents. Individual needs are fine and supporting their rights People are happy and contented The home allows individuality and progressive lifestyles while maintaining dignity and choice. The home could be better at considering the needs of the individual Outside activities could be improved for each day It became clear on the day of the inspection that during this interim period the care needs of one resident was impacting on the freedom of others to do what they wanted, as a member of staff was allocated to provide 1:1 support. Staff time appeared to be diverted from developing activities for all. The manager assured us that this was a temporary situation and professional appointments were always respected. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 12 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, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are enabled to participate in the local community, maintain links with family and friends inside and outside the home; their rights are respected and responsibilities are recognised. They are offered a healthy diet and enjoy mealtimes. EVIDENCE: The AQAA from the home informed us that the people who live there carry out age appropriate activities and they are also involved in the choice of their activities, including community access. This was evidenced in the care pans, and witnessed on the day of the inspection. Three of the people told us they were looking forward to going to the local disco that evening. The manager said the home is planning to turn the big garage in the back of the garden into an activities room, to have a vegetable patch and to fix the greehouse so people can cultivate plants and grow salad ingredients. The home is also in the process of booking holidays for all the service users. A member of staff was preparing to accompany a resident on holiday to Spain the following day. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 13 The AQAA states that service users are observed by staff during mealtimes to ascertain the food that they like and dislike and this is recorded in the menu comment book and acted upon. This information is shared with the whole staff team via minuted meetings. Care plans also gave evidence of the personal food preferences of people. A monthly menu is displayed in the home, and we were told that if the service users do not want what is on the menu or the alternative for that day they can ask for a different meal. The service users also engage with staff on food shopping. We were told that the home is considering involving more service users in meal preparation and cooking with the appropriate risk assessments in place. The residents’ comments from their surveys indicated in relation to their choice in what to do in the day, evening and weekend, out of a top score of 30, 29 with one comment—‘sometimes if there is enough staff on.’ The manager stated that all service users help with household tasks, washing up, loading the dishwasher, vacuuming the communal areas and their own rooms, laundry days, etc all with support. One of the service users is now meaningfully engaged in a college course, and an evening club. Currently the activity plans are completed on a weekly basis. The manager stated that the home aims to complete the structured two-week activity plan and ensure that it runs successfully, altering it when required. It was evident from observation and comments from the staff that the high level of support diverted to one resident meant the others were less motivated. The staff said they felt they could do more with the residents if they had the time. Fernlea has an open visiting policy and reference was made by the staff to various family members who come and go. The residents also have time at home with their family, varying from an afternoon out to a weekend, or a week away. The manager stated that as a result of regular residents’ meetings an idea was raised to have a video evening once a week with ice cream and popcorn, and this was now happening and had proved to be popular. Photographs were seen of a day trip to ‘monkey world’ last summer when all the residents had joined in. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 14 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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are supported and their physical and emotional needs are met in the way they prefer and require, including dealing with medicines. EVIDENCE: We looked at the care plans and saw that each person has a designated key worker. Working records indicate if someone has a preferred routine of personal care, and the shape of their day was determined by their own choice. The staff explained that guidance and support is given on personal hygiene where needed. Not all service users are able to bath, dress etc independently, the staff team do verbally prompt service users for what they need to do. Service users choose their own clothing with occasional guidance from staff on the weather. Service users are supported in buying toiletries, before they run out. They choose their preferred method to personal hygiene e.g. bath/shower. There was evidence of hospital/dental/specialist and GP appointments. The requirement made at the last inspection to refer a resident for an Occupational Assessment, and a doctor’s review of the strategy to manage two persons’ Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 15 epilepsy had been followed through. Professional advice had been obtained and as a result an aid had been purchased which has lead to significant reassurance for the staff, the resident and their family. This requirement has now been met. The AQAA states that Speech and language therapists, occupational therapists, clinical psychologists and physiotherapists regularly visit the home and work closely