Care Home: Fern Croft

Similar services:

• 2 Perhaver Park
• The Vicarage
• St George`s
• 5 Seafield Road
• Radfords
• Honeybourne House
• 32 Beaumont Way

What the care home does well People moving into the service are thoroughly assessed before they move into the service and this minimises the risk of people being admitted whose needs cannot be met. People living in the home have a wide range of leisure activities made available to them. The service meets people`s current cultural needs. Staff maintain good records for the finances they manage of people in the home and this minimises potential risks to people. Communal areas around the home are nicely decorated and meet the current needs of people in the home. Staff complete regular health and safety checks around the premises which minimises the potential risks to people living in the home. Policies and procedures have been reviewed recently. What has improved since the last inspection? People now have greater choice about the food they wish to eat. The standard of some areas of the accommodation has improved. What the care home could do better: People`s care plans and risk assessments should be reviewed at regular intervals to ensure that the home are still meeting their needs and they are not being put at unnecessary risks. Emotional Behaviour management plans should be implemented where required to enable staff to support people consistently. The maintenance issues highlighted in the body of the report should be addressed to ensure that all of the accommodation is of a good standard. At this site visit we identified shortfalls in the home`s fire safety procedures which put people at unnecessary risk. CARE HOME ADULTS 18-65 Fern Croft Ferncroft 14 Heathville Road Gloucester GL1 3DS Lead Inspector Mr Paul Chapman Unannounced Inspection 23 and 24th April 2008 09:00 rd Fern Croft DS0000048719.V358927.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 Croft DS0000048719.V358927.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 Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fern Croft Address Ferncroft 14 Heathville Road Gloucester GL1 3DS 01452 505803 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 Position Vacant Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2007 Brief Description of the Service: Fern Croft is a residential care home registered for seven adults with a learning disability in the Kingsholm area of Gloucester. The home specialises in supporting people who may present behaviours that challenge the service. The home is owned by New Beginnings (Gloucester) Ltd and part of a group of three homes, first established in Gloucester in 2002. Fern Croft, which opened in January 2004, provides single en suite accommodation for six people and a second floor bed sit for one person. Residents have access to a comfortable lounge, a dining room and domestic size kitchen. To the rear are spacious gardens laid mainly to lawn with a patio area. Each person has a copy of the Statement of Purpose and Service User Guide. Copies are also available from the office. The fees for the home range from £950.00 to £1400 per week. Additional charges are payable for toiletries. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection took place in April 2008 and included two visits to the home on the 23rd and 24th April. The acting manager was in attendance throughout the visits. Completed questionnaires were received from four relatives, four people living in the home, seven staff and four other health/social care professionals. We spent time observing the care of people and their interactions with staff. Two people living at the home were spoken to and several people’s rooms were inspected on their invitation. The care of two people was looked at in depth that 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. What the service does well: What has improved since the last inspection? Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 6 People now have greater choice about the food they wish to eat. The standard of some areas of the accommodation has improved. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 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 who may wish to move into the home are provided with information about the service and able to “test drive” it before they decide whether they would like to live there. Anyone wishing to move into the home is thoroughly assessed to minimise the risk of the service not being able to meet their needs. EVIDENCE: Since the previous inspection was completed 1 person has been admitted to the home. We looked at the admission process for this person which showed that the home had received a community care assessment completed by the person’s social worker. In addition to this the organisation’s area manager had completed an assessment. We spoke to the person about their admission to the home and they confirmed that they had access to the home’s service user guide, and they had visited the home on a number of occasions before they moved in. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 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 care plans in place enable the staff to work with people consistently and meet their needs. Care plans are not being reviewed regularly and may not accurately reflect people’s current needs. People living in the home are able to make decisions about their lives and the staff team respects these. Risk assessments are in place but require further development and regular reviews to ensure that people are not put at unnecessary risks. EVIDENCE: On this occasion we examined records for 2 people in depth, examining needs assessments, care plans and risk assessments. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 10 All people living in the home have Key workers. The care plans examined provided staff with sufficient detail to meet people’s needs consistently and covered a wide range of topics. The care plans seen for both people had been reviewed in July and October 2007, but not since those dates. This was brought to the attention of the acting manager and the need to ensure that all care plans are reviewed at least every 6 months. This becomes a requirement of this inspection report. One of the people living in the home has specific environmental needs that the home meet. This was discussed with the acting manager and the need for a care plan to be developed to identify these needs. This becomes a requirement of this inspection report. When examining 1 person’s risk assessments we identified that 3 risk assessments had been written to address a person’s communication skills, their finance, and their behaviour management. On examining these risk assessments it was clear that they were care plans. This was discussed with the acting manager who was in agreement with this. It becomes a recommendation of this inspection report that these documents are reviewed and re-written in the appropriate format. Records for both of the people showed that reviews with their funding authorities had taken place. None of the people in the home have 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). It becomes a recommendation of this report that these are developed in the future. Whilst visiting the home we observed people being given the opportunity to make decisions about their lives. 