Inspection on 17/03/09 for The Fearnes

This inspection was carried out on 17th March 2009.

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

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

The Fearnes 13/08/07

The Fearnes 25/07/06

The Fearnes 22/02/06

The Fearnes 06/10/05

The Fearnes 18/01/05

The Fearnes 01/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Stallcombe House

Belma

Hunters Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Fearnes 26 Knyveton Road Bournemouth Dorset BH1 3QR Lead Inspector Jon Clarke Key Unannounced Inspection 17th March 2009 10:00 DS0000003905.V374924.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Fearnes Address 26 Knyveton Road Bournemouth Dorset BH1 3QR 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) 01202 296906 01202 310065 fearnes@care-south.co.uk www.care-south.co.uk Care South Mr Alan Wyeth Care Home 40 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (40) The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 40 in the category OP including up to 30 in the category DE(E) and up to 10 in the category MD(E) Two named service users (as known to the CSCI) in the category LD may be accommodated. Two named service users (as known to the CSCI) in the category LD(E) may be accommodated. 13th August 2007 Date of last inspection Brief Description of the Service: The local County Council built The Fearnes as a residential care home over 20 years ago. It is now part of Care South (formerly known as The Dorset Trust). The home is located in a residential area of Bournemouth close to the central shopping area and the travel interchange. The Fearnes is registered to provide care and accommodation for 40 older people and this includes 30 residents with dementia. The home is divided into four separate houses - Oak Way, Beech Way, Willow Way and Lilac Way. The three houses with residents who experience dementia have magnetic keypads fitted to the entrance to minimise the risk of wandering. Each unit has 10 bedrooms, a lounge, and a dining room and kitchen area. Assisted bathing and shower facilities are available and separate toilets are located close to residents’ bedrooms. The accommodation is available over two levels - ground floor and lower ground floor. Accommodation is provided in single bedrooms with vanity unit style washbasins fitted for use in each room. The home is decorated in a homely way and is comfortably furnished. The Fearnes is gradually being extensively refurbished and developed, current improvements include upgrading the laundry, relocating the home’s hairdressing room and improving the assisted bathing facilities in some bathrooms. The spacious and inviting entrance hallway has additional seating and a piano and provides a useful central focus to the home. The home has a passenger lift to enable easy and level access to both floors. The home has front and rear gardens with raised flower borders, mature shrubs and garden seating. A driveway to the front of the home provides off road parking. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit to the home as part of our inspection. During our visit we looked at a number of records including care plans, those relating to management of medication, staff recruitment and training. We also had an opportunity to discuss with individuals who live in the home their experience of living in the home and the quality of the care they receive. We spoke with a group of staff who were able to discuss with us their views about working in the home. We received from the home their Annual Quality Assurance Assessment which told us about the improvements made since our last inspection and also changes they have made and areas for further improvement. This information has been used by us to help in making a judgment about the quality of care provided at The Fearnes. The inspector was accompanied by an Expert By Experience (referred to in our report as the Expert)who discussed with a number of individuals specific areas including activities provided in the home, the quality of meals and their experience of living in the home. Experts are individuals who are volunteers who have experience of working with older people in some instances in a care setting. They are not employed by the Care Quality Commission and therefore provide an independent view of their perspective of the care home. What the service does well: The recently introduced care planning provides a full and detailed picture of the needs of the individuals and importantly is person centred. There is clearly a commitment from staff to provide a quality service to individuals who live in the home. Staff had a real sense of the needs of individuals and particularly for those with dementia there was an understanding of their needs and of the individual as a person. There was welcoming and friendly environment and people we spoke with who were able to express their view confirmed this to us “it’s a friendly place to live” “can’t fault the staff they care about what they do and really work hard”. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 6 From observing staff in the dementia units despite the issues highlighted regarding social interaction there was a real sense of caring and wanting to provide good care to individuals. What has improved since the last inspection? What they could do better: The staffing arrangements specifically for Willow Way need to be looked at in relation to the dependency and care needs of individuals on that unit and the impact on other units in relation to flexibility and choices available to individuals around their daily routines. We have raised the issue of staffing levels in this report specifically to their impact on staffing availability. Staffing in our view warrants reviewing and it is our understanding that staffing levels and allocation is based on historical need. There was no evidence of any measures being used to make a judgement