Inspection on 04/01/07 for Fernlea Residential Home

This inspection was carried out on 4th January 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fernlea Residential Home 19/12/08

Fernlea Residential Home 24/03/06

Fernlea Residential Home 25/09/05

Fernlea Residential Home 03/02/05

Fernlea Residential Home 30/09/04

Fernlea Residential Home 12/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Aston Court Nursing Home

Polesworth Group 70 Long Street

Breme

Ravenhurst

Polesworth Group 64 Long Street

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

CARE HOME MIXED CATEGORY MAJORITY ADULTS 18-65 Fernlea Residential Home 114 Sandon Road Meir Stoke-on-trent Staffordshire ST3 7DF Lead Inspector Keith Jones Key Unannounced Inspection 4 January 2007 09:00 Fernlea Residential Home DS0000008228.V325331.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 Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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 Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernlea Residential Home Address 114 Sandon Road Meir Stoke-on-trent Staffordshire ST3 7DF 01782 342822 01782 342822 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) Priorcare Homes Limited Mrs Rachael Foden Care Home 13 Category(ies) of Learning disability (3), Physical disability (13), registration, with number Physical disability over 65 years of age (8) of places Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 24 March 2006 Brief Description of the Service: Fernlea is located on the outskirts of Meir, Stoke-on-Trent and is within walking distance of a post office, a small supermarket, a fish and chip shop, a newsagent’s and a post office. The property is set back from the main road, adequate parking is available. Fernlea provides care and accommodation for up to thirteen service users with a physical disability, eight of who may be over 65. Fernlea also has the facility to care for three adults with a learning disability. All accommodation is single storey, all the bedrooms are singles but none have an en-suite facility, not all of the bedrooms meet the minimum twelve sq metres standard size. A spacious lounge dining room and a large recreation room provide adequate communal space for the currently fully occupied home. Access to kitchen is limited due to the domestic style and size; however, a kitchenette area has been created in the recreation room to enable service users to remain as independent as practicable. Bathing facilities are provided in a spacious assisted bathroom and a separate walk-in shower room. Two additional assisted toilet facilities are also provided. The home has a good sized patio and rear garden which is well used during the warmer months. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over one day, by one inspector, the care manager, deputy and senior staff, in a professional and cordial atmosphere. The Inspector acknowledged receipt of the prepared information questionnaire and 5 comment sheets, all complimentary. The last inspection report was discussed, and it was noted that most of the requirements and recommendations had been dealt with satisfactorily. On the day of inspection there were 13 service users in residence. A tour of the Home allowed free and open access to all areas for inspection. The opportunity was taken to speak with a number of residents, relatives and members of staff. Service users and staff took an active role in the inspection process and contributed to the subsequent report. Throughout the entire inspection a sense of homeliness and familiar confidence pervaded into all aspects of daily activity expressed by those people met. A review of the administrative arrangements confirmed solid practice. A full verbal report was offered at the end of the inspection to the care manager, who had been joined by the deputy manager and for the feedback. The inspector thanked all concerned for their contribution to a pleasing and constructive inspection. What the service does well: What has improved since the last inspection? In addressing the requirements and recommendations made, the Home has demonstrated a meaningful commitment to the ethos of continuing improvement of standards, especially in addressing clinical supervision and training. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Individual Needs and Choices Lifestyle Personal and Healthcare Support Concerns, Complaints and Protection Environment Staffing Conduct of Management of the Home Scoring of Outcomes Statutory Requirements Identified During the Inspection Adults 18 – 65 (Standards 1–5) (Standards 6-10) (Standards 11–17) (Standards 18-21) (Standards 22–23) (Standards 24–30) (Standards 31–36) (Standards 37-43) Older People (Standards 1–5) (Standards 7, 14, 33 & 37) (Standards 10, 12, 13 & 15) (Standards 8-11) (Standards 16-18 & 35) (Standards 19-26) (Standards 27-30 & 36) (Standards 31-34, 37 & 38) Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 (Adults 18 – 65) and Standards 1 – 5 (Older People) are: 1. 2. 3. Prospective service users have the information they need to make an informed choice about where to live. (OP NMS 1) Prospective users’ individual aspirations and needs are assessed. No service user moves into the home without having been assured that these will be met. (OP NMS 3) Prospective service users’ know that the home that they choose will meet their needs and aspirations. Service Users and their representatives know that the home they enter will meet their needs. (OP NMS 4) Prospective service users’ have an opportunity to visit and “test drive” the home. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. (OP NMS 5) Each service user has an individual written contract or statement of terms and conditions with the home. Each service user has a written contract/statement of terms and conditions with the home. (OP NMS 2) 4. 5. The Commission considers Standard 2 (Adults 18-65) and Standards 3 and 6 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1–5 The quality in this outcome area is good. This judgement is based on the examination of the homes policies, procedures, practices and discussions with management. Fernlea ensures that prospective residents have the necessary information to enable an informed choice to be made. Aims and objectives, terms and conditions are clearly presented in a way to facilitate easy understanding of services and standards of care. It is recognised that the Statement of Purpose represents the foundation on which the home operates upon, offering service users and their relatives the opportunity to make an informed choice about where to live, through the Service User Guide. Following an assessment the senior assessor determines the suitability of the application in view of the facilities available, and of the capacity of the home, to manage the individual and any special needs. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 9 EVIDENCE: The Statement of Purpose and guidelines reflect an expression of philosophy, and have been well established in representing the foundation on which the home operates upon. It presents a sound description of the home’s aims and objectives, philosophy of care and terms and conditions. The Care Manager is consistently reviewing the key information policies of Statement of Purpose, Service User Guide and Resident’s contract to reflect the changing environment and circumstance. The care management adheres to an admission policy of personal supervision of the pre-admission assessment. Case tracking demonstrated the presentation of a highly personal approach to prospective residents and their relatives on pre-admission. Case tracking of three service users’ care records showed that an appraisal is made, and discussed, to ensure the home can satisfactorily meet those needs. Case tracking and discussion with service users confirmed that this standard continues to be well met. Following an assessment the senior assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the individual and any special needs. Likewise the applicants are informed of those facilities and are encouraged to seek clarification concerning the general and specific services available for the prospective service user. This could involve trial periods on several occasions. Case tracking and discussion confirmed that a valuable exchange between service users and assessor took place and resources made available. These resources were seen to be an appraisal of staffing skills, equipment and general environment. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6-10 (Adults 18-65) and Standards 7, 14, 33 & 37 (Older People) are: 6. Service users know their assessed and changing needs and personal goals are reflected in their Individual Plan. The Service Users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users make decisions about their lives with assistance as needed. Service Users are helped to exercise choice and control over their lives. (OP NMS 14) Service users are consulted on, and participate in, all aspects of life at the home. The home is run in the best interests of service users. (OP NMS 33) Service users are supported to take risks as part of an independent lifestyle. The service users health, personal and social care needs are set out in an individual plan of care. (OP NMS 7) Service users know that the information about them is handled appropriately and that their confidences are kept. Service Users rights and best interests are safeguarded by the home’s record keeping, policies and procedures. (OP NMS 37) 7. 8. 9. 10. The Commission considers Standards 6, 7 and 9 (Adults 18-65) and Standards 7, 14 and 33 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9, and 10. Quality in this outcome area is “good”. Residents spoken to were keen to show the extent of independence and the degree of involvement in their care and lifestyle, a ‘partnership’ approach. This focused on positive behaviour, ability and willingness of the individual, showing that service users freely make decisions about their life in the home. Residents were also seen to be supported by their key workers, and the management to take risks as part of an independent lifestyle in the home. The arrangements for socialisation are comprehensive and conducive to the ethos of supported living. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 11 EVIDENCE: Assessments, care plans and risk assessments were examined and found to offer a sound record of daily living, which were comprehensive, and included an assessment; a person centred plan, a risk assessment, and a an awareness of the socialisation aspect of a planned, therapeutic programme of care. Evidence of health care professional visits showed an attentive awareness to service user’s needs. It was noted that there is a varied schedule of events encouraging therapeutic and social activities geared to meeting service users’ sense of belonging. Three residents were case tracked with a full examination of care records, health records including general practitioners and professionals’ visits, risk assessments, dependency charts, records of reviews and action plans. Records inspected showed that residents freely make decisions about their life in the home. Altogether the care ‘package’ offers a comprehensive appraisal of resident’s needs and aspirations. Risk assessments were carried out on an individual basis and reviewed. Included in the care records were applications of established key-worker input, psychological assessment and a clear demonstration of ‘factors that maximise contentment’. During the inspection the inspector was impressed with the pleasant environment, and cheerful banter, promoting personal awareness and a sense of belonging. Throughout the Inspection there were constant attention to the individuality, and respect of ‘ownership of personal domain’. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 (Adults 18-65) and Standards 10, 12, 13 & 15 (Older People) are: 11. Service users have opportunities for personal development. Service Users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are able to take part in age, peer and culturally appropriate activities. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users are part of the local community. Service users maintain contact with family/ friends/ representatives and the local community as they wish. (OP NMS 13) Service users engage in appropriate leisure activities. Service users find the lifestyle experienced in the home matches their expectations and preferences and satisfies their social, cultural, religious and recreational interests and needs. (OP NMS 12) Service users have appropriate personal, family and sexual relationships and maintain contact with family/friends/representatives and the local community as they wish. (OP NMS 13) Service users’ rights are respected and responsibilities recognised in their daily lives. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users are offered a (wholesome appealing balanced) healthy diet and enjoy their meals and mealtimes. Service users receive a wholesome appeaing balanced diet in pleasing surroundings at times convenient to them. (OP NMS 15) 12. 13. 14. 15. 16. 17. The Commission considers Standards 12, 13, 15, 16 and 17 (Adults 1865) and Standards 10, 12, 13 and 15 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 13 11,12,13,14,15,16 and 17 The quality in this outcome area is ‘good’. Throughout the inspection residents were seen to be enjoying freedom to express themselves in positive and meaningful ways. Bedrooms were seen to demonstrate that individuality, each different to match personal outcomes. A fully flexible open visiting policy was seen to be in operation with some visitors present throughout the inspection, reflecting the importance placed upon family or friends’ regular contact. The residents and staff were seen to be enjoying a well-presented lunch. EVIDENCE: The Statement of Purpose and Guide indicate a flexible routine, established to meet the preferences of service users. The policy was evidenced in admission assessment, care plans examined, and talking to service users and relatives, a policy much appreciated and freely expressed. Routine is seen as flexible to acknowledge individuality, yet maintain a focal point for service users to latch on to without dictating events. Staff were observed to hold a friendly, sympathetic and confident interaction with service users and family, in lounge areas and at lunchtime in helping those who required assistance. Service users’ life-styles and interests are recorded in their care plans, including a ‘my life story’. Lifestyles are discussed with families prior to admission, and documented as far as possible to enhance a position of supported independence. The recording of social activities was seen to be a valuable component of care reporting and planning. The management demonstrated the strength of protecting service user’s rights, which was secured through the robustness of the procedures in place. This was confirmed on examination of records. The tour of the Home demonstrated a high degree of expressed individuality in each of the bedrooms inspected. A varied menu is decided by the residents and represent a wholesome and varied balanced diet. It was noted that the duties of cooking meals fell within the remit of a generic workforce. The Care Manager was advised to limit the variability of roles between offering care, housekeeping and catering services by one staff workforce on a given shift. Nevertheless lunch was served during inspection, and meals seen to be wholesome and nutritious, with service users Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 14 appreciative of the quality of preparation and serving. Three meals are offered daily, along with snacks and hot and colds drinks throughout. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 – 21 (Adults 18-65) and Standards 8 – 11 (Older People) are: 18. 19. 