1 person was asked if they would like to go out shopping with staff, they decided not to and the staff respected this and the person stayed home. Records seen in people’s files gave other examples of people being asked what they would like to do and them making decisions. On the second day of this site visit we spoke to 1 person at length about living at the home. They confirmed that they were able to make decisions about their life and that staff respected their choices. Risk assessments were examined for both people and showed that 1 person’s had been reviewed regularly, whilst the other person’s were in need of review. 1 person also did not have risk assessments for when they were using the home’s vehicle and risks present around the home. In addition to this the home should have missing persons risk assessments for each person. This was brought to the attention of the acting manager. It becomes a requirement of Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 11 this inspection report that the risk assessments are reviewed and that other identified risk assessments are written. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. 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 living in the home lead active lifestyles and staff provide appropriate support to people to enable them to do this where required. People are able to choose what they would like to eat. EVIDENCE: Speaking to people living in the home, staff and by examining records we were able to see the range of activities they take place regularly. These included: • Aromatherapy sessions • Pottery classes • Cinema • Swimming Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 13 • • • • • • Relaxation at a local leisure centre Attending Rainbow club (social club in Gloucester) Karaoke Massage Taking part in the grocery shopping Using local facilities in the community Whilst we were completing our visits we witnessed a pottery class being held in the home and another small group going into Gloucester for some lunch and to do some shopping. When speaking to staff they stated “the activities we complete really depends on what people want to do”. Speaking to 2 of the people living in the home they confirmed, “We go out regularly”, and that “we don’t just go out in small groups we also get the opportunity to go out 1 to 1 with staff regularly”. Recently people have been on a boating trip and the acting manager explained that they are currently planning holidays for this year. Trips already arranged included 1 person going to Brean with 2 staff and 2 others going to Weymouth. The acting manager explained another person does not like going on holiday, as a result they are planning a number of day trips. When we spoke to the person in question they confirmed this. The organisation provides people with a financial contribution towards their holidays. Speaking to people living in the home they confirmed that friends and family are welcome to visit them. A completed questionnaire from another professional involved with the home raised concerns about communication around a person attending college, this then having a detrimental effect on the person. Two of the people living in the home attend the local Baptist church. The acting manager explained that the home used to have set menus. This has now been changed and all people are involved in weekly resident meetings where they are asked to choose what they would like to eat for the following week. Meals for each day are initialled to indicate who has chosen that meal. To support people who have communication difficulties staff use recipe books with pictures to help people make choices. This is good practice. People spoken with stated that they were able to help with cooking/preparing food and meals. A recommendation discussed with the acting manager would be to take pictures of the meals they cook and use creating a “recipe book” for meals cooked in the home. Fresh fruit was available for people throughout the day. One person has a special diet (gluten free) and members of the team have researched a number of recipes for the person to choose meals from. Speaking Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 14 with the acting manager they stated that they have not accessed any specialised input from a dietician. It becomes a recommendation of this inspection report that the acting manager seeks the input of a dietician. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 15 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. The care plans for personal care are do not provide staff with sufficient information to enable them to provide consistent care to all of the people in the home. People living in the home have regular access to other health professionals to meet their needs. People are not put at unnecessary risks through the home’s well-managed medication systems. EVIDENCE: We examined the personal care plans for 2 people. One person’s plan provided a good level of detail about what care staff actually provided. This enabled staff to provide the person with the care they wished for and needed. The care plan examined for the other person also provided some good detail, but did not provide sufficient detail around washing the person’s hair. This was brought to the attention of the acting manager. People’s personal care plans should be reviewed to ensure that all plans provide staff with sufficient detail to meet people’s needs. This becomes a requirement of this inspection report. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 16 Both of the files examined contained correspondence from other health professionals and records of appointments. The home has made use of other health professionals to meet people’s needs. The home’s medication administration was examined. The home use an MDS system (Monitored Dosage System). Since the previous inspection was completed the acting manager has developed an information pack about all of the different medication used by the people. Medication administration is well managed and minimises potential risks to people living in the home. The only shortfall identified on this occasion related to the topical creams and cough mixtures that should be labelled with the date they are opened. This becomes a recommendation of this inspection report. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 17 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 living in the home are able to make complaints and are confident that if they did make a complaint that staff would listen to them. With the majority of staff having not completed training in the safeguarding of vulnerable adults risks to people living in the home are potentially increased. Behaviour management plans are not accurate, and with staff needing specialised training potentially people living in the home, and staff are being put at an unacceptable risk. Detailed records of peoples income and expenditure minimises the risk of people’s money being spent inappropriately. EVIDENCE: The home has a complaints procedure. The acting manager stated that they have not received any complaints since the previous inspection was completed. The CSCI has not received any complaints. When speaking to people they confirmed that they were aware of the home having a complaints procedure and that they felt they would be listened to if they made a complaint to the staff. Training records showed that 2 staff have completed safeguarding vulnerable adults training in the previous 12 months. It becomes a requirement of this inspection report that all of the staff that have not completed the training in the past twelve months now complete it. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 18 Some of the people living in the home display behaviour that can be challenging. As part of this inspection we examined the current plans/risk assessments that are in place. A current risk assessment seen by us highlighted stated that staff should follow some specific guidelines to manage a person’s behaviour. These guidelines were not available. We spoke to the acting manager about this and they explained that currently Emotional Behaviour Support plans are being written by a member of staff that has been trained to do this. We have been given assurances that these will be completed within 6 weeks of this site visit. We spoke to the staff member responsible for completing these plans who was clearly committed to achieving this, and ensuring that both people living in the home, and staff are safe. Training records showed that all but 4 of the staff have now completed training in behaviour management, and training is booked for 4 staff who have not attended the training. We examined the financial management for 2 people. Clear audit records were in place and at the time of this site visit records appeared accurate. One person keeps their own money and has a lockable container in their bedroom. Both people were seen to also have financial management risk assessments. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 19 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, 30 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 environment is homely and comfortably furnished and meets people’s current needs. Safe practices ensure that a clean and hygienic environment is maintained. EVIDENCE: A tour of the premises was completed with the acting manager. The lounge of the home provides people with 2 sofas, a TV and DVD player and had been decorated recently. In addition to the lounge there is also a dining room with 2 dining tables, this room then leads to the kitchen. All of the communal areas were nicely decorated and personalised with pictures and some ornaments. There are 2 bedrooms on the ground floor that are suitable for wheelchair access. We were invited into both rooms which were seen to be decorated to a good standard and personalised with the person’s possessions. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 20 All of the other bedrooms are on the first floor. 2 other bedrooms were seen, both required re-decoration, as they were looking a little tired. Earlier in this report we have highlighted the need for 1 person’s environmental needs to be addressed through care planning, as they dislike any items other than a mattress in their bedroom. There is a shower room on the first floor; this is in need of some decoration as the paint is flaking off. This becomes a requirement of this inspection report. In answering the question “what could the service do better?” in a completed questionnaire we received it states “Better up keep of the building, e.g. repairs/maintenance/replacing old appliances”. Whilst completing the site visit we noted that the carpet on the staircase was uneven and with further investigation was found to be loose and unsafe. This was reported to the organisation’s maintenance person who repaired it whilst we were there. Speaking to the acting manager it was clear that such a prompt response is not usual and there have been difficulties in getting work completed promptly. This will be monitored through regulation 26 visits completed by the provider. As mentioned in the previous inspection report it was planned that a conservatory would be fitted to the rear of the house. This has not been done yet and the acting manager stated that they believed that this was still planned for the future. At the rear of the property is a well-maintained garden. At the time of this site visit the home was clean and hygienic. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 21 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): 32, 34, 35 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. Staff receive training to meet the current needs of the people living in the home and minimise potential risks. The home’s recruitment procedures should be reviewed to ensure that they meet the criteria of the regulations and do not put people at unnecessary risks. EVIDENCE: The organisation has a training manager who is responsible for monitoring people’s training needs and ensuring that courses are booked as required. They supplied us with a copy of the home’s training matrix for April 2008. This showed that the majority of staff are trained in areas including food hygiene, health and safety, first aid, moving and handling, safeguarding adults and COSHH (Control of substances hazardous to health), and medication administration. Staff that have not completed these courses are booked to complete them in the coming months. Training records did show that: Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 22 • • • 4 support workers are currently completing NVQ’s (National Vocational Qualifications) at level 2 in care, 2 other support workers have completed theirs. Both senior carers have completed NVQ’s at level 3, and 1 senior carer is