Care Home: Nottingham Neurodisability Service Hucknall - Fernwood

What the care home does well People who are accepted for care from the community have a pre-assessment provided for them using a multi-discilpinary team approach. This is to ensure that the staff will be able to meet their needs. People are provided with the care support that they need and the staff are well trained and understand their roles and their limitations. New staff will start work when the required employment checks have been carried out including a satisfactory Criminal Records Bureau (CRB) or Vulnerable Adults check. People who spoke with the inspector said that they were encouraged to make choices for themself and their relatives were included in any plans about them. We spoke with three people at the unit and they indicated that they were happy with the choice of home provided for them. Comments on care included: `As family members we were included in the care planning and was asked what we wanted from the placement at Fernwood. I said that we had three main objectives, and within twelve to fifteen months of being at Fernwood all three objectives had been met. We feel that the improvements are as result of the care by staff on the unit.` `Staff always try to do their best.` `Staff are encouraging and helpful`. `We feel as if we are part of our relatives care package`. Comments from people who live at Fernwood included: ` It`s like living in a five star hotel.` `The staff are absolutely wonderful.` People who spoke with us felt that their care needs, privacy and dignity needs were met by the staff from this unit. The unit has a medication policy that provides guidance for staff to follow. There is a complaint procedure, which is available for people to use and procedures for staff to follow if they suspect anyone is not being properly treated. The manager of Fernwood is new and is an experienced Nurse and qualified to manage the care service. What has improved since the last inspection? The AQAA tells us that: `The unit has undergone a complete redecoration progamme throughout and each person on Fernwood has their own bedoom and that communal spaces are not restrictive.` We saw that communal areas included shared toilet and bathroom facilites. We saw copies of the accident records and minutes from health and safety meetings. We walked around the unit and we saw two bedrooms they were comfortable and warm. What the care home could do better: Management support has been weekended by the regular changes within the management structure and relatives said that they would go to the nurse on duty but that: `managers higher in the organisation were not always visible, nor had they made themselves known to them`. Key inspection report Care homes for adults (18-65 years) Name: Address: Nottingham Neurodisability Service Hucknall - Fernwood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR     The quality rating for this care home is:   one star adequate 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: Lesley Allison-White     Date: 1 2 0 1 2 0 1 0 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 Adults (18-65 years) Page 2 of 31 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Nottingham Neurodisability Service Hucknall Fernwood Hankin Street Hucknall Nottingham Nottinghamshire NG15 7RR 01159680303 01159642747 diane.eden@fshc.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Four Seasons Homes (Ilkeston) Ltd Name of registered manager (if applicable) Mr Ian David Banks Type of registration: Number of places registered: care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who may be accommodated is 20 The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home Nottingham Brain Injury Centre, Fernwood Unit is a two-storey, purpose-built care home, owned by Four Seasons Care Homes. It is situated at the corner of Hankin Street, between its two sister units. It provides full and rehabilitatory skilled nursing care for up to 20 service users with post-trauma and polyaetiological brain injuries. Care Homes for Adults (18-65 years) Page 4 of 31 Over 65 0 20 0 8 1 2 2 0 0 8 Brief description of the care home All service users bedrooms are individually decorated, many have en-suite toilet facilities. Some bedrooms have direct access via patio doors to a safe, very pleasant, enclosed garden at the rear of the property. The residents needs are well-supported, promoting independent living skills within a risk assessment framework, helping them to make active choices and to be as fulfilled as possible. The facilities within Fernwood House are conducive to achieving optimum independence for the service users. Wheelchairs can access all areas within the home, mobility aids are available such as hoists, transfer belts and strategically placed handrails and easily accessible shower and bath areas. A vertical lift is also accessible to allow easy access to the first floor of the home. The fees for 2010 are currently charged at Fernwood from £1,591.35 to £3,064.25 per week (This included the maximum fee for people who have very specific and complex needs). This does not include payments for toiletries, Podiatry/ Chiropody services, extra Phsyiotherapy, Occupational therapy, Psychology, Speech and Language therapy and one to one special care, hairdressing, holidays, newspapers or magazines. Please ask the unit for these details and check the latest Service User Guide. Care Homes for Adults (18-65 years) Page 5 of 31 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This is an over view of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The focus of inspections undertaken by the Care Quality Commission (CQC) is on outcomes for people using the service and their views on the service provided. The last key inspection report for this service was on 8 December 2008. Prior to the visit an analysis of the unit was undertaken from information gathered including information from the Annual Quality Assurance Assessment (AQAA) completed by the provider. Surveys were sent out however only one person was able to complete the form and other pieces of information was also used as part of the Care Homes for Adults (18-65 years) Page 6 of 31 evidence gathered. Evidence and judgements that are made are made on behalf of the commission and are written as we although there was one inspector for this inspection but another inspector was inspecting another of the units on the same day. We met with the