Inspection on 30/11/06 for Fernleigh Resource Centre

This inspection was carried out on 30th November 2006.

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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Fernleigh Resource Centre 16/10/07

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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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 Key Unannounced Inspection 30th November 2006 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.V322070.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.V322070.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 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.V322070.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. 7th February 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 (clients visit for the day only) and some longer-term placements. Only 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. There are bedrooms on the ground and first floor with all rooms having ensuite toilets. 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, toilets and bathrooms on the ground and first floor. The main dining room is on the ground floor as is a dinning room and lounge for day care clients. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. The inspector arrived at the home at 10:20 and left at 17:10. The inspector spoke with 5 guests, 3 visitors and 6 staff. The manager was unavailable at the site visit. 4 of day clients where also spoken with regard to the staff and the environment. The inspector completed the inspection by a site visit to Fernleigh resource Centre, a review of relevant records (detailed in the body of this report) in Fernleigh resource Centre and CSCI offices. Questionnaires where left in the home at the time of the inspection, 6 have been returned and the comments are included in this report. Copies of records were submitted to CSCI for review in this inspection. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas identified in need of review where covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the deputy manager during and at the end of the inspection. The arrangements for equality and diversity were discussed throughout the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs and the practices that they put into place into meeting those needs. What the service does well: Fernleigh is unique on the Wirral it is the only service that provides respite care for people with dementia care. The majority of the staff have worked in the home for several years and try to do the best that they can to provide a good service to the guests who stay in the home. They are enthusiastic and caring. Observations through the day showed that they treated the guests with dignity at all times. The atmosphere was relaxed and easy going with staff having a “laugh and a joke” (as one guest put it) with the people who use the services in the home. Visitors to the home were very complimentary. Comments such as, “such nice staff” and “they do the best that they can” and “ it’s a god send, I know (my relative) is safe in the home”. The guests spoken with also where complimentary Guests spoken with said “staff are very nice, you can have a good laugh with them” and “they are pleasant to be around”. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 6 The environment is warm and welcoming and decorated in a manner similar to the way the guests would have in their own home. One guest said it very comfy, my bedroom is lovely”. All staff are given full recruitment checks before starting to work in the home. They are all go through an induction that gives them basic training and tells them about the home and once they start working they are involved in regular supervision and staff meetings. All staff said that the management team was very supportive and always put the guests first. What has improved since the last inspection? What they could do better: At the moment the manager and the staff team have little involvement in the assessment procedures. This has resulted in guests whose needs the home can not meet on being admitted to the home. This issue has not been addressed by the home in over a year and has remained a requirement on this report. This practice is unsafe and places guests, staff and visitors at risk. There have been assaults on other guests and staff as staff where unable to meet the needs of the individual at risk admitted. It is concerning that the home has failed to address this and continues to place guests at risk. This is of serious concern. Enforcement action can and will be taken if this situation is not resolved within the timescales given in this report. The care plans and risk assessments need to be more detailed to give the staff team clear instructions and guidance as to the best way to support and care for guests. Staff rely on verbal instructions as assessments and plans do not cover all the areas needed in order for staff to meet the care needs of guests. . It is concerning that the home has failed to address this and continues to place guests at risk. This is of serious concern. Enforcement action can and will be taken if this situation is not resolved within the timescales given in this report. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 7 Fernleigh has a respite service and a day service operating from it. Both services use the same facilities and staff team, even though their needs and expectations are different. The last report details that the home planned to separate these services to date this has not occurred nor are there any plans to do so. The combination of facilities and staff has a detrimental impact on the quality of services provided by the respite unit. Staff say they can very often be very busy and they are unable to provide any daily activities that would promote the independence of guests admitted to the unit. Given that the staff are very keen to promote a quality service and demonstrated very caring skills it is concerning that the lack of review in this area frequently compromises staffs ability to deliver the quality service that they are keen to do so. It is a matter of urgency that the home reviews the current arrangements and puts into action ways to reduce the impact that this has on the quality of the service provided. The lack of assessments, individual care plans and the impact of the day acre services means that the guests equality and diversity needs can not be supported and they have no opportunity skills can not be developed fully, daily support can not promote independence and guests personal choices can not be fully meet. 