Inspection on 16/07/08 for Ferns Nursing Home

This inspection was carried out on 16th July 2008.

CSCI found this care home to be providing an Good service.

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 23/07/07

Ferns Nursing Home 10/10/06

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 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Ferns Nursing Home 141 St Michaels Avenue Yeovil Somerset BA21 4LW Lead Inspector Barbara Ludlow Unannounced Inspection 16th July 2008 10:45 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.V364909.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.V364909.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@almondsburycare.com HatherleyGrange@ALMONDSBURYCAREFSBUSIN ESS.CO.UK Almondsbury Care Limited Mrs Jackie Hufton Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39) of places Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following category: Old Age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 39. 23rd July 2007 2. Date of last inspection Brief Description of the Service: The Ferns is a care home providing nursing care for up to 39 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 level access around the home with 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 been recently extended in size increasing the number of places from 31 to 39 and was refurbished throughout. The home has a large rear lounge / dining room. This room is also used for activities for both resident service users and those attending for day care and has access to the garden. The home also has a conservatory, which also looks out over the rear garden. The gardens have been hard landscaped to provide accessible level outdoor space that is attractively planted at acceptable heights for people using the service and the garden is designed for ease of wheelchair use. The fees are £685 per week excluding free nursing care. Residential rates were described as negotiable. Extra charges are made for escorts and transport, personal items, hairdressing and newspapers. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection visit was to inspect relevant key standards under the CSCI ‘Inspecting for Better Lives 2’ framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are|: - excellent, good, adequate and poor. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection, and the visit was well received. The inspection visit took place over one day from 10:45 am until 19:15 pm. The manager was on duty and assisted with the inspection process throughout the day. There were 32 permanent residents and one temporary resident at the time of the visit. A tour of the premises was made. The gardens and improvements were seen with the homes manager. The communal areas were seen and bedrooms were sampled. Preparations were underway for a grand opening of the newly landscaped gardens by the town Mayor, friends and families of people at the home had been invited to attend. The inspector observed daily life at the home and people seemed to be relaxed and comfortable, they looked well kempt. Staff interactions were heard to be kind and appropriate at all times. All the people in residence were seen during the day and a number were spoken with for their views on living at Ferns. The inspector spoke with staff, visitors and two visiting health care professionals; very positive feedback was given about the care and service at Ferns. As part of this inspection comment cards were sent to people using the service and their representatives. Four people living at the home, five relatives and four staff responded to CSCI. The feedback was very positive and comments are included in the body of the report. Records relating to care, recruitment and the health and safety maintenance of the home were sampled. Ferns Nursing Home DS0000003255.V364909.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: Chemicals in the kitchen should be stored safely at all times especially when the kitchen door is kept open. Access from the adjacent lounge was possible throughout the inspection day and the due to the design of the kitchen the kitchen staff would not always be aware of someone coming in, increasing the Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 7 risk of someone accessing unattended chemicals that were labelled as hazardous to health. No risk assessment was available for this however the cook took action at the time to safely store the chemicals away. The manager has since confirmed that advice about chemical storage has been taken from the local Environment Health Officer. The untidy sluice, which is close to bedrooms and could be accessed but is to be altered, should be cleaned. 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.V364909.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 Ferns Nursing Home DS0000003255.V364909.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): 1,2,3, 4,5, 6 does not apply. Quality in this outcome area is good There is a range of clear information available to families and people making a choice of care home. The contract is a clear document that explains the terms and conditions of residency. All people coming into the home are assessed pre admission to ensure care needs can be met at the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Annual Quality Assurance Audit (AQAA) was submitted to CSCI and this indicated that there is a company website for people to access information when they are looking to choose a care home. