fernlea care home report

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Review ofcompliance

Parkcare Homes (No 2) Limited

Fernlea

Region: South East

Location address:Sway Road

Brockenhurst

Hampshire

SO42 7SG

Type of service: Care home service without nursing

Date of Publication: September 2011

Overview of the service: Fernlea is owned by Parkcare Homes(No 2) Limited, which is a tradingsubsidiary of Craegmoor Group Ltd, anational organisation.The house is a detached property set ina large garden.It is located in the NewForest village of Brockenhurst. Fernleaprovides care for up to to 10 people witha learning disability and/or a mental

disorder. The provider is not registeredto provide nursing care.



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Our current overall judgement

Fernlea was not meeting one or more essential standards. We havetaken enforcement action against the provider to protect the safetyand welfare of people who use services.

The summary below describes why we carried out this review, what we found and anyaction required.

Why we carried out this review

We carried out this review because concerns were identified in relation to:

Outcome 01 - Respecting and involving people who use servicesOutcome 04 - Care and welfare of people who use servicesOutcome 08 - Cleanliness and infection controlOutcome 10 - Safety and suitability of premisesOutcome 13 - StaffingOutcome 20 - Notification of other incidents

How we carried out this review

We reviewed all the information we hold about this provider, carried out a visit on 25 July2011, observed how people were being cared for, looked at records of people who useservices, talked to staff, reviewed information from stakeholders and talked to people whouse services.

What people told us

Overall people told us they liked living at the home. They got on well with staff. Staffunderstood their wishes and did all they could to support them. They told that staff helpwith their daily routines and personal care needs, but staff were not always able to supportthem to access the community as much as they wished to.

What we found about the standards we reviewed and how well Fernleawas meeting them

Outcome 01: People should be treated with respect, involved in discussions abouttheir care and treatment and able to influence how the service is run

People were consulted about their care and were involved in decisions about the runningof the home. However, people's preferences about social and leisure activities are not fully

respected. On the basis of the evidence provided and the views of people using theservice we found the service to be non-compliant with this outcome.

for the essential standards of quality and safetySummary of our findings



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Outcome 04: People should get safe and appropriate care that meets their needsand supports their rights

Effective use of care planning meant that staff knew each person's individual needs andwishes and their personal and health care needs were met. However, people's wishes and

aspirations regarding community based social activities were not always met. On the basisof the evidence provided and the views of people using the service we found the service tobe non-compliant with this outcome.

Outcome 08: People should be cared for in a clean environment and protected fromthe risk of infection

On the day of our visit we saw poorly maintained areas that would make cleaning difficult.The staff that we spoke to could not provide information about any audits or checks tomonitor the effectiveness of cleaning. We witnessed poor processes in the laundry. On the

basis of the evidence provided and the views of people using the service we found theservice to be non-compliant with this outcome.

Outcome 10: People should be cared for in safe and accessible surroundings thatsupport their health and welfare

There are a variety of communal areas for people to spend their time. However, theprovider has not been able to demonstrate that the environment is maintained to provide asafe and comfortable environment for people to live in. On the basis of the evidenceprovided and the views of people using the service we found the service to be non-compliant with this outcome.

Outcome 13: There should be enough members of staff to keep people safe andmeet their health and welfare needs

The current staffing levels are insufficient which means that people's needs continue not tobe fully met. On the basis of the evidence provided and the views of people using theservice we found the service to be non-compliant with this outcome.

Outcome 20: The service must tell us about important events that affect people'swellbeing, health and safety

The service has not informed the Commission of events affecting the welfare of peopleusing the service. On the basis of the evidence provided and the views of people using theservice we found the service to be non-compliant with this outcome.

Actions we have asked the service to take

We have asked the provider to send us a report within 7 days of them receiving this report,setting out the action they will take to improve. We will check to make sure that theimprovements have been made.

We have taken enforcement action against Parkcare Homes (No 2) Limited.



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Where we have concerns we have a range of enforcement powers we can use to protectthe safety and welfare of people who use this service. Any regulatory decision that CQCtakes is open to challenge by a registered person through a variety of internal and externalappeal processes. We will publish a further report on any action we have taken.

Other information

Please see previous reports for more information about previous reviews.



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What we found

for each essential standard of qualityand safety we reviewed



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The following pages detail our findings and our regulatory judgement for each essential standard and outcome that wereviewed, linked to specific regulated activities where appropriate.

We will have reached one of the following judgements for each essential standard.

Compliant means that people who use services are experiencing the outcomes relating to

the essential standard.

