Inspection on 23/01/07 for 21 Frome Court House

This inspection was carried out on 23rd January 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 9 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 19/07/06

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 23rd January 2007 09:30 21 Frome Court House DS0000003401.V328467.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.V328467.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.V328467.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 To be appointed 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.V328467.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 19th July 2006 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 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 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 £1029 per week. 21 Frome Court House DS0000003401.V328467.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 the requirements and recommendations from the inspection in August 2006 and to monitor the quality of the care provided to the residents living at Frome Court. The home has received no additional visits during this period. The Commission for Social Care Inspection has received an anonymous complaint, which the provider has investigated and taken appropriate action in respect of the concerns raised. The home has been keeping the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals living at Frome Court House and the provider has sent monthly appraisals of the service. This information was used to plan the inspection process. The inspection was conducted over a total of 5.5 hours. The inspector had an opportunity to meet with a number of the residents, three members of staff and a senior carer. The home presently has three vacancies. The methodology used during this inspection included viewing care records and other relevant documents required of a care home and a tour of the home. The inspector received responses from two visiting professionals and two relatives to questionnaires sent prior to the inspection. A pre-inspection questionnaire was completed by the acting manager was also received and this information assisted with the planning of the site visit. What the service 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. There is a good rolling programme of training based on the care needs of the residents. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There are significant outstanding requirements from the last inspection, which are of a cause for concern. Further non-compliance could lead to enforcement action being taken. However, in light of the change of management and evidence that was provided that the home was working towards these outstanding requirements no formal action will be taken at this stage. The Commission for Social Care Inspection will monitor progress closely. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 7 The home must ensure that they can demonstrate through a thorough assessment process that they can meet the care needs of the residents individually and collectively. This remains an outstanding requirement. The home must develop clear criteria on the care needs of prospective residents detailing who the home can and cannot support. This must be within the category of registration. In addition, this must be balanced with the care needs of the existing residents in relation to dependency levels. This remains an outstanding requirement. Prospective residents must have up to date information available to them about the service provided at Frome Court including a statement of purpose and a contract, which includes the terms and conditions and full information about the fees. Each resident must have a person-centred plan of care that describes their changing care needs including: personal, physical, emotional, psychological, spiritual and social. This remains an outstanding requirement. Residents must be confident that staffing levels are adequate to meet their social care needs. This remains an outstanding requirement. Residents who have or who are prone to pressure sores must have a clear plan of care to ensure a consistent approach demonstrating how the staff are supporting the individual. This remains an outstanding requirement. Relatives and significant others should have available to them the home’s complaint procedure. Residents must be 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 residents. This in part remains an outstanding requirement. 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.V328467.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.V328467.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. Commissioners and prospective residents have minimal information available to them to make a decision to move to the home. There remains a risk that the home could admit individuals that they are unable to support. The home must ensure that they can meet residents care needs individually and collectively. EVIDENCE: The home has a statement of purpose and a service user guide. Information did not fully capture the service that was offered to residents living in Frome Court. In addition this requires updating to include the change of management in the home. The home failed to describe the daily staffing of the home. Contracts were in place for residents. However, it was noted that the resident recently admitted to the home had not signed the contract, or their representative or the manager of the home. It was difficult to determine whether the individual had seen the contract due to limited communication of the individual. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 10 In addition the Care Homes Regulations have been amended (September 2006) and now state that the provider must provide information relating to the full fees payable, giving a breakdown on who pays what part of the fee and when. Two staff consulted during the visit stated that there have been some concerns in relation to the most recently admitted person and whether the home is suitable. It was evident that this was being discussed with the individual’s social worker and an appropriate placement is being sought. Staff stated it is not clear whether this person has a learning disability although the Community Learning Disability Team has placed them. There was minimal documentation in place to evidence that a thorough assessment of needs had been undertaken by the home. However, the assessment and the care plan from the placing authority were in place. Concerns were raised at the last inspection on the lack of admission criteria and a requirement was made to ensure that this is clearly