CARE HOME ADULTS 18-65
21 Frome Court House Thornbury South Glos BS35 2BU Lead Inspector
Wilfried Maxfield Unannounced 26 April 2005 09:30 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 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 Stationary 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 D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 3 SERVICE INFORMATION
Name of service 21 Frome Court House Address Thornbury South Glos BS35 2BU Telephone number Fax number Email 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 Aspects & Milestones Trust Ms Bibi Affroze Bahadoor Residential Care Home for Younger Adults 12 Category(ies) of LD Learning disability -2 registration, with number LD(E) Learning dis - over 65 - 12 of places 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 4 SERVICE INFORMATION
Conditions of registration: May accommodate 2 persons aged 45-65 years requiring personal care only May accommodate up to 12 persons aged 65 years and over requiring personal care only Date of last inspection 21-Oct-2004 Unannounced Brief Description of the Service: Frome Court House is a detached former purpose built childrens home located in a residential area of Thornbury. The home is operated by the Aspects and Milestones Trust and provides care and accomodation 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. There are a range of shops within walking distance and Thornbury boasts a wide choice of other services such as medical, further education, places of worship and community activities. The home is comfortable, provides plenty of space and is well furnished. There is a large enclosed garden to the sides and rear. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was conducted over two days with one of the two assistant managers present on the first day and the registered manager on the second day. The assistant manager helped to focus the inspection on the general care of the service users, the environment, including an extensive tour of the premises and equipment. Two members of staff were interviewed formally and two informally. Depending on individual motivation and ability a small number of service users gave their views on the care they were receiving. Time was spent to observe service users in one of the common rooms as well as a short period during lunchtime. The second day of the inspection concentrated on staffing including a thorough analysis of the current rota and bank staff arrangements. Some of the current management and staffing matters were also discussed with the registered manager. In addition care planning documentation including service user files were inspected. A sample of care plans was discussed. A Regulation 26 report was received just days before this inspection. Views expressed by the homes appointed visitor were taken into consideration as part of this inspection. An ‘Immediate Requirement’ needed to be issued to the provider after the inspector noted a number of missing pull cords in some of the service users rooms necessary for operating the call system. An inspector conducting a further additional visit in the near future will evidence the completion of the repairs. What the service does well:
Frome Court House 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. All of the service user rooms are personalised and well equipped and furnished. The primary and general care needs of residents are well taken care of and always given priority. Both managers assisting during the inspection showed an impressive range of competencies and skills. Equally, staff have a wide range of skills to ensure service users needs are met covering duties normally allocated to a much bigger staff group.
21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 6 The inspector was left in no doubt that this was a very experienced and dedicated staff team. What has improved since the last inspection? What they could do better:
The service would improve in a number of key areas if all the requirements and recommendations of inspection reports were implemented. Five of the nine requirements made after the last inspection were not, or were only partly, acted on. The home would be better able to meet newly admitted service users needs if a full needs assessment was undertaken before admission. The care management of the service would greatly benefit if a care plan were available for all service users. Missing care plans would be avoidable if the filing system were regularly audited to alert to such facts. Individual needs of service users would be better met if care plans were reviewed every six months and updated. The service users would enjoy a richer and more varied life style if their links into the community were developed and their leisure and activity needs were regularly documented, met and supported. Likewise, service users needs would only be met effectively if the staff group was sufficient in numbers and the home better staffed to meet residents leisure and activity requirements. Staff would be able to respond using a broader range of positive behaviours if the organisation would implement regular positive response training. The staff team would feel better supported and residents would benefit from this if a suitable staffing strategy were put in place and the team kept updated about developments in this area. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 7 Service users with a physical disability and similarly assessed needs would be better and more safely accommodated if their rooms had all the specialist equipment they require i.e. the call alarm system maintained in working order. Some requirements have been made in a number of previous reports. This includes that the quality assurance and inspection process would be greatly assisted if the organisation provided the home with all staffing details. Likewise, the implementation of an effective quality assurance and quality monitoring system would help the home to better assess whether it is currently achieving its aims and objectives to provide the best possible service for residents. The inspector found, that the management of the home would benefit and service users quality of lives would subsequently be enhanced if the manager were supported in achieving the NVQ to level 4 in Management by 2005. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3, 5 The home manages admissions well and residents settle in easily being well supported and cared for however the home fails to demonstrate this in documentation. EVIDENCE: Early on in the inspection visit a newly admitted resident made herself known to the inspector. She had only been at the home for a few weeks and still in her three months ‘settling in’ period. It was the first new admission to Frome Court House for some time. While case tracking the related admissions process it was noted that her file did not contain the necessary documentation in order to ascertain whether a full needs assessment had been carried out. There was also no care plan in evidence. In spite of these vital failings there was good evidence that procedures were in place for the staff team to manage the admissions process successfully. Talking to staff and communicating with the service user there was every indication that she was settling in well and was enjoying the new environment. Staff interviewed talked knowledgably about the admission process and were well informed about the particular resident’s needs. Aggressive incidents including hitting other residents seem to have been well controlled after they had occurred in the early days of the placement. This could have been documented better in individual files. Evidence for these incidents were mostly found in daily diary recordings only. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 10 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9, 10 Some individual resident’s plans are of good quality however, the home fails to document, implement and update service user plans for all its residents. EVIDENCE: Out of a sample of four, two resident’s files did not contain a care plan. This had obviously escaped the person responsible for regularly auditing the filing systems, a fact that the registered manager was not able to explain. A Regulation 26 visit undertaken shortly before this inspection did also not highlight this failing. Some residents plans were closely inspected and found to provide the necessary detail appropriate to echo individual circumstances and need. The previous inspection report reflected on the need to put into action person centred planning action plans after the team had received substantial training in this system. In line with previous findings also this inspection found that plans had not been fully put into practise yet. Similarly, there was not enough evidence on service users files to prove conclusively that the requirement from the last inspection to review and record changes in the care plan on a six monthly basis (or sooner) had been fully put into operation. Hand written notes “Updated, …date” did not clearly indicate
21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 12 what had been updated, who had updated and how this had been communicated with the service user or staff group. Staff interviewed demonstrated a positive approach and had all the required skills in order to be able to provide residents with information, assistance and communication support to make decisions about their lives. Instances of individual choices were recorded and the team is commended for their continuing positive efforts and ability to involve such a wide variety of abilities, choices and needs. The inspector saw comprehensive risk assessments in respect of each individual in the home. Resident’s files were stored safely in the office and staff were aware of the organisation policy on confidentiality. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 15, 16 An experienced core staff team is fully committed to observing and supporting resident’s development observing boundaries of dignity and respect however, staff shortages endanger the homes ability for participation and inclusion. EVIDENCE: While the inspector fully acknowledges some of the positive comments made in the previous inspection report relating to NMS13 it was difficult to ascertain whether the increased use of community facilities mentioned in this report was still ongoing. While individual plans pointed to this being a reality (not always clear and transparent recording adding to difficulty in finding sufficient evidence) interviews with all levels of the staff team seemed to suggest that regular community visits might have become a victim of the significant staff shortages. Equally, NMS14 with its major demands on the staff group to manage, encourage and arrange for appropriate leisure activities was particularly complicated to assess. While some comments from the team seemed to suggest that primary and general care needs were well managed they also suggested that this could currently not be said of coping with the demands of activities, links and inclusion and the maintenance of outside relationships.
21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 14 There was good evidence to conclude that, again, this was due to the effects of long-term staff shortages. The assistant manager explained the contact arrangements for a random sample of residents and their families, relatives and friends. These were all well documented. The inspector observed respectful, positive interactions between staff and residents throughout this inspection. Boundaries of personal privacy are well understood and bedrooms and bathrooms only entered with permission. The home is reminded of a previous recommendation made in a number of past inspection reports regarding the installation of a light warning system for rooms of those with a hearing impairment. If the home chooses to ignore such recommendations it will become necessary to explain the reasons to the Commission in writing. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 21 Personal and Healthcare support are of a good quality. EVIDENCE: Standard 18 and 19 were thoroughly assessed during previous inspections and personal and healthcare support was found to be of a good standard. These previous findings are echoed in this report. The two care plans available for inspection recorded the levels of personal care that were specific to the needs of individual service users. Time arrangements for routine events are kept flexible if residents require. The inspector was able to meet all residents on the two consecutive days of inspection and outer appearance, their clothes and hairstyles was of a very good standard and always individual. There is a wide range of support services available for residents and the service makes extensive use of local healthcare facilities. A previous requirement to involve resident’s wishes concerning their funeral arrangements was discussed with the registered manager. She reported how this requirement had led to intensive discussions amongst a group of managers and staff. The organisation is currently developing its approach to this issue and a policy is being formulated. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 16 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The homes complaint’s procedure is robust and sound and staff are aware of the different stages, time scales and other relevant processes involved. EVIDENCE: No complaints were recorded since the last inspection. Staff interviewed were clear about the organisations procedures and well informed about the role of CSCI in the complaints process. The homes adult protection procedures were not inspected, however it was noted, that all staff have received vulnerable adult training in 2004. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 17 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 30 Frome Court House is homely and comfortable, it is well decorated and maintained and is suitable for its intended purpose. EVIDENCE: The home accommodates 12 service users. A previous requirement to reduce the current group of residents to 10 was found not to be in line with amended NMS and subsequently does not form a part of requirements made in this report. Premises are suitable for the number of residents, safe, comfortable, bright airy and clean. It is fully wheelchair accessible. Previous reports from the local fire office and environmental health department were inspected. The home has a planned maintenance and renewal program. All of the individual resident’s rooms were inspected and found to be in line with NMS26.2. All rooms were personalised containing photographs, pictures and individual artwork. A number of toilet and bathroom facilities are located in close proximity to individual rooms. All were lockable and staff are fully aware of privacy protocols. The home infection control equipment was inspected and found to be of a good standard. Infection control guidelines to inform staff are robust. Laundry facilities are appropriate.