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 10 All people living at the home receive a copy of the homes Statement of Purpose; one was seen in a bedroom sampled at the inspection. This AQAA describes this document as being precise in describing what residents can expect. A copy of the homes contract / terms and conditions is available, this is a clear document that explains any extra costs that may be incurred. The AQAA states that the manager and staff take time and effort to well manage and make admission personal. It also states that care plans are written taking into account cultural, religious and social preferences where this is appropriate. There have been seven admission made to the home in the past twelve months and care plans were sampled for pre admission assessment which was seen to demonstrate a visit by the manager and detailed appropriate information for the manager to make her decision about whether a persons needs can be met at Ferns before a place is offered. The home has a block contract with Somerset social services. The AQAA reports that there has been positive feedback and this demonstrates that the home offers value for money. Comment cards sent to CSCI from four people living at Ferns all confirmed that they have received a contract. One person said their relatives found the place for them. All said they received enough information about the home before coming in. Five relatives responded to CSCI, all indicated they received enough information to help them make decisions. Four answered ‘always’ to the question: Do you feel the care home meets the needs of your friend/ relative? one said ‘usually’ and added that where they were not met the manager “has always taken immediate steps to remedy things”. Another relative reported that “the staff are very helpful if any of the family or their relative asks for information”. Ferns Nursing Home DS0000003255.V364909.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): 7,8,9,10,11 Quality in this outcome area is good. People living at Ferns receive a good standard of health and personal care. People are encouraged and supported to retain as much independence as possible and they receive dignified care by well trained staff. There are good relationships with community health care professionals giving support for people during episodes of ill health and with chronic disease and palliative care management. Medication administration is generally safely managed. The medications fridge temperature management / recording could be improved. This judgement has been made using available evidence including a visit to this service. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 12 EVIDENCE: All people had access to the statement of purpose; one copy was seen in a person’s bedroom. Five care plans were sampled. Four were examined in detail, which included looking at the pre admission assessment. One was examined for the wound care management of a pressure ulcer. All care plans had a full assessment of need and recent admissions had complete pre admission assessments. Detailed daily records were made and the care plans were reviewed regularly. Accident records where required were present in the care plans and for one person following a fall there was evidence that their General Practitioner (G.P) had been informed of the fall. 2 people had pressure sores, one had district nurse involvement and one person admitted with a pressure sore had evidence on their care plan of their wound healing. The people case tracked for the purpose of this inspection were met and all seemed to be happy with their care. Relatives seen confirmed satisfaction with the care. There was evidence of the involvement of community specialists with the care. A visiting GP and District Nurse were seen and spoken with both expressed their satisfaction with the care the people they visit receive. The management of medications was examined. A training session by the local pharmacist was held during the afternoon of the inspection and staff came into the home to attend this. The Medication Administration Records (MAR’s) are held in four files, all were seen. The records had Photographic identification and information about medication. There was a homely remedies policy signed for by three local G.P’s. There were no gaps on the signature records and medication administrations had been signed for. Hand transcribed entries on MAR’s should be signed by two people to verify the accuracy of the entry; two entries were seen with one signature only. This is recommended. Medications that are prescribed four hourly must be recorded if omitted. This relates to an analgesia prescription that did not have omission entries and the Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 13 prescription which was due for review to an ‘as required’ dose had not been made. The medications fridge was domestic in style. The temperature had been recorded daily. The records did not represent a safe range of temperatures; there seem to have been times when the fridge was too warm, up to 24.9 degrees Celsius. It was 11 degrees Celsius before opening at the time at the time of the visit. The range is between 2 and 8 degrees Celsius showing an increase when the door is opened. The manager was to take action, checking the accuracy of the thermometers and the staff’s methods of recording. The AQAA stated that the staff handbook has been introduced specifically dealing with equal opportunities, equality and diversity and training for staff on these issues. The management plan to improve the understanding and application of equality and diversity to benefit the residents including more understanding and application of positive ageing. The AQAA also stated that there is a system in place for reviewing and updating care plans each month. The home provides all aids for comfort, such as airflow mattresses and cushions, seat pads, comfortable chairs, beds and lifting equipment. Staff are trained to use aids and have attended courses on tissue viability. It said that people are treated with dignity and are offered choice with personal care and involved with their with care planning. The home was well equipped and people were seen to be treated with respect and care and attention was dignified. Four comment cards from people living at the service were received and one said there is “always good care”. Another said they sometimes receive the care and support they need because “there does not seem to be enough staff at all times”. Another said their call bell isn’t always answered and they may have to ring several times and once waited ¾ of an hour for someone to respond. All said they receive the medical support they need. Relatives responding to CSCI in writing all said kept up to date with important issues. In response to Do relatives get the support that they expect? One said “usually”, four said “always”. One person commented that honestly do “care” and observed that when visiting residents are seen to be in an “upbeat mood”. Staff responding to CSCI all agreed that they have access to relevant training that helps then to understand and meet the individual needs of service users relating to disability, gender, race and ethnicity, faith and sexual orientation. Staff said they receive support and discuss how they are working with the manager. Ferns Nursing Home DS0000003255.V364909.