Care Home: Ferns Nursing Home Limited

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What the care home does well The Ferns had a pleasant relaxed atmosphere and residents said they were happy with the care and support provided. Their comments included, "Very good indeed", "The staff are lovely" and "I feel very settled here." Staff were seen to chat freely with residents and to give them assistance when needed. This help was given in an unhurried and gentle manner. Time was spent with residents on a one to one basis and also in a group. Residents spoken with appreciated that there has to be a routine however they said staff were accommodating and took trouble to find out their individual wishes. This was discussed in relation to getting up in the morning, retiring at night and times meals were served. The care given was seen to be person centred and staff showed respect for the resident`s privacy and dignity. Residents` health care needs were recorded in an individual plan of care and this showed good input from outside health professionals, for example, a resident`s GP or consultant to promote their health. A relative said the staff were prompt in getting advice when needed. Residents said the food was good and the meals were nicely presented. Food stores had plenty of fresh fruit and vegetables to ensure residents received a well balanced diet. The menu appeared appetising and it was displayed for residents to choose what they would like. Staff also explained the choices available. Complaints made by residents and/or relatives had been recorded and the manager had investigated them and reported back her findings. It was evident that residents were listened to and their concerns taken seriously. When discussing how to report a concern, a resident said, "I would speak to the matron straightaway." The induction for new staff is now in accordance with the Skills for Care Induction Standards. These provide staff with formal learning in care and safe working. The induction is given over five days via an external company. Staff said it was very informative and well delivered. Staff had also been shown round the home and worked with a senior member to become familiar with the routine and to get to know the residents. The manager has instigated a good training programme for the staff so residents can be confident they will be cared for in a safe manner and according to need. What has improved since the last inspection? This was not assessed as this if the first key inspection since the change in registration. What the care home could do better: Consent to the resident`s plan of care should be obtained and recorded in the care file so that the residents and their relatives are fully informed of the plan of care and agree to it. This should include the use of equipment to help protect the residents, for example, the use of bed rails. It would be beneficial to include details of a medical condition that affects the resident`s general health. This would help to ensure staff are fully aware of the care needed. A record should be kept to evidence resident participation and enjoyment of the activities offered to them. Contact details of the relevant agencies involved with safeguarding people should be displayed. This and also displaying the whistle blowing policy will ensure staff are confident in how to report an alleged incident should they need to. The steep approach of the ramp should be reduced to minimise any risk to people who use this entrance. Maintenance work of the building should include repair of the plaster work in the top floor shower room and painting the ceiling on the top floor affected by water staining. This will improve the accommodation for the residents. NVQ (National Vocational Qualifications) in Care at Level 2 and 3 for staff should continue so that 50% have this formal qualification. The induction for new staff should be dated when commenced and completed to provide evidence of their learning. The staff training plan should be updated to evidence the courses undertaken by the staff and the renewal dates. This will help to establish staff training needs. The Regulation 26 reports were not available to look at. These provide an overview of the service and should be kept at the home. It was agreed that copies of the most recent reports would be forwarded to the Care Quality Commission for us to look at. Financial records kept on behalf of residents should show two staff signatures. This will ensure accuracy of the information recorded. Fire alarms should be tested weekly to ensure they are working safely to protect people. A copy of the gas certificate should be forwarded to the Care Quality Commission to ensure the safety of this service for people within the home. Key inspection report Care homes for older people Name: Address: Ferns Nursing Home Limited 40-42 Part Street Southport Merseyside PR8 1HY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Claire Lee     Date: 0 4 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Ferns Nursing Home Limited 40-42 Part Street Southport Merseyside PR8 1HY 01704501401 01704532915 davidsjackson@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ferns Nursing Home Limited Name of registered manager (if applicable) Mrs Elaine Anne Mechergui Type of registration: Number of places registered: care home 33 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category/ies of service only: Care home with nursing- Code N to people