20. Service users receive personal support in the way they prefer and require. Service users feel they are treated with respect and their right to privacy is upheld. (OP NMS 10) Service users’ physical and emotional health needs are met. Service users’ health care needs are fully met. (OP NMS 8) 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. Service users, where appropriate, are responsible for their own medication and are protected by the home’s policies and procedures for dealing with medicines. (OP NMS 9) The ageing, illness and death of a service user are handled with respect and as the individual would wish. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. (OP NMS 11) 21. The Commission considers Standards 18, 19 and 20 (Adults 18-65) and Standards 8, 9 and 10 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21 The quality in this outcome area is ‘good’ The pre-admission assessment is recognised as the foundation for a wellconsidered care planning process. A profile of the service user’s social, physical and psychological status offers an individual plan of care to be implemented and reviewed. Service users spoken to were particularly pleased in the way their privacy and dignity was respected, not only by the care staff, but everyone connected to the running of the home. The Home operates an environment conducive in support of individual physical and emotional needs. The routines involving medication was generally safe, secure and efficiently administered. Discussion concerning an aging population with associated care needs identified a recognised feature for long-term planning. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 16 EVIDENCE: It was pleasing to see that the administration of medicines generally adhered to procedures to maximise protection to service users. An appraisal of the supply administration and staff training processes has provoked the management into seeking a new pharmacy service, commencing mid-January. Evidence of staff training, homely remedy security and stock control were satisfactory. There were some gaps in the administrative record of medicines not issued, to which the Care Manager will address. There was advice offered in ensuring the provisions to handle controlled drugs were established, and to enhance the MAR records with a profile sheet with photograph, room number and special conditions for safe administration. The philosophy of promoting individuality and self-determination, as laid out in the Statement of Purpose, continues to be seen to be exercised in many aspects of care. The general atmosphere throughout the home was one of family, confidence, warmth and contentment. Staff were observed in addressing service users in a respectful and dignified way. The service user’s spiritual needs are attended to with respect. Relatives are involved and have free access at all times as desired by the service user. It was noted that an appraisal of any special preferences or observances is recorded on admission, and is regarded as integral in the assessment process. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22-23 (Adults 18-65) and Standards 16-18 & 35 (Older People) are: 22. 23. Service users feel their views are listened to and acted on. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted on. (OP NMS 16) Service users’ are protected from abuse, neglect and self-harm. Service users legal rights are protected. (OP NMS 17) Also Service users are protected from abuse. (OP NMS 18) Also Service users financial interests are safeguarded. (OP NMS 35) The Commission considers Standards 22-23 (Adults 18-65) and Standards 16-18 and 35 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The quality in this outcome area is ‘good’. This judgment is based on the examination of the homes revised complaint procedure and the recruitment and training procedures of staff to ensure the protection of service users. The Home had revised and prepared a clear complaints policy, identifying the CSCI as a resource to approach with a complaint or grievance. On discussions it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. Service users’ legal rights are protected by the systems in place in the home to safeguard them, including their contract, the continual assessment of care planning and policies in place. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 18 EVIDENCE: A revised complaints policy and procedure was seen and found to be satisfactory. The care manager kept a complaints file for minor issues resolved locally. This record was found to be sufficient, having dealt with recent problems in a way to satisfy the complainant. This reinforced the importance that Fernlea holds effective record management in facilitating a speedy resolution to conflicts. There have been no complaints submitted to CSCI over the last year. The provider showed satisfactory evidence of a protocol and response to anyone reporting any form of abuse, to ensure effective handling of such an incident. Staff induction and in-house training programmes clarified the responsibilities of all staff in their daily contact with service users, especially their privileged position in protecting service users from abuse, of all natures. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 (Adults 18-65) and Standards 19-26 (Older People) are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users live in a safe, well-maintained environment (OP NMS 19) Also Service users live in safe, comfortable surroundings. (OP NMS 25) Service users’ bedrooms suit their needs and lifestyles. Service users own rooms suit their needs. (OP NMS 23) Service users’ bedrooms promote their independence. Service users live in safe, comfortable bedrooms with their own possessions around them. (OP NMS 24) Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Service users have sufficient and suitable lavatories and washing facilities. (OP NMS 21) Shared spaces complement and supplement service users’ individual rooms. Service users have access to safe and comfortable indoor and outdoor communal facilities. (OP NMS 20) Service users have the specialist equipment they require to maximise their independence. Service users have the specialist equipment they require to maximise their independence. (OP NMS 22) The home is clean and hygienic. The home is clean, pleasant and hygienic. (OP NMS 26) The Commission considers Standards 24 and 30 (Adults 18-65) and Standards 19 and 26 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 20 24 – 30 Quality in this outcome area is “good”. The facilities in the Home are domestic in style and afford the residents with a comfortable, homely environment. The home has succeeded in meeting the needs of service users in providing a safe environment. Bedrooms were generally well maintained to meet service user’s personal preferences; the outcome is a comfortable and familiar private domain that reflects the service user’s preferences. There is evidence of an awareness of health and safety issues on training and practical supervision priorities. Individual rooms are presented as highly personalised and inviting individual residence. The Home continues to present a clean and pleasant, odour-free atmosphere, much to the credit of staff. EVIDENCE: Fernlea has been open for over 20 years, due to it being a long established home it does not fully meet with the national minimum standards, with some bedrooms not of the appropriate size. Nevertheless those rooms do not represent a problem for the incumbent residents, who appreciate the snugness and practical dimensions to meet their special needs, especially on wheelchair management. The location of Fernlea is conducive for a care home, situated in an urban setting with good access to road links, and a short drive to Stoke, Meir and Meir Heath. The building has been well maintained, having had continual attention to refurbishment and an ongoing upgrading programme. There was however several instances that ongoing maintenance/upgrade was representing a problem with debris cluttering the corridors, or awaiting delivery of items. These issues of Health and Safety were discussed with the Care Manager for immediate attention. External facilities were satisfactory in pleasing surroundings. The furniture and fittings are comfortable and are domestic in character. The communal areas of the home are nicely decorated and the overall impression is of a pleasant home, although some areas would benefit from ‘finishing touches’ to give a more homely feel, including attention to some furniture nearing replacement. It was noted that the lounge area was practical in design and use to facilitate use of wheelchairs. The recreation room was suitable, although it would be enhanced with the re-siting of the laundry rack. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 21 Each of the bedrooms provided a satisfactory level of furnishing and facilities to which each resident has been encouraged to add their personal belongings, furniture and décor as the wished. It was noted that all electrical equipment brought in for residents was PAT tested, and identified as such. Adequate attention has been given to ensure maximum privacy within riskassessed boundaries. Toilets are accessible to all and within close proximity to all communal areas. The standard of cleanliness continues to be seen to be excellent throughout. It was most encouraging to observe a clean and pleasant, odour-free atmosphere, much to the credit of staff. The kitchen area was domestic in design and adequate for the purpose. It was well equipped and clean. Fridge freezers were well maintained and monitored. The Care Manager was advised to keep the cleaning schedule record up to date. The laundry area was very small in offering a suitable environment for processing laundry. Contamination of clean items is a real possibility being in close proximity to a sluice area and only a few feet away from dirty linen skips. Alternative arrangements are to be addressed. The care Manager was advised to display COSHH posters alongside written procedures in all areas that use or house chemical products. The home uses liquid soap and paper towels for hand washing to help prevent cross infection in all the bathrooms and toilets, infection control training has also been provided to all the staff. Personal protective equipment was available and sited appropriately and the clinical waste was collected on a weekly basis. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 (Adults 18-65) and Standards 27 – 30 & 36 (Older People) are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users are supported by competent and qualified staff. Service users are in safe hands at all times. (OP NMS 28) Service users are supported by an effective staff team. Service users needs are met by the numbers and skill mix of staff. (OP NMS 27) Service users are supported and protected by the home’s recruitment policy and practices. Service users are supported and protected by the home’s recruitment policy and practices. (OP NMS 29) Service users’ individual and joint needs are met by appropriately trained staff. Staff are trained and competent to do their jobs. (OP NMS 30) Service users benefit from well supported and supervised staff. Staff are appropriately supervised. (OP NMS 36) The Commission considers Standards 32, 34 and 35 (Adults 18-65) and Standards 27, 28, 29 and 30 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 Quality in this outcome area is “good”. Staffing levels were seen to be satisfactory, the daily care staffing rota showed adequate balance between skills, qualifications and numbers to provide a good standard of care. The improvements made in staff selection/appointment have had a significant effect upon the provision of cares to ensure protection of service users, although there remain areas for improvement. Records show improved staff training had a broad spectrum of care and allied subjects covered, ensuring that staff fulfil the aims of the home and meet the changing needs of service users. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 23 EVIDENCE: There were 13 service users in the home on the day of the inspection. Off-duties for week commencing 18/12/06 – 07/01/07were provided and examined; staffing levels were seen to be satisfactory. The daily care staffing rota showed adequate balance between skills, experience and numbers to provide a satisfactory standard of care. The staffing establishments were examined and found to be satisfactory in meeting the staffing notice. An average coverage was seen to be: Early shift – 0800 - 1500 - 1 senior carer and 2 care staff. Late shift – 1500 - 2000 - 1 senior carer and 1 care staff. Night shift – 2000 - 0800 - 1 care staff 1 sleeping. Agency and bank staff are rarely used to meet shortfalls in covering shifts, with attention offered to overtime and flexible rostering. The Care Manager offers a shift coverage in times of need. All senior care staff are qualified to NVQ 2 or above, and the care staff have recently enrolled on the same course. Three files pertaining to members of staff working in the home was randomly selected for examination. The Home has reviewed and improved the procedure for interview, selection and appointment of staff. This involves a standard application form to assess and profile, 2 references taken and CRB (enhanced) checks gathered before a contract is offered to successful candidates. The Care Manager was advised to offer a letter of appointment to confirm the arrangements made at interview. The manager has yet to complete the proposed training matrix, which is expected to cover mandatory training such as training in food hygiene, health and safety, moving and handling, medication training, fire safety and infection control. Evidence of training undertaken was splintered and not clear in assessing. It was advised that a training file should be set up to bring together all training reports for all staff, and ensure that all mandatory training is provided to all staff. Staff induction was seen to be completed in the first few days, whereas a longer time would be more appropriate to ensure a comprehensive understanding of their new duties. Staff supervision has been extensively reviewed with valuable appraisal of practical procedures and general practice. The Care Manager was advised to consider establishing a similar routine in general supervision based on performance, attitude, needs and plans for staff development, on a 2-monthly basis. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 24 On this visit it was identified that all staff undertake generic duties in care, housekeeping and catering as a traditional means of handling the residential workload. The Care Manager was advised to ensure that the necessary training is offered to meet the exigencies of the task, and to ensure that staff are particularly aware of cross infection problems in multi-task work. It was recommended that staff allocated for catering duties be limited in exposure to clinical waste and general hygiene management. It was recognised that the Home employs a maintenance person for 16 hours a week and an administrator for 12 hours a week. Three staff files were tracked and confirmed the policies in action. Each of those members of staff were interviewed and were happy with their working situation, felt valued and received a good standard of training. All staff have the GSCC code of conduct to supplement internal policies. There are 11 care staff with appropriate level of NVQ training (50 ), and the Care Manager has completed Level IV and the Registered Manager’s Award last September. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 25 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 (Adults 18-65) and Standards 31-34, 37 & 38 (Older People) are: 37. Service users benefit from a well run home. Service users live in a home which is run and managed by a person who is fit to be in charge of good character and able to discharge his or her responsibilities fully. (OP NMS 31) Service users benefit from the ethos, leadership and management approach of the home. Service users benefit from the ethos, leadership and management approach of the home. (OP NMS 32) Service users are confident their views underpin all self-monitoring, review and development by the home. The home is run in the best interests of service users. (OP NMS 33) 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 homes record keeping, policies and procedures. (OP NMS 37) Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. Service users rights and best interests are safeguarded by the homes record keeping policies and procedures. (OP NMS 37) The health, safety and welfare of service users are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (OP NMS 38) Service users benefit from competent and accountable management of the service. Service users are safeguarded by the accounting and financial procedures of the home. (OP NMS 34) 38. 