managers to give feedback together. The site visit lasted seven hours. The main method of inspection used was case tracking which involved looking at the records of two people in detail and tracking the care they received by checking their records and discussing this with them where possible or with staff members. Many people on this unit have communication difficulties and the judgements about the quality of service is made through observation, case tracking, talking with relatives, visitors and staff. We spoke with six other people who either received care or were relatives of people who recieve care from Fernwood. A discussion with the unit manager took place and with other staff who were invited to speak with the inspector. Care practises were observed at inspection. Inspection of the premises was not conducted in detail however there was evidence of security to ensure that confidential information is protected. The current Registration certificate and the Employers liability certificate were seen and found to be correct. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? The AQAA tells us that: The unit has undergone a complete redecoration progamme throughout and each person on Fernwood has their own bedoom and that communal Care Homes for Adults (18-65 years) Page 8 of 31 spaces are not restrictive. We saw that communal areas included shared toilet and bathroom facilites. We saw copies of the accident records and minutes from health and safety meetings. We walked around the unit and we saw two bedrooms they were comfortable and warm. What they could do better: 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 Adults (18-65 years) Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. People who decide to live at Fernwood are provided with the information that they need and are encouraged to visit before hand. In this way they can decide if the unit is right for them. The personalised needs assessment ensures that their needs are identified before they move into the unit. Evidence: We saw that Fernwood is a unit that provides care for people with different levels of physical disability and that many people need two staff to provide personal care or support at regular intervals. Care plans included assessment for skin care, communication needs, personal hygiene and dressing, elimination( urinary) and elimination (faecal). Ability to control own body temperature, Moving and handling, activities, expressing sexuality, sleeping, death and dying, Psychological and emotional behaviour, pain and discomfort, consent and mental capacity. The Statement Of Purpose informs us: To ensure that all care and support needs are fully assessed prior to admission to the unit; this is carried out by an assigned member/s of the multi disciplinary team. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: We saw there was access to therapy staff such as Physiotherapist or Occupational staff and there was access to a Speech and Language therapist also. They were included on the rota however, their working hours was limited. We saw a copy of the Service User Guide that gave information about each of the three units which were housed on the same site. The three units included Fernwood, Millwood and Rosewood. We saw that initial assessments included information provided by both Therapy staff and by Nursing staff. The AQAA tells us that: all potential service users and their next of kin are given the opportunity to visit the unit at their convenience as many times as they need to and staff are available to answer any questions that they might have. We spoke with relatives who were present and they all said that they were made welcome and encouraged to visit and ask questions to make sure that the placement would be right for their relative. We spoke with three people at the unit and they indicated that they were happy with the choice of home provided for them. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 at Fernwood have their individual needs met and are encouraged to make choices that are supported by the staff. Evidence: We looked at two care plans to see if they had the care and support they needed. Both contained information about the care required and had entries that indicated that a multi disciplinary approach had been used. Specialised care was the responsibility of the nurses however, carers who had been trained to provide aspects within that specialised care also made entries to the care plan within the daily logs and this informed the nurses evaluations of the care provided to the individual. Each person has a named carer and named nurse who recorded and updated information about them and befriended them as part of their individual care package. We saw that there were risk assessments in place and evaluations of care that included the person and their family member or representative. It was not always easy to communicate with the two people case tracked and we were able to speak Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: with other people at the unit, other peoples family members or other people who could indicate their agreement or disagreement to a question more easily. One person with limited speech was able to indicate when they chose to get up and was assisted to sit in the armchair provided. Sadly it was noticed that this person did not have access to a specialised wheelchair when in the home and had missed attending a festive activity on another part of the unit. This meant that physically they had to be excluded and emotionally this would create a feeling of unnecessary isolation. The unit has access to an Occupational Therapists and an assessment should be readily available for anyone in this position. A personal care assessment indicated that sometimes more than two staff were needed to provide care for health and safety reasons such as risk of falls, self injury or injuries to staff. It was clearly written in the care plan for staff to follow. When we spoke with staff they also said that they followed this. We saw that people were provided with heavier persons lifting equipment when needed as part of their care package. We were told that people were mainly offered daily showers in the public bathroom areas baths were also available. However we did not see how a decision is made for someone to be given a particular type of care for example a bath or shower their preference or risk assessment to identify why and how the decision has been