of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category- Code OP The maximum number of people who can be accommodated is: 33 Date of last inspection Brief description of the care home The Ferns is a large Victorian property, which has been converted into a care home providing personal and nursing care for up to thirty-three older people. It is situated within a short walk to Southport town centre and therefore has relatively easy access to local amenities. There are twenty-seven single rooms and three double bedrooms over three floors. There is a lounge at the rear of the ground floor, which over looks the garden, and a larger lounge at the front of the building. There is ramp access at the front and the rear garden is accessible for people with limited mobility. There is a Care Homes for Older People Page 4 of 28 Over 65 33 0 Brief description of the care home passenger lift to all floors. A nurse call system with an alarm facility is available for the residents. The Ferns is part of a small group of care homes owned by Mr and Mrs Jackson. This service is presently operated by Mr & Mrs Jackson in partnership and trading as Jackson Care Group. Mr & Mrs Jackson have transferred the ownership to an existing Limited Company, which is registered as the provider of this service. Mrs Elaine Mechergui is the registered manager. The weekly fee rate for accommodation is from £616.00 to £515.00. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: An unannounced visit took place as part of the inspection and this was carried out over one day for a duration of approximately nine hours. This was the first inspection of the home as Mr & Mrs Jackson have transferred the ownership to an existing Limited Company. The inspection was completed within the first six months of registration.Twenty nine residents were accommodated at this time. The term resident is used in this report as this is what the people staying there like to be called. During the time spent at the home different areas were looked at and a number of care, staff and health and safety records were checked to see what care the residents living there received. Discussion took place with six residents, one relative, three staff, the manager and deputy manager. During the inspection three residents were case tracked (their files were looked at and they were asked for their views of the home). Other residents also took part in the Care Homes for Older People Page 6 of 28 inspection and all the key and other standards were assessed during the visit. Reference is made to them in the report. To find out more about the care provided at the home survey forms called Have your Say About..... were distributed to a number of staff and residents prior to the inspection. None however were returned. Comments included in the report are taken from residents, relatives and staff spoken with at the inspection. An AQAA (annual quality assurance assessment) was completed for the inspection. The AQAA comprises of two self-questionnaires that focus on the outcomes for people. The self-assessment provides information as to how the manager and staff are meeting the needs of the current residents and a data set that gives basic facts and figures about the service, including staff numbers and training. The manager completed this to a satisfactory standard. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Consent to the residents plan of care should be obtained and recorded in the care file so that the residents and their relatives are fully informed of the plan of care and agree to it. This should include the use of equipment to help protect the residents, for example, the use of bed rails. It would be beneficial to include details of a medical condition that affects the residents general health. This would help to ensure staff are fully aware of the care needed. Care Homes for Older People Page 8 of 28 A record should be kept to evidence resident participation and enjoyment of the activities offered to them. Contact details of the relevant agencies involved with safeguarding people should be displayed. This and also displaying the whistle blowing policy will ensure staff are confident in how to report an alleged incident should they need to. The steep approach of the ramp should be reduced to minimise any risk to people who use this entrance. Maintenance work of the building should include repair of the plaster work in the top floor shower room and painting the ceiling on the top floor affected by water staining. This will improve the accommodation for the residents. NVQ (National Vocational Qualifications) in Care at Level 2 and 3 for staff should continue so that 50 have this formal qualification. The induction for new staff should be dated when commenced and completed to provide evidence of their learning. The staff training plan should be updated to evidence the courses undertaken by the staff and the renewal dates. This will help to establish staff training needs. The Regulation 26 reports were not available to look at. These provide an overview of the service and should be kept at the home. It was agreed that copies of the most recent reports would be forwarded to the Care Quality Commission for us to look at. Financial records kept on behalf of residents should show two staff signatures. This will ensure accuracy of the information recorded. Fire alarms should be tested weekly to ensure they are working safely to protect people. A copy of the gas certificate should be forwarded to