Care Home: Fernhaven

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What the care home does well Fernhaven Care Home provides an excellent service to the people who live there. The home has a group of staff that are highly valued by people living at Fernhaven. Comments included " The staff are great and they know what they are doing" and "Staff encourage you to do things" and "I`m very happy here" A lot of good information is gathered before admission to provide the management team with a clear picture of each prospective resident`s needs and requirements, so they were confident that the assessed needs of each person could be adequately met. The plans of care were very detailed and well written providing staff with guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to live a lifestyle of their choice while being mindful of risks. Staff training is given high priority. This makes sure that staff are competent to provide a very good standard of care and ensure staff have the skills required to meet residents` expectations. All staff have a good understanding of what they are trying to achieve. One person said, "I feel the service provided is good, communication between staff and management being excellent, enabling myself to give the service users the care and support they require meeting each of the service users individual needs". What has improved since the last inspection? The registered manager and another member of staff have now successfully completed the Registered Managers Award. All but one member of the staff team has achieved at minimum a National Vocational Qualification (NVQ) in care. This is commendable. Improvements have been made to the physical environment of the home. A new roof has been fitted, new carpet or wooden flooring has been provided to all communal accommodation and a new table and chairs have been provided to the outdoor area. Communication with mental heath services has been expanded and there are good systems in place to ensure that residents` needs and requirements are met. CARE HOME ADULTS 18-65 Fernhaven 5 Derbe Road Lytham St Annes Lancashire FY8 1NJ Lead Inspector Denise Upton Unannounced Inspection 4th September 2008 09:30 Fernhaven DS0000065618.V367221.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 Fernhaven DS0000065618.V367221.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. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fernhaven Address 5 Derbe Road Lytham St Annes Lancashire FY8 1NJ 01253 781199 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) Mr Islamuddeen Duymun Manager post vacant Care Home 6 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (6) of places Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service is registered to accommodate a maximum of 6 service users in the category MD (mental disorder) 10th October 2006 Date of last inspection Brief Description of the Service: Fernhaven Care Home provides residential accommodation for up to six residents with a history of mental illness that do not require nursing care. The property is a semi detached three-storey house, with good access to the local services and amenities of St Annes. These facilities can be accessed independently or with the assistance of staff as appropriate. The homeowner/ manager and support manager both have extensive experience of supporting people with a mental illness. Emphasis is placed on providing long-term rehabilitation in order for residents to maintain and extend independent living skills. Accommodation for people living at the home is located on the ground and first floor of the building and offers individual bedroom accommodation for all residents. Communal areas of the home are comfortable and well maintained and consist of a lounge and separate dining room. A designated smoking room is available on the first floor of the home. Fernhaven DS0000065618.V367221.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 3 star. This means the people who use this service experience excellent quality outcomes. This unannounced site visit took place during the course of a morning and lunchtime period of a midweek day and in total spanned a period of approximately four hours. The twenty-two core standards and one additional standard of the forty- three standards identified in the National Minimum Standards-Care Homes For Adults were assessed along with a re-assessment of the single recommendation highlighted in the last inspection report. The inspector spoke with the registered manager, the support manager and brief discussion also took place with two residents. In addition, an expert by experience accompanied the inspector and spoke individually with five of the residents in order to gain their thoughts and feelings about living at the home. The expert by experience also informally spoke with members of staff on duty. An expert by experience is a person who because of their experience of using or visiting a care home(s) visits a service with an inspector to help them get a picture of what it is like to live in the home. A number of records were examined and a partial tour of the building took place that included communal areas of the home, kitchen, laundry and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment completed by the registered manager/homeowner. Five residents and a Social Worker also completed a Commission for Social Care Inspection survey that helped to form an opinion as to whether resident’s needs and requirements were being met. A further letter was also received from another Social Worker who is currently working with a resident at Fernhaven. