Review of compliance

Parkcare Homes (No 2) Limited Fernlea

Region: Location address: South East Sway Road Brockenhurst Hampshire SO42 7SG Type of service: Date of Publication: Overview of the service: Care home service without nursing September 2011 Fernlea is owned by Parkcare Homes (No 2) Limited, which is a trading subsidiary of Craegmoor Group Ltd, a national organisation. The house is a detached property set in a large garden.It is located in the New Forest village of Brockenhurst. Fernlea provides care for up to to 10 people with a learning disability and/or a mental disorder. The provider is not registered to provide nursing care.
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Summary of our findings for the essential standards of quality and safety
Our current overall judgement Fernlea was not meeting one or more essential standards. We have taken enforcement action against the provider to protect the safety and welfare of people who use services.
The summary below describes why we carried out this review, what we found and any action 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 services Outcome 04 - Care and welfare of people who use services Outcome 08 - Cleanliness and infection control Outcome 10 - Safety and suitability of premises Outcome 13 - Staffing Outcome 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 July 2011, observed how people were being cared for, looked at records of people who use services, talked to staff, reviewed information from stakeholders and talked to people who use services.

What people told us

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

What we found about the standards we reviewed and how well Fernlea was meeting them
Outcome 01: People should be treated with respect, involved in discussions about their 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 running of 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 the service we found the service to be non-compliant with this outcome.
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Outcome 04: People should get safe and appropriate care that meets their needs and supports their rights Effective use of care planning meant that staff knew each person's individual needs and wishes 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 basis of the evidence provided and the views of people using the service we found the service to be non-compliant with this outcome. Outcome 08: People should be cared for in a clean environment and protected from the 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 to monitor 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 the service to be non-compliant with this outcome. Outcome 10: People should be cared for in safe and accessible surroundings that support their health and welfare There are a variety of communal areas for people to spend their time. However, the provider has not been able to demonstrate that the environment is maintained to provide a safe and comfortable environment for people to live in. On the basis of the evidence provided and the views of people using the service we found the service to be noncompliant with this outcome. Outcome 13: There should be enough members of staff to keep people safe and meet their health and welfare needs The current staffing levels are insufficient which means that people's needs continue not to be fully met. On the basis of the evidence provided and the views of people using the service we found the service to be non-compliant with this outcome. Outcome 20: The service must tell us about important events that affect people's wellbeing, health and safety The service has not informed the Commission of events affecting the welfare of people using the service. On the basis of the evidence provided and the views of people using the service 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 the improvements 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 protect the safety and welfare of people who use this service. Any regulatory decision that CQC takes is open to challenge by a registered person through a variety of internal and external appeal 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 quality and safety we reviewed

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The following pages detail our findings and our regulatory judgement for each essential standard and outcome that we reviewed, 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 always experiencing the outcomes relating to this essential standard. A moderate concern means that people who use services are safe but are not always experiencing the outcomes relating to this essential standard and there is an impact on their health and wellbeing because of this. A major concern means that people who use services are not experiencing the outcomes relating 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, the most 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 level of 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 making decisions 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 provided and delivered.

What we found
Our judgement There are moderate concerns with Outcome 01: Respecting and involving people who use services

Our findings What people who use the service experienced and told us People told us they were involved in decisions made about their care and support. They received help and support with their personal care in the way they preferred because staff listened to their wishes. People told us about their involvement in planning health care appointments such as visits to the dentist. They were also involved in reviews of their 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 opportunity to be involved in making decisions about the running of the home including the choice of meals and activities. However, some people spoke about their frustration and boredom of not always being able to go out of the home for their preferred social and leisure activities. Other evidence Care plans showed evidence of people's involvement in developing and reviewing their care plans. Records of meetings showed that people living at the home were involved in making decisions about the running of the home. However, we also saw evidence that people's wishes regarding taking part in social activities outside the home are not always met
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Our judgement People were consulted about their care and were involved in decisions about the running of 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 the service we found the service to be non-compliant with this outcome.

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Outcome 04: Care and welfare of people who use services

What the outcome says

This is what people who use services should expect. People who use services: * Experience effective, safe and appropriate care, treatment and support that meets their needs and protects their rights.

What we found
Our judgement There are moderate concerns with Outcome 04: Care and welfare of people who use services