the Care Quality Commission to ensure the safety of this service for people within the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information was provided to residents and their families to enable them to decide whether the staff could provide the service they needed. Residents needs had been assessed to ensure the staff could provide the care and support they need. Evidence: There was information displayed in the home for residents to see and to help prospective residents and their families to decide whether the home was right for them. Information included brochures called the Service User Guide and Statement of Purpose. The manager was aware that the Service User Guide needs to be updated with the Care Quality Commission contact details. The last inspection report was also available and other information regarding the running of the home. Staff were seen to greet visitors warmly and to provide refreshments for them and their relative. The manager completes a care needs assessment for prospective residents. Assessments for three new residents were looked at and these showed the care and Care Homes for Older People Page 11 of 28 Evidence: support they needed. Areas seen included past medical history, medicines prescribed and help with washing, dressing and walking. The manager confirmed that assessment details for one resident had been hard to establish however assessment details were available from social services. Discussion took place regarding assessing falls and how these should be better recorded. This will enable staff to identify potential hazards and any increase in risk to the resident. Intermediate care is not provided at the Ferns and therefore this was not assessed. Care Homes for Older People Page 12 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents had a plan of care which gave the information staff needed to provide the care and support they required. This was given in a polite and caring manner. Evidence: Residents had a care file with an individual plan of care. Care documents had been looked at regularly to ensure the information recorded was up to date. Case tracking took place of three residents to review their care documents. They recorded areas such as, assistance with walking, washing, dressing, communication and eating and drinking. It would be beneficial to include details of a medical condition that affects the residents general health and ways of implementing this were discussed with the manager. This would help to ensure staff are fully aware of the care needed. The daily care records had been completed by the registered nurses in accordance with the plan of care. These also showed residents had regular visits from outside health care professionals to help keep them well. Risk assessments were in place to help staff to reduce a risk to the residents welfare and promote their safety. This was seen in relation to promoting independence with walking and transfering residents with aids to help them, care of their skin and ensuring they eat well to keep them healthy. Care Homes for Older People Page 13 of 28 Evidence: Consent to the plan of care should be obtained where possible and recorded in the care file so that the resident and their relative are fully informed of the plan of care and agree to it. This should include the use of equipment to help protect the residents, for example, the use of bed rails. Residents spoken with said they were pleased with their care and felt very relaxed and at ease with the staff. Residents who were being nursed in bed due to frail health, looked comfortable and staff were attentive to their needs. A resident said, The staff answer the buzzer promtly which is reassuring. The manager had a contract with a local chemist for supplying medicines to the home each month. A number of medicines charts were looked at and these showed that the staff had signed for medicines prescribed. Residents can administer their own medicines and the staff would complete a risk assessment to ensure they could undertake this practice safely. It was noted that the medicine fridge temperature had not been checked for this month. A daily check should be recorded to ensure the medicines are stored correctly. This was undertaken at the time of the inspection and found to be satisfactory. The manager had carried out checks of the medicines as part of reviewing the medicine procedures. This helps to ensure the medicines are given out safely. Staff were seen to be polite, helpful and caring in their approach. As a mark of respect staff knocked on private doors before entering and also addressed the resident with their preferred name. Attention had been paid to making sure clothing was appropriate and assistance was seen to be given to the residents in an unhurried manner. This was seen in relation to, assistance with walking, helping with meals and other aspects of personal care. Residents were given time to respond and the staff explained what they were going to do. A resident said, The staff know I have to take my time and they understand this. Staff care for residents in the final stages of their life and they undertake courses to ensure help provide this specialist care. Details of this were provided in the AQAA. Care Homes for Older People Page 14 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Social activities and meals were well managed to ensure residents enjoyed their day. Evidence: There was a relaxed, homely atmosphere in the home and residents