Care Home: Fern Court

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• 2 Perhaver Park
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What the care home does well Observations throughout the site visits showed that staff and people living in the home have good relationships that are respectful and friendly. The service provided in the home is led by the needs of the people living there. Daily notes kept by the staff are detailed and enable the reader to have a good understanding of what each person has been doing and their mood on that day. People lead active lifestyles in and outside the home and staff support them appropriately where required. A good range of food is chosen by the people living in the home who also have the opportunity to help prepare it with staff support. Medication administration is managed effectively which ensures that people are not put at unnecessary risks. Staff are completing total communication training to improve their communication skills. Staff commented that they are offered a wide range of training to meet the needs of the people in the home and their needs. What has improved since the last inspection? The requirements of the previous key inspection have been met by the manager and his team. What the care home could do better: The pre-admission assessment process should be reviewed with the aim of ensuring that the manager and staff team have sufficient information in reasonable time to meet the needs of people moving into the home. Examination of care plans and risk assessments showed that a number had not been reviewed recently. This made it impossible to confirm that people`s current needs were identified and being met, and that people were not being put at unnecessary risks. Each of the people in the home should have a Person Centred Plan identifying their hopes, dreams and needs for the future. Where there are restrictions to a person`s freedom of choice care plans are in place. Where a person is unable to consent to this the manager should ensure that they consider a "Multi-disciplinary" process when making the decision, or the use of an advocate. People`s personal care needs should be assessed and detailed care plans developed to meet any needs. Detailed care plans will enable staff to meet those needs consistently. Health Action Plans should be implemented for each person in the home to ensure that health needs are assessed and appropriately met. The staff team need to complete training in safeguarding adults to ensure possible risks and minimised.Maintenance around the home could be improved to provide people living in the home with a more comfortable and homely environment.Staff supervision sessions, annual appraisals and team meetings must be completed regularly. The manager needs to develop a quality assurance system that puts the views of the people living at the home as central to the future development of the service. CARE HOME ADULTS 18-65 Fern Court Down Hatherley Lane Down Hatherley Gloucester Gloucestershire GL2 9QB Lead Inspector Mr Paul Chapman Unannounced Inspection 15 and 16 January 2008 09:00 th th Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 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 Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 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. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fern Court Address Down Hatherley Lane Down Hatherley Gloucester Gloucestershire GL2 9QB 01452 731984 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) New Beginnings (Gloucester) Ltd Alan Gilbert Howe Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Ferncourt is a Care Home for 8 YA LD Date of last inspection 30th November 2006 Brief Description of the Service: Fern Court is a residential care home for up to 8 people with learning disabilities and some associated challenging behaviours. The home opened in May 2005. Fern Court is one of three homes in Gloucestershire owned by New Beginnings. Fern Court is a large Victorian House that has been fully refurbished to provide single rooms with en suite facilities. People living at the home have access to the kitchen, lounge, dining room and large well maintained gardens. Fern Court is situated in open countryside between Cheltenham and Gloucester. The home has a Statement of Purpose and a Service User’s Guide. Fee’s to live in the home start at £1250.00 per week. Fern Court DS0000062152.V358350.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 2 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection site visit took place in January 2008 and included two visits to the home on 15th and 16th January. The registered manager was in attendance throughout the visits. Time was spent observing the care of people and their interactions with staff. Two people living at the home were spoken to and three people’s rooms were seen on their invitation. The care of three people was looked at in depth. This included looking at their financial, medication and personal records. Four staff were interviewed about the care they provide. Other records examined included staff files, health and safety information and quality assurance records. The manager completed the CSCI’s Annual Quality Assurance Assessment (AQAA). Unfortunately the manager did not receive the AQAA before the site visit was completed. The CSCI supplied the home with a number of questionnaires for staff, people living in the home, relatives and other professionals. No responses were received at the time of this report being written. What the service does well: Observations throughout the site visits showed that staff and people living in the home have good relationships that are respectful and friendly. The service provided in the home is led by the needs of the people living there. Daily notes kept by the staff are detailed and enable the reader to have a good understanding of what each person has been doing and their mood on that day. People lead active lifestyles in and outside the home and staff support them appropriately where required. A good range of food is chosen by the people living in the home who also have the opportunity to help prepare it with staff support. Medication administration is managed effectively which ensures that people are not put at unnecessary risks. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 6 Staff are completing total communication training to improve their communication skills. Staff commented that they are offered a wide range of training to meet the needs of the people in the home and their needs. What has improved since the last inspection? What they could do better: The pre-admission assessment process should be reviewed with the aim of ensuring that the manager and staff team have sufficient information in reasonable time to meet the needs of people moving into the home. Examination of care plans and risk assessments showed that a number had not been reviewed recently. This made it impossible to confirm that people’s current needs were identified and being met, and that people were not being put at unnecessary risks. Each of the people in the home should have a Person Centred Plan identifying their hopes, dreams and needs for the future. Where there are restrictions to a person’s freedom of choice care plans are in place. Where a person is unable to consent to this the manager should ensure that they consider a “Multi-disciplinary” process when making the decision, or the use of an advocate. People’s personal care needs should be assessed and detailed care plans developed to meet any needs. Detailed care plans will enable staff to meet those needs consistently. Health Action Plans should be implemented for each person in the home to ensure that health needs are assessed and appropriately met. The staff team need to complete training in safeguarding adults to ensure possible risks and minimised. Maintenance around the home could be improved to provide people living in the home with a more comfortable and homely environment. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 7 Staff supervision sessions, annual appraisals and team meetings must be completed regularly. The manager needs to develop a quality assurance system that puts the views of the people living at the home as central to the future development of the service. 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. The summary of this inspection report can be made available in other formats on request. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 8 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 Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User’s Guide provide people who may wish to move into the home with information to enable them to make an informed choice. The home’s assessment process does not provide the manager and staff with sufficient information making it difficult to meet people’s needs when they are first admitted. EVIDENCE: The home has a Statement of Purpose and Service User’s Guide. Both of these documents have been updated recently. Since the previous inspection was completed two people have been admitted to the home. One person was from outside the organisation and the assessment and admission process was examined and discussed with the manager. This person had been admitted the day before this site visit. Discussing the assessment/admission process with the manager he explained that the initial assessment was completed by the organisation’s group manager, and that he became involved towards the end of the process. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 10 The only information available to the staff team was the person’s community care assessment, and information gathered from their visits to the home before they were admitted (part of the assessment process). The assessment completed by the group manager was not present. The CSCI question this approach to the assessment of potential admissions to the home. Concerns include: • • Information about the person admitted to the home was limited with only the community care assessment present after their admission. The manager’s involvement in the assessment process meant that they had limited information about the person admitted to the home and how their needs should be met. It is recommended that the pre-admission assessment process be reviewed to ensure that the home have sufficient information available to them before a person is admitted to the home. The AQAA completed by the manager identifies their limited involvement in the recent admission process and they identify this as an area to address in the future. In addition to this the manager states that they want to further develop all relevant documentation in pictorial form, especially in relation to finances and contributions towards care. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans were not reviewed regularly and it is impossible to confirm that they accurately reflect people’s current needs. People are being put at risk due to assessments not being reviewed at regular intervals. The activities in the home are led by the needs of the people living in the home. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 12 EVIDENCE: We examined the care packages for 3 people in detail. None of the files examined contained Person Centred plans (Commonly known as a PCP, this approach empowers people to make changes in their lives, achieve their goals and ensure that resources are in place to meet their future needs). Some of the care plans examined had been signed by the person agreeing their plan. The manager was aware of the need to create person centred plans and stated that this was a goal for the future. A number of the care plans examined were in need of review and this was brought to the attention of the manager. Care plans seen provided staff with information to meet people’s needs around areas including: • Meal times • Personal care • Night time care • Managing personal finance • Consent to medication • Behaviour management The daily notes kept by the staff provide some evidence of care plans being followed but mainly they give a good picture of the activities that each person is involved in, people’s moods, the food they have eaten and any appointments with other professionals. Some restrictive practices are in place around people smoking. Where this is the case a care plan has been produced that details why the restriction is in place. This is signed by the person agreeing to the restrictions. This was discussed with the manager and it is recommended that they take a multidisciplinary approach where there maybe restrictive practices. This includes seeking approval for practices in place currently, and any future plans that are required. A discussion took place a around a needs assessment that identified a person as being possibly alcohol dependant, and how the manager and his team will address this. Observations during the 2 site visits showed people being asked about activities they would like to complete and the food they would like to eat. This was done respectfully. Speaking to staff about the choices given to people they gave examples of people being involved in all aspects of the home. A good example of this is the menus chosen weekly where each person is given the opportunity to choose meals they like. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 13 Risk assessments were examined. Each of the files examined contained a selection of risk assessments and it was brought to the attention of the manager that a number of them were in need of review (many of them had last been reviewed in 2006). Personal files contained specific risk assessments for particular risks for that person. The manager had then completed generic risk assessments for areas like transport and safety around the home. It is recommended that each person has a missing person risk assessment completed. Documents are stored confidentially. The AQAA completed by the manager identifies the need to ensure that peoples care plans and risk assessments are reviewed more regularly. It also identifies the need to ensure that care plans placing restrictions on a person are agreed with the person and, a multi-disciplinary approach is used where possible. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People lead active lifestyles with the appropriate support of the staff to ensure that they are not put at unnecessary risks. People have a choice about the food they eat and are involved in its preparation. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 15 EVIDENCE: We spoke to staff about some of the activities that people living in the home complete regularly. Staff explained that there had been a system of weekly activity planners in place for each person, but lately these had not been used. Speaking to staff they stated that the use of the activity sheet is good as “it means the activity gets done”. Speaking with the manager about this they explained that they wanted there to be more freedom of choice about the activities completed, but recognised that this had meant that sometimes activities were not being completed. Activity sheets were now being reintroduced. Speaking with staff they provided examples of the regular activities completed. These included people helping to buy ingredients for the home’s weekly menu, swimming, sports sessions, ten pin bowling, using shops in the local community for shopping, cinema, pub and restaurant trips. A lot of activities are completed in small groups but activities are also completed 1 to 1 with staff and people in the home. Examples of this would be a person supported 1 to 1 to go into Gloucester on the bus, do some shopping, and have something to eat. Each person has 1 to 1 time with staff at least once a week. Whilst we were completing the site visit a group visited Weston Super Mare. A discussion took place with the manager about the use of local day services and colleges. They explained that they have tried to access these services but it has proved really difficult. Six weeks of menus were examined which showed that people have breakfast, lunch, dinner and a snack before bed each day. Two people living in the home spoke to us about the food. One person said, “the food is nice”, they were asked if they were able to do any cooking, they replied “apple pie”. Staff confirmed that people are able to help in the kitchen, and that one person enjoys making cakes. Speaking to staff and people living in the home they explained that menus are chosen each weekend for the following week. During the site visit people were observed making their own breakfasts and being able to make choices about what they would like. The AQAA completed by the manager highlights a number of areas where they feel the service could be improved. They include responding better to changes in weather, trip or activity cancellations. The reintroduction of individual planners and ensure the personalised notice boards that were purchased for each room are put up. In addition to this they state that they wish to reformalise house meetings and promote a wider participation. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Not everyone’s personal care needs are assessed and it is impossible to confirm that their needs are being met. People’s health needs are met by other professionals where the home are unable to meet them. Medication administration is well managed and ensures that people are not put at unnecessary risks. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 17 EVIDENCE: One of the files examined contained a bathing routine detailing the support staff should provide to enable a person to have their personal care needs met. The other files examined did not contain similar plans or assessments of people’s personal care needs. The manager must ensure that each person is assessed, and that any identified needs are met through care plans. None of the files examined by us contained health action plans. The manager stated that they were part of a group in the organisation who were looking at introducing health action plans for all people. The files showed that staff record visits to doctors/dentists and other professionals. The manager stated that in the week following this site visit the GP was going to visit the home to complete a medication review with each of the people living in the home. It is a recommendation of this inspection report that health action plans are implemented for each person. Medication administration was examined with the senior support worker responsible for overseeing. The home uses MDS (Monitored Dosage system), it is securely stored and only senior support workers have responsibility for administering medication. All staff receive training in the safe handling of medication. The medication administration system is well managed and minimises the potential risks to people living in the home. The AQAA completed by the manager states that they provide good provision of personal choice such as bedtimes, bath/showers, getting up etc. Evidence seen during the site visit confirms this. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People are able to make complaints if they are unhappy and the manager takes the appropriate actions to resolve these issues. Staff have not completed safeguarding adults training recently which may put people at unnecessary risks. Behaviour management plans enable staff to support people consistently and ensure potential risks are minimised. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home has a complaints procedure produced in picture format to enable people with communication difficulties to understand it more easily. Speaking to a person living in the home about what they would do if they were unhappy they said, “I would speak to the manager”. At the time of this site visit a complaint had been made to the home and an investigation was in the process of being completed. The CSCI have been in contact with the complainant and the funding authority responsible for completing the investigation. The CSCI will examine the report into the findings of the investigation and take any necessary actions where regulations have been breached. All of the people living in the home have their own bank accounts. 1 person manages their own finances, while other people’s monies are either overseen by the home or appointees. Speaking to the manager they stated that staff had not completed safeguarding adults training recently and it was agreed that firstly the management team would complete this. It becomes a requirement of this inspection report that all staff complete this training. Some of the newer staff stated that they had completed the training as part of their induction. People living in the home can sometimes display behaviour that challenges. The files seen contained detailed plans written with appropriately trained professionals about managing these situations and keeping people safe. Records were seen detailing the actual event and the staff involvement. All staff receive training in behaviour management, the manager stated that they are about to access further training in behavioural management to meet the specific needs of one person in the home. The AQAA states that the aim for the next 12 months is to review the complaints forms and notices, and re-write where needed. This will further improve the current system making it more user friendly for some people living in the home. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides people with ample space to meet their current needs. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 21 EVIDENCE: A tour of the premises was completed with one of the senior care staff. Where people gave permission some bedrooms were seen. To the front and rear of the property are substantial grounds that include an arts and crafts room and a duck pond. There are large areas of grass and some patio area. All the grounds appeared to be well maintained at the time of this visit. On entering the property by the front door there is a good-sized hall with the stairs leading to the first floor. In the hall was a notice board with evacuation procedures in case of fire, a copy of the CSCI certificate of registration and a certificate of employer’s liability insurance. There are 2 ground floor bedrooms, the laundry and a bathroom to the left of the hall and turning right leads to the communal lounge/dining room. The lounge area has a conservatory attached to it. A door from the dining area leads to the kitchen. The 1st floor has the majority of the bedrooms and there are also 2 bathrooms. From the 1st floor landing you are able to access the stairs to the manager’s office on the 2nd floor. The home provides people with sufficient space to meet their current needs. 2 people invited us to see their bedrooms. Both people said that they were able to choose what colour it was painted, 1 person had chosen pink. Speaking to 1 person they stated that they had their own key. Looking around the home a number of shortfalls were identified that the proprietor will need to address. 1. A new dishwasher has been installed in the kitchen and the floor covering no longer fits under the dishwasher. This exposes bare concrete and increases the risk to infection control. 2. The lounge and dining area are looking worn and in need of redecoration. 3. The French windows to the side of the property stick and need to be adjusted to work properly. 4. The curtain above the French doors was not hanging properly as it was missing hooks. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 22 5. The radiator in the lounge was leaking. The manager said that this was an ongoing problem that had been repaired a number of times. 6. The 3-piece suite was worn and dirty. The manager stated that they have ordered 2 new sofas and are waiting for them to be delivered. 7. The carpet in the conservatory is worn and has a whole in it. 8. All of the bathrooms are quite bare and not very homely. In the ground floor bathroom a wall tile was coming away from the wall, in an upstairs bathroom the blind did not work. The shortfalls identified above will be subject to recommendations and requirements as appropriate. The home was clean and hygienic at this site visit. The AQAA states that since the site visit was completed the lounge has been redecorated and new furnishings ordered. The rear lounge and dining room were in the process of being redecorated, and a twelve-month maintenance schedule has been devised and is currently being implemented, to include issues highlighted by this inspection report. All of these areas will be seen at the next site visit. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The organisation’s application for employment form does not reflect the criteria of these regulations and may put people living in the home at potential risks. Staff receive training in a range of subjects that help to meet peoples current needs. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 24 EVIDENCE: All staff have job descriptions and contracts of employment. A sample of staff recruitment records for people employed since the previous inspection were examined in depth. Examining the home’s application form it states that the candidate must provide an employment history for the previous 20 years. This was brought to the attention of the manager as the regulations state that there should be a “full” employment history. It is recommended that the application form be altered to reflect this. The records for people employed since the previous inspection were seen to meet all of the criteria of the regulations. The current staffing rota was examined. It showed that generally there are a minimum of 4 staff on duty for each shift. There are some occasions when figures drop below this. The rota showed when this is the case usually members of the staff team cover the shifts. There were only 2 night shifts covered by agency workers over a period of 20 days. Speaking to staff they stated, “it’s a good staff team and we cover shifts for each other”. At the time of these site visits there were the correct number of staff on as identified by the rota. The organisation has a dedicated training manager who is responsible for monitoring, planning and booking all future training. Staff spoken with during the site visit commented that training available was “good”. When asked whether there was many opportunities for training they replied “there is always lots of training available”. Records supplied by the training manager showed that there is a 3-year plan for training in subjects including behaviour management, food hygiene, health and safety, fire safety, first aid, moving and handling, safeguarding adults, medication, specialist needs and other courses. Training records seen showed a number of gaps. Talking with the training manager they explained that in some cases they had been unable to find any record of staff completing some training. Where this is the case they gave assurances that staff would be completing these courses as a matter of priority. In addition to these courses staff are in the process of completing NVQ’s (National Vocational Qualifications) at various levels. The team is made up of 17 staff (not including the manager), 7 staff are completing NVQ’s at level 3, while another member of staff is completing a level 2. The training manager stated that they are currently in discussion with a training provider to run NVQ’s with the other staff. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 25 Speaking to staff, the manager and examining records showed a major shortfall around staff supervision, appraisal and staff meetings. Staff that were spoken with stated that they had not received regular supervision with the manager. The records supported this, and the manager agreed this was a shortfall that he intended to address. This becomes a good practice recommendation of this inspection report. Good practice for staff supervision sessions is that they should be completed at a maximum of every 6 weeks. A good practice recommendation is made for staff meetings to be held regularly (minutes were seen for a senior staff meeting in the week before this site visit. The manager stated that it was his aim that full staff meetings will be held regularly in the future). Another good practice recommendation relates to staff appraisals. The manager showed us that he was about to start this with senior staff. The manager must ensure that all staff receive a staff appraisal once in a period of twelve months. The AQAA highlights the organisation’s/manager wish to achieve the Investor’s in People Award. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home does not have a quality assurance system that puts the views of people living in the home as central and it is therefore impossible to confirm that all people are satisfied with the service. In general health and safety is managed effectively but shortfalls identified I the report mean that there are some unnecessary risks. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 27 EVIDENCE: As identified earlier in this report, the home’s CSCI registration certificate, and employer’s liability insurance certificate were displayed on the home’s notice board in the entrance hall The manager of the home is registered with the CSCI and has significant experience of working with this client group. Observations throughout the 2 site visits showed they had positive relationships with both the people living in the home and his staff team. Comments from staff were positive about the manager. Some shortfalls in the home’s administration were identified through the 2 site visits these were brought to their attention manager at the time. They gave their commitment that these would be addressed without delay. Observations, records and discussions with both staff and people living in the home provided evidence that outcomes for people in the home are good. 2 people living at the home agreed to speak with us. Both stated that they were really happy living at the home. We discussed the home’s quality assurance system with the manager. They explained that previously they have sent questionnaires to parents asking for their opinion about the service. This has not been done recently (June 2006) and it was suggested that this could be repeated in the near future. In addition to this we suggested that similar questionnaires could be sent other professionals involved with the people living the home. The manager must also implement a system that enables the views of people living in the home to be central to the future development of the service. This becomes a requirement of this inspection report. Speaking with the manager they stated that all of the home’s policies and procedures had been reviewed in November 2007. They will be implemented once they have been ratified. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 28 Health and safety systems and precautions around the home were examined. • • • • • Fridge and freezer temperatures are recorded regularly. The home has a food probe to test cooked meats, records showed that this was being done inconsistently and needs to be addressed. Fire and evacuation procedures are posted on the notice board in the entrance hall. A fire risk assessment has been completed for the home in January 2007. A new fire control panel was fitted in the home last year. An appropriately qualified engineer had serviced fire extinguishers around the home in October 2007. Three shortfalls were identified with fire precaution equipment around the home. The fire blanket in the kitchen had not been inspected by the engineer with the fire extinguishers. And, in the home’s laundry there were two “old” fire extinguishers that should be disposed of. Whilst completing the tour of the premises with a senior member of staff they explained that a fire exit on the first floor was “locked”. Speaking to the manager later they said the door wasn’t locked. The manager must ensure that all staff are aware of this in case of fire. The home has a COSHH cupboard where goods are stored securely. • Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 3 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 2 28 3 29 X 30 X STAFFING Standard No Score 31 3 32 2 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 X 3 X 2 3 X 2 X Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 YA6 Regulation 15 Requirement Each of the care plans developed to meet people’s needs must be reviewed regularly. Where care plans place restrictions on a person’s choice the reasons should be clearly identified. The person, or their advocate should be involved throughout the process and the document must be kept under review. Timescale for action 28/03/08 2. YA7 17(1) a, schedule 3, 3(q) 11/04/08 3. YA9 13(4) b All risk assessments must be 28/03/08 reviewed regularly to ensure that people are not being put at unnecessary risks. Personal care assessments should be completed for each person and where required detailed guidelines should be developed. This will minimise the risk of people’s needs not being met consistently by the staff team. All staff must complete training in safeguarding adults. 25/04/08 4. YA18 14, 15 5. YA23 13(6) 01/08/08 Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 31 6. YA24 13(4) The floor covering around the new dishwasher must be replaced to ensure that it is sealed and bare concrete is not visible. The exposed bare concrete increases the risk to infection control. 25/04/08 7. 8. YA24 YA39 23(2)c 24, 35 The radiator in the lounge was leaking and must be repaired. A quality assurance system that puts the views of the people living at the home as central must be implemented. 21/03/08 09/05/08 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 YA2 Good Practice Recommendations The home’s pre-admission assessment process to ensure that the manager and staff team have sufficient information to meet the person’s needs on admission. Person centred plans should be implemented for each of the people that live in the home. All of the people in the home should have missing person’s risk assessment. Health action plans should be implemented for each of the people living in the home. All of the bathrooms are quite bare and not very homely and would benefit from re-decoration. The decoration in the lounge and dining area is looking worn and in need of re-decoration. The French windows to the side of the property stick and need to be adjusted to work properly. The 3-piece suite in the lounge was worn and dirty and should be replaced. DS0000062152.V358350.R01.S.doc Version 5.2 Page 32 2. 3. 4. 5. 6. 7. 8. YA6 YA9 YA19 YA24 YA24 YA24 YA24 Fern Court 9. 10. 11. 12. YA24 YA33 YA34 YA36 The carpet in the conservatory is worn and has a hole in it and should be replaced. Team meetings should be held regularly. The organisation’s application form should be reviewed to reflect the regulations. Staff should receive supervision regularly. Staff should receive regular staff appraisal. 13. YA42 The health and safety shortfalls identified in the body of the report should addressed. Fern Court DS0000062152.V358350.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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