Our findings What people who use the service experienced and told us People told us they were aware of their care plans and said they were consulted about them. For one person, we looked at their care plan with them and they agreed that the details in the plan described their needs and wishes. They told us their family members visited 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 supported to do their laundry, cooking and personal shopping. Some people spoke about the activities they like to take part in, shopping, listening to music, going out for drives and out for lunch. We observed that only one person was able to go out during the morning to do their personal shopping. The only other activities taking place outside the home involved medical and social care review appointments. People occupied themselves in the home by spending time in the lounge where the television was switched on. However, nobody was able to say whose choice the television programme was. We observed that other than supporting people with their personal care needs and meeting appointments there was limited staff interaction with people 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 the visiting entertainers, at times they are bored at the home and have nothing to do or
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occupy their time with. Other evidence Care plans that we looked at were personalised and detailed people's individual needs and 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 to ensure 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 educational needs of people using the service was not always being met. This meant the service was required to submit an action plan detailing the actions they would take to ensure the social and education needs of people were met. The submitted plan detailed that the home would be seeking reviews for all people and extra funding from social services so people could have one to one support with activities. Staff we spoke to told us that the present staffing levels still did not allow time for people to access activities as they would wish. The plans for one person we looked at detailed they like to go out every day. Their activity 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 the home eight times in the month of July. This meant this person was not receiving the care and support they required as detailed in their plan of care. For anther person, their activity plan detailed they should take part in outside activities every day. We saw that for the month of July it was recorded they had only taken part in four 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 the home. The told us they believed that some of the behaviours exhibited by some people living at the home were because of the boredom and frustration of not being as socially active as they would like to be. Our judgement Effective use of care planning meant that staff knew each person's individual needs and wishes 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 basis of the evidence provided and the views of people using the service we found the service to be non-compliant with this outcome.

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Outcome 08: Cleanliness and infection control

What the outcome says

Providers of services comply with the requirements of regulation 12, with regard to the Code of Practice for health and adult social care on the prevention and control of infections and 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 us People 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 home clean and tidy. Other evidence We identified several areas of concern about the environment of the home. They indicated that processes were not in place to ensure people lived in a clean environment that would promote good health and well being. There were signs of damp and mould on walls and/or ceilings in the down stairs shower room, some en suite toilets, the laundry room and the staff office. There was evidence of water leaks with water stains on several ceilings in the home. There was peeling paint in two of the toilet rooms 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 were told by staff the odour is always present. The laundry was small and cramped. There were laundry baskets and other items stored in the laundry. There was dirty laundry on the floor. This would present an unnecessary risk of cross contaminated from laundry on the floor. When we spoke to staff at the home, they told us the manager was responsible for infection 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 control practices
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Staff told us they had completed infection prevention and control training. Staff training files held certificates for all training received by staff. However, out of the six records we looked at, two members of staff had certificates that detailed training needed to be updated in 2010, two staff members had certificates that were in date and for another two staff members there were no certificates to evidence they had received training about hygiene and the prevention and control of infection. Our judgement 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 to monitor 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 the service to be non-compliant with this outcome.

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Outcome 10: Safety and suitability of premises

What the outcome says

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 were able to personalise them with their own belongs. We saw their bedrooms were personalised to reflect their own interests and hobbies. We were told by some people living at the home they found the conservatory, that is used 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 was unable to use their bedroom. This meant that at night time this person was having to sleep at another care home belonging to the provider. During the day they returned to Fernlea, 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 evidence Social Services had raised concerns about the environment of the home. They had identified the person's bedroom that was damp which had the potential to pose health problems if not attended to. At the time of our inspection the room was in the process of being dried out and the provider was waiting for quotes for the work to be completed to make the room fit for occupation again. We observed other areas of the home where the environment posed some risk to people 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 was coming away from the piping. In the same room, the floor boards under the floor covering felt unstable when walking on them, and some were lifting resulting in uneven flooring. 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 the bedrooms upstairs had no hot water supply to the en suite bathroom. The bed in one bedroom was unstable and had loose nails in bed legs coming undone. We discussed the process for reporting maintenance concerns with staff. They indicated they did not have confidence that maintenance issues are managed promptly and efficiently. We looked at two sets of maintenance records. One was a maintenance requirement 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 had been 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 records was for smaller jobs to be completed by the home's handyman. The last entries for these were dated May 2011 and had not been signed to indicate the jobs had been completed. Our judgement There are a variety of communal areas for people to spend their time. However, the provider has not been able to demonstrate that the environment is maintained to provide a safe and comfortable environment for people to live in. On the basis of the evidence provided and the views of people using the service we found the service to be non-compliant with this outcome.

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Outcome 13: Staffing

What the outcome says

This is what people who use services should expect. People who use services: * Are safe and their health and welfare needs are met by sufficient numbers of appropriate staff.

What we found
Our judgement There are major concerns with Outcome 13: Staffing

Our findings What people who use the service experienced and told us We were told by people the staff provided support with their hobbies and interests inside the home. They told us staff were always available to help them with their personal care needs. Some people told us they like to go out, but, are not always able to because there are insufficient staff available to support them to do so. We observed some people who were seeking attention from staff members. However staff were not always able to provide the attention people required because they had to attend to other people's needs. Other evidence At 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 as they wished to. The service was required to submit a plan detailing the action they were going to take to ensure that sufficient staff were on duty at any one time to meet all the needs of the people using the service. This action plan detailed that the duty rota would be reviewed to ensure it was as flexible and accommodating as possible. There was no information about how the service made the decision about the staffing levels required to meet people's needs. All of the staff we spoke with during the inspection told us they did not feel there were sufficient staff on duty at any one time. They told us they were able to meet the personal 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 expressed at 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 in meaningful 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 in the 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 judgement The current staffing levels are insufficient which means that people's needs continue not to be fully met. On the basis of the evidence provided and the views of people using the service we found the service to be non-compliant with this outcome.