due to start their RMA (Registered Managers Award) in May. All staff had completed fire safety training in January 2008. We examined the recruitment records for 2 staff that have started at the home since the previous inspection was completed. Both of the files contained a criminal records bureau check (CRB) and a POVA first check, as required by the regulations. A shortfall noted with both of the files was with the employment histories. Both application forms showed gaps in previous employment. Regulations clearly state that an employer must gather “a full employment history, together with a satisfactory written explanation of any gaps in employment”. It becomes a requirement of this inspection report that the acting manager addresses these shortfalls and ensures that all future recruitment meets the regulations. We spoke to 4 staff about the training available to them. The consensus of opinion by the longer serving members of staff was that “training has always been good here”. Newer staff confirmed that they received induction training when started at the home. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 23 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 needs to employ a suitable manager to complete the CSCI registration process. People living in the home have benefited from a well-run establishment that meets their current needs. The acting manager must be mindful of fire safety to ensure that people are not put at unnecessary risks. Other steps taken to address potential risk to people’s health and safety ensure risks are minimised, EVIDENCE: At the time of this site visit there was no registered manager and the acting manager stated that she was going to be leaving in the month following this site visit. The provider must now put another person forward for registration with the CSCI. This becomes a requirement of this inspection report. Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 24 A valid certificate of insurance was displayed in the home. All of the staff we spoke with agreed that it was a nice place to work. The two people who live at the home that we spoke to said that they liked living in the home. The group manager completes the visits required by regulation 26 and the manager sent surveys/questionnaires to people living in the home. Both staff and people living in the home spoke about the regular resident meetings that take place. It is recommended that the home continue to investigate methods of quality assurance that puts the people living in the home at the centre of the process. To enable us to monitor the progress of maintenance issues around the home the responsible individual must send us copies of the regulation 26 reports when they have been completed each month. This becomes a requirement of this report. The home’s policies and procedures have been reviewed and the acting manager has implemented a system where staff are asked to read each document then sign to confirm this. We examined the fire safety precautions taken by the home. This showed that a fire risk assessment has been completed but shortfalls were seen with other checks that should be taking place regularly. This included no fire drill being completed since January 2007, emergency lighting not being checked since December 2007 and the fire alarm not being tested in the month up to this site visit. This was bought to the attention of the acting manager. On the second day of the site visit the acting manager had taken action to address these shortfalls and as a result we did not refer the home to the fire service. The home takes a number of other steps to minimise the risks to people around the home: • COSHH data sheets are available for the cleaning chemicals used in home. Data sheets provide staff with information about the chemicals used and what steps should be taken if someone splashes them on skin, or in eyes. Environmental health have completed an inspection of the cooking facilities and food hygiene practices. The home has been awarded 4 stars. Portable Appliance Testing (PAT) had been completed in December 2007. Fridge and freezer temperatures are monitored regularly and where temperatures are unsafe corrective action is taken. A food probe is used to monitor the temperature of meals prepared in the home. DS0000048719.V358927.R01.S.doc Version 5.2 Page 25 • • • • Fern Croft 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 X 2 3 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 3 25 2 26 3 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 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 2 X 2 X X 3 X Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 26 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(1) Requirement Care plans must be reviewed regularly to ensure that peoples changing needs are identified and met. A care plan needs to be written for a person who has specialised environmental needs. To ensure that people living in the home are not put at unnecessary risks the assessments highlighted in the body of this report must be written. People’s care plans for personal care must be reviewed to ensure that they provide sufficient detail to allow staff to meet people’s needs consistently. Emotional behaviour support plans must be in place for each person that needs them. 2 of the bedrooms seen during the inspection require decoration. Timescale for action 27/06/08 2. YA6 17(1)(a) 27/06/08 3. YA9 13(6) 27/06/08 4. YA18 15(2) b 04/07/08 5. YA23 13(7), 15 19/06/08 6. YA25 23(2) d 05/09/08 Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 27 7. YA27 23(2) d The shower room on the first 05/09/08 floor requires decoration to make it an acceptable standard. Recruitment records must adhere to the regulations. There must be no gaps in people’s employment history. The provider must employ a manager suitable for registration with the CSCI. 27/06/08 8. YA34 7, 9, 19 schedule 2 8 9. YA37 29/08/08 10. YA39 26 The provider must send the CSCI 27/06/08 copies of the regulation 26 reports so that the maintenance of the home can be monitored. 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 YA6 YA17 Good Practice Recommendations A person centred approach to people’s care should be implemented. A dietician should be contacted to ask for their opinion on the gluten free diet for one of the people living in the home. Topical creams and cough mixtures should be labelled with the dates they are opened. The home’s quality assurance system needs further development to ensure that it puts the opinions of the people living in the home as central. 3. 4. YA20 YA39 Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI Fern Croft DS0000048719.V358927.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!