A minor concern means that people who use services are safe but are not alwaysexperiencing the outcomes relating to this essential standard.

A moderate concern means that people who use services are safe but are not alwaysexperiencing the outcomes relating to this essential standard and there is an impact ontheir health and wellbeing because of this.

A major concern means that people who use services are not experiencing the outcomesrelating to this essential standard and are not protected from unsafe or inappropriate care,

treatment and support.

Where we identify compliance, no further action is taken. Where we have concerns, themost appropriate action is taken to ensure that the necessary improvements are made.Where there are a number of concerns, we may look at them together to decide the levelof action to take.

More information about each of the outcomes can be found in the Guidance about compliance: Essential standards of quality and safety



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Outcome 01:Respecting and involving people who use services

What the outcome says

This is what people who use services should expect.

People who use services:* Understand the care, treatment and support choices available to them.* Can express their views, so far as they are able to do so, and are involved in makingdecisions about their care, treatment and support.* Have their privacy, dignity and independence respected.* Have their views and experiences taken into account in the way the service is providedand delivered.

What we found

Our judgement

There are moderate concerns with Outcome 01: Respecting and involving people whouse services

Our findings

What people who use the service experienced and told usPeople told us they were involved in decisions made about their care and support. Theyreceived help and support with their personal care in the way they preferred becausestaff listened to their wishes. People told us about their involvement in planning healthcare appointments such as visits to the dentist. They were also involved in reviews oftheir care with staff members and their care managers from social services.

They told us they join in with meetings with staff about the home. They have opportunityto be involved in making decisions about the running of the home including the choiceof meals and activities. However, some people spoke about their frustration andboredom of not always being able to go out of the home for their preferred social andleisure activities.

Other evidenceCare plans showed evidence of people's involvement in developing and reviewing theircare plans. Records of meetings showed that people living at the home were involvedin making decisions about the running of the home.

However, we also saw evidence that people's wishes regarding taking part in socialactivities outside the home are not always met



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Outcome 04:Care and welfare of people who use services



People who use services:* Experience effective, safe and appropriate care, treatment and support that meets theirneeds and protects their rights.

What we found

Our judgement

There are moderate concerns with Outcome 04: Care and welfare of people who useservices

Our findings

What people who use the service experienced and told usPeople told us they were aware of their care plans and said they were consulted aboutthem. For one person, we looked at their care plan with them and they agreed that thedetails in the plan described their needs and wishes. They told us their family membersvisited and were involved in reviews of their care plans.

They told us they have one day a week which is a 'house day' when they are supportedto do their laundry, cooking and personal shopping. Some people spoke about theactivities they like to take part in, shopping, listening to music, going out for drives andout for lunch.

We observed that only one person was able to go out during the morning to do theirpersonal shopping. The only other activities taking place outside the home involvedmedical and social care review appointments.

People occupied themselves in the home by spending time in the lounge where thetelevision was switched on. However, nobody was able to say whose choice thetelevision programme was. We observed that other than supporting people with theirpersonal care needs and meeting appointments there was limited staff interaction withpeople living at the home.

People told us they received the medical support they needed and we saw information

that confirmed this was happening. Some people told us that although they enjoy thevisiting entertainers, at times they are bored at the home and have nothing to do or



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occupy their time with.

Other evidenceCare plans that we looked at were personalised and detailed people's individual needsand preferences. Risk assessments were detailed to ensure consistency of approach.We saw that people were involved in their care plans along with their family and health

and social care professionals as appropriate. Care plans were reviewed monthly toensure they detailed the current care needs of people using the service.

At the last inspection, in May 2011, it was identified that the social and educationalneeds of people using the service was not always being met. This meant the servicewas required to submit an action plan detailing the actions they would take to ensurethe social and education needs of people were met. The submitted plan detailed thatthe home would be seeking reviews for all people and extra funding from socialservices so people could have one to one support with activities. Staff we spoke to toldus that the present staffing levels still did not allow time for people to access activitiesas they would wish.

The plans for one person we looked at detailed they like to go out every day. Theiractivity plan showed they should take part in an activity outside the home every day.However, the information in other records detailed they had only been outside of thehome eight times in the month of July. This meant this person was not receiving thecare and support they required as detailed in their plan of care.

For anther person, their activity plan detailed they should take part in outside activitiesevery day. We saw that for the month of July it was recorded they had only taken part infour outside activities. When we spoke with staff they told us that staffing numbers did

not enable them to support people sufficiently with activities inside and outside of thehome. The told us they believed that some of the behaviours exhibited by some peopleliving at the home were because of the boredom and frustration of not being as sociallyactive as they would like to be.

