CARE HOMES FOR OLDER PEOPLE
Fernleaf Care Home 26 Chesterfield Road South Mansfield Nottingham NG19 7AD Lead Inspector
Stephen Benson Key Unannounced Inspection 14th June 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Fernleaf Care Home Address 26 Chesterfield Road South Mansfield Nottingham NG19 7AD 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) 01623 655455 01623 406370 info@bhcarehomes.co.uk Bank House Care Homes Ltd Mrs Patricia Sooriah K Sooriah Care Home 21 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (21) of places Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service Users shall be within categories OP (21) or DE (over 60 4 beds) 6th February 2006 Date of last inspection Brief Description of the Service: Fernleaf is a care home providing personal care and accommodation for up to 21 older people and has four beds allocated to care for people with dementia. The home provides short term, long term or respite care and accepts emergency admissions subject to bed availability. The home is owned by Mr. and Mrs. Sooriah and is a run as a family business. The home is located in Mansfield town centre and is close to shops, pubs, the post office and other amenities. The home was opened in January 1985 and consists of a former hotel building with extensions added. 19 of the homes bedrooms are single, and 9 of the bedrooms have en-suite facilities. Bedrooms are located on 2 floors and there is a passenger lift. There are 3 bedrooms on the first floor that are accessed by 3 steps, which have a stair lift fitted. The home has an enclosed garden to the rear, which is easily accessible. There is car parking available for up to 8 cars to the front of the home in a small car park. The manager said on 14/06/06 that the fees for the service range from £279 £329 per week depending on dependency needs. There are additional charges for hairdressing and chiropody Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the first visit to the home since 1st April 2006 by The Commission for Social Care Inspection. The inspection lasted for 4 ½ hours and the main method of inspection used was called case tracking which involved selecting 3 residents and tracking the care they receive through the checking of their records and discussing this with them. Other residents were spoken with and additional records were seen. A discussion was had with the manager, care staff on duty and care practices were observed and relatives were spoken with. The premises were not inspected in detail but various areas of the home were visited as part of the inspection. What the service does well:
The manager ensures that all new residents are assessed before moving into the home to ensure that their needs can be met, or immediately on admission in the case of an emergency admission. Each resident has a care plan and this is kept under review. Residents and relatives are encouraged to be involved in preparing and reviewing care plans. This means that an up to date record is held of residents needs and they are able to say what care they require. The home has a separate medication room. Medicine Administration Records were fully and correctly completed and residents said they are observed taking their medication. Residents are given and take their medication as required and it is properly looked after. Practices described showed that residents’ privacy and dignity is respected. A nutritious and well balanced menu is provided which residents are able to put forward suggestions for. New dishes are tried out first to ensure that these are liked. Residents are able to eat meals that they enjoy in a pleasant dining room. Then home is kept to a high standard of cleanliness making a pleasant place for residents to live. Staff training and undertaking a National Vocational Qualification is promoted within the home ensuring that suitably qualified and trained staff care for residents.
Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better:
When the home is helping the resident look after their personal allowances they must ensure that the records made of any financial transactions are up to date and accurate to ensure that residents are not exposed to financial abuse. Please contact the provider for advice of actions taken in response to this
Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to admission and suitable arrangements are in place to respond to emergency admissions. The home does not offer an intermediate care service. EVIDENCE: A resident was admitted to the home in an emergency the night prior to the inspection. A needs assessment had been completed and a care file made up. The Social Worker delivered a Community Care Assessment during the inspection, and the manager said that a full pre admission assessment will be completed. This correctly followed the homes admission procedure, which included how emergency admissions are dealt with. Observation entries were made in the daily notes as to how the resident was settling in. Another recent admission had been planned and the manager had completed a pre admission assessment and a Community Care Assessment received prior to the admission. Care plans were prepared for the resident 5 days after the admission.
Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 10 Staff said that they are given details of any planned admission in handover after the manager has been to assess them before they move to the home. Staff said that they had been briefed on the emergency admission that morning in handover before they commenced work. A resident and a relative said that the manager had come to visit them before moving to the home. There is no arrangement made for the home to provide an intermediate care service Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are set out in a care plan. Residents’ health care needs are fully met. Residents are protected by the home’s policies and procedures for dealing with medicines. Residents feel they are treated with respect and their right to privacy upheld. EVIDENCE: Each resident has an individual plan of care, which details how individual needs are to be met. Those seen had been updated monthly. Staff said that senior staff update the plans and that their views are sought, although they are not notified when a care plan has been updated and this would be useful to know when to read up on any changes. A relative said that she had discussed her relatives care plan with staff and had been able to contribute to it, the resident said that her memory was not good enough to recall whether it was discussed
Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 12 with her. Another resident said that she has told staff she is able to look after her own personal needs and this is what happens. There is a health care services used record included in residents care plans and a record is made of any involvement with health care professionals. There was also information about residents’ psychological health where appropriate. Staff described the arrangements for meeting healthcare needs and said a doctor is contacted if a resident is unwell. Residents said that they can see a doctor when they want to and a relative said that their relative had new glasses a couple of weeks ago. There is a designated medication room and all medicines are appropriately stored. Staff said that they have to have completed the safe handling of medicines course before being able to give out medication. Medicine Administration Records showed that medication has been given as prescribed. Residents said that staff watch them take their tablets. Staff described good practices in maintaining residents privacy and dignity and a resident in a double room said a curtain is provided for her privacy. A relative said that staff always knock before coming in the room when she is visiting. Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents will have increased opportunities to satisfy their recreational interests. Residents are able to maintain contact with family and friends. Residents are helped to exercise choice over their lives. Residents have a wholesome appealing balanced diet in pleasing surroundings. EVIDENCE: There are some details of residents’ interest included in the care plan and a record made of when they have participated in an activity. The cook also works leading some activities and a second person has recently been appointed to share in this. A game of bingo was played during the inspection and a resident was discussing with staff what she needed to do some knitting, and showed some things she had made. Comments were made that residents would like more frequent activities and the manager said that this is the intention by appointing a second activities person. A notice area has been made by the front door to advertise forthcoming activities and copies of the
Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 14 residents/relatives meeting had suggestions for trips out during the summer and organising a barbecue. There are two residents who have been assessed as being able to go out unaccompanied and another resident has been assessed as being able to help in the kitchen at her request. Details of family visits are included in the care plans and visitors said they are welcome to visit at anytime and have taken their relative out to the park. Staff described offering choices to residents where able including when they get up, what they wear and when they go to bed. Staff were seen asking residents where they wanted to sit and to choose their lunchtime meal. Residents said they can choose how to spend their time, use the garden and one resident said that she does some of her own washing. The cook said that she has just finished preparing a new menu, which is being implemented next week. Residents have been consulted on what they would like and a number of new dishes have been tried, including spaghetti bolognaise, cauliflower cheese and lasagne, which although not liked by all some did. Much of the cooking is homemade and the menu provides a choice at each meal and the meal record book showed that additional choices are also provided. The main meal is at lunchtime and includes a soup course and sweet or pudding. The kitchen was well organised and the dinning room is a pleasant environment to eat meals in. Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that their complaints will be listened to, taken seriously and acted upon. Residents are protected from abuse. EVIDENCE: The home has a complaints procedure and designated book to record any complaints in. A relative said that she had seen the procedure in her relative’s bedroom and residents said they can raise anything with the manager and that staff listen to anything they have to say. Staff said they would pass any concerns onto the manager. There is a copy of the Adult Protection Procedures in the office and staff said that they were aware of the Adult Protection Procedures, but had not needed to use them. Residents said that they thought everyone was well treated. Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe well maintained environment. The home is clean, pleasant and hygienic. EVIDENCE: The manager said that a new roof has been fitted since the last inspection. A handyperson is employed to carry out routine maintenance and was decorating one of the resident’s bedrooms during the inspection. Staff said that the building had a homely feel and was suitable for them to carry out their duties. Residents said they loved the building and a relative said that the rooms seem lovely. The home was clean, tidy and fresh and residents said that it was always this clean. Domestic staff work to a cleaning plan and record where they have
Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 17 done. All bedrooms are cleaned daily. The laundry is appropriately sited and furnished and staff have received training on cross infection. Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are met by the numbers and skill mix of staff. Residents are in safe hands at all times. Residents are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. EVIDENCE: There are three care staff on each morning shift and two on afternoons and overnight. In addition the home employs catering and domestic staff and a handyperson. The majority of staff have achieved National Vocational Qualification level 2 or 3 and other staff are close to completion. The deputy manager is working towards National Vocational Qualification level 4. Staff spoken with said that they have a qualification and residents said that staff seem suitably trained at their jobs. The manager described following the correct recruitment procedures but a staff file seen had a Criminal Records Bureau check in dated after the member of
Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 19 staff had started work. The manager later forwarded a copy of a Protection of Vulnerable Adults check he had carried out but had not printed off and placed on the file. The provider also runs a training company from the home and regular courses are provided for staff. Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run and managed by a person who is fit to be in charge. The home is run in the best interest of residents. Residents’ financial interests are safeguarded. The health, safety and welfare of residents and staff are promoted and protected. EVIDENCE: The current registered manager is also the registered provider, however he has decided to put forward the current deputy manager to be the registered manager instead. An application is due to be submitted to the Commission for
Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 21 Social Care Inspection shortly. Relatives and residents said they were happy with how the home is run The manager said he had undertaken a residents’ satisfaction survey in March and has prepared a report identifying areas where improvements could be made to services, but this was at his home and not available to be seen at the inspection. The home operates a system for helping residents manage their personal allowances. This requires an entry to be made following each transaction, signed and witnessed. A member of staff made an entry for the previous day saying had not had time to do so previously. Residents’ financial records must be kept up to date to prevent any opportunity of financial abuse. Details of residents’ financial arrangements were seen in their care plans. A relative said they normally look after their relative’s money, but ask the home to do so when they go away. The fire log was completed showing that all fire safety checks and tests are completed at the correct timescales and certificates were seen for the maintenance of equipment. Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 23 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 OP35 Regulation 12 Requirement The registered person must ensure that residents financial records are kept up to date and accurate Timescale for action 01/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The registered person should notify staff when a care plan has been updated Fernleaf Care Home DS0000052265.V299848.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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