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. The fees at Fernhaven Care Home are currently £425:00 per week. What the service does well: Fernhaven Care Home provides an excellent service to the people who live there. The home has a group of staff that are highly valued by people living at Fernhaven. Comments included “ The staff are great and they know what they are doing” and “Staff encourage you to do things” and “I’m very happy here” Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 6 A lot of good information is gathered before admission to provide the management team with a clear picture of each prospective resident’s needs and requirements, so they were confident that the assessed needs of each person could be adequately met. The plans of care were very detailed and well written providing staff with guidance about how the assessed needs of people living at the home were to be met and how people were to be supported to live a lifestyle of their choice while being mindful of risks. Staff training is given high priority. This makes sure that staff are competent to provide a very good standard of care and ensure staff have the skills required to meet residents’ expectations. All staff have a good understanding of what they are trying to achieve. One person said, “I feel the service provided is good, communication between staff and management being excellent, enabling myself to give the service users the care and support they require meeting each of the service users individual needs”. What has improved since the last inspection? What they could do better: The management and staff group at Fernhaven work hard to provide an individualised service to people living at the home and are constantly looking at ways to improve. Although the pre admission assessment is very detailed to make sure that the home can provide the level of support required, the prospective new resident should be informed in writing that the home could meet their needs. It is understood that in the future, any prospective new resident would receive Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 7 written confirmation that their individual requirements could be met at Fernhaven before they become resident at the home. There is a new regulation about the way controlled drugs must be stored in care homes that provide personal care. The registered manager has agreed to establish if the current storage facility is adequate and take action to ensure controlled drugs are stored correctly within an agreed time scale. 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. Fernhaven DS0000065618.V367221.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 Fernhaven DS0000065618.V367221.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): 2 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a clear and very comprehensive pre admission assessment undertaken to make sure that people are only admitted to the home if their needs and requirements could be met. EVIDENCE: Fernhaven Care Home continues to have a well-established system in place to make sure that a thorough assessment of current strengths and needs takes place before a new resident is admitted. This includes a detailed pre admission assessment undertaken by the registered manager and/or support manager, obtaining written assessments and risk assessments from other professional staff involved and close liaison with the mental health multi disciplinary team that is supporting the prospective resident. This collated information then forms the basis of the initial care plan. Only when all the required information is available will the registered manager make an informed decision as to whether the home could meet the holistic needs of the prospective new resident. As part of the admission process, the Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 10 prospective resident is also invited to the home to meet staff and existing residents and to stay for a period of time, to help the person decide whether they would like to become resident at Fernhaven Care Home. During the course of the site visit two recently admitted residents were ‘case tracked’. It was clearly evident that a very comprehensive assessment and introductory period had take place and both residents were very satisfied with the level of care and support provided. One of the Social Workers who provided feedback to the Commission for Social Care Inspection (CSCI) commented that: “I have been extremely impressed by the very high standard regarding the referral and assessment process. Initially I met with the proprietors who rightly insisted on the provision of detailed and up to date reports/documents in order for their assessment to be comprehensive. I believe that in this respect they are very clear about the need to ensure that they would be in a position to meet prospective service users needs”. This same person went on to say, “What I also found excellent was the fact that the proprietors were keen to work with the hospital team to ensure that the young man’s transition from a low secure unit to their service was entirely client centred i.e. it should proceed in an appropriate manner and pace for that individual”. Whilst it was very clear that the needs of recently admitted people to the home were being met, there is a requirement that any person who has been assessed for possible admission to a care home must receive written information following the pre admission assessment. This should confirm the outcome of the pre admission assessment and that the prospective resident’s current needs and requirements could be met at the home. This should be provided prior to admission. There was no evidence that this had occurred. Fernhaven DS0000065618.V367221.