CARE HOME ADULTS 18-65
Fernwood 30 Fern Road St Leonards-On-Sea East Sussex TN38 0UH Lead Inspector
Jason Denny Announced Inspection 1st November 2005 09:30 Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 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 Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 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 Adults 18-65. 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. Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Fernwood Address 30 Fern Road St Leonards-On-Sea East Sussex TN38 0UH 01883-342386 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) Graham Robert Jack Graham Robert Jack Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Learning Disability (LD) not falling under any other category. The maximum number of service users to be accommodated must not exceed three (3). The people accommodated will be between the ages of eighteen (18) and sixty five (65) years of age on admission Date of last inspection Brief Description of the Service: FERNWOOD IS A LARGE DETACHED PROPERTY IN A QUIET SUBURBAN AREA OF ST LEONARDS. THE HOME HAS AN ACCESSIBLE AND LARGE BACK GARDEN. THE FRONT ENTRANCE TO THE HOME WOULD BE UNSUITABLE FOR WHEELCHAIR USERS. THE HOME HAS ONE BATHROOM AND ONE SHOWER ROOM/TOILET. ALL ROOMS INCLUDING THE KITCHEN, DINING ROOM, LOUNGE, AND BEDROOMS ARE LARGE AND SPACIOUS. THE HOME IS MODERN AND WELL APPOINTED. THE HOME IS CLOSE TO LOCAL TRANSPORT LINKS. EACH ROOM HAS SINK WITH A TOILET AND A CHOICE OF TWO BATHROOMS NEAR TO BEDROOMS. THE HOME IS REGISTERED TO PROVIDE SERVICES FOR UP TO 3 YOUNGER PEOPLE WITH A LEARNING DISABILITY. THE OWNER/ MANAGER OF THE HOME MR GRAHAM JACK OWNS A SIMILAR TYPE OF HOME IN HASTINGS. Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the home’s first inspection whose main purpose was to find out how the new service users were settling in after the home was opened from April 2005. The second purpose was to find out how the home was being managed, and managing in relation to finding the right staff and providing training along with developing all the necessary administration paperwork needed for a care home. This was an Announced Inspection and took place between 9.30am and 4pm. The inspector started the visit by talking with the home’s manager about how the home was progressing and looking at all the paperwork including care records. The lifestyle of each service user was looked at particularly in relation to activities. Staffing files were looked at with staff both spoken with, and observed. The inspector met both service users. Meal and medication arrangements were looked at along with training plans. The inspector received back positive comment cards sent to the families of service users. The inspector has received positive comments from social services who fund the home, since the inspection. 20 of 27 standards assessed were fully met, with others nearly met. What the service does well: What has improved since the last inspection?
This was the home’s first inspection so not applicable. Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 6 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. Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 & 5 Prospective new service users benefit from a basic level of information contained in the home’s service user guide. Now that the home has opened this guide needs to be updated to reflect the service user group, the admittance policy, the skills of new staff, and some other information. Although the home ensures it has thorough information from social services and other sources before new people move in, it needs to ensure that it has carried out its own written assessment. The amount of time spent with prospective new service users including a number of trial visits is exceptional. The home issues prospective new service users and their advocates with clear, comprehensive, and transparent contracts. EVIDENCE: The inspector examined the home’s service user guide and statement of purpose, which was unchanged from before the home opened. The manager stated that the next service user would need to fit in with the present two. Care-plans showed a number of assessments from social services given to the home prior to service users moving in. The manager discussed how he visited these service users and worked shifts with them prior to offering them a place. None of this assessment process had been written down, although a diary showed a number of trial visits by both service users before they moved in during May 05. These visits included overnight and full weekends. Signed contracts were examined for both service users, which showed fee levels.
Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 In a short space of time [5 months] the home has developed useful and sufficiently detailed care-plans for both service users based on supporting them to develop skills, maintain independence and promote choice. Staff and management showed a good understanding of these plans. Service users were found to have effective advocacy arrangements with their choices and rights respected in the running of the home. Service users are carefully risk assessed and given regular opportunities to access the local community. EVIDENCE: The inspector examined both care-plans, which had developed from the original assessment information. A range of guidelines was found to be in place including detailed information on supporting personal care routines. A social services review carried out on one service user 8 weeks into the placement showed that needs were being met. Both service users have limited verbal communication with both plans showing a range of communication guidelines subject to regular review. Staff were interviewed as to their understanding of these plans, and how the service users had developed since moving in. Both service users were found to have weekly to fortnightly contact with families, with both being involved in care reviews.
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The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): All standards in this section 11-17 A range of evidence showed how both service users were enjoying a greater quality of life as a result of moving into the home. The home is committed to active and meaningful lifestyles with routines carefully suited to the needs and choices of service users. Evidence showed how a particular service user had developed a higher level of motivation and independence by the way he is being supported. The home provides both in-house and mainly community based activities. Service users are encouraged to treat the home as their own with any restrictions based on careful risk assessment. Service users benefit from both healthy and tasty meals at flexible times. EVIDENCE: Activity schedules were examined along with daily notes on both service users. The inspection took place during normal business hours with only brief observation of service users due them being out for most of that time. One was at a day centre and the other attended a community event and later in the day a swimming session followed by in house music session. Records of meals served along with food stocks were examined. Both service users were observed to have full access to all parts of the home including the kitchen.