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Outcome 20: Notification of other incidents

What the outcome says

This is what people who use services should expect. People who use services: * Can be confident that important events that affect their welfare, health and safety are reported 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 us We had no information from people using the service about the home's responsibility to inform the commission about events affecting the welfare of people using the service. Other evidence Services registered with the Commission are required to inform the Commission of events affecting the welfare of people using services. The service has notified us of some events that have had the potential to affect the wellbeing of people using the service. However they had failed to notify the Commission about the environmental issues that had resulted in one person not being able to use their bedroom and having to relocate to another care home at night to sleep. Our judgement The service has not informed the Commission of events affecting the welfare of people using the service. On the basis of the evidence provided and the views of people using the service we found the service to be non-compliant with this outcome.

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Action we have asked the provider to take

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

Regulated activity
Accommodation for persons who require nursing or personal care

Regulation
Regulation 17 HSCA 2008 (Regulated Activities) Regulations 2010

Outcome
Outcome 01: Respecting and involving people who use services

How the regulation is not being met: People were consulted about their care and were involved in decisions about the running of 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 the service we found the service to be noncompliant with this outcome. Accommodation for persons who require nursing or personal care Regulation 9 HSCA 2008 (Regulated Activities) Regulations 2010 Outcome 04: Care and welfare of people who use services

How the regulation is not being met: Effective use if care planning meant that staff knew each person's individual needs and wishes 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 basis of the evidence provided and the views of people using the service we found the service to be non-compliant with this outcome. Accommodation for persons who require nursing or personal care Regulation 12 HSCA 2008 (Regulated Activities) Outcome 08: Cleanliness and infection control

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Regulations 2010 How the regulation is not being met: 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 to monitor 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 the service to be noncompliant with this outcome. Accommodation for persons who require nursing or personal care Regulation 15 HSCA 2008 (Regulated Activities) Regulations 2010 Outcome 10: Safety and suitability of premises

How the regulation is not being met: There are a variety of communal areas for people to spend their time. However, the provider has not been able to demonstrate that the environment is maintained to provide a safe and comfortable environment for people to live in. On the basis of the evidence provided and the views of people using the service we found the service to be noncompliant with this outcome. Accommodation for persons who require nursing or personal care Regulation 18 CQC (Registration) Regulations 2009 Outcome 20: Notification of other incidents

How the regulation is not being met: The service has not informed the Commission of events affecting the welfare of people using the service.On the basis of the evidence provided and the views of people using the service we found the service to be non-compliant with this outcome.

The provider must send CQC a report that says what action they are going to take to achieve 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 of compliance. CQC should be informed in writing when these compliance actions are complete.

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Enforcement action we have taken

The table below shows enforcement action we have taken because the service provider is not meeting the essential standards of quality and safety shown below. Where the action is a Warning Notice, a timescale for compliance will also be shown.

Enforcement action taken

Warning notice This action has been taken in relation to: Regulated activity Accommodati on for persons who require nursing or personal care Regulation or section of the Act Regulation 22 HSCA 2008 (Regulated Activities) Regulations 2010 How the regulation or section is not being met: Outcome Outcome 13: Staffing

Registered manager:

To be met by: 09 September 2011

The current staffing levels Terri Wardner are insufficient and mean that peoples needs continue not to be fully met. On the basis of the evidence provided and the views of people using the service we found the service to be noncompliant with this outcome.

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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 use services should experience when providers are meeting essential standards, called Guidance about compliance: Essential standards of quality and safety. CQC licenses services if they meet essential standards and will constantly monitor whether they continue to do so. We formally review services when we receive information that 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 least every two years to check whether a service is meeting all of the essential standards in each of their locations. Our reviews include checking all available information and intelligence we hold about a provider. We may seek further information by contacting people who use services, public representative groups and organisations such as other regulators. We may also ask for further information from the provider and carry out a visit with 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 include discussions 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 of serious 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 actions or 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 with essential standards, but we are concerned that they will not be able to maintain this, we ask 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 essential standards but people are not at immediate risk of serious harm, we ask them to send us a report that says what they will do to make sure they comply. We monitor the implementation of action plans in these reports and, if necessary, take further action to make 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 enforcement powers are set out in the law and mean that we can take swift, targeted action where services are failing people.
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Information for the reader

Document purpose Author Audience Further copies from Copyright Review of compliance report Care Quality Commission The general public 03000 616161 / www.cqc.org.uk Copyright (2010) 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.

Care Quality Commission

Website Telephone Email address Postal address www.cqc.org.uk 03000 616161 enquiries@cqc.org.uk Care Quality Commission Citygate Gallowgate Newcastle upon Tyne NE1 4PA

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