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): 12,13,14,15 Quality in this outcome area is good. The home has a good range of activities and people can choose to opt in or out as they wish. The garden is being developed and the use of the outdoor space is encouraged. A choice of meals is available and praise was heard for the standard of the catering. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA indicated that the weekly activities programme is printed and delivered to each person living at the home. It stated that routines are flexible and people are encouraged to keep contact with their families and friends. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 15 It stated that visitors are welcomed at any time and there are facilities for them to have a drink or a meal with their resident. The staff record wishes regarding any visiting restrictions, this was also explained at the inspection. People are able to bring in small personal possessions keep them in their rooms. Bedrooms that were sampled had been personalised and made homely. The AQAA states that contact with an external advocate can be arranged if the person wishes. Personal care records can be accessed if a person wishes to see them. The AQAA said of the catering that dietary choices, special diets are catered for. A varied and interesting diet would be offered and a healthy option. Assistance with eating would be given in a in a discrete and sensitive manner and people can eat in own room if they wish. This was observed at the inspection and lunch was an unhurried social occasion. An activities sheet for the week of the inspection was given to the inspector. This information was well presented and evidenced a range of activities across the week. This included an outside entertainer, two social sessions, reading newspapers and word games, board games, ball games, manicures, a computer session and one to one activities with those who spend time in their rooms or in bed. People were seen in the lounge mid morning, they all looked relaxed and comfortable. When asked about activities feedback was given about events and some said they were looking forward to the next visit from a regular outside musical entertainer that they particularly enjoyed. The garden around the home was seen during the tour of the premises. The garden has been attractively hard landscaped and planted it has made wheelchair friendly access and is level. An official opening was planned with the mayor for the following week and preparations were in progress. Lunch was seen served in the dining room to twenty people. Tables were nicely laid and background music was playing. Eight staff including two catering staff and a nurse were attending to the serving of lunch. The menu was braised steak, lamb chops, sliced beef or omelettes with vegetables followed by desserts. Special desserts had been made for those with diabetes. People said the meal was good and it looked and smelled appetising. During the afternoon there was no set activity but a film was chosen for communal viewing. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 16 People spoken with said they were happy here and one said “they could not be in a better place”, and the “food is excellent”, another said they food the food is “okay” but had not much of an appetite and the staff knew of “their likes and dislikes”. Visiting professionals stated that they were happy with the care the people they visit receive and find it to be offering a good service. People that live at Ferns commenting in writing to CSCI, two said they “always” enjoy the activities, one said “sometimes” and added they would like “more baking and skittles”, one said there are activities but they chose not to participate. One shared their appreciation of the activities coordinator. Feedback from staff working at the home to CSCI included that “Ferns provides excellent services to the residents especially the activities, choice of meals” and that “personal care is according to their wishes”. Another commented, “everybody gets treated as an individual”. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 17 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): 16,18 Quality in this outcome area is good. The home is managed in an open way and complaints are dealt with promptly using the homes procedure. Staff were observed to be kindly and respectful. Staff receive training and guidance that supports respect and dignity being shown at all times to the people in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA This indicated that there had been two complaints made to the Home. The records for these were seen at the inspection they had been dealt within a timely manner and both were upheld. The AQAA indicated that the complaints procedure is clear and available in a number of formats on request, large print and other languages. Also that staff are aware of their role in protecting people from abuse. It stated that the home would support people’s rights and provide opportunities to vote. Also advocacy Services can be can be accessed. The advocacy information was seen on display at the home. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 18 Staff were observed throughout the inspection day. Interactions were kindly and thoughtful. People were asked if they felt they could complain if unhappy. Generally people were comfortable raising concerns with staff at the home. One person said yes they would complain if they needed to and said that staff “do listen”. Comment cards from four people living at the home indicated that two “always” knew who to speak to if not happy. One said “sometimes”, one said “usually”. One person said they would speak to the sister, another said they were not sure who they would go to. One person who said they did not know who to go to if not happy, but added that they would ask their family to make a formal complaint on their behalf if they wanted to make one. Three indicated that they did not know how to make a complaint one said “yes”. Comment cards were returned to CSCI by staff, all staff responded “yes” they would know what to do if concerns about care were raised with them. Staff records confirmed that induction and training is given and the staff handbook directs staff to the whistle blowing policy and procedure and reminds them under the ‘no secrets policy’ that any abuse or bullying behaviour reported to them must be acted upon. There is also a strong section about upholding confidentiality at all times. One concern was raised anonymously by letter to CSCI indicating that night staff numbers had dropped to two staff on a particular night, the home was asked for information including the names of all staff on duty on that night. It was confirmed that staffing is always planned with regard to the number and needs of the people in residence and was shown to be maintained at three staff each night. Staff records were sampled and confirmed that Criminal Record Bureau (CRB) checks proir to commencing employment are part of the recruitment procedures used at the home to protect people using the service from the risk of abuse. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 19 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): 19,20,21,22,23,24,25,26 Quality in this outcome area is excellent. The home has been recently extended, refurbished and upgraded. It is well appointed, comfortable and safely maintained. The home is clean and hygienic and infection control is well managed. Private bedrooms can be personalised to make them homely. There is good access around the home and the gardens that have been attractively landscaped. This judgement has been made using available evidence including a visit to this service. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 20 EVIDENCE: A tour of the premises was made and the gardens were viewed. Communal rooms were seen and bedrooms were sampled. The home was found to be warm, clean and hygienic. One sluice room was seen which was not in use but was accessible. This room was untidy and needed cleaning and this was brought to the attention of the manager at the time of the visit who reported that the room was due to have some alterations made to it. During the past twelve months there have been some major changes and improvements to the environment, eight new rooms have been added and communal areas improved and enlarged. Service areas have been improved; a new laundry has been built. There is a new bathroom, shower room and has been refurbishment of the existing bathroom. Other areas have more recently been refurbished with new heating, new carpets, curtains and furniture. Lounge chairs and kidney shaped coffee tables were purchased when the lounge was redecorated and double doors were added for access to the garden. One visiting professional described the building work over the past months as having been “chaotic”. The work was extensive and has greatly improved the environment of the home. No concerns have been raised with CSCI during this time. The call bell systems and fire alarm systems have been updated. The gardens around the home have been improved with hard landscaping making level pathways and areas wheelchair accessible with planted areas at a wheelchair height for enjoyment. This construction was nearing completion ready for a party and official opening ceremony for families and friends of the people at the home, the homes staff and guests. The home has hand-washing facilities available for staff around the home and staff were seen to have access to protective clothing, such as gloves and aprons. Staff wear uniforms and all were looked well presented. The kitchen was freely accessible from the small lounge during the day of visiting. Due to the layout of the kitchen the catering staff were not always a visible presence during this time. An environmental risk assessment should be undertaken to review how safe this area is at all times. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 21 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): 27,28,29,30 Quality in this outcome area is good. The home has a skill mixed staff team. Staffing numbers indicated sufficient people to meet the needs of the people in residence. Staff are safely recruited and training is given from induction through to ongoing professional development. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were sampled and staff were seen on duty and the staffing levels were discussed with the manager. The nurse and care staffing levels used and departmental staffing appeared to be sufficient for the number and dependency of people being cared for at the time of the visit. No shortfalls were evident and no complaints about staffing levels or skill mix were heard at the visit. The plans to increase staffing to meet the needs of a greater number of people in residence were heard and sounded well planned with sufficient trained nurses on duty at all times. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 22 The manager is planning to increase the number of trained staff meetings and is currently building the staff team. Four staff files were seen and examined. There was good evidence of safe recruitment procedures. Staff had two references taken up and CRB / POVA First checks before commencing work at the home. Registered nurses personal identification numbers had been checked. Health declarations had been made and there was evidence of equal opportunities and diversity monitoring. Supervision was sampled and was found to be given at regular intervals. ‘Young workers risk assessment’‘ with parental support records were seen where required. Records are made of interviews and identification evidence was on file. Ten staff were seen and were observed working around the home during the inspection visit. All staff were heard to be polite and respectful in their dealings with the people living at the home and with their visitors. Visitors to the home and two visiting professionals commented positively about the response by staff towards them when visiting, they were described as “helpful” and “caring”. Interactions by senior staff with family members were seen to be open, friendly and professional. The AQAA indicated that staff have clearly defined roles and responsibilities within the home. The home sees induction and any probationary period as an extension of recruitment. It said there has been little use of agency or temporary staff. Systems are in place for their induction and support. More staff at busy times can be seen on the rotas. 