about the staffing needs against the dependency levels of those living in the home enabling staffing levels to be reviewed as needs of individuals change. We have also referred to the management of staff in that at present staff move from unit to unit with no continuity for individuals on a day to day level. We would recommend that the home reviews these arrangements to ensure that the continuity for individuals is maintained and how the staffing of units takes into account specific care needs relating to those who have dementia. The training of staff to make sure that all staff have Safeguarding training and staff receive the necessary “mandatory” training of which Safeguarding is considered. Whilst it was noted that individuals we spoke all said they were able to talk to staff about any concerns or worries they may have it was evident that information about making a complaint needs to be made more available. The dealing of complaints clearly did not follow the homes procedure in terms of recording and responding to complaints within timescales and further we were unable to establish the outcome of complaints and written evidence of such outcomes. The last inspection identified and made a requirement regarding the uncovered radiators and noted in this report this issue remains one to be addressed by the home to make sure that individuals are safe. The use of furniture as a means of alleviating the risks associated with uncovered radiators is in our view not robust or ensures the protection of individuals from potential scalding, serious harm or injury. Whilst it is noted The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 7 risk assessments had in some instances been completed there was inconsistency in this practice. We were unable to fully establish the extent of risk to individuals living in the home from the uncovered radiators in not only individual’s rooms but also communal areas of the home. The most effective means to remove risk is to cover all radiators however the use of risk assessments is a valid means of establishing the level of risk and need for action. However as stated there is not consistent practice with regard to the undertaking of such risk assessments. It is real concern that this matter was the subject of a requirement at our last inspection and there has been a clear failure to address this issue and fully protect the welfare of individuals in the home. As stated in our report whilst the environment of the home was adequate there were areas of the home specifically the sitting rooms which in our view would benefit from as aptly put by the Expert a “makeover” to improve the general “ambience”. 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 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. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs. Where individuals are admitted to the home as part of the No Delay Service improved information could be provided about their health and social care needs. EVIDENCE: We looked at a number of pre-admission assessments and they were through and contained good level of information as to the health and social care needs of the individual. Included was mental health needs, communication, continence, food and likes and dislikes. It was noted that for two individuals The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 10 who were admitted as part of the No Delays Service there was limited information provided to the home. For one individual there was an assessment from the local authority. For individuals who were admitted to the dementia units there was no mental capacity assessment. The home told us in their AQAA that they are planning to improve information provided to individuals through the introduction of a homes brochure. The individuals we spoke to about their admission to the home could not recall that they had been given information about the home before they moved to live there. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care Planning and arrangements for meeting health care are generally good providing staff with the necessary information so that the health and social care needs of residents are met. Arrangements for managing resident’s medication make sure that resident’s health needs are protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: We looked at a number of care plans including those which had been introduced as part of the homes new care plan format. It was noted that the new care plans provided improved information about the personal circumstances of the individual. Listed were Priority Needs for the individual, Nutrition was identified with nutritional screening tool being used and good detail as to how to encourage the individual in their eating of meals, preferred The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 12 eating pattern and appetite. Food monitoring record and fluid intake had been completed with weekly weight chart. Waterlow assessment with guidance in care plan to address risk of skin breakdown. For other individuals moving and handling assessments had been completed. For one individual Waterlow assessment for risk skin breakdown had been completed however information on the unit file had not been updated to show the increased risk of skin breakdown and there were no instructions in care plan as to how to address the risk identified. The carer on duty advised the inspector of their practice and was aware of the risk associated with this individual. Weight chart had been completed monthly. Where individuals have short term needs these are recorded in Short Term Care Plan as for one individual who had an eye infection. There was no record of care plan reviews taking place on regular basis in one instance since Nov 08. Risk assessments completed with regard to falls and falls monitoring charts are in use. Bowel Monitoring charts completed. For one individual a behavioural chart had been completed and guidance provided