with the service users and staff. It also states that all of the service users have regular check ups and reviews on all their healthcare needs. They are all registered with a GP, and attend with support from staff. All have a dentist and optician, but we were told that not all wish to attend. The manager said that non attendance is respected but usually now followed up by the creation of a written risk assessment. The residents present on the day had limited motivation or ability to talk with the inspector. However, we observed and noted from records and discussion with staff significant change in two of the residents who had been in the home for some time. They had previously been very withdrawn with minimal group contact, and were now moving around the home and seemed to be mixing comfortably with others. We were told by one family member that the service user’s speech has improved. We saw that pictorial aids were in use to help with basic functions. We learned that one resident looked after his own medicine administration. He is supported in renewing the prescriptions. Staff monitor that the prescription is followed and a risk assessment is in place to cover this. The drug cupboard and records were inspected. A monitored dosage system is in place. A drug refrigerator was in use. The records were all up to date and well ordered, including drugs received into the home. Over the counter remedies are now prescribed by the local practices and a record kept of their administration. This was a requirement from the last inspection, which is now met. A protocol was available for PRN medicines (as and when needed). Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 16 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 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users feel their views are listened to and acted on. They are protected from abuse, neglect and self harm. EVIDENCE: No complaints have been referred to CSCI about Fernlea since the last review of the home. In the confidential surveys all of the residents said they knew who to talk to if they were not happy with anything. Two of these residents said they did not know how to make a formal complaint. Two said they have no complaints. The survey results showed that 83 said the staff listen well and the residents feel understood. The manager explained that whenever any dissatisfaction is expressed by a resident the staff are trained to ask the residents if they wish to make a complaint and, if they receive a positive response, the staff would help them to do so. The complaints policy incorporates a pictorial guide provided by Craegmoor. A copy is incorporated into each personal file accessible by the resident. The complaints log had no record of a recent complaint. We talked with the manager about the boundary between what constitutes a concern and a complaint and it is helpful to have a central log of comments and concerns. This can then be periodically analysed to demonstrate the action the home has taken to deal with minor irritations. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 17 The AQAA from the home states that a complaints procedure is in place and all complaints are dealt with in a certain time scale and the outcome is either informed in person or in writing. All staff are aware of the complaints procedure and how to support the service users who wish to use the procedure. All staff have had safequarding training and the staff attend ongoing training around adult protection on a regular basis. The staff spoken with on the day expressed a very client centred attitude and would not hesitate to bring to light any negative issues impacting on the residents. The CSCI have received a number of notifications of incidents of a serious nature, detailing the context of the incident and the action taken to safeguard the residents and the staff. The manager told us that the home uses comment cards which are confidential and placed into a locked box, questionnaires, policies and procedures manual and a training manual. Meetings are held more regularly for all service users even when they are not in crisis so the home can be proactive instead of reactive, thus preventing issues from arising that could have possibly become a complaint. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users live in a homely, comfortable and safe environment, which is clean and hygienic. EVIDENCE: Fernlea is a detached house situated in a residential area of Brockenhurst, in the New Forest. Attention to the exterior of the house was required at the last inspection and it was pleasing to note that the home has been fitted with UPVC window frames and the exterior has been painted. Much of the interior has been also been redecorated and new carpets fitted. New fire doors including bedroom doors have been fitted. There is a small number still to be completed. The residents all have single rooms with a toilet and washbasin and two also have a bath and another a shower. There are two separate bathrooms and a Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 19 shower room. A shower curtain and the flooring in the downstairs bathroom have been replaced as a requirement from the last inspection. The home has a lounge with dining area, and a separate small dining room that is not often used by residents, but is used by staff for handover meetings and is where the medicines are stored. It was noted at the last inspection there were insufficient chairs for the number of residents as a few had been broken. A requirement was made and there were adequate numbers of chairs seen on this occasion. The manager stated that she is about to change the furniture in the lounge which is worn and jaded. The residents were evidently ‘at home’, using their rooms when they wanted and coming into the communal