Inspection on 13/07/05 for Nottingham Neurodisability Service Hucknall - Fernwood

This inspection was carried out on 13th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Nottingham Neurodisability... 08/12/08

Nottingham Neurodisability... 31/10/08

Nottingham Neurodisability... 04/12/06

Nottingham Neurodisability... 24/10/05

Nottingham Neurodisability... 19/11/04

Nottingham Neurodisability... 14/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 NBIRC Fernwood House Hankin Street Hucknall Nottingham NG15 7RR Lead Inspector Caroline Brailsford Announced 13 July 2005 10:00 th 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service NBIRC Fernwood House Address Hankin Street Hucknull Nottingham NG15 7RR 0115 968 0202 0115 964 2747 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) Four Deason Homes (Ilkeston) Limited Mrs Sandra Horton Care Home with nursing - Private 20 Category(ies) of PD - Physical Disability registration, with number of places NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19/10/04 Brief Description of the Service: Nottingham Brain Injury Centre, Fernwood Unit is a two-storey, purpose-built care home, owned by Four Seasons Care Homes. It is situated at the corner of Hankin Street, between its two sister units. It provides full and rehabilitatory skilled nursing care for up to 20 service users with post-trauma and polyaetiological brain injuries. All personal care and occupational therapies plus entertainments and outings in the home’s own minibus, are provided. All service users’ bedrooms are individually decorated Many have ensuite toilet facilities. Some bedrooms have direct access via patio doors to a safe, enclosed garden at the rear of the property. The residents’ needs are wellsupported, promoting independent living skills within a risk assessment framework, helping them to make active choices and to be as fulfilled as possible within a caring, safe environment. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took 7 hours and began at 10 am. The inspector looked at one file from each floor at the unit and inspected care plans and risk assessments. Four staff members were interviewed and some time was spent with the centre manager and clinical services manager. The inspector had a tour around the building and viewed three service users bedrooms. Two service users expressed their views about the home to the inspector, one in private. The inspector also met three other service users. Some other documentation was also inspected for example health and safety documentation. What the service does well: Care plans inspected were comprehensive in content, describing all aspects of care needed. There was good management oversight of the care plans and the running records showed that the manager is directly involved with key decisions which need to be made. The staff were patient and caring to enable good communication with the service users. The privacy and dignity of the service users is well respected by the staff. The health needs of the service users are well met and the detail in the care plans regarding health is good. There are policies and procedures in place for adult protection and there was a copy of the Protection Of Vulnerable Adults file kept in the office. All staff spoken to including domestic staff were aware of this and of what to do should an adult protection situation arise in the home. Two service users said they felt “safe” living at the home. The environment is pleasant, bright and airy. Each room is for single occupancy, eight of which are ensuite. The residents’ bedrooms are pleasantly and individually decorated and furnished to their own tastes. The staff were friendly and caring towards the service users, they clearly knew the service users well and were committed to their jobs. The home is well run and there is good management support. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 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. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 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 standard(s) EVIDENCE: These standards were not inspected on this occasion. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 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 standard(s) 6,7,10 Care plans were detailed and comprehensive and there is service user involvement as far as possible. Relatives are also involved in a way in which is sensitive and appropriate. EVIDENCE: Care plans inspected were comprehensive in content, describing all aspects of care needed and the preferences of the residents concerned, including taking into account the residents’ social needs, feelings and attitude as well as how to meet their physical needs. Visual aids, including teaching diagrams, assist nurses and carers to ensure consistency of care. Regular reviews were evident and this had recently taken place for both plans inspected. There was good management oversight of the care plans and the running records showed that the manager is directly involved with key decisions which need to be made. One service user spoken with said that she was aware of her care plan although some service users have a low awareness and limited ability to contribute. In these instances there has been a system developed for recording how often the relatives would like to review the plan with staff on behalf of the NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 10 service user. It was not clear however how often this had taken place and if relatives were happy with the plans. One staff talked to the inspector regarding how there is a focus on individual communication systems for the service users and she reported that time is taken to communicate and develop systems that work for individuals, for example blinking and eye pointing etc. The staff were noted by the inspector to be patient and caring to enable the opportunities for the expression of wishes and feelings to be maximised. One service user said that they were asked about their wishes and choices. Relatives are also involved in decision making where appropriate. Service users records were detailed, accurate and kept in a confidential manor. The running records inspected were not all signed and dated. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 11 Lifestyle 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 standard(s) 11,16 The privacy and dignity of the service users is respected by staff and their rights are respected. EVIDENCE: Staff spoken with said that they maintain the resident’s independence and dignity as much as is allowed by the medical condition of the resident. There was evidence that relatives can visit and get involved with the care of the resident. There is an area in the home where independent living skills are practised with the activities organiser who gives support for those who seek to be rehabilitated back into the community, along with the support of other relevant professionals. Some residents do go back to live in their own homes or with family. The centre manager reported that this is quite often a slow process but it is something which if the service user wants the staff will work together to ensure the correct support is given. She also said that after eight years of hard work one lady has just returned home to the delight of all concerned. The inspector observed that the staff respected the privacy and dignity of the service users. Even though there was sometimes no apparent response from the resident, the staff still knocked on the doors prior to entering and said who NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 12 was entering and why. The staff then continued to discuss what they were doing and maintained a conversation with the person. All the bedroom doors of the residents who were in bed were open. The staff reported that this so that their health needs could be monitored closely. Staff used the residents preferred form of address, which was documented in their care plan. Where bed rails are used there is permission documented on their file. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 13 Personal and Healthcare Support 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 standard(s) 19,21 Service users health needs are well met and the illness and death of service users is handled in a way in which is sensitive and dignified. EVIDENCE: The health needs of some of the service users are complex and this is a very specialised area of staff expertise. Any health care tasks were clearly identified in the care plans inspected and staff felt that they had all the appropriate equipment training and skills. Pressure-relieving equipment such as airflow mattresses and cushions are used throughout the home. The care plans are comprehensive in describing the assessed healthcare needs of the residents. Residents who are cared for in bed receive regular attention as evidenced through the records and discussion with staff. There is evidence of improvement in pressure sores when residents first come to the home and staff spoken with could not think of an instance where any pressure areas had developed in residents while they have been living at the home. Residents with percutaneous endoscopic gastrostomy (PEG) tubes have detailed care instructions in their plans and non-nursing staff have received appropriate training, assessment and have been passed as competent. All staff spoken with said that they had the time to carry out any health care tasks effectively, providing sensitivity and dignity to the resident. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 14 Residents’ final wishes are recorded in care plans inspected. Staff demonstrated through discussion that they treat the residents and relatives with dignity and sensitivity during the final illness and death. Training had not taken place for staff however on handling death and dying. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 15 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 standard(s) 22,23 Policies and procedures are in place to ensure the safety of the service users, staff had a good understanding of these. Documentation regarding physical intervention which may be required was present although could be improved. EVIDENCE: There was a complaints procedure available for inspection. This included details of the Commission for Social Care Inspection and also the timescales for responding to complaints. Two residents said that they knew what to do should they wish to complain. There is a complaints book where the acting registered manager records all complaints in the home. In the book there were three complaints since the last inspection, all had been resolved at the informal stage. The centre manager also keeps a central record of complaints, which was also available for inspection. There are robust policies and procedures in place for adult protection and there was a copy of the Protection Of Vulnerable Adults file kept in the office. All staff spoken to including domestic staff were aware of this and of what to do should an adult protection situation arise in the home. Two service users said they felt “safe” living at the home. All physical intervention is recorded but these records should be improved to include the circumstances duration and effectiveness. It would be good practice to review the guidelines for staff for recording these events. Documentation in care plans for the management of behaviour were not always detailed to provide specific action, which should be taken by staff. Not all staff have received training in this area. Staff reported that any form of physical intervention is only used as a last resort. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 16 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 standard(s) 24,26 The environment is pleasant, safe and in line with the statement of purpose. EVIDENCE: The environment is pleasant, bright and airy. Each room is for single occupancy, eight of which are ensuite. The residents’ bedrooms are pleasantly and individually decorated and furnished to their own tastes. Two service users said that they were happy with their bedrooms. One room upstairs has been converted to a relaxation and calming therapy room and music can be ‘piped’ for the musical beat to be felt by those with a sensory impairment. There are lounges, dining rooms and the independent living skills area to meet most of the residents’ requirements and preferences. Smoking is no longer permitted in the dining room and a new smoking room has been converted to provide a pleasant space for those wishing to smoke indoors. The garden is pleasant and easily accessible and is used for recreational purposes by residents and staff. There is a handyman in post who was interviewed by the inspector. He is responsible for the upkeep of the building and is well organised and up to date with health and safety documentation. The fire log was inspected and all checks were found to be up to date. Although the handyman is