Inspection on 06/05/07 for 71 The Fremnells

This inspection was carried out on 6th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

71 The Fremnells 06/03/06

71 The Fremnells 23/11/05

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 6th May 2007 10:00 Fremnells (71) (The) DS0000018112.V339280.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 Fremnells (71) (The) DS0000018112.V339280.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. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 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.V339280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2006 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.V339280.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a Saturday morning by arrangement with the registered person, who works at a nearby school as a special needs teacher. The resident was present during the two hours of the site inspection. The registered person is the main carer, and is supported by her husband and other members of the immediate family who live at home. 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. The registered person does not intend to care for any other residents. Some records were available for inspection and facilities. Information regarding this service was sought either by telephone, letter or email from social services, health care professionals and a relative. Information was received from one source within the requested timescale that advised that the registered person was always willing to work with them on to any suggestions or advice regarding the resident’s care. What the service does well: What has improved since the last inspection? The resident has benefited from the installation of ceiling tracking in their bedroom that assists with safe moving and handling. The registered person has also purchased a vehicle with a rear ramp to allow easier and safer access for the resident that allows them to continue having outings as part of the family. The registered person had certificates to show that they have attended updated training. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 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.V339280.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Quality in this outcome area is good. The residents’ assessed needs were known to, and met by, the registered person. The resident has been provided with limited information about the details of their placement relating to rights and responsibilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As this home was registered specifically only to allow the continued provision of accommodation and care to this one resident, there is no service user guide or statement of purpose. There have been no new admissions to this home. The person registered confirmed again that no further residents will be admitted. The person registered provided a copy of their general agreement with Essex social services as foster carers, signed in 1999. She advised that prior to this they had offered the resident a shared care placement. The registered manager has training and skills to meet resident needs. The resident had not been given a statement of terms and conditions as required in previous reports. There was no evidence of a clear and detailed contract with the commissioning authority to demonstrate the terms of occupancy, what the fees are, what they cover, funding for equipment, responsibility for employment of the daily one-to-one carers, and the arrangements for review of the placement. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is adequate. The resident’s care documentation provided basic information to enable consistent care to be provided, but the resident would be better safeguarded by relevant risk assessments and more detail on specific areas of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The resident has a care folder that goes everywhere with them, and is kept in a pocket in their wheelchair. It provides basic information on the residents care and is written from a person-centred viewpoint. Issues covered included mobility, personal care, education, communication and behaviour. Observations and interactions with the resident indicated that they are supported to make decisions on everyday things and all aspects of their life possible. The registered person was again advised on the need to have risk assessments in place, for example in relation to individual transfers/moving and handling, or sleeping etc. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. The resident was well supported to experience leisure and community activities, family relationships, and to maintain appropriate nutrition intake for their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two identified carers support the resident to attend a day centre each weekday, arranged and funded by social services. The registered provider explained the positive and age appropriate relationships this offered the resident. The resident is advised as having a full social life, with two separate swimming/hydrotherapy sessions each week, and other activities such as bowling, going shopping, going to markets, going to a club to play pool with the registered provider and friends as well as visiting relatives at least once a week. The resident was involved in the discussion about their activities and non-verbal communications indicated their pleasure and support of the information provided by the registered person, for example when she told us of Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 11 how many ‘strikes’ they achieved when bowling. Photographs showed the resident and friends playing pool. The resident is entirely PEG fed. The provider was pleased to demonstrate that the resident has not only maintained their weight, but continues to slowly increase this. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is excellent. The resident was provided with advocated support for their health care needs, and personal support in a way that protected their privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered person confirmed that only she provided personal care for the resident while he is at home and showed that she would ensure respect for his privacy and dignity at all times. This included ensuring that he was dressed in smart clothes as appropriate to his age and his peer group. There was evidence of involvement and routine monitoring by healthcare professionals. The registered provider explained how wonderfully supportive their local GP is to herself and the resident. The community nurse had provided an action plan in relation to the residents identified needs on continence management, the Peg feed, epilepsy and difficulty with saliva/aspiration. All medication is administered through the Peg feed. The registered person advised that a newly prescribed medication is helping to dry saliva and is greatly reducing the need for the suction machine. The resident no longer requires the use of rectal diazepam. Recording of medication administered should be considered and linked to an up to date plan of care. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 13 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): 21, 22 Quality in this outcome area is good. The resident was safeguarded by the knowledge and skills of the registered person. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A written complaints procedure is not available. In the specific nature of this care home, it is considered as unnecessary. The registered person has had training on protection of vulnerable adults in their role as a special needs teacher, with regular updates. (Please also see the information relating to Criminal Record Bureau checks in the Staffing Section). Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 14 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, 27, 28, 29, 30 Quality in this outcome area is adequate. The resident was provided with a clean, safe, homely and comfortable environment within the limitations of the premises. This judgement has been made using available evidence including a visit to this service. EVIDENCE: While the residents bedroom is clearly limited in space, the registered provider confirmed that it is adequate, in that there is enough space to use required equipment safely, and the resident is only in there at night or for personal care. The majority of time that the resident is at home is spent with the family in the lounge. Ceiling tracking has been fitted since the last inspection and is confirmed as being a positive improvement. A new sling has recently been provided for the resident. The registered provider evidenced stocks of continence aids, gloves disposable wipes, and equipment for both the Peg feed and suction machines. The registered person has obtained a specially adapted vehicle for the resident’s use with a tail ramp to allow for easier outings. The registered person needs to continue to develop her ideas on providing additional space/bathing facilities as discussed at the last inspection. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. The resident received quality care outcomes due to the knowledge and skills of the registered person. The resident could be better safeguarded by the required recruitment documentation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not employ any staff. The registered person is the main carer for the resident and is supported by members of her family. Clearly affectionate relationships were observed. The registered person has qualifications and experience in working with children who have disabilities. More especially, she has cared for the resident for a number of years on a one-to-one basis and demonstrated that she knows all aspects of his care, personality and needs. The registered person provided certificates of recent training in Appointed Persons Emergency First Aid, Handling People with Special Needs (load management etc), Lifesaver Certificate for Supervisors of Swimmers with Disabilities and epilepsy awareness including the use of rectal diazepam and buccal midazolam. She has also previously undertaken training in health and Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 16 safety, management of challenging behaviour, British sign language and intensive interaction. An original criminal records bureau check for the registered provider was seen at the last inspection, but was not available for inspection. She advised that these are updated regularly in her role as a teacher. While the registered provider explained that criminal record bureau checks were available for other relevant members of the family, not all were up-to-date. Evidence of these was not available. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 17 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, 39, 42 Quality in this outcome area is good. The resident clearly benefited from the registered persons pro-active approach to ensuring the resident had good quality life experiences. Both the resident and the registered provider could benefit from ensuring better records are kept. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered person demonstrated effective systems are in place to ensure for example routine ordering of medication, feeds and other equipment the residents needs. There is a clear house rule that only she administers medication as that way no mistakes can be made. Care outcomes for the resident at The Fremnells were observed to be positive and in their best interests. The resident was clearly consulted in all decisions possible to offer them. They were also fully involved by the registered person in this site visit and the registered person remained acutely aware of their nonverbal communications throughout. The registered person advised that there is Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 18 to be an annual review of the resident’s care and placement by social services later this month. The one area where the registered provider needs to develop relates to records, as noted in different parts of this report. She is trustee on the resident’s savings account and records indicated that more money was paid into the account than was taken out of it. The registered provider explained that this was, in one example, where she had paid a large sum of money into the account for the resident as he was treated equally to her own children, two of whom had been given similar amounts. Some the resident’s money was used as the deposit for the new vehicle. Therefore it would be in both her own and the resident’s best interests to keep a record of explanation of how money comes into the account, and what withdrawals are spent on. The resident’s parent also helps to look after their money. The limitations of the premises have been identified. No safety concerns were identified in the areas of the premises used by the resident. The registered person is considering paving the entire front garden to support easier wheelchair access, as a ramp is not feasible. Evidence was available that the gas fire in the living room, where the resident spends a lot of time, had been serviced to ensure the safety of possible carbon monoxide emissions. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 19 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 X 2 N/A 3 X 4 4 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 N/A 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 2 28 3 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 N/a CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X N/a X 2 3 X Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 The resident must be given reasonable information about their placement and a contract/statement of terms and conditions must be provided. (Previous timescales of 20/05/05, 01/02/06 and 01/05/06 not met). 2. YA6 YA9 15 & 13(4)(c) The residents Care Plan must include adequate detail on how each aspect of the resident’s care is to be managed so that consistency can always be provided and this must be supported by detailed risk assessment that safeguards the resident. (Previous timescale of 01/01/06 and 01/04/06 not fully met). 3. YA34 17(2) Sch2,4 To protect the resident, the person registered must have available for inspection Criminal Record Bureau checks for all staff employed by, or DS0000018112.V339280.R01.S.doc Timescale for action 01/07/07 01/06/07 01/06/07 Fremnells (71) (The) Version 5.2 Page 21 who work at, the care home. In this unusual case it refers to all people who support the resident and/or live in the care home. (Previous timescale of 01/12/05 and 08/03/06 not met). 4. YA41 17(2) Records that protect the Schedule4(9) resident must be maintained, including those relating to how their money is spent, and others stated in the report. 01/06/07 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. Refer to Standard YA20 YA24 Good Practice Recommendations Records of medication should be maintained and linked to development of the care plan. The registered person should continue to develop her ideas on providing additional space/bathing facilities as discussed at the last inspection, and easier wheelchair access to the premises. Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Fremnells (71) (The) DS0000018112.V339280.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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