made as part of inclusion in person centred care. We spoke with peoples family members who told us that they were included in the care planning and was asked what they wanted from the placement at Fernwood. One relative said that they had three main objectives and said that within 12 to 15 months of being at Fernwood all three objectives had been met. They also spoke about the improvements in the care as a result of the care by staff on the unit as their relative was now able to have reduced tube feeds, had gained weight and took food by mouth. We saw this person taking a semi solid meal at lunch time and was comfortable with this. We met family members that said that they were frequently involved in care and support if they chose to do so. Another persons family member told us that their relative was able to chose what to wear each time, to choose when they wanted to go to bed or to stay up to watch a film in the lounge. One person at Fernwood who could speak told us that they watched television or played dominoes with friends from the Rosewood unit, had their hair done by a visiting hairdresser. We saw that people are supported to take risks as part of an independent life style. For example we saw people with semi solid foods that included their choices such as fork mashed fish fingers, baked beans and chips. We saw that people were Care Homes for Adults (18-65 years) Page 14 of 31 Evidence: encouraged to speak and to make choices about their preferences in foot wear such as, to wear slippers or to wear socks. A family member explained that their relative is able to have a lie in, in the morning and some days to stay in bed all day if they choose to. People told us that they found the staff to be encouraging and helpful. In this way they felt they were part of their relatives care package. Families mentioned that they had noticed that there was limited support through physiotherapy but may not have been aware that extra treatments could be bought as part of a private fee. Care Homes for Adults (18-65 years) Page 15 of 31 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 benefit from the lifestyle on the unit and can contribute to the choices made. However, staff should always check that routines that they develop do not limit peoples choices. Evidence: People are encouraged to maintain relationships with family and with friends. We read that one person case tracked regularly sat out to watch television and enjoy the companionship of other people at the unit. Visitors told us that they were made welcome at any time. We looked at recordings of activities and saw that different people took part in dominoes , watching television and enjoyed when people talked with them by asking questions or sharing a joke. The activity plans that we saw were evaluated with each event. We saw that the activities coordinator provided one to one time. For one person this included making simple use of a computer by pressing the keys until the person lost interest. There are regular entries of people being involved Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: in group activities such as watching films as part of a favourite regular activity and contact with staff members. For someone else who was not taken out of their bedroom the activities coordinator visited them and provided them with one to one time as an activity. One persons family told us that their relative went out on a mini bus provided by the home into the community to go shopping. We saw that a number of family members visited on the day of inspection. People at Fernwood and their relatives spoke about the activities coordinator. They felt that she was doing a good job by ensuring that peoples social and emotional needs are met. We saw that staff carried out their duties with respect and provided dignity for those cared for by them as they took people to the shower room or assisted them with their meal. We saw that people were able to access health care, educational facilities and recreational facilities within the community. The majority of the people on the unit receive their meal through a tube. However for the few that eat meals they dine in the day lounge and have not expressed to do things differently. A dining room is provided although it is mainly used for staff training. At inspection there was a delay in serving food to people at lunch time as staff and relatives were reluctant to disturb the training taking place in the dining area and the kitchen is through this area. The manager of the unit and senior staff must ensure that peoples needs are met at a time when they prefer and are not kept waiting. This was discussed and the managers explained that people are always told that they can disturb training and walk through the training room/ dining area at any time to access the kitchen. However, in practise neither staff not relatives feel inclined to do so and will wait. People are given their medications during or after lunch time as they prefer. However, we saw that sometimes people need their medication sooner than the nurse on duty anticipates. Before starting the medicine round the nurse should check if someone wants their medication sooner than usual (before their turn) as they may not be feeling well on that particular day and by having their medications earlier it would help them. This is easily done by checking with the person and their family member each time a medicine round is to be commenced. One person was unable to eat all their meal as they had a headache and would have benefited from their medication being given before their meal with a reduced amount of fluids to ensure that they would not feel bloated and the remaining fluid could be given later. We saw that peoples diet and nutritional needs were being met. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Peoples needs are met by staff who understand the support they need and deliver care in a respectful manner. Evidence: Peoples care plans are effective in detailing individuals needs and show how they receive help and support. We saw care plans that provided sufficient details for others to follow and to provide care. The care staff that spoke with us were also able to describe complex care given. They explained that they did not carry out any tasks for which they had not been shown.