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

This inspection was carried out on 23rd July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 11 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 23/01/07

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 Unannounced Inspection 23 , 24th and 25th July 2007 09:30 rd DS0000003401.V340087.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 DS0000003401.V340087.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. DS0000003401.V340087.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 21 Frome Court House Address Thornbury South Glos BS35 2BU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01454 281445 0117 9709301 max@apectsandmilestones.org.uk admin@aspectsandmilestones.org.uk Aspects and Milestones Trust 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 DS0000003401.V340087.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. May accommodate up to 12 persons aged over 45 years with learning disabilities requiring personal care only To accommodate one named person with dementia, will revert back to original registration when that person leaves 23rd January 2007 Date of last inspection Brief Description of the Service: Frome Court House is a detached building located in a residential area of Thornbury. The home is operated by the Aspects and Milestones Trust and provides care and accommodation for 12 people who use the service with a wide range of physical and learning disabilities. Arranged over three levels the home offers single occupancy rooms for all service users. The home is comfortable, provides plenty of space and is well furnished. There is a large enclosed garden to the sides and rear. There is a range of shops within walking distance and Thornbury boasts a wide choice of other services such as medical, further education, places of worship and community activities. The Fees at the time of publishing this report range from £975 to £1066 per week. DS0000003401.V340087.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit as part of a key inspection. The purpose of the visit was to review the requirements and recommendations from the visit in January 2007 and monitor the quality of the care provided to the individuals living at Frome Court. The focus of this inspection visit was on the general care of a sample group of people who use the service, the environment, including an extensive tour of the premises and a review of the documentation held in the home. This provided a good opportunity to observe people who use the service as well as allowing for informal conversations with individuals and with the staff supporting them. The home has been sending in reports of incidents that affect the wellbeing of the individuals living in the home and copies of the monthly provider visits. These along with surveys completed by relatives (2), professionals (4) and people who receive a service (1) were used to plan the inspection. The home has only recently been sent an annual quality assurance assessment and was still in the process of completing this. The home is within the timescale for completion and this will be used to plan the next visit to the service. The visit took place over 3 days for a total of nine hours. An opportunity was taken to speak with four staff, the manager and the area manager for the home. What the service does well: What has improved since the last inspection? The newly appointed manager and the Trust have reviewed the individuals living in 21 Frome Court to ensure that the individual’s care needs can be met and the home remains suitable. This process has involved placing authorities. DS0000003401.V340087.R01.S.doc Version 5.2 Page 6 There have been some improvements in relation to the assessment process ensuring that individuals are appropriately placed at 21 Frome Court. Individuals can be confident that care plans have been developed on pressure area care and its prevention. Adequate staffing presently support the individuals at 21 Frome Court on a day-to-day basis, however the home has 5 vacant beds. Recruitment of staff has reduced the use of bank and agency staff. Relatives and other stakeholders have been sent copies of the home’s complaint procedure. The home has developed a plan of action to ensure that the home continues to recruit staff to the two vacant posts and that 50 of the staff have an National Vocational Qualification in care. Morale in the home has evidently been improved; staff were confident that this was in part due to the recruitment of staff and the support from the senior management in the home and from the Trust. What they could do better: There are a number of outstanding requirements and the Commission for Social Care Inspection is considering taking enforcement action in relation to the poor care planning processes and the lack of meaningful activities for the individuals that live at 21 Frome Court. Timescales to meet other requirements have been extended to enable the home to demonstrate compliance but with a shorter timescale. The home must ensure that a comprehensive assessment of need is completed in respect of new individuals moving to the home and this informs the home’s care planning processes. Individuals should have a contract of care that details a breakdown of what the fees include and what is not included. This should detail all additional extras pertinent to the individual. Individuals must be confident that care plans are reviewed and updated, as their care needs change. Individuals must be confident that care plans are expanded to include how the staff will meet their social, psychological and emotional wellbeing. Individuals should be assured that only relevant care documentation is held and information