to staff around responding to identified challenging behaviour. We looked at records relating to the management of medication and found that administering records had been completed as required with no gaps and any changes signed by two members of staff. The home has individuals who receive controlled drugs these are recorded in a controlled drug register with two signatures of staff when administered. We checked the medication against records and found them to be correct. For one individual who receives as required medication there was guidance for its use in the individuals care plan. We also spoke with a member of staff about its use and they were able to tell us accurately the circumstances in which it would be given. For another individual there was as required medication but no entries on administering records as to when not given or refused by the individual. Staff have received training in the administering of medication and records confirmed this as well as training provided by a district nurse in the management of an individuals diabetes with regard to taking blood sugar levels and this had been recorded. The home undertakes audits of medication and these had been completed for January and February. A returns record is kept and signed by the pharmacist representative. There is a small fridge for the storage of medication and records were kept of temperature checks. We observed staff throughout our visit and noted that there was a sensitive and supportive approach to at times challenging behaviour. In one instance when an individual was refusing to eat their meal a member of staff responded in a caring and gentle manner in trying to encourage the individual to have their meal. Staff when assisting individuals did so with respect in one instance when using a hoist spoke to the individual telling them what was happening (this was individual with dementia). The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 13 The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 arrangements for meeting the social and recreational needs of residents are generally good and there are opportunities for residents to maintain links with family, friends and the local community. Individuals are able to exercise choice in their daily routines however the staffing arrangements potentially reduce the choices individuals are able to make particularly around getting up. The home provides meals, which are balanced and meet the dietary needs of individuals in the home. However there needs to be a greater effort from staff to provide choice and create a more social environment. EVIDENCE: The Expert By Experience spoke with individuals who lived on the Willow which is the part of the home for frail older people. She reported that individuals told her there was no structured activities other then bingo though other activities arranged included artwork and painting, dominoes, reminiscence sessions and The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 15 occasional entertainers come to the home. One individual said activities “happen when they happen” and others commented they would like to see more structured programme of activities. Individuals said that occasionally taken out in the home’s mini-bus to Poole Park “never go anywhere else”. They also said that they never get off the bus. The home employs an activities organiser for 20 hours a week. We spoke to her and she told us she tries to spend time with all of the individuals in the home sometimes on a one to one basis. For those with dementia she uses history cards and picture memories. Staff told us that one of the things that could be improved was the ability to have “more time to take people out” and “don’t have time to talk with to residents”. It was noted by the Expert and the inspector that during the period we were in the home specifically in the mornings there was little interaction on a social level by staff. In the Willow Way unit a film had been put on and when finished it was put on again and continued through lunchtime. In the Expert’s view no individuals were showing any real interest in the film and the choice had been the care workers rather then any discussion with individuals whether they would like the television on or indeed what they would like. Whilst staff were in the unit giving out tea, an individual was helped to sit down and other care tasks in the Expert’s view “at no time during my stay did any member of staff appear to actually engage with any resident”. The inspector also noted when sitting for some time in one of the dementia units that whilst again staff were helpful and provided care as it was needed there was little real interaction in terms of acknowledging or engaging with individuals. It was noted that the television was on throughout the time the inspector was in the unit approximately an hour showing a children’s programme and at one point the care assistant put on some music but the television remained on showing the children’s programme ! We spoke with one relative who was visiting the home and did so once a week. They told us that they found the home welcoming and “quite impressed” with the friendliness and felt that staff “do care” “always very kind”. Importantly they felt informed about how their relative was “is very good in keeping us to date”. In talking with staff about the routines of the home they spoke of the arrangements for staffing of the individual units being two staff other then Willow Way which has one staff. They told us this creates pressure on staff to get everyone up for breakfast which they then prepare and serve. There was no sense of flexibility in this arrangement and choice being offered to individuals about the time they are able to get up rather it is dependent on availability of staff. We spoke with a small number of individuals about how they spend their day and were told that “it’s up to me”. One individual told us that they can “go where we like it’s my choice”. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 16 The Expert spent her lunchtime in Willow Way she commented that there was choice of “sweet and sour chicken with rice or a sausage roll and vegetables. The sweet and sour was good but the sausage roll (she felt) looked very bland more a supper dish then a main lunch choice”. There were no condiments on the tables. She also noted whilst one member of staff assisted an individual with their meal “there was little or no conversation”. One individual left most of his meal “there was no encouragement given by staff for home to eat more or offer an alternative”. Again the Expert noted there “was very little interaction from the staff during this meal time, just putting plates down or collecting them up!” There was selection of 4 deserts available. Individuals told the Expert that they had recently held a Residents Meeting and had reviewed the quality of the menus. They told her that the menus have improved immensely since then, with a great deal of input from the relatively “new” chef. Individuals had asked for more varied and tastier food. Lamb moussaka and vegetable curry were on offer the day previous to our visit which most individuals commented on “What a lovely change, the lamb dish was delicious” and “I like the tasty vegetarian food”. The inspector was in another unit during the lunchtime and noted that individuals were not always offered a choice i.e. shown what was available for lunch. This was a dementia unit and for some this may have helped in their making a choice of what they would like rather then staff assuming what the individual would like. It was evident however through talking with a member of staff that she had a good sense of what the individual liked and disliked however this doesn’t exclude the giving of choice. Staff encouraged individuals to eat their meals and where one person left her meal she was encouraged to return. Staff gave assistance where this was needed and did so in a sensitive way. The sausage rolls being served for main meal were in the inspectors view un-appetising and as the Expert noted bland. We would question the suitability of such a choice as the main meal of the day. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 home has procedures in place enabling individuals to make a complaint and voice their views about the service they receive. However this information should be made more readily available to individuals and their representatives. There is a failure to fully record and follow the complaints procedure in relation to responding and evidencing actions that are taken as result of any complaint being made. The home has a policy and procedures in place about the Protection of Vulnerable Adults. However because of failure to provide Safeguarding training there is potential for staff not to identify or have the knowledge needed to response to any areas of concerns they may have regarding possible abusive behaviour or incidents. EVIDENCE: We spoke to individuals who live in the home about their knowledge of the home’s complaints procedure they could not recall being given this information. One individual said they had never been told about the complaints procedure but “if I was unhappy I would tell one of the staff”. Another told us “I would talk to the manager he would do something about it” and one person said she did not think she had ever been informed of the complaints procedure however she did feel that should she have reason to complain she could, and The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 18 has on occasions talked to a member of staff or manager to sort out any problems. We looked at the complaints log and found that three complaints had been made since our last inspection. Whilst there were copies of the complaints in the log for two of the complaints there was no evidence of response in form of acknowledgement letters or outcomes of the complaints and letter to complainants as to the investigation of their complaints and any action taken as a result. One of the complaints had been upheld, another had also been substantiated in full and the other had been substantiated in part. We were subsequently informed by the manager of the changes to practice which had taken place as a result of the complaints. We are satisfied that the appropriate action has been taken to improve practice and changes to procedures to address the concerns highlighted by these complaints. The home has Safeguarding policies and procedures in place and staff receive training in this area however records (training record provided to the inspector) showed that there are a significant number of staff 23 of 28 who have not undertaken this training. Further this training is not provided to non care assistant staff. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19.25,26 People using the 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 home provides a clean and hygienic environment for the residents and staff. However individuals are potentially placed at risk because of uncovered radiators. People who live and work in the home benefit from a welcoming and well-maintained environment. EVIDENCE: The home is divided into four separate units three of which are for individuals who have dementia. Each unit has its own dining area and lounge with facilities for the making of refreshments and snacks. The furniture whilst adequate is in our view showing signs of tiredness and age. The Expert who accompanied the inspector stated the following about her view of Willow Way; “my initial reaction on entering the residents living area was neat and compact but as the The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 20 day went on I found the room had no atmosphere and seemed quite clinical. The small sitting area had 4 or 5 cottage type easy chairs (not nice comfy armchairs), one recliner, an old sideboard and a couple of small