(Senior care staff carried out suction for people with tracheostomys and were able to explain how care and support is given for this and other specialised procedures). One relative explained that senior staff will do chest excercises with their relative on the unit. This persons relative who lives on the unit said that they are able to choose the sex of the staff that attends to them and feels comfortable by being able to do so. In this way people are able to express how their individual needs are being met by staff. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: People told us that they receive the physical support that they need when they need it and relatives also commented that the staff are well trained and that their relatives were treated well by all staff. One relative commented that: staff always try to do their best. Someone else who lives on Fernwood said: Its like living in a five star hotel. and that the staff were absolutely wonderful. Another relative told us that emotionally she felt that their relative was: understood by staff and well treated. Another relative was able to say that their relative had: no breakages on their skin and that was due to good care. We observed part of a medicine round as the Nurse gave medicines into the tube feeds followed by water. We checked two medicine sheets and found that both were correctly recorded with no gaps. Neither were on Controlled Drugs. One person whose care we followed was on Oxygen. The cylinder was in their room. We saw that Oxygen is stored in a caged unit separate from other medicines for safety reasons due to the increased risk of fire. Allergies are recorded on the medicine sheets and instructions as to how the medicines should be given. We saw instructions to give all medicines by tube for specific individuals. In the care records we saw that when people are ill they are seen by the Doctor or are taken out for specialist appointments. The Optician and Chiropodist visit on a regular basis. We met a Continence adviser at inspection and spoke with them. They explained that they visit every eight weeks to review, or to change a facility and will teach care staff about continence care. This person explained the people that they saw have their needs correctly identified and that the nurses on the unit will check that the work has been done. Relatives who spoke with us also confirmed visits by other professionals to give treatment, advice or care. This was recorded in the care plans. Some relatives mentioned that there was an absence of dental treatment by the Dentists and that this is something that they would like the unit to find for their relative as part of the diversity and care needs of someone who lives at Fernwood. Care Homes for Adults (18-65 years) Page 19 of 31 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Policies, procedures and training allow staff to be able to help to protect people at Fernwood from potential risks. However, management need to recognise when potenial safeguarding issues should be reported. Evidence: We saw that a copy of the complaints procedure is included in the Service User Guide and that the details for the Commission is included. We recommend that the details are updated to reflect the Commissions change of address to Newcastle and this should include: the telephone contact detail and e-mail address. In this way Fernwood will have provided information that people at the unit or their visitors may need. A copy of the complaints procedure is displayed in the corridor of Fernwood for anyone who may need it. The Annual Quality Assurance Assessment tells us that: All complaints are dealt with by a Senior manager within 24 hours and in accordance with company policy and that rapid reporting is actioned to all relevant parties within Nottinghamshire Safeguarding Adults unit. All staff under go training with regard to the adult protection awareness of potential and actual abuse, confidentiality and whistle blowing. The AQAA also acknowledges that alerting agencies is an area where they could do better. We did not see any recorded complaints in the records. However, we are aware of a potential safeguarding issue that manangement did not deal with sufficiently at the time. It has since been dealt with. We later spoke with six staff members. They were aware of Care Homes for Adults (18-65 years) Page 20 of 31 Evidence: their own internal reporting procedures and understood the term whistle blowing and described it as being a safeguarding measure used by staff to protect the well being of someone in care. This would be done by involving and alerting the Police, Social Services or the Care Quality Commission as required. Care Homes for Adults (18-65 years) Page 21 of 31 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 live in a comfortable, clean and safe environment. Evidence: During the inspection we walked around various parts of the unit. We saw that both public areas and peoples individual bedrooms were kept clean, safe, well maintained and odour free. The AQAA tells us that: The unit has undergone a complete redecoration programme throughout and each person on Fernwood has their own bedroom and that communal spaces are not restrictive. We saw that communal areas included shared toilet and bathroom facilities. We saw copies of the accident records and minutes from health and safety meetings to show that an assessment of the environment took place. We noticed that the call bell in the lounge area was not easy to find and this should be easy to identify for anyone who may need it. It is advised that a number of call points be include in the public areas for easy access to them. We saw two bedrooms and they were comfortable and warm. Care Homes for Adults (18-65 years) Page 22 of 31 Evidence: We noticed that the once Snoozlem room was not being used and relatives also confirmed this and said that this is an area that would be appreciated for use by people on the unit. We were told that there were times when more domestic help was needed, this was usually weekends and bank holidays. The rota showed that two staff were employed for twenty five hours each week. However, the unit appears clean and well presented. A maintenance person is employed who helps to repair and report items that get broken and is part of the health and safety committee for the unit. Care Homes for Adults (18-65 years) Page 23 of 31 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff are able to meet peoples needs and the outcome for the people who live at Fernwood is good. Evidence: Basic training for all staff is provided this