that is no longer relevant or not current is archived. DS0000003401.V340087.R01.S.doc Version 5.2 Page 7 Individuals must have available to them meaningful social occupation both in the home and the community. Where individuals are paying for additional services for example day care this must be discussed with the placing authority to ensure that it is acceptable and that this does not form part of the contract between the home and the placing authority. Where this has been agreed then this should be confirmed in the social service’s assessment and clearly documented in the contract between he home and the individual. Where individuals are funding the vehicle this should be clearly documented in their plan of care to ensure an open and transparent approach and one that is equitable. Individuals should consent to the expenditure and where this is not possible consultation must take place with the placing authority. The home must review the daily records in relation to their contents and offer staff guidance on how they must be completed. Individuals must be assured their privacy is respected and staff will treat them in a dignified and respectful manner. Individuals must be assured that a thorough recruitment process is completed and the records relating to staffing must be held in the home. Individuals 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 individuals. This in part remains an outstanding requirement. The home must keep under review the staffing of the home as vacancies are filled to ensure that adequate staffing is in place to meet the diverse needs of the individuals living in the home. Training records should be maintained to fully capture the training that is available to staff demonstrating that individuals are supported by a competent workforce. 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. DS0000003401.V340087.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 DS0000003401.V340087.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): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been some improvements in relation to ensuring that individuals assessed care needs can be met whilst living at 21 Frome Court. The home is developing clear admission criteria for potential people moving to Frome Court and redefining the service. However, the lack of information gathered prior to individuals moving to the home could mean that individuals are poorly placed and that the home is unable to meet their assessed and changing care needs. Contracts are lacking in information in relation to the additional fees, which means that the service is not being transparent. EVIDENCE: The statement of purpose was viewed during the visit to the service. This has been updated to include the change of manager and the daily staffing. As yet the criteria for admission detailing the needs of prospective people entering the service has yet to be completed. The area manager and the manager stated that this was still being discussed so that it reflects both the people already living in the home and potential new persons. DS0000003401.V340087.R01.S.doc Version 5.2 Page 10 Both the manager and the area manager stated that the focus would be individuals with a learning disability and who may have a physical disability. If this is the direction the home is going, this would mean a change of category and an application to vary the conditions of registration must be submitted. It was evident that the home has reviewed some of the individuals who have complex health care needs, which has meant that two individuals have moved to other more suitable accommodation (homes providing nursing). Another individual is being reassessed as it is felt that they would benefit from a smaller home where individuals are more involved in the planning of their care and chosen lifestyle. It was evident that in the past the home has struggled to meet the diverse care needs of the individuals living in the home especially where individuals care needs have increased and required more staff support. There has been less pressure on the staff with only seven people living in the home. An opportunity was taken to review the care information for one person who has recently been admitted to the home. The assessment, areas such as health and physical needs had not been fully completed by the care staff. So it was difficult to determine whether a full assessment had been done. There was no social services assessment or care plan. The home had devised a support plan but this focused on personal care and physical needs, it was difficult to determine how the assessment had informed the support plan. There was no information about how the home would support the individual with their social, emotional or psychological needs. In addition the plan had not been updated to meet their changing needs. Four of the vacancies have been temporarily filled due to four people having to move from their registered care home in Gloucester due to the recent flooding. The four individuals were being supported by a core team of staff from their home in Gloucester. These individuals did not form part of the inspection process. The focus was the individuals who were permanently placed at Frome Court. Contracts were viewed for three of the individuals. These did not include the breakdown of fees or whether the individuals were contributing to other additional costs. It was noted that some individuals were contributing towards the running costs of the home’s vehicle and paying additional fees to the Trust for day care neither was recorded in the contract of care. Both of these additional costs will be discussed under the appropriate standards. DS0000003401.V340087.