Inspection on 19/07/06 for 21 Frome Court House

This inspection was carried out on 19th July 2006.

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 no outstanding requirements from the previous inspection report, but made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

21 Frome Court House 10/12/07

21 Frome Court House 23/07/07

21 Frome Court House 23/01/07

21 Frome Court House 11/07/05

21 Frome Court House 26/04/05

21 Frome Court House 21/10/04

21 Frome Court House 07/06/04

21 Frome Court House 26/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 21 Frome Court House Thornbury South Glos BS35 2BU Lead Inspector Paula Cordell Key Unannounced Inspection 19 and 20th July 2006 09:30 th 21 Frome Court House DS0000003401.V305179.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.V305179.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.V305179.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 admin@aspectsandmilestones.org.uk Aspects and Milestones Trust Ms Bibi Affroze Bahadoor Care Home 12 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (12) of places 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 12 persons aged 45-65 years with learning disabilities requiring personal care only May accommodate up to 12 persons aged 65 years and over with learning disabilities requiring personal care only 11th July 2005 Date of last inspection Brief Description of the Service: Frome Court House is a detached, former purpose-built childrens home located in a residential area of Thornbury. The home is operated by the Aspects and Milestones Trust and provides care and accommodation for 12 residents with a wide range of physical and learning disabilities. 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 are 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 £1029. 21 Frome Court House DS0000003401.V305179.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 key inspection. The purpose of the visit was to review progress made to the requirements from the inspection in July 2005 and to monitor the quality of the care provided to individuals living at Frome Court. The site visit was conducted over seven hours over a two-day period. An opportunity was taken to speak with four staff, the manager and to observe the residents in their home environment. There have been no additional visits to the home during the period between the two site visits. The home sent a pre-inspection questionnaire to the Commission for Social Care Inspection as part of this inspection process. In addition seven residents, two relatives and five professional questionnaires were received. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect residents’ well being and have been sending in copies of the monthly provider visits. This information assisted in the planning of the site visit. The inspection included an extensive tour of the home, reviewing safe practices and care documentation. Conversations with staff focused on their knowledge of the residents and the day-to-day running of the home. What the service does well: What has improved since the last inspection? The home now documents how residents spend their leisure time. Residents now benefit from a garden that is hazard free following the removal of the green house. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 6 Whilst the home has responded to the requirement relating to care planning in part and improvements have been made, this remains an outstanding requirement. The home now documents how residents spend their leisure time. The protection of residents has improved by ensuring that recruitment documentation is held in the home for the majority of staff, however this was not in place for most recently recruited member of staff. What they could do better: Residents must be confident that the home can meet their assessed care needs. Clear assessments of need that link into the home’s care plans must therefore be put in place. Residents must be confident that the home’s certificate reflects the categories of registration. Each resident must have a person-centred plan of care that describes their care needs including: personal, physical, emotional, psychological, spiritual and social. Residents must be confident that staffing levels are adequate to meet their social care needs. The home must be able to demonstrate through a paperwork audit that a thorough recruitment process has been undertaken that ensures the protection of residents. It is recommended that an investigation takes place in respect of the high staff turnover so as to develop a strategy to ensure staffing is maintained. Residents must be protected by a robust medication system that keeps them safe from harm. Residents must be protected by clear documentation on the decision process, which includes discussions with other appropriate people in relation to the use of restraint and equipment used to safeguard residents. The home must develop a quality audit system to monitor the care provision and ensure that documentation is reviewed. Staff would benefit from a process of reviewing their performance and a system for discussing their concerns. It is therefore recommended that formal supervision in accordance with the National Minimum Standards should take place at least six times yearly. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 7 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. 21 Frome Court House DS0000003401.V305179.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.V305179.