39. 40. 41. 42. 43. The Commission considers Standards 37, 39 and 42 (Adults 18-65) and Standards 31, 33, 35 and 38 (Older People) the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 – 43 The quality in this outcome area is ‘good’. This judgement was based on discussions with the Registered Care Manager, the examination of the home policies and procedures with regards to the effective management of the home, general observations during the process of the inspection and discussions with service users and staff. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 26 EVIDENCE: The Care Manager Rachel Foden offers a considerable resource of experience and skills, which are reflected in the high standing in which Fernlea is held by residents, their relatives and the community alike. She has recently achieved and awarded NVQ Level IV and the Registered Manager’s Award. The Registered Providers present a high profile in monitoring, management support and direction, although not able to be present on this occasion. It was pleasing to see this standard continuing to be well met. The Care Manager has a developed formal approach to monitoring quality across a wide range of activities. This includes care risk assessment, care plan review process that is recorded at least once every three months, a staff training programme and an environmental maintenance programme. This includes the setting of objectives, effective budgeting of plans and target dates to aim for, with forward planning in setting objectives on short-term and long-term planning, as evidenced in the arrangements of refurbishment of Fernlea. This process would be enhanced with a monthly review of care plans. Evidence was secured to acknowledge achievements, ongoing and planned objectives. Involved within this process are the views of service users and relatives, confirmed at case tracking and informal discussion. Family forums were routine and valued. Each service users has a personal file containing contractual, financial and personal information. Care plans were drawn up, implemented and reviewed with service users and relatives whenever possible. A sample of administrative, maintenance and care records were examined and found to offer an accurate reflection of a service committed to providing a safe and comfortable environment for elderly service users. These included procedures on first aid, restraint and codes of conduct. Service records for gas supplies, call systems and fire inspectors report were evidenced. Accidents were seen to be addressed, risk assessed, actioned and recorded in an effective way, with access to Riddor if needed. No serious accidents have been reported recently. The style of management was seen as by direct observation, and by discussion with service users, relatives and staff, and that a very open and positive attitude prevails, enhancing the home’s ‘family feel’ and homeliness. The strong support offered by the Registered Provider was evident in the maintaining and consistent appraisal of standards. There was strong evidence of openness and honesty in speaking with service users, relatives and staff in which day to day events and episodes were freely discussed. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of service users. Fernlea Residential Home DS0000008228.V325331.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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 2 3 3 3 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 3 ENVIRONMENT Standard No Score 24 2 25 4 26 4 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT Standard No Score 37 4 38 4 39 3 40 3 41 3 42 3 43 3 3 3 4 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Fernlea Residential Home Score 3 4 3 X DS0000008228.V325331.R01.S.doc Version 5.2 Page 28 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 YA24 Regulation 23(2)(p) Requirement That remedial work is carried out recognising basic health and safely requirements. Timescale for action 04/01/07 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 3 4 5 Refer to Standard YA24 YA33 YA42 YA35 YA20 Good Practice Recommendations Upgrade general fabric, furnishings and décor That staff covering laundry duties do not practice care duties in the same shift. That COSHH posters be secured in areas of chemical usage and storage. That staff training records be reviewed. That all instances of non-administration of medicines be recorded to determine reason for non-administration. DS0000008228.V325331.R01.S.doc Version 5.2 Page 29 Fernlea Residential Home 6 OP19 7 8 9 OP7 YA30 OP38 Garden area to be maintained and made safe from redundant equipment. Rationalise care planning to offer a review of care monthly. The laundry area be upgrading. That a schedule of cleaning be maintained in the kitchen area. Fernlea Residential Home DS0000008228.V325331.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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. 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