21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 18 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36 Whilst there is a competent and dedicated staff team, there ability to implement some vital elements of care planning is greatly limited by a chronic shortage of staff and the additional task placed upon them. EVIDENCE: The inspection process included good opportunities for the inspector to interview and informally talk to a number of staff. All staff were knowledgeable about the homes aims and values and in full support of them. There is a good but shrinking core team in place who know the residents well and understand the homes way of working. On inspection of rotas the inspector found considerable shortages due to sickness. In addition, staffing was down by 5 and no cleaner has been employed for some time. This also applies to one position for a cook with the second cook having been sick for some time. There was some concern amongst the staff group that the current level of service was getting more and more negatively affected due to staff being stretched to accommodate domestic cleaning and cooking duties. Reliance on agency staff and increased sickness was becoming ever greater. A previous inspector has reported similar shortfalls. Inspections report 7th June 2004: “This cannot provide consistency or stability for service users and will only
21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 20 increase the sickness absence level in due course.” Any risk assessment of the home will have to give prominence to these concerns. Evidence that the home is at risk to overstretch the ‘good will’ of the current team is now mounting. A previous requirement that a suitable strategy is put in place to fully staff the home is therefore made again as a result of this inspection. Training and development records were inspected and found to contain documentation and accounts of relevant and regular training updates. Supervision and PDPR records show improved staff supervision frequencies. The requirement from a previous report has been put in practise. Supervision and PDPR records show improved staff supervision frequencies. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 42 The registered manager and her assistant demonstrate good leadership and management skills however; this needs to be evidenced by better internal quality assurance processes and the manager needs support to achieve the registered managers award successfully. EVIDENCE: Both managers present were extensively interviewed and found to fully comply with the competency essentials required by Standard 37. One leadership concern applies after the inspector spoke to a number of staff: It is important that the management of the home keep an open and transparent culture and encourage staff to voice concerns. This can be found as a ‘Good Practise Recommendation’ in the relevant part of this report. The registered manager provided good evidence that she was monitoring the quality of service delivery through staff meetings, service user meetings and care reviews. Regulation 26 visits are completed every month.
21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 22 The inspector agrees with requirements made in previous reports for the home to comply with Regulation 35 and review the quality of care at the home at regular intervals. In spite of regular assurances the demands of Standard 39.3 are not met. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 1 2 x 3 Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 3 x x 3 Standard No
21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Score
Version 1.20 Page 23 LIFESTYLES Standard No 11 12 13 14 15 16 17 Score x x 1 1 3 2 x 31 32 33 34 35 36 3 3 1 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 x 2 Standard No 37 38 39 40 41 42 43 Score 2 2 2 x x 1 x 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 24 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 2 Regulation 14 Requirement The home shall only provide accommodation to a service user if needs have been fully assessed. The home needs to ensure that service user plans are available for all residents. The home needs to keep its care plans under regular six monthly review. The home needs to ensure that records are updated and audited regularly. Staffing needs to be sufficient so staff can support service users to participate in the local community Staffing needs to be sufficient so that stafff can support service users to have access to a range of leisure facilities That a suitable strategy is put in place to fully staff the home. Staff to receive positive response training. That the trust provides the home with staffing details. That a user-friendly quality assurance system is put in place. The registered manager to achieve level NVQ 4 in
D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Timescale for action 1 month 2. 3. 4. 5. 6 6 41 13 15 14 17 16 1 month Ongoing Ongoing 1 month 6. 14 16 1 month. 7. 8. 9. 10. 11. 33 35 41 39 37 18 18 17 35 9 1 month 6 month 1 month 3 month End of 2005
Page 25 21 Frome Court House Version 1.20 management by 2005 12. 13. 39 29 43 13 Timescales implementing reqirements of inspections are kept to The in-call system needs to be fully operational and pull-cords need to be re-installed. Ongoing Immediate 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 37 16 Good Practice Recommendations It is important that the management of the home keep an open and transparent culture and encourage staff to voice concerns. That the installation of a light warning system for rooms of those with a hearing impairment is considered. 21 Frome Court House D56 D05 S3401 Frome Court V221111 260405 Stage 2.doc Version 1.20 Page 26 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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