Inspection on 07/02/06 for Fernleigh Resource Centre

This inspection was carried out on 7th February 2006.

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 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 30/11/06

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 Helen Carton Unannounced Inspection 7th February 2006 12:30 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 Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 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.V282681.R01.S.doc Version 5.1 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.V282681.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The provision of the day care service sharing all facilities and staffing with the long-term and respite service must be reviewed to reflect the different needs of the three service user groups accessing Fernleigh. The outcome of this review must be forwarded to the Commission for Social Care Inspection by 31/3/05. Until the review is complete no more than 15 service users can be accommodated for day care. 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. 19th October 2005 2. 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 unit, a day service and some longer-term placements. Fernleigh offers 19 respite placements and 15 places for day care each day. The same staff team manage 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 has two fenced garden areas. There are lounges, toilets and bathrooms on the ground and first floor. The main dining room is on the ground floor. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 13 people staying at Fernleigh at the time of the visit. The inspection was unannounced and took approximately four hours. The inspector spent time with five service users and spoke to the manager, deputy manager, responsible individual for the service and two members of staff. What the service does well: What has improved since the last inspection? What they could do better: At the moment the manager and the staff team have no involvement in the pre admission assessment procedures. This increases the chances of people being offered respite placements at Fernleigh when the service is not designed to meet their care needs. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 6 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 service users. The service provides few structured activities with little one to one support being provided. The need for an activities programme to be implemented is essential to enable the staff team to support service user to maintain life skills. 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 inspector acknowledges the registered persons’ are currently working towards separating the two services. This should be carried out as a matter of urgency to ensure service users receive services that meet their individual needs and expectations. 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. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 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.V282681.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 The pre admission assessment procedures currently used on behalf of the service do not ensure that prospective service users are offered appropriate placements. Where they can be assured their needs can be met. EVIDENCE: The management team of the service is not currently involved in the assessment of prospective service users. With offers of placements being made on the information provided by care managers employed by Wirral Social Services who run Fernleigh. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 9 The inspector discussed concerns regarding this situation with the manager and the responsible individual. Many of the assessments indicate short-term memory loss however a mental health practitioner has not made a diagnosis. As detailed in standard 3: ‘New service users are admitted only on the basis of a full assessment undertaken by people trained to do so, and to which the prospective service user, his/her representatives (if any) and relevant professionals have been party’. The registered persons are advised to ensure there is specialist and service input in the pre admission assessment process. To ensure the offer of a placement is not going to have a negative impact on prospective and current service users mental health. The manager and the responsible individual told the inspector the organisation had allocated funding to employ a third deputy manager. This will mean the registered manager will be supernumery to the staffing complement and would allow the managers to be part of the assessment process. They hope this change will be in place by May 06. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 & 10 The care plans and risk assessments currently in place do not provide detailed information to enable the staff team to effectively meet service users needs. Service users health care needs are not being adequately met by the service. The staff team promote service users rights to privacy and dignity. EVIDENCE: Fernleigh continues to work on improving the information held in service users care plans. However examination of a sample of plans indicates further work needs to be carried out to ensure life experiences and interests are documented. This information will help the staff team to offer appropriate support, comfort and stimulus and will help to reduce the anxiety service users may experience during their stay. As the pre-admission assessment procedure has not been designed to assess the specific needs of service users with dementia. The care plans do not cover all the characteristics and possible risks service users may be presenting. Particularly when trying to support service users who are experiencing anxiety and stress resulting in aggressive or inappropriate behaviour. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 11 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 service users during these difficult times. The inspector looked at a sample of daily diary sheets and noted health care issues had not been referred to health care professionals. The inspector advised the deputy manager to ensure contact was made with the necessary service, during the visit this contact was made. The deputy manager was advised to ensure information held in the daily record sheets accurately reflect what has happened and the action taken by members of the staff team. The inspector observed members of the staff team supporting service users in a respectful manner attempting to support them to maintain their dignity and privacy. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 & 15 Fernleigh does not have detailed information regarding service users past life experiences and recreational interests. Resulting in activities being generic in nature and not specific to the needs of people with dementia. Due to the lack of separate facilities and staffing for the day service respite service users are not receiving individual support to maintain their life skills. The service provides service users with a wholesome diet in pleasant surroundings. EVIDENCE: Activities are provided to both the respite service users 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. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 13 The inspector is concerned the different needs of these groups are not reflected in the activities and staff time provided. On the day of the visit the inspector did not see service users involved in any activities other than watching TV. Fernleigh continues to provide a day care service, which operates from 08002200 hours seven days a week. The respite and day service 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 manager and the responsible individual told the inspector work has been carried out to implement change to the type of service to be provided at Fernleigh. The proposed changes addressing the concerns raised by the Commission are to be forwarded to the Commission by the 30/04/06. At the time of the visit the main lounge was not being used as structural problems had been found in the floor. This has resulted in only one lounge being available for both respite and day care service users. On the day of the visit 13 service users where receiving respite support with approximately ten receiving day care support. The inspector spent time with service user in the lounge they appeared relaxed and comfortable and were happy to chat to the inspector. Service users told the inspector they enjoyed the meals offered and would say if they did not like something. Care plans indicate foods service users enjoy or dislike and also detail where special diets are required. The dining room is pleasantly decorated and furnished. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 & 18 Fernleigh uses Wirral Social Services corporate complaints procedure, which is satisfactory. The home has a proactive approach to dealing with complaints. The arrangements for protecting service users are satisfactory. However the lack of the registered manager’s and the staff teams involvement in the pre admission process may lead to inappropriate placements. EVIDENCE: Fernleigh is part of Wirral Social Services and uses the corporate complaints procedure and the accompanying leaflets. The manager told the inspector they were in the process of developing service specific information using photographs. This is to help service users and their relatives identify whom to speak to if they have a concern or a worry. The service has detailed policies and procedures to protect service users from abuse. With the majority of the staff team having completed updating training with regard to the protection of vulnerable adults training. The lack of the management teams involvement in the pre admission assessment process is of concern. As the persons carrying out the assessment do not have detailed knowledge of the service nor the range or limitations of the service. Some of the admissions may have a detrimental effect on the individual and the other service users. The service is a respite service and is not as a matter of course involved in legal issues concerning service users. However if areas of concerns are Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 15 identified that would have a detrimental impact on service users the service will seek legal advice. The inspector discussed the outcome of a complaint made regarding poor communication and care practices. The manager and documentation was able to demonstrate the complaint had been resolved with the complainant satisfied with the outcome. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 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, 23, 24, 25 & 26. The overall standard of the environment within the service is good providing service users with a homely, clean and tidy place to stay. The lack of separate facilities for the day service puts a strain on the residential environment. EVIDENCE: Due to a structural fault being identified in the main lounge resulting in the floor requiring to be replaced it is not in use. However there is an alternative lounge available, which is large enough for all service users to sit and relax in. There are two dining rooms with the smaller one used by those people accessing the day service. All communal areas are pleasantly decorated and furnished. The inspector viewed a sample of bedrooms and checked the bed linen this was found to be of an acceptable standard. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 17 All areas of Fernleigh other than the bedrooms are shared with the day service seven days a week, not allowing those people on respite to enjoy the facilities in a smaller group. As detailed earlier in the report the registered persons hope changes to be made in the service provision will remove this difficulty. Areas of the service visited were clean, pleasantly warm and bright. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 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 & 30. Service users specialist needs are not being met due to the impact the day service has on the staffing levels. The service’s recruitment practices protect service users from possible abuse. The staff team have received specialist dementia training, which will equip them to support service users in appropriate ways. EVIDENCE: As detailed earlier in this report issues regarding the impact the day care service has on the respite service has been discussed with the registered persons. As they offer a range of services such as bathing, continence care and support during mealtimes and do not have a designated staff team. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 19 A sample of staff records were looked at they were well maintained and all the appropriate checks had been made to protect service users. At the last visit the inspector made a requirement the registered persons to provide the staff team with specialist training in Person Centred Dementia Care. At this visit the manager and members of the staff team told the inspector they had attended the specialist training and had found it very useful. 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.V282681.R01.S.doc Version 5.1 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 & 38. The lack of the management teams involvement in the pre admission assessment procedure has a detrimental impact on the health, safety and welfare of service users. The day care facility operating from Fernleigh has a detrimental impact on the care and time provided by the staff team to the people accessing the respite facility. Providing the staff team with specialist dementia training will have a positive impact on service users daily lives. The day care facility operating from Fernleigh has a detrimental impact on the care and time provided by the staff team to the people accessing the respite facility. The lack of detail in risk assessments could put service users at risk of harm. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 21 EVIDENCE: The registered manager has completed the NVQ level 4 registered managers award and has recently completed a specialist course regarding person centred dementia care. The registered manager nor his staff team are not involved in the pre admission assessment process which currently does not seek specific information about how the dementia condition is presenting in individuals. The inspector is concerned at the number of people accessing the respite facility who have not had an assessment carried out by a mental health practitioner. Fernleigh is a specialist unit that is registered with the Commission as a care home for 17 older people and two younger adults with dementia. 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 detailed earlier in the report the lack of detail in risk assessments could put service users at risk of harm. 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. The inspector observed members of the staff team providing care and support to service users in a respectful and sensitive way. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 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 1 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 3 X X X 2 3 2 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 23 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 14 Requirement The registered person must ensure the registered manager is actively involved in the pre admission assessment procedures. To ensure the home can meet the identified needs. The previous timescale of the 30/01/06 not met. 2. OP3OP4OP 18 14 The registered persons must ensure specialist assessment information is gained to ensure prospective service users fit within the registration category. 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. The previous timescale of the 30/12/06 not met. 4. OP8 12 The registered manager must DS0000035856.V282681.R01.S.doc Timescale for action 30/05/06 30/05/06 3. OP7OP38 15 30/04/06 07/02/06 Page 24 Fernleigh Resource Centre Version 5.1 ensure the health care needs of service users are met. With particular regard to requesting health care professionals input when a concern is initially identified. 5. OP27OP33 13 The registered persons must provide written proposals to the Commission detailing the changes to be made to the services operating from Fernleigh. To minimise the detrimental impact the day service currently has on the respite facility. This should be forwarded to the Commission within the stated timescale. 30/04/06 6. OP12OP14 OP27OP28 13 30/03/06 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. A staff roster indicating how the staff team are to be allocated between the two services is to be available for inspection at all times. Previous time scale of 30/11/04 and 31/3/05 not met. Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fernleigh Resource Centre DS0000035856.V282681.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 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.V282681.R01.S.doc Version 5.1 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!