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Inspection on 24/05/05 for Ferns Nursing Home

Also see our care home review for Ferns Nursing Home for more information

This inspection was carried out on 24th May 2005.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Ferns has a welcoming atmosphere, staff are friendly and helpful. Service users praised the staff for the care they receive. The office at the front of the home is used by the administrator, relatives were able to see and speak with her during their visit to the home. Service user spoke of enjoying the food. Activities are well structured and group and individual activities are catered for. The activities were observed to be enjoyed and to be fun. The home is professionally run by the company and has a capable leader in the home`s Registered Manager.

What has improved since the last inspection?

The evidence demonstrated an open management style that is providing good staff leadership and the company is taking the home forwards. There was some improvement in the record keeping.

What the care home could do better:

The risk assessment used for bed rails is not sufficiently detailed and should be improved. It would be helpful to include bed rail identification to improve the maintenance record keeping. One rail was required for tightening up. Nutritional needs seen in one care plan were not clearly recorded. The management of chemicals in the laundry area must be improved with appropriate protective equipment provision, available for staff to use. The staff areas of the home, their toilet and the laundry must be kept tidier and cleaner. Weekly fire alarm test records showed one recent intervals of 11 days and one of 13 days, these tests should be at a maximum interval of 7 days.

CARE HOMES FOR OLDER PEOPLE Ferns Nursing Home 141 St Michaels Avenue Yeovil Somerset BA21 4LW Lead Inspector Barbara Ludlow Unannounced 24 May 2005 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 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 D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ferns Nursing Home Address 141 St Michaels Avenue Yeovil Somerset BS21 4LW 01935 433115 01935 410536 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Almonsbury Care Limited Mrs Beverley Francis Davies Care Home with Nursing 31 Category(ies) of Old Age - (31) registration, with number of places Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to three places for personal care Date of last inspection 10 November 2004 Brief Description of the Service: 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 D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a very positive unannounced inspection to the service. The Manager was not at the home but did offer to return. Feedback was by telephone contact made towards the end of the inspection. There were 31 service users at the home. Staffing levels were adequate for this number. The nurse in charge and all staff were helpful. The administrator was on duty and was able to assist with access to information and records for inspection as requested. A tour of the premises was made and the bedrooms and communal areas of the home were clean, tidy and well maintained. All service users were seen and twelve were spoken with, the overall impression was of service user satisfaction with the care and service offered at the home. Activities were seen in progress during the afternoon and service users confirmed that they were enjoying themselves. What the service does well: Ferns has a welcoming atmosphere, staff are friendly and helpful. Service users praised the staff for the care they receive. The office at the front of the home is used by the administrator, relatives were able to see and speak with her during their visit to the home. Service user spoke of enjoying the food. Activities are well structured and group and individual activities are catered for. The activities were observed to be enjoyed and to be fun. The home is professionally run by the company and has a capable leader in the home’s Registered Manager. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 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 standard(s) 1,2,3,4,5.NMS 6 does not apply. Prospective service users have access to clear service user information. Visits to view the home are welcomed. Contracts are clear. Pre admission assessments are made to ensure that care needs can be met at the home. EVIDENCE: The home has an administrator who deals with all service user information. The home prepares a pack for individual Service Users which contains, a copy of the homes Statement of Purpose, Terms and Conditions of Residency and if publicly funded a copy of the financial agreement and the home’s booklet. The finances are managed centrally. Three service user financial agreements with the home were examined. The home charges are broken down on the contract document or financial agreement. The Registered Nurse Care Contribution was assessed for and is claimed from the Social Services, the process was documented in all cases but not completed for one. The RNCC money is retained by the home. Visitors confirmed that they were pleased with the help their relative was given on admission and to help ‘settle in’ to life at the home. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 9 Bedrooms were not defined where a service user had a block contract social services placement. The contract states that a bedroom may be ‘subject to change.’ Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 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 standard(s) 7,8,9,10 Service user care plans demonstrated overall a good level of care management for individual service users. Medications were safely managed. Service users are addressed appropriately and treated kindly by staff. EVIDENCE: Four care plans were examined, there has been some improvement with the care plans but further work is required with individual bed rail risk assessments. One care plan was unclear about a service user’s nutritional needs and requires to be made clearer and be risk assessed if appropriate. Service users were seen and spoken with, all confirmed that they are well cared for and spoke positively about the care given at the home. One person said that the care was 110 . All appeared well attired and feedback included comment that the laundry service was better and much quicker than it had been. Medication management was seen. Medication Administration Record (MAR) charts were clear and complete. There was photographic identification with the MAR charts to assist staff and reduce the risk of error with administration. All controlled drugs were stored and recorded appropriately. All creams in use had discard by dates for safe use. The medications fridge temperature is monitored to maintain an acceptable and safe level. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 11 Staff interactions observed and heard were appropriate and kindly. Service users preferred term of address was heard being used. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 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 standard(s) 12,13,14,15. Service users are able to join in with a range of activities. The home has an activities coordinator who was well organised and offers a good service to the homes clients. Visitors are welcomed and the home has a friendly atmosphere. The home offers home cooked foods and a choice is available. EVIDENCE: The afternoon activity was observed, a number of service users were participating and were having fun preparing for a family garden day. The home offers day care of up to four places and has a stroke club twice per week. Resident and non-resident service users were seen spending time together and the impression was of a group that were getting along very well together. Trips out are organised, one such outing was recalled separately by two service users as ‘great fun’ and a ‘good time’. One service user has been given dedicated space to pursue a painting hobby and was very pleased to be able to do so. Service users can have a daily paper delivered. Two visitors were spoken with, they confirmed that their relatives are well cared for and that they are made welcome when they come to the home. One service user commented that they ‘can go to bed and get up when they like’. One person has an appointed advocate from Age Concern to assist them with their affairs. Service users were asked about the food and comments included ‘I had a good breakfast’, ‘I wake early ( 7am) and nearly always I’m offered a cup of tea’. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 13 The kitchen staff were seen, one member of the care staff team had been rostered to kitchen and was undertaking kitchen assistant duties. Lunch was homemade meat pie, chips or mashed potato, cauliflower and green beans. The food looked appetising and there was a choice offered to service users. Alternatives of ham, tuna or egg salad was available. Staff are catered for and they are offered the main menu choice. The kitchen was clean and tidy. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 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 standard(s) 16,18. Service users asked confirmed that they would not be afraid to speak up if unhappy about something at the home. Service users are protected from abuse by the recruitment process and policies and procedures in place at the home. EVIDENCE: Service users were asked if they would feel able to complain, one service user said that he would not be ‘shy’ about saying if he was unhappy with something. The home has recruitment checks and procedures and carries out CRB / POVA First checks on new staff. There have been no complaints since the last inspection. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26. Individual accommodation was clean and comfortable and can be personalised by the service users. There is a good level of maintenance and servicing. The home is kept clean and well presented. Precautionary measures are in place for the prevention of cross infection. Staff facilities could be tidier. EVIDENCE: The home has two dedicated maintenance staff to carry out regular service checks, both were seen at this inspection and were fitting new fire door closures. The adjustment and safety checking of bed rails was discussed at the inspection see Section Management and Administration. A tour of the home was made and the home was found to be clean and well maintained. The staff facilities should be kept tidier. The communal rooms were well used and the gardens accessible. A family day was planned, with lunch, to encourage a families to attend and get involved with the garden upgrading. There are sufficient toilets and bathing facilities. Corridors have grab rails and the facilities are adapted to meet the needs of the elderly service users at the home. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 16 Bedrooms that were seen were personalised, clean and comfortable. The home has sluice facilities. Infection control measures were evident, hand cleansing gel was available and is used by staff. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 The home has a Registered Nurse Manager. There was an adequate staff number on duty at the home. Recruitment practice was satisfactory and afforded protection for service users. POVA First information and CRB storage was discussed. Adaptee staff work permits were clarified after the inspection. Staff are trained and job grades reflect the individuals achievement of National Vocational Qualifications (NVQ) and their experience. EVIDENCE: The homes has an experienced Registered Nurse Manager, there is a registered nurse on duty at all times. The home has grades for care staff that are related to their NVQ level qualification and experience. Seven care staff were on duty at the time of this unannounced inspection and one other care staff member was on duty to assist in the kitchen. There was sufficient ancillary staff on duty at the home. Recruitment records for four new staff were seen, and these were satisfactory, POVA First check confirmation was not evident for one member of staff and one had been received after a persons state date. This was discussed with the home’s administrator as a change in practice had been implemented after the last inspection. The administrator stated that she was now clear about the recording and storage of CRB information for staff. The most recent recruitment practice seen was satisfactory. One query was made of the company management regarding the adaptation of overseas staff and their work permits, this was confirmed as resolved and satisfactory at the time of the enquiry. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,35,37,38 The home is generally well managed and has an experienced Registered Nurse Manager who takes a clear leadership role at the home. The financial records for individuals were satisfactory. All records were well managed however a change in practice is recommended to ensure that accident records are stored in line with the guidance for Data Protection. Health and safety requirements were made. EVIDENCE: The service users gave positive feedback about the care and service they receive at the home. There are two maintenance staff and records kept by them and the servicing documentation was inspected. This included hot water checks that in April 05 were in a safe temperature range. Room checks are made and were carried out in April; window restraints, wardrobe fixings, carpets and keys are checked as are adjustable beds. One bed rail was found to require tightening, this was brought to the attention of the nurse in charge and one of the maintenance staff. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 19 The fixed wiring was checked on the 25th May 05 and gas safety was certificated on 11th March 05. The home has a current waste collection contract and the sluice machines had been serviced in March ’05. Hoists for patient handling had been serviced in May ’05. The home has a current service contract for the fire alarm, detection equipment and emergency lighting. The annual fire extinguisher servicing was due. In house weekly fire alarm testing is recorded it was noted that on 2 occasions the tests intervals had been more than 7 days, a gap of 11 days and one of 13 days was noted. Accident records were seen, these were retained together, the Data protection Act requires that personal records such as these are stored separately and securely. This is recommended at this inspection. The laundry staff use pumped liquid laundry destainer, no eye protection was seen for use by staff when changing the bottles over, these are required. Gloves provided should also be adequate for use with chemicals. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x 3 x 2 2 Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 21 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 OP26 Regulation 23(2)(d) Requirement The staff toilet and laundry must be kept tidy. The laundry must have accessible hand washing facilities. Bed rails must be securely fitted. Staff using hazardous chemicals in the laundry must have access to protective eye wear and appropriate gloves. Timescale for action 25.06.05 2. 3. OP38 OP38 13(4)(c) 23(2)(c) 25.06.05 25.06.05 4. 5. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP38 OP38 OP37 OP8 Good Practice Recommendations Weekly fire alarm tests should be carried out at intervals of not more than seven days. Bed rail risk assessments should be more detailed. Accident records should be stored in line with Data Protection Act. Nutritional requirements must be clear and any risks identified and documented. Ferns Nursing Home D53 - D02 S3255 Ferns Nursing Home V227326 24.05.05 Stage4.doc Version 1.30 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier Taunton TA1 4AL 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. 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