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 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is a clear and consistent care planning and risk assessment system in place to provide staff with the information they need to maintain a high quality service. Opportunities are made available to ensure that people living at Fernhaven are involved in day-to-day decision-making. This promotes self worth and influences change. EVIDENCE: All residents at Fernhaven Care Home have an individual care plan that is regularly reviewed. Care plans provide a comprehensive and detailed account of the requirements of each individual and describe how strengths and needs are to be addressed. Good risk assessments are also in place with significant Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 12 outcomes incorporated in the care plan. Each individual care plan incorporates elements of the Care Programme Approach (CPA) care plan, identifies CPA risk assessment strategies and positive planned interventions to assist the resident to maximize their potential. Residents are invited to contribute to their individual care plan and encouraged to become involved in developing and reviewing their care plan. All care plans are reviewed on at least a six monthly basis with more frequent reviews taking place soon after admission or when required. Care plans continue to be signed by the individual resident to acknowledge their understanding of and agreement to the outcome. Residents are, wherever possible, positively encouraged to make informed decisions for themselves and are provided with advice and support to make an informed choice. Details of local advocacy services are made available to residents although in practice, the individual resident’s Social Worker frequently takes on this role if and when required. The Social Worker who completed a CSCI survey stated, “The Fernhaven practice person centred care. The service provides steps to positive recovery and advises individuals about the possible consequences of their actions to allow them to make informed decisions regarding their behaviour” People living at the home are encouraged to take informed risks as part of an independent lifestyle. Risks are assessed and support plans and risk management strategies in place. Although one professional person involved in supporting a resident at the home felt that a less maternal approach would allow people to take more positive risks, the same person went on to say, “Overall I am very satisfied with the quality of care at the Fernhaven and believe it is the best residential home in the locality who manage individuals who have mental health problems who can often present with very challenging behaviour” Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The are opportunities made available for personal development that includes support with relationship issues. Links with the community are good that support and enrich resident’s social and educational opportunities. Resident’s rights are respected and responsibilities recognised while remaining mindful of any agreed restrictions in place. People staying at Fernhaven Care Home enjoy healthy nutritious meals. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 14 EVIDENCE: Education, occupation and personal development opportunities are addressed on an individual basis. Staff work hard on confidence building with residents to help them feel more able to access and enjoy valued and fulfilling activities. One resident has recently chosen to attend to the garden, an activity that he is now enjoying. Another resident, although reluctant to go out independently will join in with staff led activities and outings. A further resident is hoping to start a college computer course in the near future and is being well supported to achieve this aim whilst another resident enjoys helping with cooking and domestic tasks at the home. Fernhaven continues to have good links with a local mental health resource centre where a variety of different courses are offered. A number of residents are accessing this venue and enjoying activities that include fishing, swimming and badminton. However staff listen carefully to what resident’s say about attending the centre and had taken steps to re-negotiate the attendance of one person who was unhappy about the amount of time he was spending at the resource centre. As noted at previous inspections, staff are very keen to encourage residents to participate in activities in the local community and try hard looking at individual skills and exploring things that the individual resident may enjoy. As a result of this, one resident is now enjoying an occasion football match and also shopping trips with the registered manager. Another resident attended a family wedding with staff support and a further resident regularly visits his mum in a care home. Social relationships are always encouraged. Family and friends can visit the home at any time of the resident’s choice. Likewise, residents are enabled and encouraged to maintain family and friendship links and visit their relatives and friends on a regular basis. Residents spoken with all felt that they were individually well supported and that they got on well with the staff team. One person stated to the expert by experience that, “Staff encourage you to do things”. This person did not think that any improvements could be made stating, “They’ve got it just right”. All residents and most staff continue to be racially and culturally similar. However the home does accommodated residents with differing diversity needs that are always respected and accommodated. A member of staff gave a good account of the information she obtained to ensure that the religious beliefs of one resident was adhered to and was also well informed about other beliefs and cultures. A Social Worker also passed comment when she said that the home had made several attempts to respond to individual needs in relation to Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 15 spiritual/religious needs, sexual orientation and disability and went on to say, “They are a pro-active and responsive service”. Although in the main residents choose their own preferred daily routines and lifestyle, this can incorporate Care Programme Approach (CPA) decisionmaking outcomes particularly in respect of any therapeutic employment opportunities that a resident may choose to access. In these instances staff assist the resident to develop appropriate employment skills in conjunction with the resident’s social worker/care manager. As previously stated, routines are kept flexible to accommodated individual wishes. However there are a number of agreed restrictions within the daily routines that have been determined