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.V322070.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 Fernleigh Resource Centre DS0000035856.V322070.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3, 4 were reviewed standard 6 is not applicable. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The lack of up to date information about guest needs before they are return to Fernleigh prevents staff from having a good understanding of individual needs and has resulted in guests not receiving care suitable to their needs. This practice is against the homes policy on equality and diversity as it does not meet the guests needs and places all guests at risk. Information in the home that helps guests and their families make an informed choice is not always available in formats that helps them do this and may result in guests and relatives not understanding what care the home does provide. EVIDENCE: Fernleigh takes admission as a direct referral from Social Services only. All the guests are assessed by Social Services before their first ever admission. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 10 However this assessment is rarely repeated even when the guest returns for further respite. The manager has done some assessments before guests have been admitted but this has not covered all the guests. The lack of up to date assessments has meant that some guests have been admitted to Fernleigh whose needs the home can not meet. Staff do not always have the information that they need to make sure that they can meet individual needs. As the only respite unit for Social Services in the Wirral, the services of Fernleigh are very much in demand. This has resulted in the home having to turn down caring for people as they are full and people whose needs the home may be able to meet turned away on the basis if no available space and not because the home could not meet their needs. On the day of the site 4 people where denied admission as the home was full. Two guests need additional GP and psychiatric nurse help as the home’s staff where not fully able to meet the guest’s individual needs. There is no clear admission criteria that would help staff and social services make sure that those individuals who need the service provide where more able to do so. This would also reduce inappropriate placements of guests whose needs the home cannot meet. This is poor practice and does not safe guard guests in the home and those wishing to stay. Information in the home is not always available in formats that can meet the guest’s needs. The majority of guests have dementia 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. Two relatives where spoken with who both said that the “care” given by the home was of great “benefit” to them and that their relative was “well-looked after”. One relative said “there really isn’t any alternative, this is virtually the only place that I can taken my relative and care for them. It’s a bit out of the way but the only choice. I haven’t been given any information other than what the social worker said when she first came to see us”. There is a notice available in the foyer that details the charge rates for all new guests this is in large writing and clearly displayed for all. Fernleigh Resource Centre DS0000035856.V322070.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 where reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff are aware of how to support guests with dignity and guests feel that they are supported to maintain their dignity. The management of medications follows the homes own policy and safeguards the guests’ needs. The lack of clear care plans has resulted in a reliance on verbal communication that will result in staff not delivering care that is appropriate to the guests needs. Although some work has been undertaken to produce more informative care plans the lack of clear information given to the home and not updating plans to include changes since the guest’s last admission means that staff are not always aware of the specific needs of individual guests. EVIDENCE: Fernleigh continues to work on improving the information held in guests care plans. However the three care plans viewed showed that the care plans are rarely up date from one period of respite to another. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 12 They are very brief and contain little information regarding behavioural needs, emotional needs, personal routines and daily activities of guests. This information will help the staff team to offer appropriate support, comfort and stimulus during the guests stay in an unfamiliar environment. Many of the staff spoken with rely on what they are verbally told about the care needs of the guests either from the guest, relative or staff member. Very little of this is record and will mean that staff will not always deal with guests needs in a consistent and appropriate way. The home has equality and diversity policies that cannot be meet without making sure individual needs are clearly identified and support put in place to meet these needs. The risk assessments do not provide the staff team with detailed information about any potential risk, nor do they offer staff clear guidance as the best way to support guests during their stay. This places both staff and guests at risk. Accident records reflect a number of assaults on staff and other guest by individuals staying in the home and unexplained falls. On the day of the site visit a lot of discussion with the staff detailed severe difficulties in them being able to access medical assistance as needed. They can access a community psychiatric