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents have information available to them to make a decision to move to the home. There is a risk that the home could admit individuals that they are unable to support as there is no clear criteria for admission. The home is supporting residents with changing needs and these are not fully documented in the home’s assessment and plan of care. The home is operating out of their category of registration and an application must be submitted to include dementia. EVIDENCE: The home has a statement of purpose and a service user guide. Residents had contracts in place as seen at the last inspection. The home has admitted one individual since the last inspection. Whilst it was evident that the home was supporting the individual and liaising with the appropriate professionals, there was little documentation completed by the home in the form of an assessment or a care plan. There were significant letters from professionals guiding the staff. This information had not been transferred through the home’s care planning processes. The home was following the care plan that had been in place from the previous placement. It was evident from talking with staff and observation, that in parts this did not fully describe the changing care needs of the individual. The home must ensure 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 10 that a care plan is in place for new residents in accordance with National Minimum Standard and within 5 working days of taking up a placement. This remains an outstanding requirement. There were concerns voiced by the staff and the manager at the previous site visit that the needs of the residents due the ageing process, were more complex and were making demands on the staff group for specialist interventions. This remains the case. Since the last inspection the home has admitted an individual whose primary care need is because of dementia. The home is operating out of their conditions of registration. Frome Court is registered to provide personal care and accommodation to individuals over the age of 65 with a learning disability. On a positive note the team have had training relevant to the care needs of the individual including dementia care training and pressure area care. The statement of purpose lacked clarity on who the home could or could not support in relation to identifying specific care needs. The statement of purpose must detail the criteria for prospective residents to ensure that an appropriate placement is made, detailing the care needs the home can and cannot support. This must include an assessment on the present needs of existing residents to ensure that care needs can be met individually and collectively. Interviews with staff evidenced that the home was supporting individuals’ changing care needs even though there was a lack of documentation supporting this. Staff confirmed that the most recently admitted individual was settling in well. All staff consulted with had good insights into the care needs of the individual. 21 Frome Court House DS0000003401.V305179.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents cannot be confident that their assessed and changing care needs plus personal goals are being met due to the lack of documentation. Risk assessments were lacking in both content and review to fully demonstrate that residents are protected. Serious shortfalls in the documentation could lead to a resident coming to harm. EVIDENCE: Care plans were viewed for three residents. There was no consistency in the planning of care. Two of the care plans seen related to care from a previous placement. It was evident from reading letters and social services care plans that the individual’s needs had changed considerably since moving to the home. Care plans lacked detail to ensure a consistent approach. One individual had a person centred plan that was dated 2000. However it was clear that this had not been updated. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 12 Whilst there was valuable information in the care folders that could direct staff, this was from reading letters from professionals. Care plans did not look at the individual holistically; to demonstrate that a person centred approach to care was in place. However, from talking with staff it was evident that residents were well cared for in relation to their personal care needs. The home has started to review care documentation. However little progress has been made. The home had one box file containing information to enable staff to have a quick reference to the planning of the individual’s care. Two individuals plans of care were not in place. In addition one individual’s plan of care stated ‘see plan’. However a member of staff or the inspector could not find this. It was noted that only 8 folders were in place and the home supports 10 individuals. Not all staff were aware of the box file that only came to light as the inspector was leaving. Care planning is an outstanding requirement from the last inspection. A member of staff stated that they had little direction on what was expected of them in relation to the care documentation that must be in place. Staff were reviewing care on a monthly basis for two residents’ from files seen, whilst the third individual’s care had not been reviewed since April 2006. This further evidenced that there was no consistency within the team. The review was based on a model of activities of daily living and whilst there was evidence that the home was responding to changing care needs, this had not been formalised into a plan of care. A care plan would have enabled a full and structured review to take place guiding staff and ensuring consistency both in the review process and the delivery of care. Risk assessments were in place for some residents. Some were dated 2000 and had not been formally reviewed since 2004. There were some risk assessments for the use of equipment to aid manual handling or to ensure the individual’s safety. There were significant gaps, for example although risk assessments for the prevention of pressure area linked in with the plan of care, only one person had documentation for the use of bed sides. It was noted that at least three people had bedsides. This