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are striving to provide an individualised package of care. However, serious shortfalls in the care planning processes are putting individuals at risk and do not capture how the home is meeting the changing needs of the people it supports. EVIDENCE: An opportunity was taken to look at four persons’ care documentation including day-to-day records, support plans, risk assessments and other associated documentation. This is called case tracking. There are significant gaps in the planning of the care for individuals. From talking with staff and reading the care documentation what happens in practice is not being recorded and plans are not being amended to meet changing needs. DS0000003401.V340087.R01.S.doc Version 5.2 Page 12 One person’s care plan detailed staff support as two however staff stated that in fact three staff were required to support the individual at times. It was evident that the outcome for the individual was there but the process of recording and amending care plans was not. This raises serious concerns, as there are only two staff working at night, and raises questions if there are only three staff working in the home, about who is supporting the other individuals. The plan offered no guidance to staff for example when three staff are required or what had happened to determine that this individual required the additional support. Another example where the support plan had not been updated was that one individual had built an important relationship with one of the other occupants of the home. However, this person had died a number of years ago and the plan had not been updated to reflect the changes in the individual’s life and how this had impacted on their wellbeing. Other examples were seen where plans had not been updated. These could have a detrimental effect on the well being of individuals. A further example was where an individual had new support plans, but the old plan remained in the file. This could lead to confusion with staff following the incorrect support plan. Generally plans seen focused on the physical needs of the individuals, lacking was how the home was meeting social, emotional and the individual’s psychological needs. Care planning remains an outstanding requirement from the last three visits to the home. The Commission for Social Care Inspection is considering further enforcement action. Whilst there were serious shortfalls in the home’s care planning processes (the documentation), talking with staff and reading daily records there was evidence that people were treated as individuals and staff were knowledgeable about the people living at 21 Frome Court. Staff stated that much of the day is spent with the people living at 21 Frome Court and there is little time to spend doing paperwork. However, it was noted that the manager and the two senior carers have some administration time. Evidence was provided that the individual’s care is reviewed monthly. However, this focuses on daily living skills and does not review the formal care plans that are in place. Lacking is an annual review for individuals where they can participate in fundamental decisions about their care. A senior carer stated that this is changing under the direction of the new manager who is in the process of organising reviews for a number of individuals. This was confirmed in the home’s diary. This will be followed up at the next visit to the service. DS0000003401.V340087.R01.S.doc Version 5.2 Page 13 Risk assessments were in place and detailed sufficient information. These covered issues relating to manual handling, choking, pressure care and mobility. Again the focus was on physical needs rather than emotional, psychological and social needs and focused on the environment in 21 Frome Court House rather than community based activities. DS0000003401.V340087.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Individuals are not having meaningful activities. There is a lack of planning and monitoring of social opportunities. Individuals are having a healthy balanced diet. EVIDENCE: Three staff stated that the individuals had been given more opportunities to go out since the last visit. Staff stated that individuals were going out on a daily basis to places of interest including trips to the seaside, cafes and shopping. However, this was not captured in the daily records or the record of activities. DS0000003401.V340087.R01.S.doc Version 5.2 Page 15 Staff confirmed that they are meant to record activities in the individual’s daily dairy, an activity record and on the handover record. From randomly reviewing all the individuals this was not happening. Events were recorded in the home’s diary and in some cases recorded on the activity sheet but the majority had not been captured in any of the documentation. A review must take place of how and where staff are recording the information to ensure consistency. One individual attends church on a weekly basis. This had not been recorded on the activity record but in the daily diaries. Generally, information was insufficient to determine where individuals had been and whether it had been an enjoyable experience. Whilst staff confirmed that presently there is sufficient staff to enable individuals to go out, this was not being recorded. Information relating to structured activities did not resemble the changes that had recently occurred. For example one person was paying for their day care for seven hours per week but due to the lack of funds this had been stopped. The day care planner had not been updated to reflect the changes. There was no formal plans relating to social activities which were clear to staff and measurable. It was positive to see that one individual had been referred to the wheel chair services