Our judgementEffective use of care planning meant that staff knew each person's individual needs andwishes and their personal and health care needs were met. However, people's wishesand aspirations regarding community based social activities were not always met. Onthe basis of the evidence provided and the views of people using the service we foundthe service to be non-compliant with this outcome.



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Outcome 08:Cleanliness and infection control


Providers of services comply with the requirements of regulation 12, with regard to theCode of Practice for health and adult social care on the prevention and control of infectionsand related guidance.

What we found

Our judgement

There are moderate concerns with Outcome 08: Cleanliness and infection control

Our findings

What people who use the service experienced and told usPeople living at the home told us they had an allocated day per week for tidying and

keeping their bedrooms clean. They made no other comments about keeping the homeclean and tidy.

Other evidenceWe identified several areas of concern about the environment of the home. Theyindicated that processes were not in place to ensure people lived in a cleanenvironment that would promote good health and well being. There were signs of dampand mould on walls and/or ceilings in the down stairs shower room, some en suitetoilets, the laundry room and the staff office. There was evidence of water leaks withwater stains on several ceilings in the home. There was peeling paint in two of the toiletrooms and the laundry. The sealant around the bath upstairs was lifting and looked

dirty. Joins in the kitchen work surfaces were lifting.

In one of the upstairs bedrooms there was a strong offensive odour of urine. We weretold by staff the odour is always present.

The laundry was small and cramped. There were laundry baskets and other itemsstored in the laundry. There was dirty laundry on the floor. This would present anunnecessary risk of cross contaminated from laundry on the floor.

When we spoke to staff at the home, they told us the manager was responsible forinfection prevention and control at the home. Staff were not able to show us any audits

or checks to monitor the effectiveness of cleaning or infection prevention controlpractices



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Staff told us they had completed infection prevention and control training. Staff trainingfiles held certificates for all training received by staff. However, out of the six records welooked at, two members of staff had certificates that detailed training needed to beupdated in 2010, two staff members had certificates that were in date and for anothertwo staff members there were no certificates to evidence they had received training

about hygiene and the prevention and control of infection.

Our judgementOn the day of our visit we saw poorly maintained areas that would make cleaningdifficult. The staff that we spoke to could not provide information about any audits orchecks to monitor the effectiveness of cleaning. We witnessed poor processes in thelaundry. On the basis of the evidence provided and the views of people using theservice we found the service to be non-compliant with this outcome.



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Outcome 10:Safety and suitability of premises


This is what people should expect.

People who use services and people who work in or visit the premises:* Are in safe, accessible surroundings that promote their wellbeing.

What we found

Our judgement

There are moderate concerns with Outcome 10: Safety and suitability of premises

Our findings

What people who use the service experienced and told us

People living at the home told us they were happy with their own bedrooms and wereable to personalise them with their own belongs. We saw their bedrooms werepersonalised to reflect their own interests and hobbies.

We were told by some people living at the home they found the conservatory, that isused a dining room, too hot to sit in during the warm weather.

We spoke with one person who because of the damp condition of their bedroom wasunable to use their bedroom. This meant that at night time this person was having tosleep at another care home belonging to the provider. During the day they returned toFernlea, but were only able to use the communal areas. There was no facility for the

person to spend time on their own in a private room.

Other evidenceSocial Services had raised concerns about the environment of the home. They hadidentified the person's bedroom that was damp which had the potential to pose healthproblems if not attended to. At the time of our inspection the room was in the process ofbeing dried out and the provider was waiting for quotes for the work to be completed tomake the room fit for occupation again.

We observed other areas of the home where the environment posed some risk topeople using the service as well those identified in outcome 08.

In some rooms including, the lounge, the radiator covers were coming away from the



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wall. In the downstairs bathroom the wooden boarding covering the water pipes wascoming away from the piping. In the same room, the floor boards under the floorcovering felt unstable when walking on them, and some were lifting resulting in unevenflooring.

In one person's bedroom there was unfinished painting around the door to the room.

We were told the room had been in this condition for at least two years. One of thebedrooms upstairs had no hot water supply to the en suite bathroom. The bed in onebedroom was unstable and had loose nails in bed legs coming undone.