through multi disciplinary decision-making outcomes. For example it is acknowledged that some residents are at risk of excess alcohol consumption. However generally residents understand the reasons for any agreed restrictions. One resident explained to the expert by experience that he did use to drink excessively but “there is a no drugs, no alcohol policy here and they stick to it”. Residents spoken with enjoyed the meals served. Although there is a rotating menu available this is kept flexible. Residents are involved in menu planning. One recently admitted resident confirmed that although there were set meals over a two-week rota, the meals were “very good and if I didn’t like it I’m sure I would be able to have something else but this hasn’t happened: the food is good”. Meals are varied and specialist diets in respect of religious, cultural or medical need could be accommodated. The relationship observed between staff and residents was again seen to be relaxed and comfortable with residents deciding whether to participate in an activity or enjoy the privacy of their individual bedroom accommodation. Fernhaven DS0000065618.V367221.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 Quality in this outcome area is excellent. Personal support is offered in such a way as to maximise resident’s lifestyle choices. The physical and mental health care needs of residents are very well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for the administration of medication are good with clear and comprehensive arrangements being in place to ensure resident’s medication needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents’ personal and healthcare support needs are identified and met in a manner that respected their privacy, dignity and independence. Residents at Fernhaven continue to be mainly self-caring and at most only require prompting and encouragement in order to undertake personal care tasks. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 17 Residents spoken with said staff were helpful and supportive with healthcare needs. As at previous inspections, it was identified that residents are also assisted with lifestyle support as identified on the individual care plan. This takes into account the strengths, needs, wants and wishes of each individual. Residents select their own General Practitioner, are supported to manage their own individual healthcare requirements and have access to a range of health care professionals either independently or with the assistance of staff when required. The health of residents, including mental health is monitored by the home and prompt referral to the appropriate professional secured if there is concern. A resident has recently been referred to a dietician in order to obtain advice on a suitable diet. The active involvement of Community Psychiatrist Nurses and Mental Health Social Workers is encouraged. The home retains close links with the local psychiatric services that will provide staff with advice as needed. Staff also receive ‘in-house’ mental health awareness training specific to each resident that is comprehensive and provides staff with a very good understanding of the individual needs of each resident. The staff group are also very aware of when a resident becomes less well and take swift action to involve other relevant mental health professionals in order to ensure prompt action. A Social Worker who has contact with the home wrote, “I have found Fernhaven to be a good service in that they are attentive to the individual’s needs and are prompt to respond to any health queries and ensure appropriate follow up”. Fernhaven has good systems in place to ensure the safe management and recording of medication. All staff that has responsibility for medication have received appropriate medication training. Staff do not undertake any medication related tasks independently until their training is completed. A resident made reference to this when he told the expert by experience that all the staff were, “great” and that they “know what they are doing”. This same person went on to explain that if a new member of staff started, they were always supervised and appeared to receive good training, i.e. staff gave medication out but if the staff member was new then he/she would be supervised by another member of staff. Currently one resident is self administering his own prescribed medication. There is a locked facility in his individual bedroom accommodation for the safe storage of medication, the resident signs the self-administration record and a risk assessment is in place. Observation of the medication administration record of the residents ‘case tracked’ confirmed that these were well recorded, accurate and gave clear instruction. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 18 A second Social Worker confirmed good practice when she said “----(The support manager) and staff administer medication to the service user as he is not able to do this for himself at present. If the G.P. alters his medication ---(The support manager) will ring and confirm this via myself with the consultant psychiatrist” An amended Regulation has recently been introduced with regard to the storage of controlled drugs in care homes. The requirements of the amended Regulation were explained to the management team. These requirements must be put into place within a specified time scale. It is understood that this requirement will be addressed by the homeowner within the time scale specified. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 19 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 Quality in this outcome area is good. The home has a robust complaints procedure, so residents can be confident that any complaints would be taken seriously and acted upon. An appropriate vulnerable adults policy and procedure and staff training ensured that people living in the home are protected from risk of harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaint or concern has been made in respect of Fernhaven Care Home for some considerable period of time. The home’s continues to have a complaint procedure that is compliant with requirements and incorporated in the written information provided to newly admitted residents. The policy outlines the home’s commitment to providing a written acknowledgement of any complaint received with two working days and to resolving complaints wherever possible within 28 days. People living at the home are encouraged to voice any concerns and complaints immediately so that issues can be discussed and addressed. Residents spoken with were aware of the written formal complaint information and were also clear as to whom they would speak with if they did have a complaint. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 20 The home also has a robust policy and procedures in place for protecting residents from possible abuse. This topic also forms part of the mandatory training provided to all staff. A variety of other policies are also in place to protect people living at the home that include, whistle blowing, restraint, and resident’s monies. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 21 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 & 30 Quality in this outcome area is good. The standard of the environment in this home is good in providing residents with a comfortable and homely place to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The property is in keeping with the local environment and is in close proximity to local facilities and services to suit the personal and lifestyle needs of the people accommodated. The home is arranged over two floors and is comfortable and well maintained. Furnishings are domestic in character and provide welcoming and attractive accommodation. All residents are provided with individual bedroom accommodation. All residents currently accommodated are independently mobile with no physical mobility difficulties. Recently the existing stair lift was removed as it Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 22 was not required and most communal areas including the stairs and landing have been provided with new carpets. The kitchen and bathrooms and downstairs corridor has been provided with wood flooring. Since the last visit a new roof has been fitted, ceiling cracks repaired that had developed in the lounge area and the outdoor space provided with a new table and chairs. There are plans in place to refurbish the kitchen and repair some damaged tiles and quotes have been obtained to redecorate various other areas of the home including the hall and stairways, smoking room, lounge and porch. In order to promote independence, residents continue to be encouraged to attend to their own washing with the assistance of staff as required. To further facilitate this an additional washing machine is to be purchased so that residents do not have to wait to attend to their own washing. The Annual Quality Assurance Assessment (AQAA) confirmed that staff have received infection control training either ‘in-house’ or through external training provided by the infection control nurse. From individual discussion with a number of residents and comments made on the Commission for Social Care Inspection surveys, no concerns were expressed with regard to the physical environment of the home. People expressed satisfaction with the communal and individual accommodation provided. Fernhaven DS0000065618.V367221.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): 32, 34, 35 & 36 Quality in this outcome area is good Staff morale remains high. Staff are well supported and work positively with residents to help improve their quality of life. Recruitment processes are robust that helps to protect people who live at the home from harm. There is a good programme of staff training to ensure staff have the skills to provide a consistently high service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As stated in previous reports, Fernhaven is a smaller care home with a family type atmosphere and a core group of staff that have worked at the home for an extended period of time. The staff group know the needs and requirements of each individual resident very well and the relationship observed between staff and residents was very positive. When a staff vacancy does arise care is Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 24 taken to appoint the right person even if this means the remaining staff have to cover additional hours until a suitable appointment is made. Residents spoken with were very positive about the staff team and the support received, and felt confident in the ability of staff to carry out their duties very well”. One person said, “I’m very happy here” and another said, “I’m quite content”. A third person said that he liked the fact that there were routines, “the staff take an interest and if I need to I can chill out”. Staff were very clear about their role with one member of staff writing on a Commission for Social Care Inspection (CSCI) survey that “the home strives to give our service users independence (within their own capabilities) structure and daily living skills and to build a therapeutic relationship to give them confidence to attain their personal goals and hopefully independence to live a lifestyle in the community”. Staff training continues to be given high priority. Currently there are four care/senior care staff and a combined care/domestic post. Four of these five members of staff have successfully achieved a National Vocational qualification (NVQ) Level 2 award in care and the fifth person is waiting to commence this qualification. In addition, one member of staff has recently completed Level 3 of this award and the senior carer has attained the Registered Managers Award. This is commendable and ensures that the staff group is well trained and competent to provide a good consistent service. All staff receive mandatory training and where possible, further training in specialised areas. Additional training is arranged to address the individual needs of staff