Inspection on 16/10/07 for Fernleigh Resource Centre

This inspection was carried out on 16th October 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fernleigh Resource Centre 30/11/06

Fernleigh Resource Centre 07/02/06

Fernleigh Resource Centre 19/10/05

Fernleigh Resource Centre 22/02/05

Fernleigh Resource Centre 12/07/04

Fernleigh Resource Centre 16/02/04

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Fernhaven

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Creative Support

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

CARE HOMES FOR OLDER PEOPLE Fernleigh Resource Centre Twickenham Drive Leasowe Wirral Cheshire CH46 1PQ Lead Inspector Mrs Julie Garrity Unannounced Inspection 16th October 2007 10:15 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 Fernleigh Resource Centre DS0000035856.V353039.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. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernleigh Resource Centre Address Twickenham Drive Leasowe Wirral Cheshire CH46 1PQ 0151 638 5602 0151 666 3603 boboswald@wirral.gov.uk 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) Metropolitan Borough of Wirral Mr Robert Oswald Care Home 19 Category(ies) of Dementia - over 65 years of age (19) registration, with number of places Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered persons to be registered to accommodate two (2) adults with a diagnosis of dementia and seventeen (17) older people with a diagnosis Of dementia. 30th November 2006 Date of last inspection Brief Description of the Service: Fernleigh is known as a resource centre as a number of different services operate within it. They are all services that support older people with dementia and include a respite (short stays for people of 2 to 3 weeks) unit, a day service (guests visit for the day only) and some longer-term placements. Only the respite unit is registered with CSCI. Fernleigh offers 19 respite placements and 15 places for day care each day. The same staff team work on both the respite and day care services. People accessing the day care service use all the communal and bathing facilities of the residential service. Fernleigh is situated in a residential area of Moreton on the Wirral. It is on a main road through a large estate and was purpose built for day care and residential care. It does not provide long-term care or nursing care. The home is owned and run by Wirral Council and is the only respite unit for dementia care on the Wirral. Although registered for 19 clients the home can only cater for 15 people on the respite unit at anyone time. Parking is available to the front of Fernleigh and has two fenced garden areas that are accessible by the clients staying in Fernleigh. The home refers to people who use their services as guests. There are a variety of lounges, bedrooms, toilets and bathrooms on the ground and first floor. The main dining room is on the ground floor as is a dining room and lounge for day care clients. The fees for staying on the respite unit are £64.65 a week from the guest, fees cover food accommodation, laundry services and daily care, not covered is hairdressing, newspapers and taxi fees. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was carried out over a period of one day. We arrived at the home at 10:15 at and left at 17:30, the site visit was a total of 7 hours and 15 minutes. The people who use the services of Fernleigh are referred to by the home and by themselves as guests. Over all six guests, eight members of staff, two relatives and the manager were spoken with. It is usually practice to send out questionnaires to the home however as the guests will have left the home before the questionnaires arrive and a postal strike was occurring no questionnaires were sent. Instead additional time was spent observing staff and guests interactions. We completed the inspection by a site visit to Fernleigh, a review took place of many of the records available in the home and our offices. Records viewed included care plans, medications, staff files, staff training, residents records, menus, activities records, documents known as the statement of purpose and the service users guide, the homes policies and procedures and daily records. An inspection plan was written before the start of the site visit to make sure that all areas identified in need of review were covered. All of the key standards were covered in this inspection, these are detailed in the report. Feedback was given to the deputy manager , the potential new manager and Social Services representation during and at the end of the site visit. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. What the service does well: Fernleigh is the only respite care unit for people with dementia needs in the Wirral and therefore provides a unique service to the people who need this type of support. The home has a staff team that demonstrate a very caring attitude towards the guests that they care for. Guests made positive comments about the staff including “kind”, “caring” and “hard-working”. Relatives spoken with said that it was “a life line”, that “would be difficult to manage without”. Where guests need medical services these are arranged. As a respite unit a significant number of people come to stay and leave over very short periods of time staff try very hard to understand the different needs of the guests and the management of medications makes sure that all guests get the medications that they bring into the home with them. Fernleigh Resource Centre DS0000035856.V353039.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. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 7 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 Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 4 and 5 were reviewed. Standard 6 is not applicable. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Assessment arrangements for guests have improved and now better support both the guest and the staff to identify if they can meet individual needs. The lack of accurate and complete information available in formats that meet individual needs prevents guests from making an informed decision as to whether the home is where they would like to stay. EVIDENCE: Fernleigh takes admission as a direct referral from Social Services only. All the guests are assessed by Social Services before their first admission. Many individuals are determined as dementia needs without the relevant medical diagnosis and this will lead to inaccurate assessments of potential guests. The manager has done some assessments before guests have been admitted but this has not covered all the guests. The assessments do not always cover all the needs of the guests before they assessed. However phone assessments are Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 9 now taking place for guests return in order to determine if there has been any changes in their needs and more direct assessments are taking place with new guests. This is an improvement on previous inspections and helps the home determine if they can meet individual needs. Guests spoken with said, “I’m staying for a few days until I can get back home” and “I have stayed a few times, I think the staff have told me all kinds of information but I haven’t read anything”. There is no clear admission criteria that would help staff and social services make sure that the people who stay in the home have all their needs assessed and staff are able to meet their needs fully. Information in the home is not always available in formats that can meet the guest’s needs, the home does send out an information pack that contains relevant information however important documents included in the pack are out of date and have a number of inaccuracies. The majority of guests have dementia, some guests also have visual or cognitive impairment care needs but the information available for them about Fernleigh is in regular print and offers no alternatives such as large print or pictures as a possibility. Staff spoken with said that this can be ordered but is not readily available in the home. They also detailed that this information is discussed with the guests and their relatives on admission. A review of the home showed that this information is not readily available to remind guests of the services provided during their stay. Relatives spoken with recalled receiving a pack and that some of the information in it was useful. Other comments included, “The staff talk to me about any changes when I bring my mum in”, “It’s the only place for him to come when I need a break” and “I was sent a pack of all kinds about a week before”. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Many staff are aware of how to support guests with dignity, guests feel that they are treated well in the home. The management of medications makes sure that all clients get the medications that they bring into the home. There is room for further improvement in order that medications are always given in the correct manner. The lack of clear care plans has resulted in a reliance on verbal communication that will result in staff not delivering care that is always appropriate to the guest’s individual needs. EVIDENCE: Residents spoken with said, “lovely here, I like it each time I come for a stay”, “the staff are very nice, kind and caring, so happy here” and “it’s like a little holiday”. Relatives agreed with this point of view, one of who said, “great service, I feel she is well looked after and safe”. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 11 Fernleigh continues to work on improving the information held in guests care plans. However examination of a sample of plans indicates further work needs to be carried out to make sure that where guests needs are identified that staff have clear instructions as to how to meet individual needs in a consistent manner. The risk assessments do not provide the staff team with detailed information about the risk, nor do they offer them clear guidance as the best way to support. An example of this was with regards to a resident who smoked, the risk assessment identified a high risk and stated to be observed overnight. The deputy explained that staff held the guests lighter and pipe and sat with them when smoking. This information was not available in the risk assessment and as such not all staff will be aware that this is the approach to maintain the individuals safety. A sample of daily diary sheets were looked it, health care issues had been referred to health care professionals. The deputy explained that a local GP service is used, but they do make contact with the guests own GP to make sure that there is full information available. An example of accessing outside professional services was seen on the day of the site visit when a guest fell and the ambulance service was called. The deputy manager detailed that this was standard practice for guests who fell. It was also noted that the individual who fell had been identified as having a high risk of falls but no falls management plan was in place to assist in reducing the risk. The management of medications and a review of this showed that the medications brought into the home were accurately given. However there are a number of areas for the overall management of medications that need to be maintained including checking with the prescriber that the individual has brought in the correct medications, accurately recording the medications recieved by the home and making sure that where medications need to be given in a certain manner that this information is readily available for all the staff. A medication that is to be given as needed had no instructions to staff as to when to give it. Staff would need to make a decision without the correct guidelines and therefore run the risk of giving the medication inappropriately. Members of the staff team were observed supporting guests in a respectful manner that promoted their independence. Other staff were observed to be very kind and caring, but to be overly protective of some of the guests. This action did not promote guests independence and meant that they were on occasions not supported with dignity and respect. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Meals and mealtimes are unrushed and are enjoyed by the guests. However the opportunity to fully determine individual needs and choices prevents staff from fully supporting the guests in a manner that meets their choices, equality and diversity needs and does not promote their independence. EVIDENCE: Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 13 Activities are intended to be provided to both the respite guests and those attending for day care. They are not organised in advance and can only take place if there are enough staff on duty and the physical needs of both sets of guests are being met. On the day of the visit there was no activities programme in place, one care staff was putting rollers in the hair of residents and the only other activity observed was watching the television. The home has been doing life histories of residents but these have not been used to develop a flexible activities programme that meets the diverse needs of the guests or to promote their individual social needs. There is no assessment of individual strengths that would enable staff to support guests to maintain skills such as cleaning, washing, cooking, shopping or medication as examples. Subsequently individual opportunities for maintaining and developing independent living skills were not in place that took account of the guest’s needs, choices or capabilities. The day care service users and respite care guest’s mix freely during the day sharing all the facilities the impact of this has not been determined by the home. As an example in the evening the day care guests have an early meal, as they are due to go home. The guests do not get their meal at this time. However they see others going in and sitting down to eat which is not positive for individuals who have dementia and are not always able to make sense of different meal sittings. An observation of the mealtime showed that a variety of choices were offered, however it was difficult for staff to determine individual choices as this information was not easily available. Staff had tried to address this by asking guests earlier in the day what they would like. However on several occasions this was not confirmed for the guests. Meals were placed in front of guests without explanation one guest asked, “what’s this” and was told it was their lunch. There are no records in the home as to need of adapted cutlery or plate guards. Guests who staff thought may have issues with a plate were given a bowl without discussion The support of independent eating would be better with the availability of special equipment for meal times for those guests who need it. The support of independent eating would be better with the availability of special equipment for meal times for those guests who need it. Menus were available that detailed a choice of meal, however they did not indicate any special diets. Guests spoken with were complimentary about the quality of the food comments such as, “tasty”, “I always enjoy the food here” and “well cooked” were made. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were reviewed. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Guests feel safe and listened too. However formal processes need to be further developed so that the home’s procedures are available, understood and consistently applied. EVIDENCE: Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 15 Fernleigh is part of Wirral Social Services and uses the corporate complaints procedure and the accompanying leaflets. However this information is not available in formats that are easy for the guests to read and access. A copy is readily available for all visitors to use. Staff spoken with detailed that they often addressed concerns as they occurred and did not always report these. Guests spoken with said, “lovely girls, will do anything for you. If I have a problem I just ask”, “No complaints, but If I did I’d talk to one of the staff” and “ I’d have no issues discussing any problems I have, they are very understanding, caring staff I would think they would move heaven and Earth to fix any issues”. Information sent to the home prior to this site visit detailed that there was one on-going complaint however no information as to what this was, how it was being dealt with or what the outcome was not available. The Senior management team available in the home on the day of the site visit were unaware of this concern. The service has detailed policies and procedures to protect guests from abuse. With the majority of the staff team having completed updating training with regard to the protection of vulnerable adults training. Staff spoken with were aware of how to raise any concerns and who to raise these concerns with. However they were unaware of how these would be dealt with and ran the risk of interfering inappropriately in any potential investigation. A review of the records detailed an incident that whilst occurring on the day centre involved staff that also work on the respite unit. It was a concern that was serious in nature but had not been passed on to the manager and dealt with. Information was received after this site visit that showed that this was now being addressed appropriately. Fernleigh Resource Centre DS0000035856.V353039.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 23, 24, 25 and 26 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. General maintenance of the environment has declined. This has resulted in an environment in which the décor and fixtures and fittings are inadequate and does not provide an environment that meets the guests needs. EVIDENCE: As a respite unit it is difficult for bedrooms to be very personalised. However guests are encouraged to bring in familiar items to help them settle in to the home for their stay. As a unit for dementia there are very few “signposts” for guests that would indicate their own bedrooms, toilets, dining rooms and lounges. All the doors are very similar and the decoration style on the main corridors are similar. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 17 All areas of the home are checked regularly maintained and any maintenance issues are referred to the council, if it is urgent it is addressed within 24 hours. All the bedrooms are ensuite, however guests spend very little time in their bedrooms. Bedroom doors are locked during the day. There is no evidence that guests are assessed to see if they can hold a key and all the key’s are kept in the main office. This action is taken to “prevent people wandering into other, guest bedrooms and to keep their personal items safe”. The deputy detailed that some guests do hold the keys for their rooms and it depends on their ability to do so. There is a lift to the second floor that assists those guests less able to access their bedrooms. Handrails that assist guests access the home as they walk around are available. Moving and handling equipment is available throughout the home to help guest’s access bathing facilities as needed. The communal areas such as lounges and dining rooms are on the ground floor. Many areas of the home are now showing signs of wear and tear. The main foyer carpets are badly stained and worn. Furniture is scuffed and in need of repainting. The home has regular audits in place for furniture and furnishings however records of this were not available. The operations manager said, “we do not have a plan to maintain the environment it gets done as needed, but in many cases this is no longer cost effective”. Residents and relatives spoken with said, “It’s comfortable, nice bedrooms and generally safe”, “Lots of different places to sit, can walk around or go in the garden” and “It’s a nice home, some of it needs a bit of redecoration, but in general its very clean”. Fernleigh Resource Centre DS0000035856.V353039.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff demonstrated a caring attitude and are keen to develop new skills. However staff training, recruitment and levels are not managed or monitored sufficiently in order to make sure that the guest’s needs are met at all times. EVIDENCE: As a respite unit there is a fast change in guest’s needs and this is further impacted on by the needs of the day care services. This issue was highlighted in the previous reports but no action to resolve the situation has been taken. The home does not monitor the needs of the guests or the impact of day care services in order to match staff to the needs of the people they care for. Staffing levels do not vary to meet the assessed needs of the guests. Extra staff can be asked for on occasions but the staff have not taken this action in recent months. The staff spoken with said, that it could be very busy at times, particularly in the morning and at mealtimes. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 19 A sample of staff records was looked at but one had the appropriate employment checks done before the staff member started work. In one case there was no references available for the member of staff. Staff have received training in protection of vulnerable adults, which is good practice. However there were very few staff that have received training in dementia beyond a one-day course. This was the same situation at the last site visit and training for staff in the main need of admittance has not been developed, reviewed or planned for. Observations over the day showed that staff did not have the appropriate skills to fully support the guests in the home at all times. Staff observed during the site visit were observed to be caring and aim to do the best that they can to look after the guests, however their approach is to do as much for the guests as possible and not promote independent living skills for people who return back to their home after a two week stay. The deputy manager explained that all staff receive a full induction that covers a variety of training including moving and handling, staff spoken with confirmed that they have received training that has included, moving and handling, health and safety, protection of vulnerable adults, fire safety and some other care aspects such as diabetes. All staff spoken with said that they were not always sure when training was due and that they would welcome more training in dementias. There are plans to include training for dealing with challenging behaviour and the majority of staff have qualifications specifically for staff working in care. However there is no plan that details what training staff need to meet the needs of guests and when. There is a computerised system maintained from Social services, this details mandatory training such as moving and handling and alerts the manager when staff are due. This does not cover that the staff working in the respite unit may and the opportunity to look at the needs of the guests who stay on the unit and match staff skills to this. Fernleigh Resource Centre DS0000035856.V353039.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has not been an increase in the overall quality of the service provided to the guests. Although some work has been done in some areas this has not been maintained or further developed in order to develop the quality and safeguard the guests. EVIDENCE: There are plans in place from Social Services to change the service that this home delivers. Respite dementia care services will not be delivered from Fernleigh and the home will apply to registered as a mental health support service. It is anticipated by Social Services that this will take about 9 months and be completed next year. The registered manager is due to leave the home Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 21 and there is no acting manager in place. There were two deputy managers on duty on the day of the site visits, both were enjoying working in Fernleigh and were keen to provide the best care that they could to the guests that they cared for. Guests, staff and visitors spoke very