We discussed the process for reporting maintenance concerns with staff. Theyindicated they did not have confidence that maintenance issues are managed promptlyand efficiently. We looked at two sets of maintenance records. One was a maintenancerequirement book which detailed issues that needed to be managed by the provider.For the month of July this included entries of which there were details that only one hadbeen acted on. This left a number of outstanding issues regarding the damp bedroom,ceiling leaks and the kitchen fire door as not been attended to. The other set of recordswas for smaller jobs to be completed by the home's handyman. The last entries forthese were dated May 2011 and had not been signed to indicate the jobs had beencompleted.

Our judgementThere are a variety of communal areas for people to spend their time. However, theprovider has not been able to demonstrate that the environment is maintained toprovide a safe and comfortable environment for people to live in. On the basis of theevidence provided and the views of people using the service we found the service to benon-compliant with this outcome.



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Outcome 13:Staffing



People who use services:* Are safe and their health and welfare needs are met by sufficient numbers of appropriatestaff.

What we found

Our judgement

There are major concerns with Outcome 13: Staffing

Our findings

What people who use the service experienced and told usWe were told by people the staff provided support with their hobbies and interestsinside the home. They told us staff were always available to help them with theirpersonal care needs. Some people told us they like to go out, but, are not always ableto because there are insufficient staff available to support them to do so. We observedsome people who were seeking attention from staff members. However staff were notalways able to provide the attention people required because they had to attend toother people's needs.

Other evidenceAt the last inspection, in May 2011, it was identified that the numbers of staff on duty

meant the people living at the home were unable to access the community as much asthey wished to. The service was required to submit a plan detailing the action they weregoing to take to ensure that sufficient staff were on duty at any one time to meet all theneeds of the people using the service. This action plan detailed that the duty rota wouldbe reviewed to ensure it was as flexible and accommodating as possible. There was noinformation about how the service made the decision about the staffing levels requiredto meet people's needs.

All of the staff we spoke with during the inspection told us they did not feel there weresufficient staff on duty at any one time. They told us they were able to meet thepersonal care needs of people, but for people who liked to be socially stimulated and go

out on a daily basis this was impossible with the current staffing numbers. As expressedat the last inspection staff told us they thought some of the challenging behaviours



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exhibited by some people would not occur if there were more staff to support people inmeaningful activities, particularly outside of the home.

Staff told us there had been no increase in staffing numbers since the last inspection.The staff duty rota for the month of July showed there were three or four staff on duty inthe mornings, three in the afternoon and one staff member awake and one staff

member sleeping at the home, for support if needed, at night.

Our judgementThe current staffing levels are insufficient which means that people's needs continuenot to be fully met. On the basis of the evidence provided and the views of people usingthe service we found the service to be non-compliant with this outcome.



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Outcome 20:Notification of other incidents



People who use services:* Can be confident that important events that affect their welfare, health and safety arereported to the Care Quality Commission so that, where needed, action can be taken.

What we found

Our judgement

There are moderate concerns with Outcome 20: Notification of other incidents

Our findings

What people who use the service experienced and told usWe had no information from people using the service about the home's responsibility toinform the commission about events affecting the welfare of people using the service.

Other evidenceServices registered with the Commission are required to inform the Commission ofevents affecting the welfare of people using services. The service has notified us ofsome events that have had the potential to affect the wellbeing of people using theservice. However they had failed to notify the Commission about the environmentalissues that had resulted in one person not being able to use their bedroom and havingto relocate to another care home at night to sleep.

Our judgementThe service has not informed the Commission of events affecting the welfare of peopleusing the service. On the basis of the evidence provided and the views of people usingthe service we found the service to be non-compliant with this outcome.



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Compliance actions

The table below shows the essential standards of quality and safety that are not beingmet. Action must be taken to achieve compliance.

Regulated activity Regulation Outcome

Accommodation for persons whorequire nursing or personal care

Regulation 17HSCA 2008(Regulated

Activities)Regulations 2010

Outcome 01:Respecting andinvolving people who

use services

How the regulation is not being met:

People were consulted about their care andwere involved in decisions about the runningof the home. However, people's preferencesabout social and leisure activities are not fullyrespected. On the basis of the evidenceprovided and the views of people using theservice we found the service to be non-compliant with this outcome.


Regulation 9 HSCA2008 (RegulatedActivities)Regulations 2010

Outcome 04: Care andwelfare of people whouse services


Effective use if care planning meant that staffknew each person's individual needs and

wishes and their personal and health careneeds were met, However, people's wishesand aspirations regarding community basedsocial activities were not always met. On thebasis of the evidence provided and the viewsof people using the service we found theservice to be non-compliant with thisoutcome.