nurse (CPN) who works well with the home and made a number of positive comments about the staff in the home. However accessing a GP can be very difficult as the guests can originally be from all over the Wirral and as such are now out of their own GP’s area. The home has an arrangement with the local surgery who will temporarily take on the guests who stay in Fernleigh. However this means that the GP has limited knowledge of the guests and does not always have easy access to the guest previous records. Records showed that staff do the best that they can in these circumstances and contact the GP as they their support . Medications in the home where reviewed. A full policy and procedure is in place that the staff are following. Although the assessments do not always detail the medications prescribed for the guest before they are admitted, the staff undertake the good practice of confirming with the GP the medications that each individual should be taking. The records were clear and showed what medications were received by the home, what was given and how many were left. An audit of these records and medications showed that medications are being given in accordance with the prescription from the GP. There were a few areas that would result in clearer records such as all handwritten records being sign by one individual and checked and signed by another. Staff spoken with during the day spoke of how they support the dignity of guests, this included training that they had been given during induction. Staff where clear that dignity was about making sure that each guest was treated as an individual and that their choices where respected and supported. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 13 Two residents made very positive comments one said, “the staff are very nice, so kind, they can be such good fun”, another residents said “they make sure that I look nice at the start of the day. One girl always asks me what I want to wear and makes sure that its clean. I like my hair done and she helps me do it every morning”. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 14 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, 15 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The guests enjoy the food that is available to them in the home. A lack of clear documentation that would support staff to be fully aware of individual choices and needs prevents them from fully supporting the guests in a manner that meets their choices and needs. The staff have to be split between day care services and respite care and this has resulted in a lack of activities that are appropriate to the needs of individuals and a daily routine that does not deal with the guests’ diverse needs and support them to maintain independence. This is not in the best interests of the guests and does not address their equality and diversity needs. EVIDENCE: Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 15 As there is a lack of clear identification of individual needs and choices it is not possible for staff to provide daily activities and choices to meet the guests needs. There is no assessment of individual strengths that would enable staff to support guests to maintain skills such as cleaning, washing, cooking, shopping medication etc. Activities are 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 service users are being met. On the day of the site visit staff where unable to undertake any activities. This is further impacted on by staff not always knowing what time day care service users will arrive or who is attending. Planning appropriate activities for those individuals staying on the respite service is made very difficult by the need to also care for day care service users. The respite and day service users share the same staff team. This limits the ability of the staff team to provide individual support to those accessing the respite service. The continuing presence of the day care service operating within a residential respite setting continues to effect the environment, atmosphere and the effectiveness of the staff team. The day care service users and respite care guests 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 service users 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. Two guests told the inspector they enjoyed the meals offered and would say if they did not like something. 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 available. One guest was supported by a member of staff to eat and this was done in a dignified manner with encouragement from the staff member. However the guests meal was presented uncut and she struggled to eat this independently. Another guest was noted to not manage to keep the food on the plate and was having difficulty holding the spoon. There were no records in the home as to need adapted cutlery or plate guards. The support of independent eating would be better with the availability of special equipment for meal times for those guests who need it. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 16 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The inappropriate admission of some guests has not safeguarded the other guests. Incidents have happened that have not been dealt with in the correct way, as they are seen as a normal occurrence within the home and not addressed as appropriate. Guests and family spoken to have not been given clear information on raising a concern but felt that any issues could be raised and they would be addressed. EVIDENCE: Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 17 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. One visitor spoken to said, “I have no cause to complain, the staff are very good here”. Another said, “ a minor point was sorted, when I asked the staff it was no problem”. The residents spoken with where unaware of a complaints policy but two had positive comments to make one said “I’d tell it would be sorted no problem” and another said, “oh, they are too nice here, they are so nice. But If I wanted to ask for something I would. I’m sure they would make it all right”. 