and staff were seen to chat together in the lounge. Residents were comfortable with the staff and there was plenty of good interaction. A staff member had organised a quiz for two ladies which they enjoyed. Visitors were seen at different times of the day and a relative said they were always made welcome by the staff any time they visited. There are two lounges and residents can decide which room they would like to sit in with their visitors or they can use their own rooms if preferred. Residents said the routine was fine and that staff respected their wishes. This was discussed in relation to meal times, time of getting up or retiring at night. A resident said, The staff are very accommodating. Details of a local advocacy service were on the noticeboard so that residents and their families can seek independent advice if they need it. Resident now benefit from a more organised social programme and the manager has undertaken a course to help implement this. An activity plan was seen and this Care Homes for Older People Page 15 of 28 Evidence: included bingo, light exercise, quizzes, musical entertainment, bowling and a garden fete. A cruise party is planned for this month and the lounges will be decorated to reflect the theme. The AQAA reported that relatives are invited to party occasions and an open buffet provided. The home has a minibus and plans are in place to use this during the summer. Residents said they were content with what was on offer and they could choose to take part if they wished. It would be beneficial to record the activities to evidence resident participation and enjoyment. Residents can continue with their chosen faith and take Holy Communion at the home. A regular hairdressing and chiropody service were also available. Residents said they enjoyed the food and that the meals were nicely served on trays. There is no separate dining room. The menu offered a good choice of different foods and there was plenty of fresh fruit and vegetables to provide a well balanced diet. The main meal was served at lunch time with a lighter meal in the evening. Snacks and hot or cold drinks were offered to the residents by the staff throughout the day. The menu was on display and staff also explained the choices available to the residents. Environmental health records were up to date to ensure good standards of hygiene in the kitchen. A recent environmental health inspection has taken place and this reported favourably regarding the standards of cleanliness. Care Homes for Older People Page 16 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service were protected by the complaints and safeguarding procedures, which are understood by the staff. Evidence: Residents and their relatives have a complaint policy and procedure to refer to should they wish to raise a concern. The AQAA reported that if complaints are received corrective measures are put into place to prevent reoccurrence. Residents interviewed said they had no concerns at this time however they would talk to the manager if worried. The complaint log showed complaints received and the action taken by the manager. Since the home was newly registered earlier this year four complaints have been received and these have been investigated and resolved to the satisfaction of all parties. This included one complaint which was brought to the attention of the Commission. A policy was seen to safeguard people from abuse and also Seftons local guidelines for safeguarding people. Staff interviewed were able to describe the different types of abuse and said they would report anything untoward. They were aware of the agencies involved to protect people. It is recommended that contact details of the relevant agencies involved with safeguarding be displayed. This and also displaying the whistle blowing policy will ensure staff are confident in how to report an alleged incident should they need to. Safeguarding training is ongoing for all staff as part of their learning and development. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents lived in safe, well maintained, comfortable and clean accommodation. Evidence: The Ferns was found to be clean, warm and pleasantly decorated. Maintenance of the building is ongoing and rooms had been decorated when needed. The manager confirmed that the two lounges are being decorated this month. The residents will therefore benefit from the change of decor and it will make the rooms brighter. A ramp provides disabled access to the side door of the home. Concerns have been raised by external professionals regarding the steep approach of the ramp and this should be looked at to reduce any risk to people who use this entrance. Staff commented that it is presents problems when pushing a wheelchair or also when residents require a stretcher. This was brought to the owners attention who stated that quotes have been obtained for the necessary work. The need to improve the ramp access were stated in the AQAA and this should be undertaken as soon as possible to minimise the risk of injury to people who use it. With regards to the upkeep of the building the AQAA reported that the manager completes regular checks to ensure it is maintained to a good standard. It was however noted that the ceiling on the top floor needs painting due to water staining. The manager said this would be carried out. Care Homes for Older People Page 18 of 28 Evidence: The gardens to the front of the home are landscaped. The gardens at the rear are