Regulation 12HSCA 2008

(RegulatedActivities)

Outcome 08:Cleanliness and

infection control

Actionwe have asked the provider to take



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Regulations 2010


On the day of our visit we saw poorlymaintained areas that would make cleaning

difficult. The staff that we spoke to could notprovide information about any audits orchecks to monitor the effectiveness ofcleaning. We witnessed poor processes inthe laundry. On the basis of the evidenceprovided and the views of people using theservice we found the service to be non-compliant with this outcome.


Regulation 15HSCA 2008

(RegulatedActivities)Regulations 2010

Outcome 10: Safetyand suitability of

premises


There are a variety of communal areas forpeople to spend their time. However, theprovider has not been able to demonstratethat the environment is maintained to providea safe and comfortable environment forpeople to live in. On the basis of the evidence

provided and the views of people using theservice we found the service to be non-compliant with this outcome.


Regulation 18 CQC(Registration)Regulations 2009

Outcome 20:Notification of otherincidents


The service has not informed theCommission of events affecting the welfare of

people using the service.On the basis of theevidence provided and the views of peopleusing the service we found the service to benon-compliant with this outcome.

The provider must send CQC a report that says what action they are going to take toachieve compliance with these essential standards.

This report is requested under regulation 10(3) of the Health and Social Care Act 2008

(Regulated Activities) Regulations 2010.



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The provider's report should be sent to us within 7 days of this report being received.

Where a provider has already sent us a report about any of the above compliance actions,they do not need to include them in any new report sent to us after this review ofcompliance.

CQC should be informed in writing when these compliance actions are complete.



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Enforcement action we have takenThe table below shows enforcement action we have taken because the service provider isnot meeting the essential standards of quality and safety shown below. Where the action isa Warning Notice, a timescale for compliance will also be shown.

Enforcement action taken

Warning notice

This action has been taken in relation to:

Regulatedactivity

Regulation orsection of the Act

Outcome

Accommodati

on forpersons whorequirenursing orpersonal care

Regulation 22 HSCA 2008

(Regulated Activities)Regulations 2010

Outcome 13: Staffing

How the regulation orsection is not being met:

Registeredmanager:

To be met by:

The current staffing levelsare insufficient and meanthat peoples needs continuenot to be fully met. On thebasis of the evidenceprovided and the views of

people using the service wefound the service to be non-compliant with this outcome.

Terri Wardner 09 September 2011



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What is a review of compliance?

By law, providers of certain adult social care and health care services have a legal

responsibility to make sure they are meeting essential standards of quality and safety.These are the standards everyone should be able to expect when they receive care.

The Care Quality Commission (CQC) has written guidance about what people who useservices should experience when providers are meeting essential standards, calledGuidance about compliance: Essential standards of quality and safety .

CQC licenses services if they meet essential standards and will constantly monitorwhether they continue to do so. We formally review services when we receive informationthat is of concern and as a result decide we need to check whether a service is still

meeting one or more of the essential standards. We also formally review them at leastevery two years to check whether a service is meeting all of the essential standards ineach of their locations. Our reviews include checking all available information andintelligence we hold about a provider. We may seek further information by contactingpeople who use services, public representative groups and organisations such as otherregulators. We may also ask for further information from the provider and carry out a visitwith direct observations of care.

When making our judgements about whether services are meeting essential standards,we decide whether we need to take further regulatory action. This might includediscussions with the provider about how they could improve. We only use this approach

where issues can be resolved quickly, easily and where there is no immediate risk ofserious harm to people.

Where we have concerns that providers are not meeting essential standards, or where we judge that they are not going to keep meeting them, we may also set improvement actionsor compliance actions, or take enforcement action:

Improvement actions: These are actions a provider should take so that they maintain continuous compliance with essential standards. Where a provider is complying withessential standards, but we are concerned that they will not be able to maintain this, weask them to send us a report describing the improvements they will make to enable them

to do so.

Compliance actions: These are actions a provider must take so that they achieve compliance with the essential standards. Where a provider is not meeting the essentialstandards but people are not at immediate risk of serious harm, we ask them to send us areport that says what they will do to make sure they comply. We monitor theimplementation of action plans in these reports and, if necessary, take further action tomake sure that essential standards are met.

Enforcement action: These are actions we take using the criminal and/or civil procedures

in the Health and Social Care Act 2008 and relevant regulations. These enforcementpowers are set out in the law and mean that we can take swift, targeted action whereservices are failing people.

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