Inspection on 08/12/08 for Nottingham Neurodisability Service Hucknall - Fernwood

This inspection was carried out on 8th December 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Nottingham Neurodisability... 31/10/08

Nottingham Neurodisability... 04/12/06

Nottingham Neurodisability... 24/10/05

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 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Nottingham Neurodisability Service Hucknall - Fernwood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Angela Starr     Date: 0 8 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Nottingham Neurodisability Service Hucknall Fernwood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR 01159680303 01159642747 diane.eden@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Homes (Ilkeston) Ltd Name of registered manager (if applicable) Kim Lesley Santon Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who may be accommodated is 20 The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home 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. 20 Over 65 0 care home 20 Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home All service users bedrooms are individually decorated, many have en-suite 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. 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. The fees currently charged at the home range from 1,591.35 pounds to 3,064.25 pounds per week (The maximum fee is for people who have very specific complex needs), and does not include payments for toiletries, podiatry services, hairdressing, holidays and newspapers or magazines. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of Inspections undertaken by the Commission for Social Care Inspection is upon outcomes for people who use the services and their views on the service provided. This process considers the providers capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. We have introduced a new way of working with owners and managers. We ask them to fill in a questionnaire called an Annual Quality Assurance Assessment, which tells us about how well their service provides for the needs of the people who use it and how they intend to improve their service. Care Homes for Adults (18-65 years) Page 6 of 29 We received this back from the manager within the required timescale and the form was completed in a satisfactory manner, providing us with information to assist in planning our visit and deciding what areas to look at. We also reviewed all the information we have received about the service since we last completed a key inspection on 4th December 2006 and we considered this in planning the visit and deciding what areas to look at. The main method of Inspection we use is called case tracking which involves us selecting a number of people who use the service and looking at the quality of the care they receive by speaking with them, observation, reading their records and asking staff about their needs. We also sent Have Your Say questionnaires to a random selection of people who use the service, some relatives and some staff members. The information provided in the replies we received, was also a contributory factor in the focus of our inspection visit. We spoke with three members of staff, three people who use the service and three relatives to form an opinion about the quality of the service being provided. We read documents as part of this visit and a separate pharmacy inspection took place to form an opinion about the health and safety of people who use the service. A copy of the latest inspection report can be found on the web site at www.csci.org.uk What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are provided with the necessary information to enable them to make an informed choice. People have their needs assessed prior to admission to the service which ensures that each persons needs can be met. Evidence: The acting manager told us in the written information she provided to us We complete a robust pre-admission assessment on all prospective clients. All staff grades assist the unit manager with these assessments including care staff and therapists. The Statement of Purpose and Service User Guide were on display in the entrance of the unit, along with a copy of the complaints procedure and the last Key Inspection Report. These were produced in a suitable format for the benefit of people who may wish to use the service. As part of our case tracking process, we looked at the care files for three people who Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: use the service. All had pre-admission assessments in place which were detailed and comprehensive, providing enough information for staff to deliver appropriate care and support whislt developing a detailed plan of care. People considering moving to the service are able to visit for varying periods of time to experience the service and consider whether it would be suitable for them. People wishing to look round are welcomed at any time without making an appointment. We sent out Have your say questionnaires to a random selection of people who use the service, some relatives and some staff members. Four of our questionnaires were returned by relatives of people using the service. Three of the four told us that they were given enough information about the service to assist them making their decisions. The fourth person said that they felt the communication to be poor. We spoke with three relatives who were visiting at the time of the inspection. One person told us that the choices available for their relative to move to were extremely limited as they require such specialist input. The main priority at the time was location as they visit on a daily basis. This person visited the home and looked round. They told us The staff were very friendly and answered all my questions. They showed me this room and said I could bring anything I wanted. This person told us that after five years of their relative living at the service, they know they made the right choice. They are good to me here. I can visit any time of day or night. Another person told us I was invited to check out the home and was quite happy for my relative to take up residence. Choice of home was very limited for my relative. All the files we looked at contained copies of contracts of care and people we spoke with said that they had received contracts as well as terms and conditions of residency. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the service have their personal and health care needs assessed and met. Evidence: As part of our case tracking process we looked at the care files for three people who live at the service. All three files contained detailed and comprehensive care plans which had been developed in conjunction with the person and their relative as far as possible. In some cases, the person receiving the care had been unable to contribute to this process but there was clear evidence that a family member had been involved. These care plans were developed in a person centred manner, with reference to peoples choices and needs. Dignity and respect had been considered throughout. The acting manager told us in the written information she provided We provide a wide range of activities in house and within the local community following discussion with people and taking their requests into consideration. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: This information also told us that where possible, people have a choice of food. This is not an option for all the people who use the service, due to varying medical conditions. We undertook a partial tour of the premises and saw that most people had brought personal possessions into the home and their rooms were decorated in a style of their choice. Our surveys asked people Does the care home give the support or care to your relative that you expect? The replies we received said Always. and comments included My relative is treated very well. One person we spoke with told us that their relative is very well looked after. Ive never had a problem at all. They are always kept clean and comfortable and have never had any pressure sores or other skin problems. My relative cannot do anything but the activities co-ordinator sits and talks to my relative and reads to them. They have physiotherapy to keep their chest clear and have a shower every day. When my relative came here, they sat and discussed all their likes and dislikes, hobbies etc and always consult with me about everything. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Fernwood experience a fulfilling life as far as is possible. Individual goals are identified and people are enabled to make choices and exercise preference. Evidence: We looked at the menus and saw that a choice is offered to people at lunch time and tea time. The food offered is varied and there is always a vegetarian option. Snacks are available in the evenings. There is a dining room but there are currently no people who use it. Meals are served to people in their rooms or in the lounge, but a large number of people experience difficulties with a normal diet and require direct feeding through a peg. Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: On the day of the inspection none of the people living at the service were able to discuss their particular likes, dislikes and preferences with us. We did speak with peoples relatives to gain an understanding of how the service assesses and then meets any identified social needs. People told us that they have spent time with the activities co-ordinator discussing their relatives previous hobbies and interests. One person said that they felt their relative would be supported to do anything they chose to do, but unfortunately, they cannot do anything. Records we looked at provided us with evidence that people who are able to make their choices known, are supported to achieve their goals and aspirations. This may be having a holiday or being supported to embark on a flight to a particular destination. Family links and friendships are encouraged and on the day of the inspection we saw many visitors at the service. People we spoke with told us I am with my relative for up to eight hours a day. I visit every day and am always made welcome. My relative is having a larger room so that we can have more comfortable chairs for family when we visit. One person told us The staff always talk to my relative respectfully.They close the door when delivering any personal care. There are always two staff involved in my relatives care and they always have a laugh with them. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are receiving personal and healthcare support in the way they prefer and require. Their health care needs are being met. Evidence: The written information provided to us by the acting manager was very brief and did not address all the key standards in this outcome area. We continue to ensure our residents receive appropriate high standards of care to meet their needs whilst maintaining their independence wherever possible. We always ensure that personal preferences are adhered to. As part of our case tracking process we looked at the files for three people who use the service. All three files contained comprehensive care plans detailing all aspects of support required by each person. Where possible, the care plans had been developed in a person centred way and there was evidence that people and their relatives had been involved. The files also contained risk assessments pertaining to a variety of activities each Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: person may undertake as well as addressing potential risks to health, such as skin integrity. Each file contained evidence of a multi disciplinary approach to meet the persons health care needs. Examples included physiotherapy, tissue viability, speech and language therapy. Specialist input is also available where required from a neuro-specialist and a consultant in rehabilitation. Relatives we spoke with told us My relative had extensive physio when they came here from hospital. They had a number of pressure sores but these all healed and havent returned. My relative receives very good nursing care. Staff always speak to my relative respectfully and tell them what they are doing. They always close the door when they carry out any personal care. They maintain