extensive however are devoid of colour and would benefit from planting shrubs and flowers for the residents to enjoy. Bedrooms seen were pleasantly decorated and the manager said that a number of carpets and curtains have been replaced. This was seen whilst looking round the home. Residents had the use of a call bell for assistance and special beds were provided for those who were frail in health and needed to spend long period of time resting. Shared rooms had screens to maximise resident privacy and residents had brought items in from home to make their rooms feel cosy. Their comments included, Very nice room, and I am quite happy with the colour scheme. The AQAA reported that the shared rooms are often used by couples or the rooms are used for single accommodation if preferred. Residents had lockable drawers for storing their personal items safely. Bathrooms were clean and smelled fresh. Equipment was available to help residents to bathe safely. Plaster work surrounding the walk in shower room on the top floor needs repair and the manager said this would be carried out. Hot water to the baths was tested at the time of the inspection as records showed that this had not been carried out recently. These were found to be satisfactory. The temperature of the hot water should be checked regularly to ensure it is at safe temperature for residents to bathe safely. Emergency lighting for fire prevention was subject to a monthly test to ensure it was working correctly. Hand rails were available in corridors to help residents when walking round the home. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received care and support from staff who were recruited safely and had the skills and knowledge to care for them correctly. Evidence: At the time of the inspection sufficient numbers of staff were on duty to provide care and support to the residents. The staffing rota showed the hours worked by the staff. A registered nurse is on duty twenty four hours a day. There were seven carers on duty in the morning, five carers till 5pm, four carers till 8pm then two carers at night. Two domestic staff were on duty with a cook and laundry assistant. The domestic staff had ensured a good standard of cleanliness in the home. A resident said this was always the case. A maintenance person and gardener both work part time at the home. Three staff files were looked at and these showed that staff were recruited safely. Their employment checks included police clearance and references from past employers. Staff interviewed said they had received a good induction with an external company and this covered different courses including moving and handling, first aid, abuse, food hygiene and infection control. They also stated that they were shown round the home and given instructions on fire prevention. New staff work with an experienced member of staff to support them during their induction period. The induction booklets should be signed when started and completed to provide evidence Care Homes for Older People Page 20 of 28 Evidence: of their learning. A staff member reported that they were given plenty of information and Senior staff were always on hand to help. The AQAA reported that the new induction was helping to provide a better standard of care. Training had been given to the staff in how to work safely and as stated above these courses are included in the induction. Course certificates were seen in staff files, however the training plan had not been updated with dates of recent courses undertaken by the staff. The staff training plan should be updated to evidence the courses undertaken and the renewal dates. This will help establish staff training needs. A number of staff have attended training in dementia care and the manager has recently undertaken a course regarding how to assess residents who may lack capacity to agree to their treatment and how this is managed. This will help the staffs understanding of how to provide care and support at the appropriate time. Equality and diversity training is currently being accessed by the staff to ensure they respect, understand and promote the residents individual wishes in areas such a gender, belief, culture and faith. NVQ (National Vocational Qualifications) in Care at Level 2 and 3 are ongoing for staff. The AQAA reported that of the thirty permanent staff, eleven have an NVQ in Care. This should continue to ensure 50 staff have achieved this formal qualification. Residents made the following comments regarding the staff, Very good indeed, Always polite and kind, I have no worries and We can have a good chat with them. Care Homes for Older People Page 21 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Ferns was being run in the best interests of people who lived there and their welfare was promoted and protected. Evidence: Mrs Elaine Mechergui is a registered nurse and is the registered manager of the Ferns. She has obtained the necessary management qualifications to manage the home. Residents and staff said the manager was always on hand to give advice and that she was approachable. During the time spent at the home it was evident that good communication existed between the manager, staff and residents. A resident said, We see the matron most days and you can ask her anything. Likewise a staff member said, The matron is very good. The manager is supported by a deputy manager and full compliment of staff to provide a good standard of care and support to the residents. In 2008 