responsible for NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 17 these checks, when he is on leave or days off the checks do not happen, there is not always a staff member present who knows how to do the checks or to reset the alarm should there be a problem with the system. There has been a ‘break in’ by local youths in the unit next door and the police have advised that the home would benefit from security cameras. The centre manager is aware of this and is taking this up within the organisation. The centre manager informed the inspector that there are plans for the replacement of some of the carpets. In particular the carpets in the dining area and some of the bedrooms were identified by the inspector to need replacing. The bathrooms are adequate and the staff were happy with the facilities, however they looked tired and in need of redecoration. One downstairs toilet had some exposed pipes which need to be boxed in. All service users spoken with said that they were happy with the environment. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,36 Staffing in the home is appropriate to the needs of the service users. The staff on the day of the inspection were committed to their job, enjoyed their work and were highly motivated. They had the skills and competencies required to do their jobs well. EVIDENCE: NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 19 The home has a new manager who is currently applying for registration with the CSCI. She has almost finished her registered managers award. Staff members spoken with spoken said they understand their roles and work well together well as a team. They all reported that they feel valued and motivated. The inspector observed that they know the service users well, were respectful towards them and have the skills and competencies required to do the job. All staff spoken with, including housekeeping and other ancillary staff, stated that they feel included in the running of the home and that they clearly understand their roles. They were very committed to the job. The centre manager said that the staff receive rewards for areas of good practice and commitment for example on staff received a gift voucher for recognising an issue and dealing with this well. Staffing appeared to be adequate on the day of the inspection to meet the needs of the service users and all staff and service users spoken with were happy with the current staffing levels. During the day there are five staff upstairs working with 9 service users including two trained nurses. Downstairs there are three staff to 7 service users including one trained nurse. At nights the staffing includes a trained nurse for each floor. The centre manager and acting registered manager reported that adaptation nurses from overseas are given full training to achieve their accreditation with the Nurses and Midwife Council (NMC.) The home’s induction programme for overseas nurses appears to be adequate for any training needs that overseas nurses may have. The School of Nursing works closely with and supports the manager in this programme Staff state that they feel well supported and have accessed training since the last inspection. There are some gaps in training for example death and dying and physical intervention. One registered nurse interviewed stated that there is a budget for special clinical and practical training such as giving percutaneous endoscopic gastrostomy feeds and other specialist treatments. Also that she is being given time to set up a programme of training assessment and monitoring for staff. Three staff files were checked and contained the relevant recruitment records which included an up to date CRB certificate at enhanced level. One staff was working at the home with out a CRB but this had been applied for and the management assured the inspector that they will not have any unsupervised access to the service users until this comes back clear. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 20 Conduct and Management of the Home 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 The home is well run and the staff receive good leadership and support from the acting registered manager and deputy. EVIDENCE: The new acting registered manager is a qualified nurse and has almost completed her registered Managers Award. The management at the unit is reported by staff to be very good with the acting registered manager providing good support and leadership to the staff. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 21 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 x x x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x x 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 4 x x x x Standard No 11 12 13 14 15 16 17 3 x x x x 4 x Standard No 31 32 33 34 35 36 Score 3 3 4 3 x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 NBIRC Fernwood House Score x 4 x 3 Standard No 37 38 39 40 41 42 43 Score 4 x x x x x x C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 6 Regulation Requirement Documentation regarding physical intervention must be improved to ensure that steps are in place for staff to follow should this be required. The recording of the incidents must include more detail regarding the circumstances and nature of the restraint. CCTV cameras must be installed to prevent further break in to the buiding by local youths and to ensure the safety and welfare of the service users Carpets identified in the report must be repaired, cleaned or replaced Bathrooms must be redecorated. Timescale for action 30/8/05 2. 24 13 3. 4. 24 24 23 23 Action plan to be provided to the CSCI by 30/8/05 30/8/05 30/9/05 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. Refer to Standard 6 10 Good Practice Recommendations Where relatives are involved with care plans this should be recorded. All running record should be fully signed by staff. C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 23 NBIRC Fernwood House 3. 4. 5. 6. 21 23 24 27 Staff should receive training in death and dying. Staff should recive training on physical intervention. There should always be somweone on duty who understands how the fire alarm system operates. The pipes in the downstairs toilet should be boxed in. NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 24 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI NBIRC Fernwood House C53 C03 S59006 NBIC Fernwood House V227632 130705 Stage4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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