and people living at Fernhaven. This has resulted in a ‘Deprivation of Liberties’ course being arranged for one member of staff. Each member of staff has an individual training and development assessment and profile. Fernhaven Care Home has in place a structured recruitment process that helps to protect people who live at the home. Since the last inspection, new members of staff have been appointed. From observation of a recently appointed staff member’s personnel file, it was evident that the recruitment practices had been followed. This included an application form, health questionnaire, job description, references and a Criminal Records Bureau (CRB) POVA clearance had been obtained prior to the applicant actually taking up post at the home. All newly appointed staff are provided with the General Social Care Council, Code of Conduct that sets out the requirement of staff working in social care. As part of the recruitment process, all prospective employees spend time with residents in order to elicit their views and opinions as to the applicant’s suitability, which is taken into account when offering the post. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 25 Good staff supervision arrangements are in place. All staff receive formal one to one supervision on at least a two monthly basis covering a variety of topics. There was good written evidence to confirm the topics that had been discussed. The written supervision report was signed and dated by the supervisor and supervisee. Structured formal staff supervision helps enable staff to be well supported and provides opportunity for individual discussion about care practices within the home and any particular support or training the carer or supervisor feels is relevant. Fernhaven DS0000065618.V367221.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 & 42 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. The registered manager is well supported with all staff demonstrating a good awareness of their role and responsibilities. The home regularly reviews aspects of its performance through a programme of self-review and consultation with users of the service and staff. Systems are in place to ensure as far as possible the health and safety of residents, staff, and visitors. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 27 EVIDENCE: The homeowner/manager is a registered mental health nurse and has extensive experience of supporting people with a mental illness. Since the last inspection the homeowner/manager has successfully completed the Registered Managers Award and has undertaken additional training to ensure professional development. The support manager is also a registered mental health nurse and provides a lot of support to both staff and residents. Effective quality monitoring and quality assurance systems are in place and the home has made an application for the ‘Investors In People’ award. Fernhaven Care Home regularly reviews aspects of its performance through a good programme of self-review and consultation. This includes resident questionnaires that were last provided in June 2008, and surveys for professional staff involved in the home such as General Practitioner surgeries, Social Workers and Community Psychiatric Nurses. There is also a specific questionnaire for relatives, which is about to be sent out. All the feedback from the questionnaires helps to inform the internal quality assurance audit and highlights areas of satisfaction and any areas that could be improved. However residents in the main prefer to voice their thoughts and opinions through discussion with members of staff and this method is an important source of information. Staff views and opinions that can also influence change are highlighted in staff meetings minutes and through regular formal supervision. Fernhaven Care Home ensures safe working practices are maintained through implementation of the home’s policies and procedures and staff training in respect of health and safety training issues. All members of staff receive mandatory health and safety training including first aid, medication training, fire training and infection control training. Although users of the service are physically able, the majority of staff have also received manual handling training. It is understood that the remaining staff that have not done so will receive this training in due course. A written statement of the policy, organisation and arrangements for maintaining safe working practices is available. Observation of documentation including maintenance records confirmed that various routine health and safety checks are maintained and environmental and fire risk assessments specific to the individual are in place so that the health and safety of people living at the home was protected. There is a system in place for recording health and safety issues and it was evident that equipment is regularly serviced and a number of up to date certificates were evidenced that included fire safety equipment and a small appliance testing certificate. Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 28 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 4 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 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 3 4 3 X 4 X 4 X X 3 X Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 29 N/A Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14(1)(d) Requirement Prospective residents must receive confirmation in writing, that their current needs and requirements could be met at the home. The storage of controlled drugs must be maintained in line with the recently amended regulation Timescale for action 01/10/08 2 YA20 13(2) 04/12/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North West Region 3rd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ 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 Fernhaven DS0000065618.V367221.R01.S.doc Version 5.2 Page 31 - 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. 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