the staff were awarded an external quality award for the service they provided. Part of this award included surveys which had been given to residents and Care Homes for Older People Page 22 of 28 Evidence: their families to gain their views of the home. Surveys look at areas such as food, staff attitude, cleanliness of the building and care provided. A review of the surveys showed satisfaction for the overall service they received. The owner undertakes a monthly visit of the home and writes a report of his findings These are called Regulation 26 visits. The Regulation 26 reports were not available to look at. These provide an overview of the service and should be kept at the home. It was agreed that copies of the most recent reports would be forwarded to the Care Quality Commission for us to look at. Staff were supporting residents with their monies. Financial records seen were up to date and receipts had been kept for services they received, for example, hairdressing and chiropody. It is recommended that financial records kept on behalf of residents should show two staff signatures. This will ensure accuracy of the information recorded. Looking at records and discussion with staff confirmed that they receive regular supervision of their work. Staff said at these formal sessions they discuss training and care practices in the home. Staff said they attended meetings and have informative hand overs at shift changes to discuss the care needs of the residents. This helps to provide the information they need to provide person centred care. Staff had recorded accidents that affected the residents health and daily care records showed what care was needed following the accident. This provides a means of monitoring the safety of the residents and any treatment they may need. The AQAA reported dates of maintenance of equipment and services to the home. A spot check was undertaken of the fire prevention contract and hoisting equipment in the home. These were in date. The manager is waiting for the gas certificate to be issued following work needed in the home. It was agreed that a copy of this would be forwarded to the Care Quality Commission to provide evidence that this service is safe for people within the home. Staff had received fire prevention training and those interviewed were aware of the fire precautions in the home. Fire alarms had not been tested weekly since May 2009 and a check was carried out at the time of the inspection. This was found to be satisfactory and the manager was advised that weekly tests should be undertaken to ensure people at the home are safe. Staff have access to policies and procedures and they are asked to read a number of them when they commence employment. This ensures they work safely. The AQAA Care Homes for Older People Page 23 of 28 Evidence: reported that they are being updated to ensure they are in accordance with current legislation and best practice. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Consent to the plan of care should be obtained where possible and recorded in the care file so that the residents and their relatives are fully informed of the plan of care and agree to it. This should include the use of equipment to help protect the residents, for example, the use of bed rails. It would be beneficial to include details of a medical condition that affects the residents general health. This would help to ensure staff are fully aware of the care needed. 2 3 4 9 12 18 A daily check for the medicine fridge should be recorded to ensure the medicines are stored correctly. A record should be kept to evidence resident participation and enjoyment of the activities offered to them. Contact details of the relevant agencies involved with safeguarding should be displayed. This and also displaying the whistle blowing policy will ensure staff are confident in how to report an alleged incident should they need to. The steep approach of the ramp should be reduced to Page 26 of 28 5 19 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations minimise any risk to people who use this entrance. Maintenance work of the building should include repair of the plaster work in the top floor shower room and painting the ceiling affected by water staining on the top floor. 6 26 The temperature of the hot water should be checked regularly to ensure it is at a safe temperature for residents to bathe. NVQ training at Level 2 and 3 for staff should continue so that 50 have a formal qualification in care. The induction for new staff should be dated when commenced and completed to provide evidence of their learning. The staff training plan should be updated to evidence the courses undertaken by the staff and the renewal dates. 9 33 The Regulation 26 reports were not available to look at. These provide an overview of the home and should be kept at the home. It was agreed that copies of the most recent reports would be forwarded to the Care Quality Commission for us to look at. Financial records kept on behalf of residents should show two staff signatures. This will ensure accuracy of the information recorded. Fire alarms should be tested weekly to ensure they are working safely to protect people. A copy of the gas certificate should be forwarded to the Care Quality Commission to ensure the safety of this service for people within the home. 7 8 28 30 10 35 11 38 Care Homes for Older People Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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