for them to have a suitable wheelchair to enable them to access the community. Sadly the person is on a waiting list, which is in excess of six months. It was evident that the staff were continuing to chase up this service as this individual is unable to go out in the community and has not done since their admission twelve months ago. The staff recognised the importance for this person to have meaningful activities, which were organised within Frome Court however again this was not captured in the daily records. As mentioned previously three individuals are contributing to their day care at a considerable cost per week. One person has direct payments to enable them to afford this. There was no record of the decision process or that the individual, their representative or the placing authorities had been consulted. There was no record in the home’s contract detailing these additional costs. However, there were contracts from the day care service and the previous registered manager had signed this. In one person’s case this had not been amended in light of the reduction of the hours due to the individual having insufficient funds. This was similar for the home’s transport, which all but one of the individuals contribute to on a monthly basis. This was not fully documented to demonstrate that it was equitable or that the individual, their representative or the placing authority had been involved in the decision process. Where individuals do not have capacity is fundamental that decisions are clearly documented ensuring it is the best interest of the person. DS0000003401.V340087.R01.S.doc Version 5.2 Page 16 Staff spoken with stated the new mini bus that has been purchased has made a great difference, as there are more drivers, which enables individuals to go out more often. Observations of staff interactions were generally positive and inclusive of the individual. It was observed that a member of staff walked into an individual’s bedroom without knocking, and a member of staff was observed discussing personal information about an individual in a communal area. These were indicators that the individual’s right to privacy was not respected. More able individuals were observed accessing all parts of the home independently, and staff confirmed that individuals that require support are offered opportunities to spend time in their bedroom should they wish. Staff spoken with stated that all the individuals could make their needs known either through verbal or non-verbal communication. One person’s record seen had a communication dictionary but this was held on a file that had been brought from a previous placement and not in the home’s care plan. Individuals are encouraged to maintain contact with relatives. One person stated that they visit their mother on a weekly basis or relatives regularly visit the home. A member of staff stated that as part of their role in supporting one individual they write regular letters involving the individual. The menus were viewed during the inspection. These provided evidence that individuals are offered a varied and nutritious diet based on preferences. Information was available in care plans and in the kitchen on the individual’s preferences and the special dietary needs. The catering staff were aware of the dietary needs of the individuals living in the home. Two meal times were observed. Staff were supporting individuals sensitively and the atmosphere was relaxed. An individual stated that they enjoyed the food. Staff stated that individuals are offered alternatives to the planned menu and individual preferences are catered for. DS0000003401.V340087.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. 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 this service. Individual’s personal care and health care needs are being met. However there are shortfalls in the documentation, which could put individuals at risk. Individuals are protected by robust procedures in safe handling of medication. Death of individuals is responded to sensitively and with respect. EVIDENCE: As already mentioned and as seen at the last two visits to the home there remains a lack of care documentation to guide staff and ensure consistency to meet the individual’s care needs. This is true of this standard. However, it was evident that staff ensured that personal care was being met. DS0000003401.V340087.R01.S.doc Version 5.2 Page 18 Care plans have been developed in response to a requirement from the last visit to the home to prevent pressure sores. There is now guidance for staff in relation to prevention and monitoring of pressure area care. Daily records were being maintained on what action has been taken including visits from the district nurse. Fluid charts, weight charts and records of epileptic seizures are maintained for those individuals for whom it is appropriate. There were no health action plans. Training records demonstrated that some staff had attended training on pressure area care. Individuals have a personal care statement, which clearly states their support needs, preferences and aids in relation to manual handling and ensuring their safety. Recording of medical and health input was seen to be of a good standard. Evidence of other professionals involved in the care planning was good. In addition the home maintains clear records of all personal care delivered to individuals. Individuals have an opportunity to see a dentist, optician and chiropodist routinely and as required. It was evident that the individuals 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 to enhance the skills and the knowledge of the care team. Feedback from professionals was generally positive. One professional stated that the care delivered to the individuals