included medication management, food hygiene awareness, moving and handling of people, infection control, Management of substances used around the home, safeguarding of adults, fire training and health and safety. Future training is planned to re emphasise equalities and diversity within the work place. Specialist training included trachaeostomy procedures and awareness by staff, enteral feeding (giving liquid food supplements and fluids through a tube). First aid and basic life support. We looked at the rota and noticed that there was always two nurses to deliver care on the floor. Each nurse was found on each of the two floors plus the manager who was an experienced nurse. We noticed that agency nurses were still used regularly to make up nurse shifts although we were told that the organisation has been trying to recruit their own nurses but it has been difficult to do due to the specialism. At lunch time we noticed that the downstairs nurse may have needed extra help due to giving Care Homes for Adults (18-65 years) Page 24 of 31 Evidence: out medicines and the number of people who needed tube feeds. Care staff were available and helped where they could. One person had a headache, their relative did not feel that they should disturb the nurse until their relatives turn for medicines. This resulted in the person not eating their meal as well as they would normally have done. Nurses giving medicines should always check that everyone is comfortable and not in pain before they commence the procedures of medicine administration. Staff told us that they have an induction process and work with experienced staff during this time. The probationary process lasts up to three months. Support from experienced care and nursing staff is provided to them when on duty. They told us that they are not asked to or expected to carry out duties that they are not familiar with and work in pairs and when necessary in threes for people who are assessed to need this. We saw the supervision records for staff they were satisfactory and saw their individual training achievements on their records. We saw two staff records they included a completed application form, Criminal Record Bureau checks, a probationary period letter, Two references including one from a previous employer, a medical fitness check, interview and identification checks to verify details provided by the staff. Family members told us that their relative sometimes when out with the staff. Two people who live on the unit also said that they went out with staff. We looked at the activities sheet and saw that people took part in individual and group activities within the unit and were invited to join the other units when activities took place such as outside entertainers or parties on special occasions. The relatives of people at Fernwood told us how helpful the staff were. One person described living at the unit as being: Absolutely wonderful, like being at a five star hotel. Care Homes for Adults (18-65 years) Page 25 of 31 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Fernwood feel that the quality of their lives is good. However, when the managers become more visible to them the structures in place will ensure that their needs are being fully met. Evidence: People continue to have their needs met. Relatives and people at Fernwood confirmed this. However, management support has been weekended by the regular changes within the management structure and relatives said that: they would go to the nurse on duty but that managers higher up were not always visible nor had they made themselves known to them. This was discussed during the feedback given to the managers on the day of inspection who said that they would attend to this so that everyone would know who to go to if they had any concerns about any aspect of life on Fernwood. Quality Assurance is provided in the form of accidents reported and acted on and are included in the health and safety internal meetings each month. The outcomes are Care Homes for Adults (18-65 years) Page 26 of 31 Evidence: then sent to a central monitoring system and reviewed by a quality development manager. Staff training, forms part of the quality monitoring. This is encouraged and maintained, as are supervision records for staff. We met a number of people whose relatives visit each day. They told us that they are willing to say what they think of the unit as are the residents who are able to communicate. However, they said that they have not received a survey to express their opinions for a while. A new acting manager has been appointed and since visiting the unit has been accepted by the Care Quality Commission for all three units. This should provide stability within the management structure for the units on this site. However, it is important that all managers re visit their training on complaints and concerns with a potential safeguarding element in them and alert the relevant agencies in a timely manner. The managers at inspection were able to verify that all health and safety matters were up to date and that staff had received fire training. In this way people at the unit would be kept safe. Care Homes for Adults (18-65 years) Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 37 8 The acting manager must make an application to The Commission for Social Care Inspection to become a registered manager. This will ensure that people who live in a care home that is well run and well managed 31/03/2009 Care Homes for Adults (18-65 years) Page 28 of 31 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 1 7 15 Staff should be able to 12/03/2010 demontrate how individual choices have been made and record when decisions have been made by others and why. This will encourage good practice and show staff to have an understanding of the Mental Capacity Act. 2 37 12 Mangers in charge of the unit must be aware of Safeguarding issues and know when to refer them. When this is done well people at Fernwood will be appropriately protected. 12/03/2010 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 37 The management structure needs to be made more visible Page 29 of 31 Care Homes for Adults (18-65 years) 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 on a daily basis for people the who live at Fernwood and for their relatives and representatives. Care Homes for Adults (18-65 years) Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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