positively about the management team. Residents said, “staff are great, kind, can just ask them anything” and “Lovely people it’s nice to come and stay here”. The regularity of staff meetings and staff supervision has not continued. Supervision records for staff were dated sometime ago and despite major changes planned for the service regular staff meetings have not occurred. There were no minutes made available to review as such staff views are not used to assist to determine the quality of the service or in developing their skills. There is no quality assurance system in place questionnaires are sent to all departing guests. Over the last 12 months over 400 guests at some point stayed in Fernleigh, however no questionnaires were returned. There have been no attempts to find alternative means to determine guest’s point of view. The home does not undertake any informal or formal quality checks with the exception of environmental checks, which have not promoted an increase in quality. Areas such as medications, care plans, staff files, staffing levels, staff training as examples are not reviewed regularly in order to determine that these vital areas determine the competency of the staff and meet the needs of the guests. Policies and procedures in the home are easily accessible by all staff and are regularly updated. Staff were able to identity where policies could be found and each policy was dated when last reviewed. The lack of specialist assessments, separate facilities and staff team for those people accessing the day service is affecting the standard and quality of care being provided to those people staying at Fernleigh for respite and this situation has not been addressed. As Fernleigh is a respite service they have limited involvement with guests finances. However they have detailed financial policies and procedures to use when the need arises. The home has regular health and safety checks, there have been recent visits from environmental health, Fire Authority and actions from these have been taken. Fire risk assessments are all up to date and are kept reviewed. The fire escape has been blocked off with flowers and pots, as this was in a courtyard that guests could access and was thought to present a risk. This has been included in the fire risk assessment. Risk assessments for individual guests are not kept up to date and do not reflect their needs. This includes things like, managing own medications, room keys kept in the office, access to stairwells, falls and behaviour support. Fernleigh Resource Centre DS0000035856.V353039.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 2 X 2 2 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 3 2 3 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 2 x 3 2 2 2 Fernleigh Resource Centre DS0000035856.V353039.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 OP7 Regulation 15 (1) (2) (a) Requirement Timescale for action 16/11/07 2. OP12 3. OP18 4. OP33 Care plans need to clearly detail what actions staff need to take in order to fully support all guests during their stay in the home. 16 (2) The individual needs, choices 16/11/07 (m) and personal preferences of the guests need to be determined and used to create a flexible approach to the daily routines in the home in order to meet their equality and diversity needs. Guests and their representatives need to be consulted and agree to the care plan in order that they can make an informed decision about the care they are to receive. 13 (6) Staff need to be fully aware of 16/11/07 the ways to protect vulnerable adults. When information is available that needs to be dealt with as a potential abuse this needs to be passed to the appropriate persons in order that the situation can be investigated and any necessary actions taken. 24 (1) (a) The home needs to explore and 16/02/08 (b) (2) (3) develop ways in which it will DS0000035856.V353039.R01.S.doc Version 5.2 Fernleigh Resource Centre Page 24 determine the quality of the service provided, take into account the views of the guests and plan to sustain and develop the quality of its service. 5. OP38 13 94) (a) (b) (c) Risk assessments need to be in place that detail how to manage the identified risks of guests were they are identified, such as falls, accessing a bedroom key and smoking as examples only. 16/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP2 OP3 Good Practice Recommendations Information in the home should be suitable to support the service users and their families to make an informed choice. Assessments should incorporate all the areas needed in order to make sure that an informed decision can be made before service users are admitted to the home based on the individual need. Consideration should be available to incorporating the best practice information regarding environment for service users with dementia. Such as textures on walls, different coloured doors, pictures on doors, flooring and relaxation. Staffing levels should be regularly reviewed taking into account service users needs in order to ensure that sufficient staff are always available. Staff training should be reviewed in order to make sure that they have received sufficient training to meet the needs of the service users in their care. A programme of training needs to be developed in order to monitor staff training. Staff files need to be reviewed to make sure that all recruitment information is available, accurate and kept up to date. DS0000035856.V353039.R01.S.doc Version 5.2 Page 25 3. OP19 4. OP27 5. OP28 6. OP29 Fernleigh Resource Centre 7. 8. OP36 OP38 Staff supervision needs to be done on a regular basis and used to maintain the skills of the staff. Accident and incident reports should be regularly reviewed, recorded accurately and used to influence care plans, assessments and the risk assessments of service users. Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Fernleigh Resource Centre DS0000035856.V353039.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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