especially over the last year in relation to individuals that are dying has been sensitive and heart felt. A doctor did raise concerns that individuals could not be seen in private, that a senior carer was not always available and the home does not work in partnership. However they were satisfied with the overall care. A senior carer stated that individuals could be seen in private. Two other visiting professional stated that they are always able to see individuals in private and that the staff treat individuals with dignity and respect. One professional stated that “concerns have been raised in the past about the complex needs of some of the individuals and that some of the care has been moving in the direction of nursing. This has had an impact on the staff and how they can meet the diverse needs of all the individuals. However this has significantly improved with the reduction of individuals living at Frome Court and that individuals with complex needs have either moved on or have died”. DS0000003401.V340087.R01.S.doc Version 5.2 Page 19 The Commission for Social Care Inspection will be monitoring this at future visits in relation to new and existing persons living in the home. Medication held in the home was stored appropriately and the documentation was up to date and in good order. Policies and procedures were in place as seen at the last inspection. The senior carer stated that medication stock is checked at frequent intervals and this was evidenced in the stock records held in the home. The home is in the process of developing an audit for ensuring that staff competence in relation to giving of medication is checked routinely. A senior carer stated that they had yet to complete this, however the manager was aware and was addressing the shortfalls. This will be followed up at the next visit to the home. The home has a policy on death and dying and individuals last wishes are recorded in the plan of care. A number of staff have attended bereavement and loss training. It was evident that the utmost care and dedication had been given to individuals from conversations with staff and feedback from a visiting professional. What was clear from talking with staff was that the team supported each other and the individuals during this unsettling period. DS0000003401.V340087.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Individuals and their representatives can be confident that they are protected by the home’s procedures on protection and complaints. There is poor practice relating to the decision-making on spending individual’s money. EVIDENCE: The home has a complaint policy available to individuals in pictorial format. However, not all individuals can verbalise their concerns. Staff described different ways individuals 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 at the last visit. The manager and the staff stated that copies of the complaint procedure have been sent to all relatives and other significant stakeholders. The home maintains a record of complaints. There have been no complaints since the last visit to the home. The complaint record would benefit from being formatted to include the nature of the complaint, the outcome and actions taken including timescales to enable a full audit to be undertaken by the home. DS0000003401.V340087.R01.S.doc Version 5.2 Page 21 Evidence at this and 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 Code of Conduct for staff are made available to staff as evidenced at previous visits to the home. The policies relating to protection were not viewed on this occasion. A new member of staff confirmed that they had attended training on Protection of Vulnerable Adults as part of their induction. In addition they were aware of what action to follow where abuse is suspected and were clear what constitutes abuse. Whilst the home has now recorded the use of bedsides and wheelchair straps, the home has not included consent from the individual, relative where possible and other professionals to demonstrate that the decision process is within a multi-disciplinary approach. This remains outstanding from the last two visits to the home. Finances were checked on this occasion. Records corresponded with the amounts held in the home. Staff complete daily checks on finances and routine checks are completed by the area manager as evidenced via the records of monthly visits in respect of regulation 26. The home has financial procedures these were not viewed on this occasion. Concerns were raised about three of the individuals paying considerable amounts towards day care and all of the individuals except one person were contributing towards the home’s transport. There was no evidence provided that this had been in consultation with the individual, their representative or the placing authority. There was no documentation to support the decision process. This is subject to a safeguarding adults strategy meeting in respect of this practice across the Trust. DS0000003401.V340087.