my relatives dignity at all times. One person told us in the questionnaire they returned to us They give 100 care to my relative and I am very happy with this. We spoke with some staff and they told us For the first three months of working here I was with an experienced carer or a senior at all times and I always work on this unit, meaning I get to know the people I am caring for and their families. We always have access to care plans and are made aware of any changes. Two staff members returned our questionnaires and where we asked Are you given up to date information about the needs of the people you support or care for? One said Always and the other said Sometimes adding the comment Not always told things. There is a lack of communication. One person we spoke with told us that the routines are flexible and staff always provide support in the way they prefer. A separate pharmacy inspection has been completed and therefore this inspection did not look at key standard 20. Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Fernwood are protected from potential abuse and harm. There are robust policies and procedures in place that are understood and followed correctly by the staff team. Evidence: The written information provided to us by the acting manager was very brief and did not address the key standards in this area. We continue to resolve potential and actual safeguarding issues by working closely and collaboratively with social services and families, with notification given to relevant authorities, whilst maintaining an open and transparent communication system. We spoke with the acting manager and two other staff members about the policies and procedures relating to complaints, concerns and protection to ascertain their level of knowledge in these areas. Staff were able to demonstrate a clear understanding of these and of Nottinghamshires Safeguarding Adults procedures. Safeguarding Adults is a process of identifying and reporting suspected or potential abuse of vulnerable people and provides a framework of consistency to protect those individuals at risk. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: Staff also told us that they know about and understand the homes Whistle Blowing policy. This is a means for staff to feel supported to report anything of concern that they may witness. These measures help to ensure that people living at the service are safe and protected from abuse. The people we spoke with who live at the service told us that they know who to complain to and also, that they would feel confident to complain if they wish to. They also told us that they feel safe. The acting manager showed us the complaints book. It is suitable for recording any complaints received and the outcomes of any investigations that may be undertaken. The entries supported the information we have received since the last key inspection that took place in December 2006. During this period we have received a number of notifications from the service and there have been four safeguarding referrals. The notifications were relating to medication errors and have been appropriately addressed. The complaints that have been looked at under safeguarding have been thoroughly investigated by the service and the outcomes were satisfactory. We looked at the records of some peoples monies that are managed by the service and found these all to be correct with receipts for any expenditure and all entries signed. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the needs of the people living at the service and it is well maintained. Evidence: The written information provided to us by the acting manager told us We provide a comfortable, clean and homely environment. Infection control procedures are in place and these are subject to monthly audits. Testing of electrical and lifting equipment is completed as required. Fernwood is a purpose built unit that is designed specifically to meet the needs of the people who live there. We conducted a partial tour of the home and observed it to be clean and odour free. The communal areas were furnished in a homely and comfortable manner whilst providing suitable chairs for people with complex physical needs and space for people to remain in their own specifically designed wheelchairs. The bedrooms we saw were decorated in individual styles and people had brought their own belongings into the home, making their rooms a personal space. All the rooms Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: were equipped with audio and visual systems for people to watch television or listen to music. A visitor we spoke with told us that their relative would be moving into a larger room to provide space for comfortable chairs for family when they visit. They spend a lot of time at the service, up to eight hours a day. Another relative told us I was told I could bring anything I wanted for my relative. I have purchased a special bed as they spend all their time in bed. The laundry facilities appeared to be well organised and managed and measures were in place for minimising spread of any infection. People we spoke with told us that they have not had any problems with laundry. The acting manager told us that they employ a handyman and all maintenance is kept up to date. We saw the maintenance book and it showed us that any tasks that are identified are recorded by staff for the handyman to see. When the task is completed he signs the book. Staff we spoke with told us that they know how to report any faults or problems and that repairs or replacements take place very quickly. We saw the site maintenance reports that told us regular safety audits are carried out and all required testing is valid and up to date. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are not supported by competent and appropriately trained staff in sufficient numbers to meet their assessed needs. Robust recruitment policies protect people from potential harm and abuse. Evidence: The acting manager told us in the written evidence she provided We ensure that all shifts are covered with appropriate numbers and skill mix of staff. We have robust recruitment procedures in place and all new staff receive one week of supernumery hours to integrate and familiarise themselves with the residents and the environment Training is provided in respect of statutory training as well as specialised knowledge, for example, ventilator care and palliative care. We looked at the staff rota and saw that there are sufficient numbers of staff on duty at all times, to meet the assessed needs of the people currently living at the service. However, a large number of agency staff are needed and employed in order to provide Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: this level of staff. This was reflected in the data provided to us by the service. One of the questionnaires returned to us by a relative stated Things would improve if they employed more permanent staff. A relative we spoke with said A lot of agency staff are used. No problem except they dont always know the person they are looking after. Further questionnaires completed by staff also commented on the use of agency staff We have a lot of agency staff working on the unit. Mainly qualified nurses and some of them dont seem to know what they are doing. Morale on the unit is low having so many agency staff. We looked at the files for three members of staff including the last person to be employed at the service. All three files contained evidence that policy and procedure had been adhered to in the recruitment process. All the files contained two written references obtained before employment commenced, confirmation of a criminal records bureau check and confirmation of the persons identity. Staff we spoke with confirmed that they had completed an application form and had received a formal interview. Staff told us I had a three month induction and was always with a senior or experienced member of care staff. I have access to all policies and procedures as well as to peoples care plans. I have already had a lot of training but will be doing a lot more. Another person said This is a fantastic place to work. We spoke with staff about their understanding of safeguarding adults and all were able to demonstrate a good level of knowledge and told us that they would always report anything of concern. Staff told us that they do receive supervision and feel well supported but also said it is very hard work. Relatives we spoke with said My relative gets good nursing care and I havent had anything to complain about. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has an acting manager in post who is making some progress in developing the service, but further progress is required to ensure the health, safety and welfare of people living at the service and of the staff. Evidence: The Annual Quality Assurance Assessment was returned to us by the acting manager within the required timescale, but the information it provided us with was very brief and did not address all the key standards. Fernwood has not had a registered manager in post since April 2007. The previous Annual Service Review that was completed in March 2008 said that the acting manager would be applying for registration imminently. The service has continued to operate without a registered manager in post and at the time of this inspection there is still no application in process. The service has also relied heavily on agency staff and has not employed permanent Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: staff in sufficient numbers to provide consistency for people living at the service. Relatives we spoke with told us Things would improve if they employed more permanent staff. A lot of agency staff are used. No problem, except they dont always know the person they are looking after. Staff we spoke with told us We have a lot of agency staff working on the unit. Mainly qualified nurses and some of them dont seem to know what they are doing. Morale on the unit is low having so many agency staff. The acting manager was absent on the day of this inspection and we were assisted by the acting clinical services manager from another area of the service. We looked at the records of peoples finances that were being managed by the service. The records were all correct and the monies balanced. Receipts were provided for all transactions. Relatives spoken with said they were satisfied their relatives money was safely taken care of by the manager and they were able to have their own money whenever they wanted it. There was evidence of staff supervision having taken place and staff we spoke with confirmed that they do receive supervision and generally feel supported by the manager. However, one staff member said that they did not feel supported as the manager is hardly ever on the unit. When I do discuss things with her, especially concerns or complaints she doesnt always act on them. We saw evidence that qualified nurses are provided with regular clinical support sessions and the training provided around the administration of medication has been improved. The service does have a system for internal quality audits but this needs to be improved to incorporate the views of the people who use the service. We did not see any evidence that peoples views and opinions were being taken into account when planning and development of the service is taking place. We did see evidence that the health and safety of people living at Fernwood and the staff is assessed and any issues are dealt with. Staff receive training in the use of any specialist equipment including moving and handling. No accidents or incidents have been recorded and none have been brought to our attention. Care Homes for Adults (18-65 years) Page 25 of 29 Care Homes for Adults (18-65 years) Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 37 8 The acting manager must make an application to The Commission for Social Care Inspection to become a registered manager. This will ensure that people who live in a care home that is well run and well managed 31/03/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 32 The service would benefit from recruiting more permanent staff as this would develop a more consistent and reliable team to support the people who live at there. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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