Inspection on 24/10/05 for Nottingham Neurodisability Service Hucknall - Fernwood

This inspection was carried out on 24th October 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.

Other inspections for this house

Nottingham Neurodisability... 08/12/08

Nottingham Neurodisability... 31/10/08

Nottingham Neurodisability... 04/12/06

Nottingham Neurodisability... 13/07/05

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 Nottingham Brain Injury Rehabilitation Ctr Fernwood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR Lead Inspector Steve Keeling Unannounced Inspection 24th October 2005 10:00 Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.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 Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.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. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Nottingham Brain Injury Rehabilitation Ctr Fernwood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR 0115 9680202 0115 9642747 Address 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) Four Seasons Homes (Ilkeston) Ltd Mrs Sandra Horton Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th May 2004 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 homes 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, very pleasant, enclosed garden at the rear of the property. The residents needs are well-supported, 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. The facilities within Fernwood House are conducive to achieving optimum independence for the service users. Wheelchairs can access all areas within the home, mobility aids are available such as hoists, transfer belts and strategically placed handrails and easily accessible shower and bath areas. A vertical lift is also accessible to allow easy access to the first floor of the home. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place over a 3.5 hour period and involved one inspector. The main method of inspection was case note tracking, this is a method of selecting service users within the home and discussing with them if possible, their expectations and experiences of living within the home environment. The case tracking method also analyses the records of the service users to ascertain if the service users identified needs are being addressed appropriately within the care home setting and that their safety and well being is being maintained. On this occasion two residents notes were case tracked. At the time of the inspection a total of 20 residents were accommodated at the home. It was evident that the acting manager and staff within the home are very committed to providing a high standard of care for the service users. The manager within the unit was very helpful and cooperative thus ensuring that the inspection process progressed in a professional and efficient manner. What the service does well: Care plans inspected were comprehensive, clear and concise in content, all identified needs are being addressed effectively. The acting manager of the unit ensures that service users care plans are reviewed on a monthly basis to guarantee that the changing needs of the service users are identified and addressed efficiently. The acting manager is directly involved with key decisions appertaining the care afforded to the service users within the unit. The environment is pleasant, bright and smelt fresh. Service users rooms are for single occupancy, eight of which are ensuite. To promote a homely environment service users bedrooms are pleasantly and individually decorated and furnished to the service users own tastes. It is evident that service users have lots of personal possessions in their rooms to further promote the homely atmosphere. It was evidenced that the home has appropriate mobility aids to optimise service users independence and that the equipment is maintained to a high Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 6 standard thus promoting the safety of the service users. It is evident that regular fire safety checks, water temperature monitoring and chlorination are performed and recorded by the homes handyman and that the documentation appertaining to the safety checks clearly and concisely maintained. The handyman performs visual checks, all electrical equipment and Portable Appliance Tests (PAT) are undertaken appropriately. 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. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.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 Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.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): 2. 3. 4 Service users identified needs are assessed effectively. Fernwood House provides information appertaining to the services that the home can provide to meet identified needs and aspirations of the service users. Service users are afforded the opportunity to “trial” the home before permanent residency is established. EVIDENCE: A thorough pre-admittance assessment was evidenced within both case tracked notes. The assessment process identified specific needs of the service users to maintain optimum independence within the home. It was established that the home does offer trial periods of up to four weeks. At the end of the four-week period a comprehensive re-assessment process is performed by the multidisciplinary team at Fernwood House to ensure that the service users requirements can be fully met within the home and the service user are satisfied with the services and facilities within the home. The acting manager in highlighting the facilities that Fernwood House, ensures that copies of the homes statement of purpose, mission statement, general Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 9 information leaflet and a contract of the terms and conditions is made available to the service users or their family. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 10 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. 9. Service users assessed needs together with personal goals are reflected in individual care plans. Service users are supported to take risks as part of an independent lifestyle. EVIDENCE: The care plans examined at the time of the inspection were clear, concise and very well organised. The service users needs were assessed holistically and all identified needs were addressed effectively in the care planning process. Care plans are evaluated on a monthly basis so as to address any changes in the service users needs. All care plans were signed and dated by the assessor. As far as practically possible all service users or relatives are involved in the care planning process, which was evidenced by service users or their representatives signatures within the relevant documentation. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 11 In ensuring that all grades of staff are fully informed of the needs of the service users the acting manager makes sure that all service users are allocated two “key workers” whose responsibility is, under the supervision of the acting manager, to ensure that all aspects of the service users care is reviewed on a monthly basis and that the changing needs are addressed appropriately. In supporting the service users to promote an independent lifestyle and take risks, Fernwood House adopts a multidisciplinary team approach to health promoting interventions and the rehabilitation process. Members of the multidisciplinary team includes a neuro-specialist, consultant in rehabilitation medicine, psychologist, qualified nursing staff, social workers, physiotherapists and occupational therapists, Fernwood House also offers alternative therapies via a shiatsu specialist. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 12 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 the following standard(s): 12. 13. 15. 17 Service users can participate in age, peer and culturally appropriate activities. Service users maintain contact with the local community Service users can participate in appropriate personal, sexual and family relationships. Service users are offered a healthy diet and enjoy their mealtimes. EVIDENCE: Fernwood house benefits from a specialised area in which independent living skills are practiced with an activities coordinator. In rehabilitating the service users within the unit the expertise available within the multidisciplinary team can be utilised. The activities coordinator within the home ensures the provision of varied and stimulating social activities such as bingo, clay modelling, painting, collage, working with clay and providing films for the service users enjoyment. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 13 Transport is utilised to take service users to parks, the coast, theatres, local parks, pubs and restaurants, and small animal farm within the area. Service users, if they wish, can access Hucknall town centre to shop or browse. No restrictions are in place in relation to visiting times placed on relatives and friends of the service users. The acting manager was aware of the complexities of monitoring personal relationships for the service users within the home and it was evident through discussion with the acting manager that she would respect the service users privacy and dignity whilst protecting the service users from potential abuse. It was observed that the service users within the unit were very well presented, dressed in appropriate clothing for the season, and was wearing their own shoes or slippers. It was evident that the food in the home is wholesome, nutritionally appropriate and varied. It was evidenced that service users always have a choice of meals and that daily menus are displayed for service users perusal. As far as practically possible the service users can exercise choice and preference. The lunch provided on the day of the inspection consisted two main choices and a vegetarian option. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 14 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 the following standard(s): 18. 20. Service users receive ongoing support in a way they prefer and require. Service users would be supported in the self-administration of medicines once an assessment has been performed and the service user is deemed safe in performing the procedure. EVIDENCE: To ensure that service users receive support in a way they prefer and require and to further support the initial assessment process the acting manager makes certain that multidisciplinary “quality circle” team meetings are performed to assess the service users progress within the unit to identify and discuss the quality of care afforded to the service users. The quality circle team meeting also creates a forum so that staff of all grades can voice any concerns relating to any aspects of care within the unit. It was established at the time of the inspection the no service users are independent in the administration of medicines. Although if, after a thorough assessment, the service users is deemed as competent and safe whilst performing this task the acting manager at Fernwood would attempt to facilitate independence in relation to self medication. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 15 It was established that service users are protected by the homes policies and procedures for dealing with medicines. All medication is received, stored, administered and disposed of in an appropriate way. Controlled medicines are stored securely and all areas that are used for the storage of medication, dressings and Percutaneous Endoscopic Gastrostomy (PEG) feeds are temperature monitored to prevent premature degradation of the products. The medication room at Fernwood House is well organised, clean and appropriate for purpose. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 16 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): Standards 22 and 23 were not addressed at this inspection. EVIDENCE: Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 17 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): 24. 30. Fernwood House offers a homely, comfortable and safe environment for service users. Fernwood House is maintained effectively and is clean and hygienic although the carpets in some service uses rooms require replacement due to staining from Percutaneous Endoscopic Gastrostomy (PEG) feeds. EVIDENCE: Fernwood House has an ongoing routine maintenance programme and a dedicated handyman deals with any shortfalls within the home environment effectively. The temperatures of water outlets are monitored on a monthly basis and emergency lighting and fire alarm checks are performed on a weekly basis. Shower temperatures are monitored and the handyman at the unit also chlorinates all showerheads within the unit to control Legionella contamination. All mobility equipment within the unit is covered by service contracts to ensure service user safety. The handyman, as part of the induction process performs fire-fighting training for all new staff members. The grounds are tidy and well maintained and easily accessible to service users thus providing a very pleasant, safe, area for the service users to utilise as they wish. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 18 The home has a high standard of cleanliness and all areas smelt fresh. Some carpets are stained as a result of Percutaneous Endoscopic Gastrostomy (PEG) feeds being splashed, it is the intention that all the carpets in the service users rooms will be replaced with a non slip flooring to aid the cleaning process so as to make the service users rooms more aesthetically pleasing. The case tracking process evidenced that the service users bedrooms were very comfortable and homely, personal possessions are evident such as family photographs, televisions and stereos and it was established that the service users can choose colour schemes within the rooms when they are redecorated so as to satisfy and encourage personal choice. To promote security and safety for the service users and staff, and to satisfy a requirement from the last inspection performed on 13th July 2005, it is the intention that a Closed Circuit television (CCTV) system will be installed. The acting manager is currently in the process of obtaining quotes so that system can be installed in the near future. In the interim a security firm is employed to patrol the grounds throughout the night. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 19 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): Standards 31 to 36 were not addressed on this occasion. EVIDENCE: Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 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 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): 42. The health and safety and welfare of service users are promoted and protected effectively at Fernwood House. EVIDENCE: The acting manager at Fernwood House benefits from a wealth of experience as a qualified nurse, she is currently in the process of applying for the registered manager with the Commission for Social Care Inspection and the process will be finalised in the near future. It was established that all new members of staff are only employed after a robust recruitment process has been performed which includes a Criminal Records Bureau (CRB) check, two satisfactory references and a Protection of Vulnerable Adults (POVA) check if necessary. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 21 The acting manager performs supervision for nursing and care staff to ensure that a quality service is always achieved and that staff within the unit feel supported through effective leadership. Should agency staff be employed within the unit to cover unforeseen staff absenteeism the acting manager has devised a very effective aid memoir. Agency staff, in utilising the aid memoir, can quickly gain an insight into service users needs, likes and dislikes once again promoting safety and comfort for the service users within the unit. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 22 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 3 3 3 X Standard No 22 23 Score X X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 4 X X 4 X Standard No 24 25 26 27 28 29 30 STAFFING Score 4 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 x Standard No 37 38 39 40 41 42 43 Score X X X X X 3 x Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 23 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. Standard Regulation Requirement Timescale for action 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 12 Good Practice Recommendations The activities coordinator should maintain documentation to evidence service user involvement in a varied social activities within the home. Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Nottingham Area Office 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 Nottingham Brain Injury Rehabilitation Ctr Fernwood DS0000059006.V261135.R01.S.doc Version 5.0 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!