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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 21 Frome Court provides a safe, clean and suitable place to live and work. EVIDENCE: 21 Frome Court is a detached property in a residential area of Thornbury. There is a wide range of shops within walking distance and Thornbury boasts a good choice of other services such as medical, further education, places of worship and community activities. Arranged over two levels the home offers individuals their own bedroom. The home is comfortable, clean and free from odour. A lift is in place to enable access to the first floor. Certificates were seen demonstrating that the lift is serviced at regular intervals. DS0000003401.V340087.R01.S.doc Version 5.2 Page 23 The environment is suitable for the individuals presently living at Frome Court. Evidence was provided that aids and adaptations are in place and checked at regular intervals. As noted at the last visit the lounge area has been redecorated and new furniture has enhanced the homely feel. Staff made positive comments that this area is no longer clinical. It was noted that woodwork and walls in the hallway require painting. The manager stated that whilst the hallway was not on the redecoration plan the vacant bedrooms would be redecorated prior to new individuals moving to the home. It was seen that in some of the bedrooms continence aids, gloves and plastic washbowls were apparent. These did detract from the homely feel of the home and whilst it is acknowledged that these are required to ensure safety of individuals and staff in relation to cross infection. It would be recommended that more discreet storage could be considered. Safety in the environment is paramount. All radiators and hot water pipes had covers, windows had restrictors and the water was being controlled to a safe level. This is good practice. The home was inspected by the local Council’s Environmental Health Service in January 2006 and has won a food safety award. This was displayed in the entrance to the home. Evidence was provided that staff were continuing to ensure that this was maintained. Good records were seen of food, fridge and freezer temperatures and checks on the cleanliness of the kitchen including risk assessments. DS0000003401.V340087.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. 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. Individuals living at 21 Frome Court can be confident that the staff supporting them are dedicated and committed to their role. Individuals are now benefiting from the employment initiatives that have been undertaken ensuring a full staffing compliment is in place. Familiar staff support individuals. Individuals are potentially at risk due to poor recruitment processes. Staff are competent and supported in their roles, however there are concerns about the record keeping in the home. EVIDENCE: Considerable effort has been taken by the manager and the Trust to recruit staff to 21 Frome Court. The home now has two staff vacancies and steps are being taken to ensure that the home is fully staffed. Consequently this has had a reduction in the use of bank relief staff and agency staff. DS0000003401.V340087.R01.S.doc Version 5.2 Page 25 Six new staff have been employed this year. The home is demonstrating compliance with a previous requirement. Staff spoken with stated that this has had a real positive effect on the morale in the home. Where the home has had to cover with bank this has been covered with familiar staff. One bank staff spoken with stated that they work permanently in 21 Frome Court, it was evident that they were aware of the needs of the individuals. From talking with staff, the manager and the area manager it was evident that the reduction in people living in the home has had a positive impact on the quality of the care provided to the remaining individuals. With this information in mind, an exercise must be undertaken to ensure that staffing levels are correct taking into account the size of the home, the number of people using the service and which includes looking at the assessed needs both individually and collectively. Staff stated that there were always four staff working in the home in the mornings, three in the afternoons and two waking staff working at night. This was confirmed in the homes record of staff. From this record it was evident that there has been a significant reduction in the use of bank relief, and agency staff. Staff were both knowledgeable about the individuals living at the home and positive about their roles and the future of the home. Recruitment information was seen for three of the new staff. There were gaps in the information. For one person recently employed there was no information, one was complete and for one member of staff there were no references. From this information it was difficult to determine that a thorough recruitment process had taken place for two of the staff. Information relating to staff must be held in the home. The manager stated that this is held at the Trust’s Human Resources Department and copies are sent to the home once the person starts work. From talking with the manager she was aware what checks must be undertaken prior to employment. A member of staff confirmed that they were unable to start work until a satisfactory Criminal Record Bureau check had been completed. A new member of staff stated that they had completed an induction with the Trust and completed health and safety training, first aid, manual handling, a ‘values’ day and a protection from abuse course. This was not fully captured in the training records. DS0000003401.V340087.R01.S.doc Version 5.2 Page 26 The Trust has a rolling programme of training covering statutory training, which includes manual handling, health and safety, first aid and food hygiene training. Certificates were seen confirming attendance. Other training staff had attended included courses on dementia, epilepsy, supporting individuals as they get older, bereavement and loss, PEG feeds and pressure care to name a few. These were evidently linked to the needs of the individuals living at 21 Frome Court. It was noted at the last visit that only one member of staff has a National Vocational Qualification (NVQ) level 3. The manager stated that since the last visit two further staff are working towards their National Vocational Award Level 3 with a further two staff enrolling in September 2007 and one member of staff has transferred from another home and has already completed an NVQ at level 3. This will continue to be a focus at future visits to the service. Supervision was discussed in detail with staff. It was evident from conversations with staff, the manager and senior carers that staff felt supported in their roles. Formal supervision records were being maintained and it was evident that staff were receiving a minimum of six formal supervisions per year. This was the responsibility of the manager and two senior carers. DS0000003401.V340087.