documented in the statement of purpose and made available for prospective residents, relatives and placing authorities. The senior carer stated that the temporary manager is in the process of developing this documentation. This requirement remains. From the last site visit, it was evident that the residents care needs were changing due to the ageing process, which were more complex in relation to their health and were making demands on the staff group in relation to personal care evidenced further by the lack of social opportunities offered to residents. This has changed slightly but one resident was in hospital and the home has three vacancies due to age related deaths. A visiting professional stated that the atmosphere is more relaxed in the home and staff are spending more time with residents in the lounge areas. This will be discussed further in this report. In light of the three vacancies, the home must ensure that the statement of purpose details the care needs of prospective residents that 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 taken into consideration the dependency levels of each resident in the home and the staffing levels. A visiting health professional raised concerns that residents are admitted to the home who have complex care needs that exceed the staffing skills and in their professional opinion nursing staff should be employed to manage complex epilepsy, severe dementia, PEG feeds and the management of challenging behaviour. Where residents have complex health care needs these individuals should be reassessed by the appropriate professional (health) to determine whether the home continues to a care home without nursing. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 11 Since the last inspection the home has successfully made an application to include one named individual with dementia to the certificate of registration. Staff have received training in dementia as seen at the last inspection. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 12 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, 8 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are striving to provide an individualised package of care. Care plans did not fully capture how the home was meeting the changing care needs of the residents. Residents are at risk due to poor documentation. EVIDENCE: There has been some improvement in the care planning processes for residents. Each resident now has a file containing pertinent information relating to the day-to-day care. These have been implemented within the last five months in response to a requirement from the visit in August 2006. However, from one of the three care plans seen it was evident that the care plan did not capture the changing needs of the individual. It was evident from 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 13 daily records and conversations with staff that the staff had been responsive to the changing care needs but the care plan had not been updated. Care planning remains an outstanding requirement from the last inspection. The senior carer stated that the acting manager has been liaising with an external facilitator to support the home with person centred planning. This will be followed up at the next inspection. Reviews of case tracked plans were monthly up until November for the three residents seen. Staff stated that much of the day is taking up with the care of the residents and there is little time to spend doing paperwork. But this is changing under the direction of the new manager. The review documentation was based on the 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 a consistency both in the review process and the delivery of care. It was evident from talking with staff and reading the daily records that they strive to provide an individual package of care and were knowledgeable about the care needs of the residents living in the home. Staff spoken with stated that their key role is meeting individual’s personal care needs, as the demands that are put on them are high due to the complexity of resident’s needs, as they get older. Age related needs of older residents included increased hoisting, additional feeding, more hygiene needs, increase in the management of continence issues and greater demands on staff related to moving and handling. Further the home is supporting individuals with dementia, which is placing additional demands on the staff team. Risk assessments were in place and covered a spectrum of activities both in the home and the community. The home has installed a keypad system to the front door in respect of one individual. This must be clearly documented in the statement of purpose, as this is a restriction imposed on all residents and link with the individuals risk assessment and kept under review. As of April a risk assessment and determination will be required under the Mental Capacity Act. There has been an improvement in the documentation of risk assessments in the home. Documentation included the use of wheelchair straps and bed rails, however this did not evidence consent from the individual, their representative or an appropriate professional. From conversations with staff it was evident that two individuals had pressure sores, there was no care plan or risk assessment guiding staff on the monitoring and minimising the risks. However, staff had involved appropriate professionals. Evidence was provided via the daily records that the staff were monitoring and taking action to minimise pressure sores. Where residents are of risk of pressure sores a risk assessment and care plan must be in place. A further requirement was made. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 14 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 15 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. Care staff are not meeting the social care needs of the residents. Access to the community is limited due to the lack of staffing and drivers. Residents are provided with a healthy diet. EVIDENCE: There was information that residents did have access to some leisure activities and external agencies were providing these. One resident attends a day centre three days a week, and some self fund their day care through either a private agency or through day care organised via Aspects and Milestones. On the day of the visit some of the residents were receiving aromatherapy. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 16 Staff stated that it is still difficult to provide residents with opportunities to go out in the community due to low staffing levels. On the day of the inspection there was only one permanent staff member and three bank staff on duty. It was pleasing to note that the bank staff have worked regularly in the home providing continuity of care. The new manager is reviewing social activities for individuals. The vehicle is being changed to enable more staff to drive the vehicle. Presently the home only has one driver. In addition swimming is being explored for some of the individuals. This still remains a requirement as there was little evidence that care staff were supporting residents to go out into the community or that activities were taking place in the home. This will be followed up at the next inspection. It was evident that one resident was supported to attend church on a regular basis. Contact with relatives varied, however, where residents had close family this was maintained. Two relative questionnaires were returned stating that they were kept informed of changes and made to feel welcome. One relative stated, “We are very happy with the care our son has at Frome Court”. A resident stated that their relatives visit a couple of times per week and it was evident they enjoyed the visits. Respectful, positive interactions observed between staff and residents were noticeable throughout the inspection. Boundaries of personal privacy are well understood and bedrooms and bathrooms are only entered with permission. Residents were seen accessing all parts of their home. A visiting professional stated that she has noticed a big difference in the care of the residents in the last two months in that staff are spending more time with residents in the lounge and the atmosphere is more relaxed and welcoming. Two residents consulted about the food stated that it was good. The cook stated that since the acting manager has been in post the catering budget has increased and a further cook has been employed. Menus were seen and provided evidence that residents were offered a varied and healthy diet. Observation of the lunchtime meal provided evidence that residents were supported sensitively. The meal was relaxed and unhurried. Residents were given a choice of where to eat and one resident chose to eat their meal later. This is good practice and demonstrated a person centred approach. The choice during the meal was limited, however, one resident was being offered a variety of drinks, a choice of beans or tomatoes and offered condiments. This level of 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 17 choice was not offered to the other five residents in dining area. Consideration should be taken how to offer choice to all residents. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s personal care needs are being met but there was less assurance that health care needs were being responded to. Residents are protected by robust procedures in the safe handling of medication. Death of residents is handled with respect and sensitively. EVIDENCE: As already mentioned and as seen at the last inspection there remains a lack of care documentation to guide staff and ensure consistency to meet health care needs. This is true of this standard. However, it was evident that staff ensured that personal care was being met. For example there was no care plan to prevent pressure sores however, there was monitoring in daily records of any breakdown of skin condition and evidence that a resident was moved 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 19 frequently to reduce pressure on the skin. However, there was no care plan to guide staff on the prevention of pressure sores or for an effective review to take place. 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 as stated above for one of the residents who have the need for district nurses to treat pressure sores. This remains an outstanding requirement. There were no health action plans. Training records as seen at the last inspection demonstrated that staff had attended training on pressure area care. Feedback from the district nurses was positive stating that the home was responsive to changing care needs and access their service for support and guidance and that advice was taken on board. Each resident has a personal care statement, which has been expanded to guide a personalised support plan. This was in response to a requirement from the last site visit and the home has demonstrated compliance. It was evident that the residents had complex health care needs including asthma, heart conditions, epilepsy, diabetes, dementia, eating difficulties and skin conditions. Staff were knowledgeable on the support needs of individuals and it was evident that the home was accessing support from other professionals and attending training enhancing the skills and the knowledge of the care team. Recording of medical and health input was seen to be of a good standard, Evidence of other professionals involved in the care planning was excellent. In addition the home maintains clear records of all personal care delivered to individuals. Feedback from professionals was positive. One professional stated that the care delivered to the residents especially over the last year in relation to residents that are dying has been sensitive and heart felt. Medication held in the home was stored appropriately and the documentation was up to date and in good order. Staff competence is checked at regular intervals. Only staff that have been assessed as competent administer medication. Policies and procedures were in place as seen at the last inspection. The home has responded appropriately to a requirement to ensure medication is within its expiry dates. The senior carer stated that medication stock is checked at frequent intervals. The home has a policy on death and dying and residents last wishes are recorded in the plan of care. A number of staff have attended bereavement 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 20 and loss training. It was evident that the utmost care and dedication had been given to residents from conversations with staff and feedback from professionals. What was clear from talking with staff was that the team supported each other and the residents during this unsettled period. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 21 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. Residents can be confident that they are protected by the home’s policies on protection and complaints. However, this may be enhanced if relatives have information on raising concerns. There is no consent by the resident, their relative or other professionals to use bed rails and wheelchair straps. EVIDENCE: The home has a complaint policy available to residents in pictorial format. However, not all residents can verbalise their concerns. Staff described different ways residents make their needs and feelings known and it was evident that they knew what appropriate action to take. Two relatives stated that they were unaware of the home’s complaint procedure. The home maintains a record of complaints. There was only one complaint recorded since the last inspection, which involved a resident accessing the bedroom of another. It was evident that this was discussed with the individual concerned and involved the senior management of the Trust. A further complaint was noted in a resident care file and whilst it was evident that the home had taken the appropriate action it was not cross-referenced to the central complaint record. This involved a resident and a neighbour. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 22 In addition the Commission for Social Care Inspection has received an anonymous complaint from a member of staff in respect of the support mechanisms and the lack of staffing to support individuals with their complex care needs. The provider has investigated this and action is being taken to address the issues including the transfer of the manager. This will be monitored at future visits to the home. Evidence at the last visit was that staff were aware of the procedure in the event of an allegation of abuse, whistle blowing and the complaints procedure. Training records provided evidence that staff have attended training in Protection of vulnerable Adults. Copies of the General Social Care Council are made available to staff as evidenced at previous visits to the home. Whilst the home has now recorded the use of bedsides and wheelchair straps the home has not included consent from the resident, relative where possible and other professionals to demonstrate that the decision process is within a multi-disciplinary approach. Finances were not checked on this occasion. Good practices were demonstrated at the last inspection. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 23 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. 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 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 single occupancy for all residents. The home is comfortable, clean and free from odour. A lift is in place to enable 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 24 residents to access the second floor. Certificates were seen demonstrating that the lift is serviced at regular intervals. The home is suitable for present residents living at Frome Court. Evidence was provided that aids and adaptations are in place and checked at regular intervals. The lounge area has recently been redecorated and new furniture has enhanced the homely feel. Staff made positive comments that this area is no longer clinical. Safety in the environment is paramount therefore 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 was inspected by the Environmental Health Agency in January 2006 and has won a food award. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 25 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, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents at Frome Court can be confident that the staff supporting them are dedicated and committed to their role. Residents must be assured that there is sufficient staffing to enable them access to meaningful activities both in the home and the community. There is a high percentage of shifts being covered by bank staff and the home must continue to recruit permanent staff to offer consistency and move this home forward. There is a good rolling programme of training. Residents could benefit if more staff have completed the National Vocational Award (NVQ). Staff feel better supported through the supervision process. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 26 EVIDENCE: A requirement was made at the last inspection to review the staffing levels in the home to enable the residents to be supported in accessing more leisure opportunities. It was evident from talking with staff the new manager was exploring this. This includes changing the vehicle to enable more staff to drive. However, there was little evidence that residents are regularly accessing the community with the care staff in accordance with the statement of purpose. This remains an outstanding requirement. The home continues to be heavily reliant on bank staff. On the day of the site visit only one of the four staff was a permanent member of the care team. The pre-inspection questionnaire indicated that 219 shifts have been covered with bank staff in an eight-week period. Staff stated that home has four full time staff vacancies, which are being advertised. Two new staff have started in December 2006 and are presently completing their induction. In light of the above and the home having three resident vacancies the manager should ensure that adequate staff are in post prior to filling the vacancies. Consideration could be given to recruit an additional member of staff to support residents with recreational activities as staff stated that much of the day is taken up with personal care tasks. Evidence from previous visits was that the home had a high turnover of staff. From this inspection staff stated that the team are more settled and positive and committed to continuing their employment under the direction of the new manager. In response to the complaint and the recommendation from the last inspection. The organisation completed an audit on why staff were leaving. From information sent to the Commission for Social Care Inspection on the outcome of the investigation the following was noted. The results from the analysis of exit interview questionnaires was that information recorded, overall reflected positively with no major issues highlighted. However, another part of the complaint related to how the manager spoke and supported her staff. The investigation report from the Trust stated that some staff had witnessed all/some of these concerns. Recruitment Records were not viewed on this occasion in the absence of the manager. From correspondence from the provider and the previous manager it was evident that the home has demonstrated compliance to a previous requirement to ensure that all records relating to the recruitment and employment of staff are held in the home. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 27 Training was not explored during this visit, as there is a good rolling programme of health and safety training in place as seen at the last inspection. A member of staff stated that they had recently attended a fire training session and manual handling was planned in February 2006 for the majority of the team. Other training included dementia, epilepsy, first aid, ageing, bereavement and loss to name a few. Presently the home has only one person with an National Vocational Qualification 3 with a further two staff in the process of completing. The home is not meeting the government target to ensure that 50 of the staff have an NVQ. A member of staff stated that it is difficult to complete their NVQ work whilst on duty and much is done at home. A member of staff is coming in on their day off and the home having to access an external assessor to support them further evidenced this. At the last inspection a recommendation was made for all the staff to receive at least six supervisions per year. This could not be fully explored in the absence of the manager. Although a member of staff stated that a senior manager in relation to the complaint as detailed previousily had interviewed all staff during October/November 2006 and offered them support in their role. In addition a senior carer stated the area manager had completed a number of supervisions in the absence of the registered manager. A senior carer stated that the new manager has organised supervisions for all staff to enable her to get a picture of the home and to support the staff and the long-term plan that this role will be shared between manager and the senior care staff. No further recommendation has been made but supervision will be followed up at the next inspection. It was clear that staff morale has improved greatly since the last inspection, evidenced through conversations with staff, visiting professionals and observations. A member of bank staff stated that they are more prepared to work in the home covering all shifts due to the change of management. Staff stated that they felt more listened to and appreciated. It was evident that the acting manager valued her staff and was generating ideas collectively to move the home forward as evidenced through staff meeting minutes and conversations with staff. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 28 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, 38, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff and residents would benefit from a period of stability in relation to the management of the home which will offer the staff clear direction and guidance. There are good systems to ensure that residents and staff’s health safety and welfare is promoted and protected. EVIDENCE: Presently there is an acting manager in post at Frome Court who has been transferred from another home within the organisation where she was the 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 29 registered manager. Ms Bolt has been in post since December 2006. A member of staff stated that the manager’s post has been advertised and a date for interviews has yet to be confirmed. Feedback from staff, both permanent and bank staff indicated that the team were more settled and generally the atmosphere in the home was more relaxed. A visiting professional confirmed this. 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 checks were taking place and copies of the report were sent to the Commission for Social Care Inspection. 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. Risk assessments had been reviewed including the fire risk assessment in response to a requirement from the last site visit. Quality assurance was not discussed on this occasion in the absence of the manager. The home has a policy on quality assurance and a tool has been developed for use across the organisation. This will be a focus of future inspections. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 30 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 2 3 2 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 X X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 3 3 3 X 3 X 3 X 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 31 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 4 (1) (c) Sch 1.6 Requirement The home must develop clear criteria for potential residents, which is clearly described in the statement of purpose. (Outstanding since 19/08/06) Where residents have complex health care needs the home must make referrals for the individual’s care needs to be reassessed to ensure Frome Court is an appropriately registered setting for their needs and that nursing care is not required. Revise the statement of purpose to include change of manager, staffing arrangements on a dayto-day basis and to ensure it reflects the service provided at Frome Court. Expand contracts for residents to include information relating to Regulation 5a which includes a full breakdown of fees and who responsible for paying them. For residents to have a copy of their contract and this to be signed by the resident where DS0000003401.V328467.R01.S.doc Timescale for action 23/03/07 2. YA2 14 (1) 23/03/07 3. YA1 4 (1) (c) Sch 1 23/03/07 4. YA5 5A 5 (2) 23/06/07 21 Frome Court House Version 5.2 Page 32 5. YA6 6. YA13 7. YA19 8.. YA22 possible and other appropriate persons by 23/02/07. 15 Ensure service user plans are available for all residents. These must clearly describe how residents are to be supported in meeting their changing care needs including emotional, social, physical and psychological. These must be kept under review. (Outstanding since 01/11/05) 16 (m), Staffing needs to be sufficient so 18 (1) (a) that staff can support service users to participate in the local community and with meaningful activities. (Outstanding since 23/07/06) 17 (a) Sch Develop a risk assessment and 3.3 (n) care plan for individuals in relation to pressure area care where relevant. (Outstanding since 19/08/06) 22 (5) Ensure all relatives and significant others have a copy of the home’s complaint procedure. 17 (a) Sch 3.3 (p) Document the use of bed rails, 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. Keep these decisions under review. (Outstanding since 19/08/06) 23/04/07 23/02/07 23/01/07 23/03/07 9. YA23 23/03/07 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 33 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. Refer to Standard YA35 YA33 Good Practice Recommendations For the home to develop a plan on how they are going to achieve the government target to ensure 50 of the workforce have an NVQ in care. A suitable strategy is put in place to enable the home to be fully staffed. 21 Frome Court House DS0000003401.V328467.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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.V328467.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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