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The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Service users receive personal support in the way they prefer and require. Service users benefit from having recorded routines and guidelines, which help staff to know how best to support them. Service users physical and emotional health needs are fully met Service users have minimal medication, which is securely stored by trained staff that follow all necessary guidelines. EVIDENCE: Personal care guidelines were looked at for both service users this included looking at detailed bathing guidelines, which showed service users preferences, what they could do for themselves, and what support they required. One service user has his right to have a bath before breakfast respected. Care-plans itemised health needs with records kept of health appointments and follow up action. One service user has relieving anxiety guidelines. This service user now for the first time, has a meal with others. The medication cupboard, medication stocks and records were examined along with staff being observed giving medication. Medication consisted of over the counter remedies namely folic acid and indigestion tablets. All staff were found to have recent refresher training from a supplying pharmacist. Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The home operates in an open and inclusive way in the best interests of service users. The home has a clear complaints policy although it is recommended that a complaint recording form is introduced which sets out how a complaint should be investigated and dealt with. Staff are aware of how to both identify and report suspected abuse. The homes adult protection reporting policy needs clarifying to ensure that any suspected abuse is correctly reported and investigated. EVIDENCE: It was evident from records and discussions with the manger that no recorded complaints have been made to the home in respect of service users. The manager demonstrated through discussion how any complaint would be dealt with and investigated including any complainant being written to with the outcome. It was agreed that the home should introduce a complaint recording form to ensure that all staff would process a complaint in the same way regardless of who initially took the complaint. The manager confirmed that he had recently attended a Protection of Vulnerable Adults course. All staff have previously covered adult protection training in their previous jobs. The home was found to have adult protection prevention of abuse policy and reporting procedure. The reporting procedure was found to make no reference to Social services who take the lead role in adult protection investigations. Staff were interviewed as to their understanding of adult protection issues. Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 13 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None None of these standards were inspected on this occasion as they were found to be fully met on a previous visit prior to the home being registered in April 2005. It is noted that service users live in an exceptional environment in all respects. EVIDENCE: Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 14 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34,35 & 36 Service users benefit from good staffing ratios, which help them to have an active, and well supported lifestyle. The rota would benefit from being clearer. Staff are motivated, skilled, and dedicated to their work. The home follows tight recruitment procedures, which ensures that only suitable people work in the home. Training is developing for staff although insufficient numbers of staff are studying for National Vocational Qualifications. Staff benefit from regular and wide ranging, written supervision, which supports them in their roles as confirmed by staff. EVIDENCE: The rota was found to be followed although it was not clear what hours were being worked and what capacity each person on the rota worked in. The manager was advised to indicate when his hours were management time. A service user who is funded to have 7 hours a day 1:1 staffing Monday to Friday was also found to have this plus 1:1 most weekends. The other service user was found to receive similar staffing ratios. Staffing files on all 3 staff were examined with Police CRB and references along with all other information in place. The manager was advised to get POVA firsts in writing to confirm phone calls. One of the 3 care staff was found to have NVQ 3 with the other two staff not currently on any NVQ courses. Supervisions records for all staff were looked at which showed that they were occurring at least every two months.
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The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40 & 42 The home is well managed by an experienced and dedicated manager. The manager is urgently advised to commence a national recognised management course [NVQ4] in line with the expectations of the post and as a condition of being registered with the Commission. Effective Quality Assurance systems are in place. Service users are protected by staff who have either achieved all necessary health and safety training or are working towards the qualifications. The building is well maintained with all equipment regularly serviced. The home is required to have a visitor’s book to protect service users. EVIDENCE: The manager/owner has previously managed similar services. The manager was found to have not yet started a relevant management course [NVQ 4]. The manager is currently a registered nurse in learning disability. Some staff were found to have Moving and Handling, First aid, food hygiene, and health and safety training with all other staff booked on these courses over the next 3 months. All equipment such as fire, gas, and electrical, was found to be within its service schedule.
Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 3 4 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30
STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X 2 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Fernwood Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 2 X 3 3 X 2 X DS0000060878.V251807.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? NA 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 YA1 Regulation 4 & 6[a] Requirement Timescale for action 01/02/06 2 YA2 14 3 YA23 12[1] [a] 4 YA42 17[2] schedule 4 That the home’s Statement of Purpose must be complete, is reviewed to ensure that it is kept up to date, and, reflects the service provision of the home. That the Registered person must 01/01/06 ensure that the homes carries out its own written assessment on a prospective new service user prior to admittance. That the home confirms in writing prior to admittance that it can meet the assessed needs. That the Registered person must 01/01/06 ensure that the home’s reporting procedure in respect of Adult Protection is complete and makes mention of Social services being the lead agency along with their contact details. That the Registered person must 01/12/05 keep a record of all visitors to the home, including the names of visitors, and the purpose of each visit. Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 18 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 YA22 YA33 YA35 YA37 Good Practice Recommendations That the home introduces a complaints recording form to assist the recording of key information including guidance on how to conduct an investigation. That the home’s rota clearly identifies the hours worked by each person and in what capacity. That sufficient numbers of care staff are enrolled on National Vocational Qualifications level 2 or equivalent as soon a possible and before December 2005. That the Registered manager commences an NVQ level 4 in Management as soon as possible and before December 2005. Fernwood DS0000060878.V251807.R01.S.doc Version 5.0 Page 19 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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