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individuals and staff have benefited from the new management approach in the home. There are good systems in place to ensure the safety of the individuals and the staff living in the home. 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 registered manager. Ms Bolt has been in post since December 2006. DS0000003401.V340087.R01.S.doc Version 5.2 Page 28 A letter was received confirming that Ms Bolt has been successful in becoming the permanent manager in April 2007. Ms Bolt confirmed that she was in the process of sending an application to the Commission for Social Care Inspection to become the registered manager. 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 relative stated in a completed survey that “the manager has had a positive impact on the home and whatever she says she will do, she does it”. Staff evidently had regular meetings, as did the people receiving a care service. Both provided evidence of an open approach where individuals 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 21 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. The staff have recently completed a team building exercise and developed a care path. This will be explored further at future visits. As already discussed there are some serious shortfalls in systems for recording care, which must be addressed by the home. A photograph was not available for one of the individuals as required by legislation. 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. 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. DS0000003401.V340087.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 3 2 2 3 3 4 3 5 2 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 2 2 X LIFESTYLES Standard No Score 11 X 12 2 13 1 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 3 3 3 3 3 X 2 3 X DS0000003401.V340087.R01.S.doc Version 5.2 Page 30 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA2 Regulation 14 (1) Requirement Ensure that the needs of the individual have been assessed by a competent person prior to admission, that this is kept under review and revised when it is necessary to do so having regard to any change of circumstances. Timescale for action 25/08/07 2. YA6 15 Ensure service user plans are 25/09/07 available for all residents. These must clearly describe how people who use the service 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) Individuals must be offered opportunities to participate in meaningful activities. Clear plans of care must be developed demonstrating how the home is meeting the social needs of individuals. (Outstanding since 23/07/06) 25/09/07 3. YA13 16 (m), DS0000003401.V340087.R01.S.doc Version 5.2 Page 31 4. YA2 4 (1) (c) Sch 1.6 The home must develop clear criteria for potential residents, which is clearly described in the statement of purpose. (Outstanding since 19/08/06) 25/08/07 5. YA23 17 (a) Sch Ensure that there is consent 3.3 (p) obtained from the individual or their representative on 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) 25/09/07 6. YA5 5A 5 (2) Expand contracts for people who use the service to include information relating to Regulation 5a, which includes a full breakdown of fees and who responsible for paying them. For people who use the service to have a copy of their contract and this to be signed by the individual where possible and other appropriate persons. The contract must include what is included in the fees and any additional costs. For the home to have a current photograph of individuals receiving a service. The decision process must be documented in relation to individuals paying for their day care and the transport costs including consultation with the individual, their representative and the placing authority. DS0000003401.V340087.R01.S.doc 25/09/07 7. YA41 17 (1) (a) Sch 3.2 17 (1) 5 (1) (a) 25/08/07 8. YA23 25/09/07 Version 5.2 Page 32 Where individuals are paying additional fees this must be included in the contract of care. 9. YA16 12 (4) (a) For individuals to be treated in a dignified and respectful manner ensuring their privacy is maintained Ensure information relating to staff as detailed in schedule 4.6 is held in the home. A staffing skill mix must be undertaken to ensure that the home is adequately staffed at all times to meet the assessed needs of the individuals, taking into consideration the number of people living in the home. 25/07/07 10. YA34 17 (2) Sch 4.6 18 (1) (a) 25/08/07 11. YA33 25/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA14 YA41 YA24 YA24 YA35 Good Practice Recommendations Maintain clear records relating to social activities. Staff to have training and be given guidance on the management of records. To consider discreet storage for continence aids and gloves to promote a more homely environment. Decorate hallway. For staff training records to be kept up to date and give sufficient detail on the courses that they have attended. DS0000003401.V340087.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: 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 DS0000003401.V340087.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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