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. A review of the incident logs clearly detailed two assaults on guests by other guests. These had not been documented or referred to the appropriate person, despite the policy clearly detailing that it should be done so. Two staff spoken with did not see these as incidents as potentially needing to be referred under the adult protection policy as “this kind of thing happens all the time”. There are no clear records, assessments, plans and risk assessments that would help staff refuse admission to guests whose needs they can not meet, assess those guests most at risk of assaulting other guests, how to manage incidents of this nature. The incident records viewed did not allow staff to fully explore when issues occurred, how they occurred or what action. This information did not get used in care plans and therefore prevented staff from being aware of who was most at risk and how to manage that risk. This practice does not protect the guests from abuse or protect those residents whose needs may result in assaulting another guest or a staff member. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 18 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, 21, 23, 26 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Fernleigh has a welcoming and friendly atmosphere. The main areas are decorated in a homely style in keeping with what the guests would have in their own home. Bedrooms are well maintained and guests are encouraged to bring in familiar items. 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 little “signposts” for guests that would indicate their own bedrooms, toilets, dinning rooms and lounges. All the doors are very similar and the decoration style on the main corridors are similar. There are some good items that include old postcards that would help guests know the “room near the postcards” as an example. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 19 All areas of the home are well maintained and any maintenance issues are referred to the council and if urgent addressed within 24 hours. All the bedrooms are ensuite. One guest spoken with said, “I like having a toilet very near, saves on leg work over night”. The decorating style in the home is generally very similar to that, which the guests would have in their own home. One resident said “I like the way it (the home) looks, its got nice comfy chairs, nice tables and my bedroom is lovely”. 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 guests access bathing facilities as needed. The communal areas such as lounges and dinning rooms are on the ground floor. The kitchen and laundry were viewed, they were cleaned and well maintained. A cleaning schedule is used by staff that help keep the home clean and make sure that all areas are cleaned regularly. The day care clients can access all areas of the home. As part of the need to maintain individual privacy, bedroom doors are locked when guests are not in them. Keys are available at all times and guests are supported to access their own bedrooms when they are on respite. As a busy unit it is difficult for the staff to make sure that returning guests get the same room but staff do try to make sure that this happens. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 20 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, 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 are enthusiastic and keen to provide a good service. The guests appreciate their efforts. Staff training is in place but staff would benefit from further training specifically to meet the needs of the guests. The day care unit impacts on the staffing levels in the home. This situation has not been addressed or action put into place to make sure that there are enough staff in place to meet guests’ needs at all times. Insufficient staff training and time has resulted in guests’ independence and daily activities not being fully promoted. EVIDENCE: As detailed earlier in this report, issues regarding the impact the day care service has on the respite service have been highlighted. The same staff team provides services such as bathing, continence care and support during mealtimes for the day care clients. Staffing levels do not vary to meet the assessed needs of the guests and as the admissions are mostly dependent on weak assessments and vacancies this can mean that there are some guests with very high needs being cared for. This event does not alter staffing levels. Extra staff can be asked for on occasions but the staff have not taken this action in recent months. The staff spoken to said that it could be “unbelievably busy on occasions especially if all the day care people also arrive”. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 21 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. A sample of staff records were looked at they were well maintained and all had appropriate employment checks done before the staff member came to work in the home. Staff working in the home have done so for several years. One member said “I love this job, the guests, the staff, the people I work with are all really good”. Staff records also reflected induction for all new staff. Training records for the staff were in place and showed that mandatory training is regularly reviewed. Staff have received training in protection of vulnerable adults, which is good practice. However there was very few staff who have received training in dementia beyond a one-day course. As the main needs of the guests is dementia in its many forms, supporting independence, maintaining skills, managing any behaviours and maintaining safety a one day course can not cover the degree of Knowledge that staff need. A copy of the areas covered on this training was not available. Staff spoken to said that they had enjoyed the training but would like to know more. Examples of lack off knowledge and skills were seen in the dinning room when meals where wrongly presented, decoration in the home that is not designed to meet dementia needs, care planning and assessments that cover needs fully and activities not in place to promote independence. Staff are very caring and want to do the best that they can to look after the guests. The lack of staff knowledge does not promote the independence of guests. The staff team work very hard to support service users. During the visit the inspector observed members of the staff team supporting service users in a sensitive and respectful manner. They demonstrated an ability to defuse anxious and upsetting situations. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 22 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, 33, 36, 38 where reviewed. Standard 35 is not applicable, as the home does not deal with individual’s finances, as it is short-term care only. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager and the management team are well thought of by guests, staff and visitors. Staff are keen to deliver a quality service. However the issues around assessments and the day care services that prevents the service from being good quality addressed despite it being mentioned on several reports. The health and safety in the home is managed appropriately with the exception of risk assessments for individual guests that would help reduce their risks and lack of action taken from incidents such as falls. EVIDENCE: Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 23 The registered manager has completed the NVQ level 4 registered managers award and has completed a specialist course regarding person centred dementia care. Unfortunately he was not available on the day of the visit. There where two deputy managers on duty who were very fulfilled with their job roles. One was a recent recruit into the post and brought skills from community care to the role. Another had been in post for several years and brought extensive experience to the role. Both where enjoying working in Fernleigh and where 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 saying that they were “always happy to help”, “keen to do their best” and “very good at their jobs”. Positive comments were also directed towards the care staff with all visitors saying “they do their best”, one visitor pointed out that “its not an easy job, the staff do the best that they can. They are always very kind, attentive and get the help they need when they need it”. There are regular staff meetings and staff supervision in which staffs strengths are identified and opportunities of support discussed. Copies of staff supervision were seen on staffing records and staff meets were available. Staff said that they were “well supported”` and found meetings and supervision of “value” to them. The home has policies on equality and diversity that are in place for recruitment this includes harassment and bullying policies. All staff are aware of these policies. Although the home has embarked on a quality assessment in order to review the quality of the service it provides this has concentrated on the systems in place in the home such as recruitment and policies and procedures. Policies and procedures in the home are easily accessible by all staff and are regularly updated. Staff where able to identity where policies could be found and each policy was dated when last reviewed. However the quality of the service regarding the impact of day care services has not been done. 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. As Fernleigh is a respite service they have limited involvement with service users finances. However they have detailed financial policies and procedures to use when the need arises. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 24 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. Environment risk assessments and 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. The incident and accident book was not always accurately completed although an improvement in this had been noticed over the last three months. Information was brief and did not influence risk assessments or care plans. A number of incidents such as assaults on guests and staff by other guests and falls had not been explored and actions taken to reduce these risks not in place. Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 1 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 X 3 X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 2 Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation Requirement Timescale for action 30/01/07 14 (1) (a) The registered person must (b) (c) (d) ensure the registered manager is (2) (a) (b) actively involved in the pre admission assessment procedures. To ensure the home can meet the identified needs. This requirement is outstanding since 30/01/06. The registered manager must ensure the care plans and risk assessments produced by the service identify all service users needs and risk factors. Particularly with regard to specific needs relating to their dementia condition. 2. OP7 15 (1) (2) (a) 30/01/07 3. OP33 13 (1) (b), (4), (b) (c), (6) This requirement is outstanding since 30/12/05. 30/01/07 The registered persons must ensure the day care service operating within Fernleigh does not have a detrimental impact on the registered residential unit. With particular regard to shared facilities, activities offered and one to one support provided. This requirement is Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 27 outstanding since 30/11/04. 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 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 need in order to make sure that an informed decision cam be made before service users are admitted to the home based on the individual need as to apposed to an available vacancy. 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 is 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. Accident and incident reports should be regularly reviewed, recorded accurately and used to influence care plans, assessments and the risk assessments of service users. OP3 3 OP19 4 5 6 OP27 OP28 OP38 Fernleigh Resource Centre DS0000035856.V322070.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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.V322070.R01.S.doc Version 5.2 Page 29 - 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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