tables. The floor throughout was laminate.” The other units were similar in their furnishings and general environment there was little in the way of decoration such as pictures, photos and decorative items. We were able to see a number of individual rooms and all had personal items of furnishings and personal processions such as pictures and family photos. The home’s AQAA advised that a number of bedrooms have been redecorated and there are plans to improve the lighting in some areas of the home. We were advised that there is also planned decoration of toilets and bathrooms. At the time of our visit some corridors were being decorated. In walking around the home it was noted that there were a number of radiators in individual’s rooms and corridors which were uncovered. In some instances furniture and or chair had been placed in front of or by the side of radiators. Risk assessments had been completed for some of these rooms with regard to uncovered radiators but measures taken to reduce risk were stated as “using furniture to reduce likelihood of trapping”. The home has procedures and policies in place with regard to infection control and it was noted that there was hand washing facilities available to help in preventing and controlling any infections. Staff are provided with protective clothing such as gloves and aprons and these were observed being used by staff. At the time of our visit the home was of a good standard in terms of cleanliness with no adverse odours. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the 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 staffing arrangements in the home potentially impact on the ability of staff to provided care in a relaxed, unhurried and efficient manner whilst also meeting the social care of individuals. The recruitment and selection practice of the home helps to make sure the welfare of individuals who live in the home is as far as possible protected. There is a failure to make sure that all staff have the necessary training particularly of a mandatory nature so that staff have the required knowledge and skills to provide care in an efficient and competent manner. EVIDENCE: Each unit of the home other then Willow Way is staffed by 2 care assistants from 7:15 to 10:00pm with three waking night staff. Willow Way is staffed by one care assistant. In addition there is a Care Team manager throughout the daytime period. There is a maximum of 10 individuals living in each unit. The inspector was provided with the homes handover sheet which sets out the level of care needed by individuals in each of the units. It is noted that Willow The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 22 Way had two individuals needing “All Personal Care” 6 need “assist personal care” one “assist with personal care if asked” one independent. One individual non weight bearing. Staff told us there were 4 individuals who in their view and experience needed full assistance. In talking with staff about staffing levels in the home they told us that Willow Way is considered as being for more independent people however this had changed over time and this unit should be staffed by two staff as other units. They told us they don’t “have time to talk with residents”. That staff have to cover or move to Willow Way to support staff leaving other units with only one staff member. Staff told us it is particularly busy in the morning when they have to get all individuals up for breakfast and there is no assistance for the breakfast period in that they are getting individuals up and have to also get breakfast before half past 8? One individual who lives in Willow Way told the Expert “I don’t think they have enough day staff here now more of the people need help”. We observed whilst on another unit during the morning period that whilst staff were undertaking care tasks there was little if any other social interaction with individuals. Certainly during the period we was in the unit which was for over an hour at no time did staff sit and talk with individuals. The interaction between staff and individuals was purely around undertaking a task such as giving a drink, assisting to the toilet. The arrangements for staffing the home are that the majority of staff moves from unit to unit. In our view this doesn’t meet the needs of individuals from a continuity of care perspective in that where units were to have a set team of carers this would in our view be of greater benefit to individuals particularly those with dementia. One staff member told us that they would work better “if we were on the same unit” and an individual told our Expert “I like to have the same person so they know how I like things”. Another individual said they had not seen their key worker for two weeks because they were working on another unit. We looked at recruitment records for four members of staff and found that the correct procedures had been followed. For all of the perspective employees a full application form with employment history had been completed, two references obtained. In addition a Criminal Record Bureau check had been undertaken as well as POVA1st check. Staff told us they had completed training in moving and handling, dementia, fire, health and safety. In examining training record given to us it was noted that of the 28 staff only 11 had undertaken Dementia training, only one night staff had first aid training. There were also gaps in training for staff with regard to infection control, moving and handling (9). Of the 28 care staff 10 staff have NVQ professional qualification, all of the Care Team Managers have NVQ 2 or 3. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 practices of the home help to make sure that the health, safety and welfare of residents and staff are protected however the failure to complete risk assessments in relation to uncovered radiators potentially places individuals at risk. There are opportunities for individuals to express their views about the service they receive however there was no evidence that Quality Assurance questionnaires take place to further audit the quality of care provided in the home. EVIDENCE: The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 24 The manager was not present during this inspection visit being on annual leave. He was registered as manager by the Care Quality Commission in November 2008 having previously worked at the home for a number of years and has extensive experience of working in a care home setting. People we spoke with were all positive about his approach. One individual told us he is “someone you can talk to” and another “if I have a problem I would speak to him”. Staff told us that communication with management is good and they get positive feedback and complimented about what they do. Staff told us there is a good atmosphere in the home and they considered it a happy home to work in. We were unable to establish if the home undertakes quality assurance questionnaires with individuals who live in the home or their relatives. The AQAA provided by the home advised that quality audits of practice take place regularly. Residents and relative meeting have been held and minutes showed that topics discussed included the activities arranged in the home, staffing, menus and meals. We looked at records relating to health and safety practice in the home. We found that a Fire Risk assessment had been completed with servicing of fire equipment undertaken. Fire alarms tests take place weekly and emergency lighting monthly as required. Staff have completed Fire Training the last being in November 2008 and last fire drill march 09. Equipment and electrical system is serviced and maintained on an annual basis or greater as required. As noted previously in this report there are a number of uncovered radiators in the home and inconsistency with regard to undertaking risk assessments and taking the necessary action to alleviate the risk associated with hot surfaces such as radiators. A requirement was made at the last inspection in relation to this matter and has not been met. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X 1 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X 2 The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP38 Regulation 13(4)(c) Requirement The registered manager to make sure that all parts of the home are so far as reasonably practicable free from hazards to the safety of individuals who live in the home. This refers to the need to undertake risk assessments where there are uncovered radiators. Where the assessments indicate risk action to be taken to alleviate or remove risk. We would consider the use of furniture inappropriate and the covering of radiators as the most effective way to address risk to individuals. The registered manager to make sure that the service user’s plan is kept under review. The registered manager to make sure that the care home is conducted so as to make proper provision for the health and welfare of individuals who live in the home. This refers to the need through The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 27 Timescale for action 01/06/09 2 3 OP7 OP7 15(2) (B) 12 (1) (a) 01/05/09 01/05/09 4 OP16 17(2) Schedule 5 the use of risk assessments to identify the actions needed to alleviate or reduce the risk of skin breakdown and protect the skin integrity of individuals. This to be part of the individuals care plan. The registered manager to make sure that a record is kept of any complaint and the actions taken in respect of such a complaint. This refers to the need to fully records complaints and records to be kept of response to complaint and letters to complainant as per the home’s complaints procedure. The registered manager to make sure through training of staff to prevent as far as possible individuals who live in the home being placed at risk of harm or abuse. 01/05/09 5 OP18 13 (6) 30/07/09 6 OP27 18 (1) (a) This refers to the need for all staff to have undertaken what is considered “mandatory” Safeguarding training as part of staff being knowledgeable and competent to recognise possible abuse and how to respond to any concerns they made have regarding potential abuse. The registered manager to make 30/06/09 sure having regard to the size of the care home, the statement of purpose and the number and needs of individuals who live in the home that at all times there are suitably qualified, competent and experienced persons working in the care home in such number as are appropriate for the health and welfare of individuals who live in the home. This refers to the need to review The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 28 7 OP30 18 (1) © staffing arrangements in the home and provide us with a report outlining their decision as to the review and how they have reached a judgement as to level of staffing in the home. The registered manager to make sure that persons who work at the care home receive training appropriate to the work they are to perform. This refers to staff undertaking the required “mandatory” training i.e. Dementia, Moving and Handling, Infection Control, First Aid. The registered manager to establish a system for reviewing and improving the quality of care and this shall provide for consultation with individuals who live in the home and their representatives. 30/08/09 8 OP33 24 30/08/09 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 OP15 OP19 Good Practice Recommendations At mealtimes look at ways that individuals particularly those with dementia can have greater choice of meal. To look at ways of improving the home’s environment to make more homely and less stark in its appearance. To consider updating of furnishing and decoration of communal areas. The Fearnes DS0000003905.V374924.R01.S.doc Version 5.2 Page 29 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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