Inspection on 23/11/05 for 71 The Fremnells

This inspection was carried out on 23rd November 2005.

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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

71 The Fremnells 06/05/07

71 The Fremnells 06/03/06

71 The Fremnells 19/03/05

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

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

CARE HOME ADULTS 18-65 Fremnells (71) (The) 71 The Fremnells Basildon Essex SS14 2QZ Lead Inspector Mrs Bernadette Little Unannounced Inspection 23rd November 2005 04:00 Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 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 Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 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. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fremnells (71) (The) Address 71 The Fremnells Basildon Essex SS14 2QZ 01268 526692 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) Mrs Julie A Atkins Mrs Julie A Atkins Care Home 1 Category(ies) of Physical disability (1) registration, with number of places Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19 March 2005 Brief Description of the Service: The home is a four-bedroomed terraced modern house in Basildon suburbs. The home consists of three bedrooms upstairs with bathroom and w.c. Downstairs facilities consist of a large living/dining room and kitchen. The Service User’s room is on this floor. A hatch has been made from the kitchen that allows the carer to monitor the service user when asleep without disturbing him. There is a door with a key for emergency access. There is also a large enclosed garden. The Service User shares the home with the proprietor’s family and is considered to be part of the family. The Service User attends a day college locally during the week and is at home in the evening. When at home he joins in activities with the family. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on Wednesday evening by arrangement with the registered person who works as a nearby school as a special needs teacher. This also allowed opportunity for introduction to the resident. This service was registered specifically to comply with the legislation and so allow the main carer to continue to offer care to the resident, which was an arrangement already in place. Because of this, it does not meet many of the National Minimum Standards. The focus of the inspection was on the outcomes of the care of the resident. Time was spent with the registered person, who is the main carer, and those who support her, that is husband and three teenage children who live at home, as well as with the resident. Some records were available for inspection and facilities and parts of the premises used by the resident were also seen. What the service does well: What has improved since the last inspection? What they could do better: Accepting that this family home does not meet the majority of the national minimum standards but provides excellent quality care outcomes for the resident, the registered person should however give more attention to specific documents. Examples would include the availability of Criminal Record Bureau checks and contracts and who remains responsible for the safe recruitment of the carers who look after the resident during the day. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 6 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. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 7 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 Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 The registered person was well able to demonstrate the home’s capacity to meet the assessed needs of the particular resident EVIDENCE: As this home was registered specifically to allow the continued provision of accommodation and care for this one resident, there is no service user guide or statement of purpose. The registered person confirmed that there have been, and will be, no further admissions to The Fremnells. The registered person demonstrated effective communication with the resident as did other members of the family. The resident did not have a written statement of terms and conditions or contract with the registered person, although this was documented as requirement in the last inspection report. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Care management documentation was not adequately detailed to demonstrate how all aspects of the service users health and well-being were to be met EVIDENCE: There was no clear, identified plan of care or risk assessments available. The registered person did have documents from other healthcare professionals, for example from the nutritional nurse or for oral care needs from the speech and language therapist. A community nurse had provided the carer with an information folder which, when completed will show the resident’s personal details, and needs in relation to health, communication, mobility, medication, sleep, eating and drinking, teeth, skin and chiropody care. Risk assessments were said to have been done by the community nurse in relation to for example where the resident’s chair can be sited because of his specific needs. There is a clear need for additional risk assessments for example in relation to pressure area care, moving and handling etc both documents also need to refer to the management of the suction machine, take defeat on possible need for rectal diazepam to be administered. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 The Fremnells provides the resident with good support to achieve their potential in living as ordinary and meaningful at life as possible. EVIDENCE: The resident was supported to continue with the everyday experiences , including his attendance at daycare five days each week, where he has a oneto-one carer. The records showed that he went shopping, bowling and was included in family outings such as going to the zoo. There was also discussion about watching videos and playing electronic games with the main carers teenage sons, which clearly the resident enjoyed. The resident had contact on a regular basis with members of his family. Photographs demonstrated that he also had appropriate family relationships with the main carers extended family. The resident is now completely nil by mouth and is PEG fed. The carer identified that there is an effective system for the ordering and supply of the residence requirements including supplement drinks. There were clear written instructions from a healthcare professional and how to give the feed. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 The registered person demonstrated that the resident’s health care needs were identified and met. This could be better supported by clearer care management records. EVIDENCE: Discussion with the main carer and the community nurse who was present at the beginning of the inspection, along with inspection of the records available confirmed that the resident has all the positive support needed to gain any necessary health care service or intervention he needs. The resident’s medications were all administered through the PEG and only by the registered person. Medication was stored in a separate cupboard in the kitchen. The person registered described an appropriate and effective system to ensure availability and stock control. No records were maintained. The registered person has had training on medication in the past The registered person advised that the resident had had a period of time in a residential establishment elsewhere prior to her caring for him full-time and his weight had dropped to under five stone. Weight records for the resident confirmed that he continues to gain weight. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The registered person had sufficient training and knowledge to protect the resident EVIDENCE: There is no complaints procedure and this was an issue advised upon at a previous inspection. No complaint had been received since the last inspection. The registered person said that she and her husband had had Enhanced Criminal Record Bureau checks both because they are registered foster carers with Essex County Council and through her job at a special needs teacher. Evidence of current CRB checks for them was not available, and was not available for the older members of the family who assisted in the resident’s care and lived on the premises. The main carer confirmed she had had training in the protection of vulnerable adults. The register person did not have confirmation writing from the supplier of the agency carers who provide one-to-one care of the day centre during the day for the resident, that they have had all the appropriate checks undertaken. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25, 26, 27, 28, 29, While the home did not meet the majority of the national minimum standards it did provide are lovely and comfortable environment to the resident. EVIDENCE: The lounge had a large empty area that was needed as a safe place to put the resident’s individual wheelchair. The person registered had remodelled this room to allow ease of access. The resident’s bedroom was on the ground floor and was limited in space. The registered person confirmed that safe use of the hoist was possible. She advised that a tracking system was now required to meet the resident’s needs, and she will be seeking support from social services to provide this for the resident. The person registered had remodelled the bathroom to accommodate the resident’s needs. The person registered confirmed that his needs had now increased to such a level that there was no ordinary/assisted bath available that would suit him so he was completely being bedbathed. The person registered said she would like to provide a Jacuzzi/hot tub in the future, as this might be appropriate for the resident because of its size. The person registered had remodelled the kitchen to allow the main carer to monitor the resident in his room without disturbing him. The resident has a Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 14 heart monitor/pressure pad in his bed. There was a monitor connected to the main carers bedroom, to allow continued monitoring of the resident at all times. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 15 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 There were no staff employed at the home. The family type staffing approach provided the resident with consistent care. EVIDENCE: The registered person was the main carer and she was supported by members of her family. The registered person was a qualified class teacher at a local school for children with disabilities. Training certificates were seen for health and safety in the workplace, management of challenging behaviour, British sign language, swimming instructor for people with disabilities, intensive interaction, moving and handling and administration of rectal diazepam. Some of these need to show updates. Evidence should be more readily available of Criminal Record Bureau checks for all appropriate people involved in the residents care. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 41,43 Whilst the majority of the standards were not met because of its unique situation there was a clear view that the home was run with the residents needs as paramount. EVIDENCE: The home does not have any policies and procedures or keep any records such as rosters. There is no quality assurance system in place but there was clarity throughout the inspection that the resident’s views are able to be communicated to the family and were taken into account. The registered person advised that a relative of the resident looked after the majority of the resident’s money and provided for example the money he required at the specialist day centre. She advised that she was a trustee for the resident on one savings account. The passbook was provided and considered appropriate. The person registered did not have a clear and detailed contract with the commissioning authority. This needs to be sought and include issues such as the terms of occupancy, what the fees cover, funding for equipment, Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 17 responsibility for employment of the additional carers who provide one-to-one care to the resident during the day and the arrangements for the review of the placement. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score N/A N/A 4 N/A 1 Standard No 22 23 Score N/A 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 X 1 X Standard No 24 25 26 27 28 29 30 STAFFING Score X 1 2 1 3 1 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 N/A 3 2 2 N/A CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Fremnells (71) (The) Score X 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X N/A N/A 2 X X DS0000018112.V267623.R01.S.doc Version 5.0 Page 19 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 YA5 Regulation 5(c) Requirement Timescale for action 01/02/06 2 YA6YA9 3 YA34 4 YA35 A placement agreement or contract must be drawn up.(Previous timescales and from last inspection of 20/05/05 not met). 15 & There must be a Service User 01/01/06 13(4)(c) Plan in place, which includes risk assessments and include adequate detail on how each aspect of the resident’s care is to be managed. 17(2) The person registered must 01/12/05 Sch2,4 evidence robust recruitment practices. This includes the availability of Criminal Record Bureau and records for all staff employed by or who work at the care home. 18(1)(a)(c) The person registered must 01/02/06 evidence appropriate/updated training. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 20 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 Refer to Standard YA41 Good Practice Recommendations Records should be better maintained and organised. Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Fremnells (71) (The) DS0000018112.V267623.R01.S.doc Version 5.0 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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