areas when they chose to do so. The survey comment in relation to the house being fresh and clean drew 95 positive comment (9 out of 10 residents gave the home full marks). The kitchen is domestic in type and the home has a separate laundry room. Rooms seen looked clean and homely, fitted with appropriate furniture and designed with personal items and memorabilia of residents’ choice. There were no adverse odours. Visitors to the home are admitted by a staff member and are asked to sign the visitor’s book. The visitors’ book contained times when visitors had signed on arrival at the home and when they had left the premises. There is a large garden to the rear of the property with parking spaces and there is also a small parking area at the front of the home. We saw four residents using the patio area during the day. Patio slabs that were unsafe had been identified at the last inspection and these had been made safe. A risk assessment was also required of the patio area on the day of the last inspection, and also of the steps from the kitchen doorway and hall doorway into the lounge area to ensure residents with mobility difficulties are not at risk from falling. These had been completed. The manager said she is obtaining quotes to improve the patio area. The AQAA states that the home has an ongoing maintenance schedule and a maintenance man who will do decorating jobs and minor repairs. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 20 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, 34 and 35. 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 committed and competent staff team that is currently overstretched, and lack regular supervision. EVIDENCE: The AQAA submitted by the home states that the usual roster pattern is to have three staff on shift between the hours of 07.30am and 14.30 and 14.30 until 10pm. After 10 pm there is 1 waking member of staff and 1 sleep-in member of staff who is on call if needed. In addition the manager is on the premises Monday to Friday and is always contactable outside of working hours if needed. This was found to be the case on the day of the inspection during the morning, but down one staff member in the afternoon and evening due to a sudden family bereavement. We were told that the manager was staying on into the evening to help with the cover. We noted that one of the residents required the full time 1:1 attention of one member of staff, leaving: • the manager to assist with the inspection, • one member of staff, in part, assisting a service user in the community • one to co-ordinate the activities of the other 9 residents. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 21 The staff were working quite hard as each of the residents require significant communication and encouragement. The manager stated that the extra demand from one resident had drawn a lot of focus and extra energy leaving the team feeling tired. The manager said this was a short term problem as she hoped there would soon be a placement change, but she was concerned to protect the team from prolonged additional demands. We were told that in the interim the purchasers have arranged and expect 1:1 staff support for this service user. It is expected therefore that an additional member of staff be rostered on duty during daytime hours to dedicate to this service user’s needs. Two of the staff were spoken with in private and interactions with the residents were observed. Almost all the staff have been employed for a long time, are experienced and understand the needs and individualities of the residents. Four staff records were sampled. The majority were up to date and contained the necessary information. One file contained testimonials rather than references; one lacked a reference and a photograph. These were brought to the manager’s attention with a recommendation that each file have a checklist of content to ensure they are all up-to-date and complying with the legal requirements. The AQAA states that before starting work all staff have a completed POVA and CRB check. There is a probationary period of 3 months, and in that time they are assessed by the manager and comments included from the service users. The service users support new and potential staff by showing them around and informing them of how they like things done. A Code of Practice booklet is given to each member of staff and an induction completed. All staff have the opportunity to complete a National Vocational Qualification (NVQ) in care once their probationary period is over. 3 full time staff hold an NVQ 3 and two members of staff are currently completing an NVQ 3. The home has ongoing training in place and a personal development plan in place for individual staff. All staff receive adequate training and the home maintains high statistics on training levels. Confidential surveys from the six staff members reported that: • 100 confirmed that all checks were completed pre employment • 91 agreed they are given enough information about the needs of the people they support • 85 felt the induction covered what they needed to know when they started. • 100 felt the training was relevant and helpful • 71 agreed that the manager met with them to give support and discuss how they are working. • As far as the residents commented, 98 said the staff were kind. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 22 The AQAA states that work performance is monitored through supervisions. The records on file confirm this does take place but not for all staff regularly. This was brought to the manager at the time of the inspection. Reserved/negative comments from staff include: • If we are doing 1:1 sometimes there are not enough staff on shift to meet the needs of other service users, especially when they have professional appointments/visits. • Some staff need more training in how to interact with the residents. • Communication can be poor • We could definitely use more staff • Sleep room is poor-noisy • Sleep rate is poor • Some staff are rude and one is bullying to other staff • There is a lack of drivers, and because of this I feel we let the service users down • Some staff do too many long days. • Sometimes there is inconsistent management that creates confusion • Unfair distribution of tasks • Some staff are overloaded on day shift • We need more staff allowing for better 1:1 All of these points were brought to the attention of the manager, with an urgent recommendation to review through regular supervision and appraisal the concerns of the staff team. The issue of the sleep-in facility has happened since the registration increased from 9 to 10 residents and the large office converted to a dedicated resident’s room. Staff sleep either in the dining room or the small office in the extension. Neither are suitable in terms of routine household noise or comfort. We were told that broken and disturbed sleep leading into a full day shift can be over stretching and contributes to the high stress levels. It is strongly recommended that the provider consider making more suitable arrangements for the sleeping night staff. Staff meetings are held regularly, and are minuted. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 23 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 adequate. This judgement has been made using available evidence including a visit to this service. The home is run by a manager who is taking action to promote the health, safety and welfare of residents and staff, and the providers use feedback from residents and their relatives to plan improvements to the service. EVIDENCE: The home has experienced a number of changes of management in recent years. The new manager has been in post since January 2007 and therefore since before the last inspection. She is full time and experienced in the care of people with learning disability but has not previously held a registered manager’s role. She is qualified to NVQ level 3 rather than the level 4 which is the required National Minimum standard. She is currently working towards the Registered Manager’s Award and anticipates gaining this qualification in approximately four months time. She informed us that her application for Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 24 registration was ready for submission and would shortly be processed. However, this is a priority to be resolved. It is a legal requirement for a care home to have a manager who is registered, and the submission of the application is made a requirement at the conclusion of this report. We were told by staff and family members that in the leadership the manager gives the team, the outcome for the residents and the staff team working to set standards and objectives, there is respect and affirmation of the current leadership arrangements. The provider conducts an annual audit of the home and a copy was supplied during this inspection. It identified a number of improvements needed last summer and the manager told us these have all subsequently been fulfilled. Regular monthly monitoring visits are conducted by a representative from Craegmoor and their findings were recorded. Records were available for the servicing and maintenance of equipment, and maintenance of electrical systems and fittings. Fernlea operates a number of methods for gaining the views of service users, their families and the staff. These include group meetings, suggestion cards, a comment box, ‘your voice’ regular forum, and stake holder surveys. Care managers and specialist /professional staff engage in the care planning process and reviews. Service users said their views mattered and they felt listened to, scoring an 83 rating. The manager had ensured that all of the staff had received training on health and safety, moving and handling, first aid, food hygiene and infection control. Records were seen. We were told that the manager had recently attended a training day on legionella. The accident book was inspected. Three incidents had been recorded and remedial action taken where necessary. No health and safety hazards were identified during this visit apart from the improvements that are required from the identified deficiencies i.e. assessment systems, recruitment checks, and supervision. Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 25 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 2 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 3 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 3 33 x 34 3 35 2 36 x 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 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 3 x x 2 x Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA36 Regulation 18 (2) Requirement All staff must receive regular support and supervision to ensure consistency for the service users and feedback on their performance. The provider shall confirm the name and date of the appointment of the manager and arrange for this person to submit an application for registration with the Commission. Staff records must include references and proof of a person’s identity including a photograph, to ensure service users are protected by the home’s recruitment practices. An additional member of staff must be rostered on duty during the day shifts during the current placement to ensure all service users are protected and supported. Timescale for action 31/07/08 2 YA37 8 (2)(a and b) 30/06/08 3 YA34 19 (1) b 31/07/08 4 YA33 18 (1)a 30/06/08 Fernlea Care Home DS0000037572.V361169.R01.S.doc Version 5.2 Page 27 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.V361169.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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