is a form of restraint and the decision process must be clearly documented and consent sought from the individual, the placing authority or an appropriate professional. Again this principle should be applied where a resident requires wheelchair straps. At the last inspection, the home was noted to have made some progress to the requirements relating to the planning of care. A person centred facilitator had visited the home to support the staff. However there was no evidence that this had moved forward in the last twelve months. It was recommended that the manager regularly audits the care documentation. Evidence was lacking and this remains a requirement. There was no evidence that the person responsible for the monthly provider visits had examined any of the care planning 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 13 processes. A system of auditing must be put in place to monitor any shortcomings. Staff interviewed demonstrated a positive approach and had a good knowledge of the individuals living in the home and had attended core training relevant to residents’ care needs. All staff spoken with during this inspection stated that they key role is meeting individuals’ personal care needs as the demands that are put on them are high due to the complexity of residents’ needs as they are now getting older. Age related needs of older residents include: increased hoisting, additional feeding, more hygiene needs, increased incontinence management and greater demands on staff for moving and handling. In addition the home is supporting individuals with dementia, which in addition is placing demands on the staff team. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Care staff are not meeting residents’ social care needs. External providers are in part meeting these. Access to the community is limited due to lack of staffing and staff that are competent to drive the mini bus. Residents have available to them a healthy diet. Concerns were raised on the day of the site visit about the support that is given to them. EVIDENCE: There was information that residents were having access to some leisure activities and external providers provided these. One resident attends a day centre three days a week, some receive aromatherapy and some self-fund their day care through an agency. There are concerns about the latter as to whether this should be included in the fees that individuals are paying. Whilst contracts stated activities were included aromatherapy was an additional cost. Residents were paying for their day care activities, which included trips out for a cup of tea. This must be included in the fees as detailed in the statement of purpose and the service user guide, as this should be a role of the staff team. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 15 Staff stated that there are a number of recording systems for activities including an activity record, the handover sheet, a small logbook and daily care records. Consideration should be taken to streamlining this. From reading this documentation it was evident that residents were not accessing the community with the care staff. In a period of four weeks only three residents had been out with staff. Some of the criticisms received during this site visit were of the home’s capacity for community links and social inclusion, as staff’s role is spent supporting individuals with their personal care. One resident requested to go out in the mini bus, to be told that this could only be accommodated two days later. This is not acceptable in light of the organisation’s and the home’s aims and objectives where social inclusion is at the forefront. It was evident from the records that equality in social activities was not apparent. For example some residents self funded and where residents could not afford this there was no structure for them to access the community with key workers or care staff. Residents have access to a mini bus. From discussions with staff it was clear that there are difficulties as presently the home only has one driver. This means that outings are limited to when this person is working. The manager stated that a further four staff at least will be completing the advanced driving test to enable them to drive the mini bus. This will be followed up at the next inspection. Information in care folders was lacking on the contacts that individuals have and how they are supported to maintain these with friends and family. Whilst documentation was lacking this contact was reviewed on a monthly basis. Staff stated that some of the residents have built good links with the church and some are supported to attend a social afternoon in Thornbury once a week where they meet up with friends. Two relative questionnaires were received. Both provided information that they were made welcome. One stated that they were involved in the planning of their relative’s care, and both stated they were kept informed of changes. Both completed questionnaires stated that they were satisfied with the overall provision of care. Respectful, positive interactions between staff and residents were noticeable throughout this inspection. Boundaries of personal privacy are well understood and bedrooms and bathrooms are only entered with permission. There was a good opportunity to discuss dietary arrangements with the cook on duty. A healthy, balanced and nutritious diet is offered. Residents are involved in planning of the menu. A dietician and speech therapist have been consulted and plans of care have been developed for specific individuals. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 16 On the day of the site visit, there were four staff on duty. Two staff were out with one resident and one resident was at the day centre. Two staff that remained were relief staff. It was noticeable during the lunch time there were insufficient staff to adequately support the residents. One staff member was assisting an individual with personal care, the telephone was constantly ringing and residents were left for short periods without staff support. One resident’s meal was in front of him without him being able to access it, another was using a knife instead of a fork. In discussions with staff at least three residents required physical support with feeding and others required supervision. Consideration should be taken to ensure adequate staffing, to explore options re the telephone and consider whether two sittings would be more sensitive to the needs of the residents. It was evident that the two bank staff were working extremely hard to meet residents care needs. During this period a permanent member of staff returned for a short period and was seen eating their lunch whilst the resident opposite had no way of accessing their meal. This is poor practice. The inspector was informed that they had only a short time for lunch before providing transport to a resident’s day placements. The manager was informed of this situation on the second day and in response stated the home has an answer machine and would address the other issues. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19,20,21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents’ personal and health care needs are being met. However, this would be further enhanced if plans of care were expanded. The home must be mindful that it is operating within its category of registration and not undertaking “nursing care or making clinical decisions”. Residents must be protected by safe medication systems ensuring medication is within the expiry date. EVIDENCE: As already mentioned in this report there was a lack of documentation to guide staff and ensure consistency. This is true in this standard area. However, it was evident that staff ensured that personal care and health care needs were being met. There was a record of personal care in the form of a tick chart given to each individual including when a bath was given, hair cut and other areas relating to personal care. This should be expanded to fully describe how the person would like to be supported, when and how often. Each resident has a personal care statement. However this did not detail how an individual would like to be supported but focused on good practice of the staff. It was difficult to determine how independent the residents were in this 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 18 area. Staff stated that all residents require some support with their personal care to varying degrees. Staff interviewed had a good understanding of residents’ care needs and it was a shame that this was not captured in the documentation held in the home. All staff, including the registered manager, commented on the increasing demands on the staff group for specialist interventions. Most of the tasks are increasing because the population of residents at the home is becoming older. The increase in personal care support and insufficient staff numbers has a detrimental affect on staff morale that impacts on the ability of residents to access the community and participate in social activities. Observation of staff showed that they were trying their best and working extremely hard within the limitations of the staffing accomplishment. The management of the home needs to be mindful of increasing nursing type tasks and the considerable stresses it puts on the staff group. For example, having criteria for filling the two vacancies in the home that balances the needs of the present group and the staffing accomplishment. Recording of medical and health input was seen to be of a good standard. Evidence of other professionals involved in care planning was excellent. A visiting physiotherapist stated that the team were supportive of the individual and were aware of their role and carried out the professional’s instructions. Feedback received from professionals was positive – comments included “always find the staff team friendly, approachable and they have the wellbeing and interest of the residents at the centre of the care provision”. A comment from a consultant psychiatrist stated that the home operates as a “nursing home at times and that there is a heavy burden of complex clinical care”. Records from placing authorities were viewed for individuals with the most complex needs. Whilst it was evident that nursing care tasks were undertaken by district nurses and community nurses from the learning disabilities team, the manager must be mindful that where care needs change residents must be reassessed by a competent professional to determine if the placement is appropriate, or whether a nursing care placement would be more suitable. One assessment stated: “fluxating complex health care needs” that presently could be met by the primary care team (GP and district nurses) whilst living in a care home, and that reassessment would take place in six months. Where this individual’s care needs change the home must instigate a reassessment sooner if nursing tasks are needed or care staff are making clinical decisions. None of the residents manage their own medication. Medication is monitored and altered in accordance with medical instructions. Records seen demonstrated that staff were administering and managing medication within the home’s guidelines. In all areas except four, medications were noted to have expired in accordance with the pharmaceutical guidelines. Three tubs of 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 19 cream were found in a bathroom outside of the expiry date of opening and one person’s eye drops were being used after the 28-day guideline. Staff were making a note of the date it was opened but not the expiry date. Fluid charts, weight charts and records of epileptic seizures are maintained for those residents for which it is appropriate. There were no risk assessments or care plans for two of residents who have the need for district nurses to treat pressure sores. The home was commended about the way it supported a resident before their death, at the last inspection. Since then the home has experienced a further death. It was evident that the utmost care and dedication had been given to both residents. It was noted that some staff have attended loss and bereavement training. What was clear from talking with staff was that the team supported each other and the residents during this unsettling period. One care file was noted to contain a pro-forma: “information in the event of my death”. However, this was not consistently applied to the other two files. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. 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 the service. Residents can be confident that they are protected by the home’s policies on protection and complaints. Staff have received training and had no hesitation in reporting concerns about practice. Residents are not being protected in relation to the use of restraint in the form of bedsides and wheelchair straps with clear decision processes being documented. EVIDENCE: The home’s record showed one complaint had been made in the last twelve months. There was good evidence that this had been responded to appropriately. Staff interviewed were clear about the organisation’s procedures and well informed about the role of the Commission for Social Care Inspection in the complaints process. Staff were aware of the protection of vulnerable adults, whistle blowing and complaints procedures and stated that these are discussed as part of the induction process and updated periodically. The policies were not viewed on this occasion. The home has a user-friendly complaints procedure. Good evidence was provided that the Trust systematically trains its entire staff group on protection of vulnerable adults. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 21 There was evidence that home is using restraint in the form of wheelchair straps, bedsides and the use of stair gates. There was a lack of documentation demonstrating the decision processes used or that other appropriate professionals, residents or their relatives had been consulted in their use. The home has clear financial policies and procedures to ensure that the residents and the home’s budget are protected. Finances were being checked at regular intervals by the care staff. The manager is the appointee for all the residents. All residents have their own bank accounts. Financial audits are completed at regular intervals by the Trust’s Financial Department. Two signatures support all expenditure and two named staff are required to make a withdrawal from a resident’s account. These safeguards are seen as good practice in protecting residents’ finances. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents have available to them a clean, homely and comfortable environment which is meeting their changing needs. Frome Court is maintained to a good standard ensuring the safety of the residents. EVIDENCE: Frome Court is a detached former purpose built children’s home located in a residential area of Thornbury. There are 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 three levels, the home offers single occupancy rooms for all residents. The home is comfortable, clean and free from odour. There are adequate bathrooms to meet residents’ care needs. This will be enhanced by further refurbishment to an upstairs shower room that will enable residents with physical needs to fully access this area. Sufficient space is provided and all areas were comfortably furnished. The manager stated that there is a plan for the lounge area to be redecorated during this financial year. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 23 The home has a large dining room, a sunroom, a large lounge and a smaller lounge. It was evident that residents could access all areas of the home. One resident stated that they use the smaller of the lounges to watch the football. There were board games, puzzles, videos and books available for residents. There is a large enclosed garden to the sides and rear. At the last site visit it was noted there was broken glass from the green house. This has since been removed and the area is now hazard free. There was a large gazebo in the garden to provide a pleasant shaded area for residents to sit. The home has a number of aids and adaptations to assist staff and enable the residents to be more independent. The home has good relationships with the local community learning disability team and there was good evidence that the home responded to the changing care needs of the residents, with the purchase of new equipment. The home has a lift to the second floor. All areas of the home were accessible to residents using wheelchairs. Evidence was provided that routine checks were completed on equipment used. Less evident was documentation in the form of a plan of care, of the equipment in use. It only became apparent when a tour was completed of the environment. For example one individual has an alarm on their bed to alert staff in the event of a seizure. No documentation was in place supporting this. Safety in the environment was paramount with all radiators and hot water pipes having covers, windows having restrictors and the water being controlled to a safe level. This is good practice. The home has a good refurbishment programme and repairs are responded to promptly. There is a large crack in the hallway and in the large lounge. The manager stated this is being closely monitored and as yet cause has not been determined. The home has had an environmental health inspection and it was evident that it has responded to the recommendations made and has been issued an award for their efforts. The home has laundry and sluice facilities that meet the care needs of the residents and is separate from the kitchen area. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Staffing is insufficient to meet the social care needs of the residents. An experienced staff team is aware of the support needs of the residents. Qualification and competence of the team is good. Staff would benefit from regular supervisions to improve support and direction. EVIDENCE: Staff spoken with during this inspection were aware of their roles in supporting residents in relation to personal care. Less clear was their meeting of residents’ social and emotional support needs. All staff stated that the focus of the care is the provision of personal care, as there is a lack of staff to support residents out in the community. One member of staff was asked why person centred plans have not been introduced in line with the Trust’s aims and objectives. The response was that the staff could not fulfil the person centred plan because of the lack of staffing. One member of staff stated that they felt that they had not been given clear directions in relation to the planning of care and just told to “get on with it”. This echoed the findings of the site visit in that care plans varied in their content and there was no consistency. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 25 The staff rota provided evidence that there were always four staff working in the morning, three in the afternoon, with two staff providing waking night cover. Because of the lack of good care planning, access to the community in accordance with the Statement of Purpose, the size of the home and the numbers and the complex care needs of the residents, staffing levels are insufficient. This has been described in previous sections of this report. Staffing arrangements have been problematic over a period of time as highlighted in previous reports. Whilst a number of core staff have worked in the home for a considerable time, there is a particularly high staff turnover. Since the last inspection seven staff have left. One member of staff stated that seventeen staff have left in two years and questioned why an investigation had not taken take place, as it is felt some have left due to lack of support and direction. The manager stated that she completes ‘leaver’ interviews and many of the staff left for personal reasons or new career opportunities. It is evident that the Trust has completed a recruitment initiative and employed three staff from overseas. It was also evident that two of the individuals still remain and from conversations with staff have settled in very well. Staff described positive working relationships that have been fostered both with the residents and the staff team. A new member of staff was spoken with during this site visit and described a good induction process, planned training and support networks within the team. A requirement was made at the last inspection that staffing recruitment information be held at the home. Whilst steps have been undertaken to complete this, a recently employed member of staff’s records were not in place even though they have been working in the home for the last two months. This remains an outstanding requirement. The manager described good recruitment procedures in ensuring the protection of the residents from receipt of an application to starting employment. Staff were protected by equal opportunities policies. There are presently three staff vacancies, which are being advertised. One of the posts has been filled and the new staff member is waiting for a completed criminal record check prior to taking up employment. Training records seen demonstrated that staff have access to relevant training to enable them to meet residents’ care needs. This included: induction, periodic updates in health and safety, to training relevant to the care needs of the residents including NVQ training in line with the Skills for Care Standards. Less apparent was training for the Trust’s bank staff. An opportunity was taken to speak with the two bank staff in relation to their ongoing training and periodic updates. Both staff stated that their training was 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 26 out of date in relation to food hygiene, manual handling and fire training, with no date arranged to remedy this. Staff spoken with during the inspection described different support mechanisms from staff meetings, to support from professionals and team members to formal supervision with a senior member of staff. The latter was not consistently in place for all staff. One member of staff had not received supervision since November ‘05 and another had not had supervision since February ‘06. Supervision records were not maintained in a satisfactory manner, for the manager to review and audit whether staff were receiving supervision at appropriate intervals in line with the National Minimum Standard and the Trust’s Policy. The manager stated that some of the staff keep their own records. The manager and the person in control must review this practice to enable an audit of performance. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. There is a lack of direction for staff in the management of care documentation. Residents and staff would benefit from support in this area and a system of auditing to ensure care documentation meets with the National Minimum Standards. Residents’ benefit from a safe place to live; however this would be enhanced if risk assessments were kept under review. EVIDENCE: Ms Bahadoor is the registered manager. She has been in post in excess of three years. Records showed her good attendance at training with periodic updates relating to management and care. Ms Bahadoor is in the process of completing an NVQ 4 in management. There can be no doubt of her commitment in providing a good service to the residents where the resident is the centre of the planning. However, there was a lack of auditing to ensure 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 28 that systems were in place: for example care planning or regular staff supervision. Staff felt supported in their roles and described a good team spirit. It was also evident that the increased demands from the changing needs of residents and the minimal staffing was having an impact on morale. Staff stated that they had voiced their concerns but no changes are made. It was evident that staff did not have direction in the documentation of care planning as described earlier in this report. Staff evidently had regular meetings as did the residents. Both provided evidence of an open approach where residents and staff were kept informed of changes in the home. Staff meetings clearly described the changing care needs of individuals, changes to staffing, environmental issues and other matters relating to running of a care home. Meetings included an element of training and professionals were invited to discuss chosen topics relating to the care needs of individuals living at Frome Court. This is good practice. In addition new and existing policies were discussed. The home has a business plan that focuses on recruitment, staff training and the environment. In addition the Trust completes quality assurance initiatives. Regulation 26 monthly provider meetings were taking place and copies were sent to the Commission for Social Care Inspection. There are a number of requirements relating to records including expanding on the care plans and ensuring recruitment records, including supervision records are held in the home and are accessible to the manager. Policies and procedures required by regulation and set out in Appendix 2 of the National Minimum Standards were in place. These were being regularly reviewed, as seen in the pre-inspection questionnaire and discussed at staff meetings and during the induction of new staff. There were good systems in place for ensuring that the home was a safe place to live and work. All records relating to fire, including ongoing training for permanent staff, were up to date and in order. Less apparent were regular reviews of risk assessments in respect of health and safety i.e. manual handling, fire and activities. Some of these were dated 2002 with no formal review. The fire risk assessment was not dated or signed. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 29 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 2 2 1 3 2 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 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 2 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 2 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x 2 2 2 3 3 2 x 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 30 No 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 Requirement Timescale for action 19/08/06 2. YA2 3. YA6 4. YA17 5. 6. YA20 YA18 The home must make an application to vary the condition of registration to include dementia – the home must be assured that they can meet the assessed care needs of a resident prior to admission. 5, The home must develop a clear criteria for potential residents, which is clearly described in the statement of purpose. 15 The home needs to ensure that service user plans are available for all residents. These must clearly describe how residents are to be supported in meeting their care needs including emotional, social, physical and psychological. These must be kept under review. (Outstanding since 01/11/05). 18 (1) (c), The home must ensure that there is adequate staffing during mealtimes – review organisation of the mealtime to ensure safety of residents. 13 (2) To ensure that medication remains within the expiry date. 15 (2) To develop a personal care DS0000003401.V305179.R01.S.doc 19/08/06 19/09/06 23/07/06 19/07/06 19/09/06 Page 31 21 Frome Court House Version 5.2 7. YA19 13 (4) Sch 3.3 (n) 13 (6) Sch 3.3 (p) 8. YA23 9. YA41 17 10. YA13 18 (1) (c) 11. 12. YA33 YA34 18 (1) (c) 17 Sch 4.6 statement for each individual detailing how they would like to be supported and by whom. To review all risk assessments. To develop a risk assessment and care plan for individuals in relation to pressure area care where relevant. To document the use of bedsides, the bed alarm, wheelchair straps and the stair gate as these are deemed as forms of restraint, seeking consent from the individual or their representative clearly documenting the decision process. To keep these under review. The home needs to ensure that records are updated and audited regularly. (Outstanding since 01/11/05) Staffing needs to be sufficient so that staff can support service users to participate in the local community. A suitable strategy is put in place to enable the home to be fully staffed. Staff employment records to be kept in the home as required by Schedule 4 of the Care Homes Regulations 2001. (Outstanding since 01/11/06) 19/08/06 19/08/06 19/09/06 23/07/06 19/09/06 19/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000003401.V305179.R01.S.doc Version 5.2 Page 32 21 Frome Court House 1. 2. 3. YA39 YA13 YA36 That an investigation is completed into the high staff turnover and the findings fed back to the CSCI detailing strategies for reducing staff turnover. To review how and where staff are recording similar information (for example leisure activities) to avoid duplication. All staff to be supervised at least six times per year and the records available for audit purposes by the manager and the provider. 21 Frome Court House DS0000003401.V305179.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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.V305179.R01.S.doc Version 5.2 Page 34 - 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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