Inspection on 10/10/06 for Ferns Nursing Home

This inspection was carried out on 10th October 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 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

Ferns Nursing Home 16/07/08

Ferns Nursing Home 23/07/07

Ferns Nursing Home 06/03/06

Ferns Nursing Home 24/05/05

Ferns Nursing Home 10/11/04

Ferns Nursing Home 28/04/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Ferns Nursing Home 141 St Michaels Avenue Yeovil Somerset BA21 4LW Lead Inspector Judith Roper Unannounced Inspection 10th October 2006 10:00 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 Ferns Nursing Home DS0000003255.V318120.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. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ferns Nursing Home Address 141 St Michaels Avenue Yeovil Somerset BA21 4LW 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) 01935 433115 01935 410536 ferns@almondsbury.fsbusiness.co.uk HatherleyGrange@ALMONDSBURYCAREFSBUSIN ESS.CO.UK Almondsbury Care Limited Mrs Jackie Hufton Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Up to three places for personal care. The named Registered Manager to commence the Registered Managers Award by 1st February 2006. 6th March 2006 Date of last inspection Brief Description of the Service: The Ferns is a care home providing nursing care for up to 31 older people. The home also has up to 3 places available for older people who require personal care only. The home provides day care for a small number of people when required. It is a largely purpose built home in a residential area about one mile from the centre of Yeovil which has all the facilities of a small town. There is a lift to the first floor where six of the bedrooms are located, in the older part of the building. All bedrooms are for single occupancy and have the en-suite facilities of a toilet. The home has a large rear room, which is used to provide activities to both resident service users and those attending for day care as well as the main dining area. This room leads out to the rear garden area. The home also has a conservatory, which also looks out over the rear garden. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was carried out by one inspector and took place over one day for a total of seven hours. Twenty nine residents were at the home on the day of the inspection. There are currently two vacancies at the home. The inspector was able to see and spend time interacting with the residents. Many staff on duty were able to give time to speak with the inspectors. The registered manager Mrs. Hufton was not scheduled on duty and the inspector was assisted during the inspection by the administrator and senior duty nurse. The Company chief executive Mr. Harling was at the home during the inspection and was available for comment. The inspector would like to thank the staff for their time and hospitality shown to the inspector during her visit. The atmosphere at the home was relaxed and friendly. Staff carried out their duties in a pleasant and attentive manner. Prior to the inspection the CSCI forwarded service user surveys to the home and received eighteen completed returns. Professional surveys about the home were sent out to associate community health care professionals and four were completed and returned. The general trends in the responses were shared with the home’s manager and the overall impression of the home by respondents was of a well managed home where service user’s health care needs are met. Records examined during the inspection were a selection of care plans, Almondsbury Care quality assurance processes, medication management records, staff training records and staff recruitment records, staffing rosters, service user menus, equipment servicing records, fire safety records, information provided by the home to prospective and new admissions, staff handbook, The Ferns activity and social news sheet, a selection of service use contracts and records of staff meetings. Prior to the inspection the home completed and forwarded to the CSCI on request a pre-inspection questionnaire. This inspection examined key National Minimum Standards for Older People and any Standards where a requirement or recommendation were made at the last inspection. The aim of this inspection visit was to inspect outcomes for service users against key National Minimum Standards as part of the Commission’s ‘Inspecting for Better Lives’ strategy. Inspectors measure the quality of the service against four general judgements. These are - excellent, good, adequate and poor. The judgement descriptors for the seven chapter outcome groups are given in this report. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 6 What the service does well: 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. Ferns Nursing Home DS0000003255.V318120.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 Ferns Nursing Home DS0000003255.V318120.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): 1, 2, 3, and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good level of information about the home to inform prospective services and their families when making their choice of care home. Appropriate pre-admission processes have been developed and are adopted. Service users are provided with contracts detailing terms ad conditions of their stay at the home. EVIDENCE: The home has produced a detailed Statement of Purpose, which is periodically reviewed to ensure information within remains current. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 9 Pre-admission assessments for prospective service users were viewed as part of the inspection of care planning and good assessment of need was demonstrated to ensure that the placement was appropriate. A sample of three residents contracts were inspected and seen to be signed by both parties. Ferns Nursing Home DS0000003255.V318120.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): 7, 8, 9, and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were sampled these held a good level of health care information although care planning management for some clinical conditions was absent. Medication management was organised well and recorded accurately. Service users and staff interactions were observed to be respectful, friendly and caring. EVIDENCE: Care plans were sampled, there was evidence of health care needs being recorded and input by visiting professionals, the G.P, the district nurse and others for specific health care needs. These specialists included consultant input and the dietician. Feedback cards form visiting community health care professionals linked gave a positive overview of care management at The Ferns. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 11 Some care plans did not contain information particular to the resident in the management of their diabetes. One person with epilepsy had no plan of care how this presents and should be managed. Residents on Digoxin medication to slow and regulate the heart did not have plans of care why daily pulses are measured by nursing staff. Two persons were identified that have pressure sores. Care plans were seen and wound care was recorded for both people. Pressure relieving equipment is available and was seen in use. Bed rail use was documented in the individuals care plan and consultation for use was recorded as discussed with the next-of-kin. Where the service user is capable of giving their consent this needs to be recorded. During the day the inspector observed that the majority of service users spent long periods of time sitting in wheelchairs that were in most cases not individually adapted to need and did not provide lumbar support. Pressure relieving cushions was provided in wheelchairs where assessed and residents had pressure relieving care in their rooms for a period in the afternoon. Nevertheless, the home needs to be mindful that the primary function of a wheelchair is for transportation and unless individually adapted for sitting support wheelchairs can fail to provide necessary back, buttock and leg support if used for extended periods of sitting. It is recommended that the home review the length of time that some service users spend in wheelchairs during the day and considers appropriate alternative specialist seating. Medication management, storage and record keeping was inspected. The home also consulted with the CSCI pharmacist inspector following the inspection visit for further advice on managing medicine rounds with greater efficiency in the home. All staff and service user interactions observed throughout the day were friendly, caring and appropriate. Service users commented on the generosity of staff with their kindness and attention. There was a notice in one bathroom reminding staff to weigh residents that compromised resident dignity. This notice has subsequently been removed after being highlighted to the management by the inspector Ferns Nursing Home DS0000003255.V318120.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): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users were satisfied with the social opportunities available to them. The food was described as ‘good’ and looked appetising. Choices are available for menu options and the dining area is pleasing and attractive. EVIDENCE: There are regular in-house activities and a Ferns newsletter detailing forthcoming events provided by the home. Service user surveys indicated that residents were satisfied with the range of activities on offer. A small number of service users prefer to stay in their rooms and watch television or read, some had hobbies for example knitting. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 13 Regular relatives meetings are held three monthly. The time is rotated from Saturday to Sunday to an evening, to allow all relatives the opportunity to attend. Service users opinions were asked for with regard to the catering, the feedback was positive and service users reported that the food was good. The kitchen was briefly inspected. Fridge/freezer temperatures were maintained daily and the cleaning rota was seen to be adhered to. The chef has completed required food hazard analyses for the kitchen. The menu is varied and seasonal. Lunch was observed in the dining room. The meals were nicely served and the food looked appetising. The dining tables laid in the large lounge, were adequately presented and twenty one service users had lunch together. Service users can eat in their rooms if they wish; meals were nicely presented on trays. Drinks were served with the meal. The chef took time to chat with residents during the meal and to enquire whether residents were satisfied with the lunch. Protective clothing is available and staff assistance with meals was given sensitively. Specialist crockery and cutlery was provided appropriately for service users. Ferns Nursing Home DS0000003255.V318120.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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints policy and procedure that is adhered to. Residents expressed comfort with approaching staff or the manager should they need to raise concerns or complaints. Service users are protected from abuse by appropriate internal policies and procedures. Staff had received recent training in the protection of vulnerable adults. EVIDENCE: All concerns or complaints made to the home are logged and investigated. These records were inspected. The manager is very aware of her role in protecting vulnerable people in her care. Any concerns are taken seriously and would be acted upon. Regular resident and relative meetings are held to complement annual quality assurance questionnaires to assess the satisfaction of residents and relatives in the delivery of services at the home. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 15 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): 19, 20, 22, 23, 24, 25, 26, 27, 28 and 29. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Accommodation is generally comfortable, clean and tidy. Bedrooms can be personalised. Communal facilities are comfortable and the structure of the home is suitably adapted for the client group. Infection control is managed well. EVIDENCE: The Ferns is in the process of having an extension to the main building. Work is progressing and this is being managed in a way that causes as little disruption to running of the home as possible. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 16 The Ferns is purpose built and has level access. There are handrails, wide corridors and assisted bathing and toilet facilities. Health and safety adaptations include radiator covers and bath hot water temperature restriction to safe limits. Individual service user accommodation is comfortable and can be personalised. A tour of the premises was made and bedrooms were sampled. There is pressure relieving equipment available if required and overlays and cushions were seen in use. Hoisting equipment is provided for residents assessed as needing mechanical assistance with moving and handling. The laundry was inspected and appeared to be well managed. The home was clean and suitable cross infection equipment was provided in the building. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing numbers were adequate at this inspection. Staff receive induction and training relevant to statutory requirements and the clinical needs of service users. Staff supervision has been developed since the last inspection. Staff recruitment processes are generally safe, protecting vulnerable service users but needed to be more robust in one sampled case. EVIDENCE: The home has a Registered Nurse on duty at all times, in the morning the home has six care staff, the afternoons have a minimum of four care staff rising to five in the evening, overnight there are two care staff with the Registered Nurse. No concerns were raised about the staffing levels at this inspection. NVQ care awards training is promoted in the home several staff have achieved a National Minimum Standards level 2, some exceed this qualification level and several more staff are currently studying toward a NVQ qualification. Staff files for five staff employed since the last inspection were inspected. Overall the home has robust policies and procedures in staff recruitment in Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 18 order to protect residents. In one file inspected the robustness of recruitment fell below the Requirements of the National Minimum Standards and this is required to be addressed. Night workers are not presently offered health screening at the point of employment or thereafter on an annual basis as part of the Working Time Regulations 1998. This is recommended. Staff inductions map good practice of the Skills Council guidelines and staff receive a Ferns staff handbook on employment. The frequency and formalism of staff supervision has improved since the last inspection and the manager has worked hard to achieve this. Staff individual training files were inspected. There has been a range of necessary and appropriate staff training over the last 12 months. The home has an annual training plan for the staff team. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 19 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): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mrs Hufton is registered as the homes manager with CSCI. Mrs Hufton is managing the home and all challenges arising in her duties, professionally and very well. The atmosphere at the home is friendly. Quality assurance processes are well developed inviting continuous feedback on satisfaction with service provision. The handling of service user monies is audited in-house robustly with clear records maintained. Maintenance of the home was satisfactory and supports the health and safety of service users. Hoist slings should be formally inspected for suitability of continued use six monthly and bed rail risk assessment needs to improve. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 20 EVIDENCE: Mrs J Hufton was approved by CSCI through the Fit Person Interview process. Mrs Hufton manages Ferns very professionally and has dealt with situations arising for her as the manager, very well. Mrs Hufton is approachable and has a quiet, firm management style. Service user and relative meetings are held and service user satisfaction survey is carried out by the company. The Ferns was reaffirmed its Quality Rating by Somerset County Council in September 2006. Records relating to the handling of resident finances were inspected and god audit trails of monetary records were maintained. Accident records were seen and there is now a regular accident audit being completed. There are sufficient staff who hold a current suitable first aid certificate to ensure a first aider on shift throughout the 24 hour period. Fire records were sampled; there was evidence of a weekly fire alarm test being carried out on a regular basis. Servicing of fire equipment was also documented as being in order. Records of staff fire training were inspected and were up to date. The provider carries out Regulation 26 visit to the home on behalf of the company and a report is produced. The registered manager has consistently kept the CSCI informed in writing of any events on the home that require reporting. Bed rail use is individually risk assessed but the assessments inspected were generally poorly completed with insufficient detail and should be improved. Hoists are serviced six monthly in accordance with LOLER regulations. This is not the case for hoist slings, and is recommended in order to comply with this legislation. Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 21 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 3 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 2 Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 (1) Requirement There must be a clear plan of care management written for service users’ clinical care needs. This relates to service users who have diabetes, epilepsy or who take medication to regulate their heart rate (digoxin). Whilst awaiting full CRB clearance, prior to any staff member commencing employment two satisfactory written references must be received, in addition to receipt of a POVA first and supervised work. Timescale for action 09/12/06 2. OP29 19 (5) (4). Schedule 2 09/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 23 1. OP8 The registered manager should review the length of time that service users spend sitting in wheelchairs during the day. Night workers should be offered an annual health assessment annually. (Questionnaire plus medical consultation, if needed). Bed rail risk assessments should be more detailed. Slings for use in conjunction with hoists should be individually logged and inspected as fit for continued use by a competent person at least six monthly. 2. OP29 3. 4. OP38 OP38 Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Ferns Nursing Home DS0000003255.V318120.R01.S.doc Version 5.2 Page 25 - 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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