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Inspection on 10/12/07 for 21 Frome Court House

Also see our care home review for 21 Frome Court House for more information

This inspection was carried out on 10th December 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Frome Court is a clean, homely and well cared for environment. It is of a generous size providing ample space in both private as well as public spaces. Frome Court has supported individuals sensitively through periods of illness and death.

What has improved since the last inspection?

There have been a number of outstanding requirements and the Commission for Social Care Inspection served a Statutory Notice as a result of the visit in July 2007. The home has demonstrated compliance in relation to the poor care planning processes and the lack of meaningful activities for the individuals that live at 21 Frome Court.Individuals have a contract of care that details a breakdown of what the fees include and what is not included. Individuals have benefited from a review of the care planning processes. These have been expanded to include how the staff will meet their social, psychological and emotional wellbeing. Individuals have available to them meaningful social occupation both in the home and the community. Where individuals are funding the vehicle this has now been clearly documented in their plan of care to ensure an open and transparent approach and one that is fair. Individuals are assured their privacy is respected and staff treat them in a dignified and respectful manner. Individuals are protected by clear documentation on the decision-making process, (which includes discussions with other appropriate people) in relation to the use of restraint and equipment used to safeguard individuals. Individuals have benefited from a staffing review to ensure that there are sufficient staff to meet the needs of the people living in the home.

What the care home could do better:

The home should ensure that the where requirements have been met, that the work in progress continues. This should include building on the care plans that are in place and keeping these under review and ensuring that individuals continue to be supported with meaningful occupation. Individuals must be reassured that the admission process is completed to ensure that the home can meet the individual`s care needs. A competent person and the involvement of professionals where relevant must complete this. New people moving to the home must be assured that they have a current care plan to guide staff, ensuring a consistent approach. An individual who has recently moved to the home would benefit from their bedroom being personalised with their pictures, artwork and a lampshade. Suitable storage should be in place for continence aids, suitcases etc ensuring bedrooms are more homely. The woodwork in the hallway on the ground floor would benefit from being painted.Individuals must be assured that competent and trained staff support them. Training records should be maintained to fully capture the training that is available to staff. Safeguarding Adult training should be periodically updated for staff.

CARE HOME ADULTS 18-65 21 Frome Court House Thornbury South Glos BS35 2BU Lead Inspector Paula Cordell Unannounced Inspection 10th December 2007 09:45 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 21 Frome Court House Address Thornbury South Glos BS35 2BU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01454 281445 0117 9709301 max@apectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Mrs Josie Bolt Care Home 12 Category(ies) of Dementia (1), Learning disability (12), Learning registration, with number disability over 65 years of age (12) of places 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 12 persons aged over 45 years with learning disabilities requiring personal care only To accommodate one named person with dementia, will revert back to original registration when that person leaves 23rd July 2007 Date of last inspection Brief Description of the Service: Frome Court House is a detached building located in a residential area of Thornbury. The home is operated by the Aspects and Milestones Trust and provides care and accommodation for 12 people who use the service with a wide range of physical and learning disabilities. Mrs Josie Bolt is the registered manager. Arranged over three levels the home offers single occupancy rooms for all service users. The home is comfortable, provides plenty of space and is well furnished. There is a large enclosed garden to the sides and rear. There is a range of shops within walking distance and Thornbury boasts a wide choice of other services such as medical, further education, places of worship and community activities. The Fees at the time of publishing this report range from £975 to £1066 per week. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit as part of the key inspection process. The purpose of the visit was to review the requirements and recommendations from the visit in July 2007. In addition to monitoring the quality of the care provided to the individuals living at Frome Court. There has been one visit to the home conducted in November 2007. The purpose of this visit was to review the progress to the Statutory Enforcement Notice that was served in respect of poor care planning processes, and the lack of social occupation for the individuals living in Frome Court. The home has demonstrated compliance, as seen at this visit and the visit in November. The visit was conducted over five hours. A sample group of people’s care was looked at, along with an extensive tour of the home. This provided an opportunity to meet with people living in the home and the staff that were supporting them. In addition various records were looked examined, which must be in place in accordance with the Care Homes Regulations. The home has been forwarding copies of the Regulation 26 monthly provider visits and incidents that affect the wellbeing of the individuals in respect of Regulation 37. These along with the completed surveys from relatives (2), professionals (7) and people who use the service (3) were used to plan the inspection process. What the service does well: What has improved since the last inspection? There have been a number of outstanding requirements and the Commission for Social Care Inspection served a Statutory Notice as a result of the visit in July 2007. The home has demonstrated compliance in relation to the poor care planning processes and the lack of meaningful activities for the individuals that live at 21 Frome Court. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 6 Individuals have a contract of care that details a breakdown of what the fees include and what is not included. Individuals have benefited from a review of the care planning processes. These have been expanded to include how the staff will meet their social, psychological and emotional wellbeing. Individuals have available to them meaningful social occupation both in the home and the community. Where individuals are funding the vehicle this has now been clearly documented in their plan of care to ensure an open and transparent approach and one that is fair. Individuals are assured their privacy is respected and staff treat them in a dignified and respectful manner. Individuals are protected by clear documentation on the decision-making process, (which includes discussions with other appropriate people) in relation to the use of restraint and equipment used to safeguard individuals. Individuals have benefited from a staffing review to ensure that there are sufficient staff to meet the needs of the people living in the home. What they could do better: The home should ensure that the where requirements have been met, that the work in progress continues. This should include building on the care plans that are in place and keeping these under review and ensuring that individuals continue to be supported with meaningful occupation. Individuals must be reassured that the admission process is completed to ensure that the home can meet the individual’s care needs. A competent person and the involvement of professionals where relevant must complete this. New people moving to the home must be assured that they have a current care plan to guide staff, ensuring a consistent approach. An individual who has recently moved to the home would benefit from their bedroom being personalised with their pictures, artwork and a lampshade. Suitable storage should be in place for continence aids, suitcases etc ensuring bedrooms are more homely. The woodwork in the hallway on the ground floor would benefit from being painted. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 7 Individuals must be assured that competent and trained staff support them. Training records should be maintained to fully capture the training that is available to staff. Safeguarding Adult training should be periodically updated for staff. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been some improvements in relation to ensuring that individuals assessed care needs can be met whilst living at 21 Frome Court and that documentation is in place to fully describe the service provided. Whilst the home has developed a criteria for admission there are still concerns that the home is still admitting people not within the category of registration. The lack of documentation in place to support how the home has assessed the care needs of people moving to the home could mean that the placements are not suitable to meet the assessed care and changing care needs of the individuals. EVIDENCE: The home has a statement of purpose and a service user guide. These have recently been reviewed and updated and meets with the Care Homes Regulations and the National Minimum Standards. The home has a criteria of admission and a procedure to follow in the event of a vacancy occurring in the home. Previous visits have raised concerns that the home has offered placements to individuals with complex care needs, and 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 10 some individuals have needed nursing care. Frome Court is a care home to provide personal care only. Some of those individuals have moved onto more appropriate placements. It was noted that social service’s assessments and care plans for three of the individuals mentioned nursing care. One of the individuals is funded via “Continuing healthcare funding” and a visiting professional supporting this person confirmed that they were looking for a more suitable placement, which provides nursing care. Two of the individuals have recently been admitted to Frome Court from homes within the organisation. It was identified that previous placements were no longer suitable due to changing care needs. As seen in the Social Services plan of care, the Registered Managers from the previous placements both highlighted that a nursing care placement would be required. However this was not clear from Social Service’s documentation whether this had been fully explored or whether an appropriate professional had completed the assessment relating to health care. There was no documentation in place to determine whether the home had completed a comprehensive assessment relating to the health care needs of the individuals. For one person who had recently moved to the home it was noted that much of the care plan documentation had been written by the previous placement and not by the staff from Frome Court. Whilst some of this may still be relevant some of the risk assessments related to the previous home. Staff stated that the new individuals were settling in well, and prior to agreeing to a placement they had visited on a regular basis to ensure the home was appropriate. Relatives had been encouraged to visit the home prior to the move as seen in care documentation. Contracts were viewed for three of the individuals. It was noted for one of these individuals that it was not fully completed in relation to the fees and any extras the person has to pay. This was in respect of the last person to move to the home. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements have been made to ensure that individuals have a care plan that is meeting their assessed and changing needs. The home is developing and building on the risk assessments to ensure that individuals safety is assured. EVIDENCE: Care plans have been expanded considerably since the last visit to the home. A person centred planning facilitator is assisting the staff with the reviews and development of the care plans. A member of staff stated that in addition staff are receiving training on care planning and some value based training. The home has demonstrated compliance to the Statutory Notice in respect of the home’s care planning processes. This will be monitored on subsequent visits to ensure that the care planning processes are embedded in practice. Individuals living in the home are involved in the planning of the care, which includes where possible, seeking their views. Staff stated that where 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 12 individuals are unable to communicate, staff would continually assess and review how the plan of care is being delivered to ensure that it is appropriate to the individual. From talking with staff it was evident that they had a good understanding of the needs of the individuals and how they communicate. Each person has a profile on how the individual communicates. This has been developed since the last visit. The care plans seen were person centred and covered all aspects of the care provision including physical, emotional, social, health and psychological. Staff stated that further work is being undertaken on the care plans. All areas identified during the last visit to the home have been addressed. Each person had a key worker a named member of staff to support them. Part of the key worker’s role was to complete a monthly review. Areas included health, personal care, mobility, and contact with relatives and pertinent information to the individual. It was evident that these would inform the six monthly review and address any issues by devising or reviewing the original care plan. This is good practice. The home has recently admitted an individual from another Aspects and Milestones’ home. This person had a comprehensive care plan, which included pictures and was written in plain English. However the plan was from the previous placement. There was no evidence that the staff at Frome Court had reviewed the documentation to ensure that it remained appropriate. Some of the written documentation talked about people from the previous placement and the use of stairs (this person now resides on the ground floor). These must be kept under review to ensure it is appropriate. In addition it was noted that the documentation was not dated and signed in parts. Risk assessments have been expanded and covered a wide range of activities in the home. These had been kept under review except for the person mentioned previously. Concerns were raised at the last visit in respect of ensuring conversations of a confidential nature were not discussed in the communal areas of the home. Staff stated that this had been discussed with individuals and the table in the lounge has been removed to address the issue of staff congregating in this area. It was evident that the home had addressed the previous requirement. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are benefiting from the increased opportunities to access the community and participate in meaningful activities. Individuals are supported to maintain contact with relatives. Individuals are having a healthy and varied diet. EVIDENCE: Individuals have available to them a structured day care plan. Activities are varied to suit the individual. Staff stated that the individuals are being supported to access the community on a more regular basis. On the day of the visit one individual was being supported to go out for the day shopping with their key worker, another person was supported to go for a health care appointment and a cup of coffee with a member of staff. In addition, a day care worker was supporting two other people to go out in the local community. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 14 Care records demonstrated that individuals were being supported to go out more frequently than on previous visits to the home. The home has demonstrated compliance to a Statutory Notice in respect of activities. Improvement must continue in relation to ensuring that individuals have available to them meaningful social and leisure opportunities. Staff stated that all individuals would have an opportunity to go Christmas shopping and out for a Christmas meal with their key worker. One of the individuals is being supported by their key worker to go out with relatives for a Christmas Meal. Staff stated that all individuals are enabled and supported to access the community. For one person this has been made easier now that they have an appropriate wheelchair. Daily records demonstrated that there was a balance of individuals going out and activities undertaken in the home. An aroma therapist visits on a weekly basis. Staff stated that the individuals find this relaxing. Individuals are supported to go to church on a regular basis. This was confirmed in conversation with one of the people living in the home. From conversations with staff it was evident that individuals spiritual needs would be met. This was included in the care documentation. Individuals have access to a mini bus. The individuals contribute to the running costs. This is clearly recorded in the contract of care for two of the three contracts seen. From reading care documentation and the completed surveys from relatives it was evident that links were maintained. Relatives stated that they were kept informed of changes to the care and informed of important events. Menus were viewed and demonstrated that individuals have available to them a healthy and varied diet. The home employs a cook five days a week, with care staff preparing food at the weekends. One person stated that the food was good. The lunchtime was unrushed and individuals were supported sensitively. From records it was evident that individuals were offered alternatives to the menu and they could choose where to take their meal. This was observed on the day of the visit. Documentation was in place describing the support needs of the individuals and any specialised diets including preferences. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual’s personal and health care needs are being met. Individuals are protected by robust procedures in safe handling of medication. EVIDENCE: Care plans have been expanded. Clear directions are in place in relation to the support that is required for individuals in respect of their personal and health care. Staff were knowledgeable about the contents of the care plans. Daily records were maintained in relation to personal care and who supported the individual. This is good practice. Care plans are in place in relation to pressure area care. Daily records were being maintained on what action has been taken to prevent pressure sores including visits from the district nurse. Training records provided evidence that some of the staff have attended training on pressure area care. Fluid charts, weight charts and records of epileptic seizures are maintained for those individuals it is appropriate for. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 16 Individuals are supported to attend health appointments. This includes routine visits to the dentist, opticians and visits from the chiropodist. Recording of medical and health input was seen to be of a good standard. Evident of other professionals involved in the care planning was good. Staff stated that good links have been built with the local Community Learning Disability Team including the psychiatrist. It was evident that the individuals had complex health care needs including epilepsy, mental health, diabetes, dementia, eating difficulties and skin conditions. Staff were knowledgeable and aware of the needs of the individuals. Staff training records demonstrated that some of the staff have attended training in these areas. However, this was not consistent for all team members. In relation to the staff training it was noted that staff have completed training in rectal diazepam and a member of staff stated that the manager plans the duty rota to ensure that someone with this training is always working in the home. Training in relation to supporting individuals with mental health was less apparent. Feedback from professionals was generally positive. However, comments included there is a high staff turnover, which could impact on how care is delivered. One professional stated that the staff do not have the appropriate training for example rectal diazepam administration, supporting individuals that challenge or mental health. A concern was raised that the local Community Learning Disability Team are not involved in the assessment stage prior to individuals moving to the home. Positive comments from some of the professionals included staff are knowledgeable, show genuine warmth and affection and are responsive to the advice of the professionals, staff work in a person centred way and good personal care. Medication was stored appropriately and the documentation was up to date and in good order. Policies and procedures were in place as seen at a previous visit. Staff that administer medication have attended training with the local pharmacy and the manager routinely checks their competence. The home has a policy on death and dying and individuals last wishes are recorded in the plan of care. A number of staff have attended bereavement and loss and care of the older person training. Previous visits have evidenced that the home has supported individuals sensitively and with utmost care during the last stages of life leading up to the person’s death. Professionals have echoed this in the past. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals are protected from harm and their concerns listened to. However, this would be enhanced if the outcome of complaints were recorded. EVIDENCE: The home has a complaints procedure that is available in a pictorial format. However, not all individuals can verbalise their concerns. Staff on duty during the visit described how individuals communicated using non-verbal communication. It was evident that the staff had built good relationships with the people living in Frome Court. Further more it was noted that care plans included how individuals communicate. This was called a communication dictionary. This is good practice. The home maintains a record of complaints. There has been one complaint relating to a meal. An individual who was staying in the home for a short period of time raised this complaint. Whilst it was clear from talking with staff that this was addressed at the time of the complaint. This was not captured in the home’s complaint book. Evidence at this and the last visit was that the staff in the home had a good awareness of what constitutes abuse, whistle blowing and the procedures to follow. Training records provided evidence that staff have attended training in safeguarding adults from abuse. Some of the staff would benefit from this being updated, as they have not attended this training since 2004. It was confusing reviewing the training records for staff as it was noted that three 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 18 staff had not attended training on abuse. However, from speaking with staff it was clear that the three staff no longer work for the organisation. Good practice would be to archive these records. Copies of the General Social Care Council’s Code of Conduct and the local authorities policy on safeguarding adults was in place as seen at the last visit to the home. This ensures that safe working practice. A member of staff stated that the only form of restraint in use in the home is the use of bedsides and wheel chair lap straps to ensure the individuals safety. Clear records were maintained in relation to the above, with the decision process clearly being recorded. Professionals are involved in the decision process. The home has demonstrated compliance to a previous requirement. Finances were checked for three individuals. Records corresponded with amounts held in the home. Two signatures supported the expenditure. Daily checks are completed on the finances by the staff and during the monthly provider visits in respect of Regulation 26. In addition the organisations financial department complete periodic audits. Individuals have their own bank accounts and good records were maintained of all expenditure. Financial procedures are in place but were not seen on this occasion. These demonstrated good financial procedures are in place to ensure that individual’s money is being protected. Previous visits have highlighted that two of the individuals are paying large sums of money for day care. This has since stopped. This has been subject to a safeguarding adults strategy and the organisation has met with the three unitary authorities. The organisation is in the process of devising a protocol to assist with the decision process where individuals are paying large sums of money for their day care. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 21 Frome Court provides a homely and safe place to live, which meets the needs of the people living there. EVIDENCE: 21 Frome Court is a detached property in a residential area of Thornbury. There is a wide range of shops within walking distance and Thornbury boasts a good choice of other services such as medical, further education, places of worship and community activities. Arranged over two levels the home offers individuals their own bedroom. The home is comfortable, clean and free from odour. A lift is in place to enable access to the first floor. Certificates were seen demonstrating that the lift is serviced at regular intervals. The environment is suitable for the individuals presently living at Frome Court. Evidence was provided that aids and adaptations are in place and checked at 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 20 regular intervals. Corridors and doors are suitable for people who use a wheelchair. There is level access throughout home. Since the last visit the home has completed some redecoration to vacate rooms. As noted at the last visit, it was noted that woodwork and walls in the hallway could benefit from being painted. This remains. It was seen that in some of the bedrooms continence aids, gloves and plastic washbowls were apparent. These did detract from the homely feel of the home and whilst it is acknowledged that these are required to ensure safety of individuals and staff in relation to cross infection. It would be recommended that more discreet storage could be considered. Some improvements have been noted in this area with blanket boxes being purchased for some rooms. In two of the bedrooms empty suitcases were stored on the top of the wardrobe again this detracts from the homely appearance of some of the bedrooms. It was noted that one person who has been in the home in excess of a month and the individual’s artwork, pictures and notice board had not been put on to the walls. There was no lampshade, which again detracted from what could be a pleasant area. Staff were not aware when this would be completed and it had not been recorded in the home’s record of repairs. Safety in the environment is paramount. All radiators and hot water pipes had covers, windows had restrictors and the water was being controlled to a safe level. This is good practice. The home was inspected by the local Council’s Environmental Health Service in August 2007 and has won a four star rating. This was displayed in the entrance to the home. Evidence was provided that staff were continuing to ensure that this was maintained. Good records were seen of food, fridge and freezer temperatures and checks on the cleanliness of the kitchen included risk assessments. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staff support the individuals living at 21 Frome Court. Staff are knowledgeable about the needs of the individuals living in the home. However, there is a lack of ongoing training on the care needs of the individuals, which would enhance the skills of the team to ensure that a quality service is being provided. Communication between the team could be enhanced if meetings were more frequent. EVIDENCE: The home is being staffed in accordance with the statement of purpose. There are four staff working in the morning, three in the afternoon and two staff providing waking night cover. The manager and the senior support worker are supernumerary. This is adequate for the seven people presently living at Frome Court. This must be kept under review, as new people move to the home or as needs of the existing people change. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 22 The home has demonstrated compliance to a previous requirement to review the staffing. A letter from the provider has given reassurances that the staffing will continue to increase in order to match the needs of the people living in the home. A domestic and a cook are employed to assist with the smooth running of the home enabling the care staff to support the people living at 21 Frome Court. Concerns in the past have been raised in respect of the heavy reliance on bank staff working in the home. Staff stated that the manager has worked hard to recruit to the vacant staff positions. There are still five staff vacant posts, which the manager is recruiting to. From talking with staff it was evident that the home tries to use a core group of bank people to offer the individuals continuity. The manager was not present during the visit, so documentation was not seen to demonstrate a thorough recruitment had taken place. Concerns were raised at the last visit that some of the information was held at the Trust’s headquarters and was not forwarded to the home prior the person commencing in post. However, during the previous visit the manager was aware that these checks had to be in place prior to a member of staff starting employment in the home. This will be followed up at subsequent visits. Training records were viewed for a random group of staff. Three staff no longer work in the home but their records remain on file, which was confusing. Three staff that are still working in the home have had no training according to their training record since Nov 05, September 2000 and July 2005. One member of staff had two training records. Training records could be better organised ensuring that it fully captures training undertaken. Whilst it was evident from certificates that staff were completing a rolling programme of health and safety training. It was less apparent that staff were attending training relevant to the needs of the people living in the home. This should include epilepsy, mental health, supporting the older person, supporting individuals that challenge, diabetes, pressure area care and other health issues pertinent to the individuals to name a few as an example. Staff would benefit from updates in specialist feeding and the use of rectal diazepam. For some staff it was noted from the training records that they have not had an update. A member of staff stated that the manager ensures that there is always a member on staff with this training. The National Minimum Standard states that staff should attend at least five days training per annum and pro-rata for part-time staff. Each member of staff should have an appraisal of their work, which identifies a training plan for each person and the team collectively. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 23 A member of staff stated that two staff are presently in the process of completing a National Vocational Award (NVQ) and one person has completed this prior to being employed at Frome Court. The home must develop a plan to ensure that 50 of the workforce have an NVQ in accordance with the government targets. At the last visit to the home it was noted that staff meetings were occurring on a regular basis, demonstrating that there was an open and transparent service being provided. However, this was less apparent on this occasion. There has been a gap of three months from the meeting in July to the last meeting, which was October 2007. A member of staff stated that there was a meeting in November but was unable to locate the minutes. Staff were knowledgeable about the individuals living in the home and positive about the changes that were taking place under the new manager. It was evident they were feeling part of the changes. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals continue to benefit from a good management structure being in place. Individuals can be confident that their safety is paramount. Building on the quality assurance initiatives will further benefit the people living at 21 Frome Court. EVIDENCE: Since the last visit Mrs Bolt has successfully become the registered manager. She has been in post for twelve months. Feedback from both permanent and bank staff and visiting professionals via the surveys and during conversations was positive about the management of the home. Team members indicated that the atmosphere and morale in the 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 25 home was good. Staff confirmed that they were involved in making decisions and felt included. The home has a quality assurance tool that is being completed. The manager has developed an action plan to address the shortfalls. This will be followed up at the next visit to the home. The action plan focuses on recruitment of staff, staff training, care planning and the environment. The provider is completing monthly visits in respect of Regulation 26 to monitor the quality of the service being provided. Copies of these are being sent to the Commission for Social Care Inspection. It is evident that the provider is ensuring that the home is complying with the previous Statutory Notices that were served in relation to care planning and activities. The monthly provider visits have included improvements and further action that the home must complete relating to these two areas. There were good systems to ensure the safety of the individuals living in the home. This included maintaining the fire logbook, which demonstrated that fire equipment had been routinely checked, that staff participate in fire drills and training. However, a member of staff stated that further fire training was planned for December 2007 as it was noted that three staff have not had annual training in the last thirteen months. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 25 26 27 28 29 30 2 3 X 2 3 3 3 2 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 x 15 3 16 3 17 STAFFING Standard No Score 31 X 32 x 33 2 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 DS0000003401.V351672.R01.S.doc 3 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 21 Frome Court House Score 3 3 3 3 3 X 3 X X 3 X Version 5.2 Page 27 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 (1) Requirement Ensure that the needs of the individual have been assessed by a competent person prior to admission, that this is kept under review and revised when it is necessary to do so having regard to any change of circumstances. Outstanding since 25/08/07 To review the care plans and risk assessments of the most recent person to ensure still current and relevant. Develop an action plan that will be monitored by the Commission for Social Care Inspection on how the home will ensure 50 of the workforce have a National Vocational Award. A training plan to be devised for all staff individually and collectively, which is relevant to the needs of the people living in the home. (See section in main body of report on training) For staff to complete training in mental health and supporting individuals that challenge. DS0000003401.V351672.R01.S.doc Timescale for action 10/02/08 2. YA6 15 (1) 10/01/08 3. YA32 18 (1) (c) 10/02/08 3. YA35 18 (1) (c) 10/03/08 4. YA35 18 (1) (c) 10/03/08 21 Frome Court House Version 5.2 Page 28 5. YA22 22 6. YA34 17 (2) Sch 4.6 Ensure that the record of complaint includes the outcome and the action taken to address the concern. Ensure information relating to staff as detailed in schedule 4.6 is held in the home. (Not inspected previous date for compliance 25/08/07) 10/01/08 10/12/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA6 YA26 YA24 YA24 YA35 YA23 Good Practice Recommendations Ensure that all care documentation is dated and signed. For the home to put up the pictures, artwork, lampshade and notice board of the person who most recently moved to the home. To consider discreet storage for continence aids and gloves to promote a more homely environment. (Outstanding since July 2007) Decorate hallway. (Outstanding since July 2007) For staff training records to be kept up to date and give sufficient detail on the courses that they have attended. (Outstanding since July 2007) For staff to have periodic updates in safeguarding adults at least every two to three years. 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 21 Frome Court House DS0000003401.V351672.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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