90 of staff have or are working towards a National Vocational Qualification. The home now has an ‘In house moving and handling trainer’. They plan to do more work towards patient centred care. The evidence seen at the inspection supported this information. Of the twenty two care staff eight have an NVQ care qualification and eleven are working towards one. The AQAA indicated that all staff have received food hygiene training. Four people living at the home returned comment cards to CSCI. In response to the question do you receive the care and support you need? 2 said always 2 said sometimes. In response to, do staff listen and act on what you say? 3 said yes, one commented Sometimes saying it “depends who it is” and that staff are usually “too busy”. In response to, are staff available when you need them? 2 said usually two said sometimes. One person added that the call bell is not answered promptly Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 23 and they may have to ring several times and have waited up to “three quarters of an hour for someone to respond”. One person said they wish staff had more time to talk to them. Five relatives returned comment cards to CSCI. In response to the question, Do the care staff have the right skills and experience to look after people properly? Three said “usually”, two said “always”. One commented that they have not had reason to complain. One said they have been very impressed in recent months with the general quality of care. Four staff returned comment cards to CSCI. In response to, are there enough staff to meet the individual needs of all the people who use the service? 2 said always 2 said usually. Staff indicated that they may be down a bit in numbers because of staff sickness but that all the needs of individuals are met. Another said they are sometimes short staffed but have to ‘get on with it’. Which makes our work a lot harder. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 24 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): 31,32,33,35,38 Quality in this outcome area is good. The Registered Manager, Mrs J Hufton, capably manages the home in an open and inclusive way. There is a quality and safety monitoring of the care service and environment by the homes staff and management team. Feedback indicates that the quality of the care service provided at Ferns has improved. This judgement has been made using available evidence including a visit to this service. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 25 EVIDENCE: Prior to the inspection visit the AQAA had been submitted to CSCI and was comprehensively completed and contained a lot of information. Contact had previous to the visit, been with the homes deputy regarding a letter of concern about staffing on a particular day. This was helpfully and professionally dealt with. The inspection was well received. The manager was available throughout the inspection day. There is an open management culture and style that was seen to be supportive of staff, people in residence and towards visiting relatives. Staff training is important at the Ferns, there is a strong approach to induction, training and staff development. Four staff files were randomly sampled at the inspection. Supervision and appraisal were well-managed and record support training events. People living at the home can place small amounts of money for safekeeping, access is restricted and records are maintained and are audited on a monthly basis. Since the last inspection the monies have been kept separately, one balance was checked at random and was found to be correct. Signatures are recorded for withdrawals of money and where possible this is the person in residence and the administrator. Receipts are kept for purchases and where there is a joint receipt this there is cross-referencing to this on the individuals record. The company holds no appointeeships for people in residence. No concerns about finances were raised by relatives or people in residence with either CSCI or the home. Maintenance records were sampled for the fire safety equipment. The fire plan has been thoroughly reviewed by the manager since the alteration of the home and a fire protection company visited the home in April 2008. An emergency telephone line has been installed in the homes foyer for use in the event of it not being possible to access the office. Weekly and monthly fire equipment checks were up to date and a quarterly service visit had been carried out on 3/6/08. Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 26 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 4 4 4 4 4 4 3 4 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 2 Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The fridge temperature must be maintained with the safe range of 2 to 8 degrees Celsius for the storage of temperature sensitive medication and must be accurately checked and recorded each day. The manager is required to ensure that all substances hazardous to health are stored securely under the COSHH guidelines. This refers to the storage of dishwasher tablets in a safer place than near a kitchen door which was open and which leads into the lounge. Timescale for action 30/09/08 2. OP38 13(4) 30/09/08 Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 28 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP38 Good Practice Recommendations An environmental risk assessment should be undertaken to review how safe the kitchen area is at all times of the day and night. This relates to the kitchen door being widely open by day and unlocked at night. Nurses should follow the nursing and Midwifery Council guidelines and obtain a second signature to verify as accurate any hand transcribed entries on MAR charts. 2 OP9 Ferns Nursing Home DS0000003255.V364909.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V364909.R01.S.doc Version 5.2 Page 30 - 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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