Inspection on 09/01/09 for Framland Residential Home

This inspection was carried out on 9th January 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Framland Residential Home 14/02/07

Framland Residential Home 03/11/05

Framland Residential Home 05/07/05

Framland Residential Home 20/01/05

Framland Residential Home 01/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Framland Residential Home The Mansion House 11 Faldo Drive Melton Mowbray Leicestershire LE13 1RH     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Fiona Stephenson     Date: 0 9 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: Framland Residential Home 11 Faldo Drive The Mansion House Melton Mowbray Leicestershire LE13 1RH 01664564922 01664564922 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Firstsmile Limited Name of registered manager (if applicable) Mrs Eleanor Rosemary Cant Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: No person in category PD(E) to be admitted to the home when there are 4 persons of that category already accommodated in the home. Service user numbers. No person to be admitted to the home in categories MD(E) or DE(E) when 4 persons in total of these categories/combined categories are already accommodated in the home. Date of last inspection 0 0 0 0 Over 65 4 4 31 4 care home 31 Care Homes for Older People Page 4 of 28 Brief description of the care home Framland Residential Home can admit a maximum of 31 older persons, some of whom may have dementia or a mental health condition. The home is situated in a residential area in Melton Mowbray. The town centre of Melton Mowbray is near to the home, so people living at Framland have access to a variety of shops and other facilities nearby. Framland is easy to get to by private and public transport. The building has three floors, the bedrooms being on the second and third floor. People living at Framland can get to their rooms by passenger lift or by walking up the stairs. The home has one large dining room and three lounges. There are 30 single bedrooms, 28 with en-suite facilities. There is a garden at the back of the house. The range of fees charged is between £400 and £450 per week. Care Homes for Older People Page 5 of 28 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This key inspection included a visit to the service. We (the CSCI) visited Framland Residential Home on Friday 9th January 2009. Ellie Cant, the registered manager, and Hadley Newman, one of the directors of the company, helped us during the visit. We arrived at Framlands at 7.45am, and we finished our visit at 3.45pm. The main method of inspection we used was case tracking. This means looking at the care given to people in different ways. We did this by: - talking to people who live at Framland - talking to staff and management Care Homes for Older People Page 6 of 28 - watching how people are given support - looking at written records. We looked at the Annual Quality Assurance Assessment (AQAA). This is a document the provider (the person who owns the service) sends to us at the CSCI to tell us what the provider thinks of the service they deliver to people who live at Framland. As well as this we looked at information that had come to our attention since the last key inspection. We sent Have your say about... questionnaires to people who live at Framlands. We received 12 responses back. We looked at these questionnaires to find out what people thought about the care they received from Framlands. We had a number of positive comments from the questionnaires. These included: the home feels like a home. A lovely atmosphere, the food always looks nice and the home is immaculately clean, and most importantly the staff are helpful and kind. If my mother is not happy about something I try to investigate and usually we get something done about it. I choose what I want to do each day, what I like to have to eat etc. and if I wish to go out etc. excellent surroundings, excellent food. Any problems can be dealt with straight away. Other less positive comments received from the survey said: suggestions are not always followed up the home could improve by better food, more staff, have more entertainment for the residents the kitchen could do with some spring cleaning I feel that they dont listen to me at times. When we talked to people living at Framland during our visit they told us that staff are very good, all the staff are very good to me. Theyre very friendly. I like it here, I get my washing done, clean clothes everyday and meals are cooked for you. Ive never been hungry since Ive been here. they have quizzes and sometimes have floor skittles, theres not alot of activities because alot of people cant do any walking. staff are very nice, they do what you ask, they will put themselves out. If I had a concern I would talk to the manager but havent needed to. One person said its grim here, but wouldnt elaborate. During our visit, we spoke to five staff, six people who live at Framlands, a visiting relative and a visiting social worker. We checked all the standards the Commission for Social Care Inspection has decided are key standards during this inspection. The information given in this report is based only on what we checked at this inspection. We have kept details of individual people out of the report to make sure we respect their confidences. Care Homes for Older People Page 8 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Care plans could inform staff of the reasons why people living at Framlands are prescribed medication, and what the effects of the medication are. This would support them in having a better understanding of the health care issues, and could help in identify whether changes in behaviour are linked to changes in medication. Care plans could more clearly identify the social, emotional and cultural needs of each person living at Framlands, and how staff and management are going to meet their needs. Although detailed care planning is not expected during the first few weeks of a persons admission, the process should start at the point of admission, and care plans drawn up if there is a need identified early on in the persons stay. The cook should ensure that those who have a liquidized diet, unless agreed in their care plan, have their food liquidized in a way that people needing a liquidized diet can still determine the different foods on their plate. The service could look at how they deploy staff to further support people in engaging in social activities during times of the day when people living at Framland are more responsive. The service must ensure it has the correct medication cupboard for controlled drugs, and that medication requiring refrigeration is not housed in a fridge alongside food. Care Homes for Older People Page 9 of 28 Although the service has signs in place to help people know where facilities are in the home, it could provide more written and visual information to support people with dementia. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Framland have good information about the service, and on the whole have their needs appropriately assessed prior to moving into the home. Evidence: We looked at the information given to people who are looking to move into Framland and saw that it gave accurate information about the service and how people would be supported whilst living at Framland. We looked at the needs assessments of three people who live at Framland. These are documents that show the manager or trained staff in the home have looked closely at the needs of each person to ensure that the service can meet their needs. Usually an assessment is undertaken by social services and is followed up by the manager of the care service. Of the three people we case tracked, two had thorough needs assessments undertaken by the manager at Framlands. The third, a recent admission, Care Homes for Older People Page 12 of 28 Evidence: although having had a needs assessment written by social services one month prior to being admitted to the home, was not followed up with a needs assessment more pertinent to the persons needs whilst living at Framland. Care Homes for Older People Page 13 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Framland receive good health and personal care. Evidence: We looked at the care records of people who live at Framland, and found that the majority had their health, and personal care needs set out in an individual plan of care. This plan had been reviewed regularly and changed when necessary. We spoke with people who live at Framland who told us that they were aware of when their plan changed and signed to say it had been changed. We saw by looking at the records that good links have been formed with other health care professionals such as District Nurses, G.P.s, Chiropodists, Dentists and Opticians. We saw that personal histories had been taken, and information had been received about the hobbies and social interests of people living in the home. This information had not been used as well as other information in informing how the social and emotional needs of people living at Framland could be met. We looked at the AQAA which told us that the service does research and provides for Care Homes for Older People Page 14 of 28 Evidence: specific language, communication, religious, cultural and sexual needs. On case tracking one person living at Framlands we did not think that enough research was done to support the needs of this individual. We looked at medication records of people who live at Framland. Staff were administering medication as directed by the persons doctor, and were documenting the administration well. An incident happened during our visit regarding the administration of medication to one person who lives at Framland. The care plan and risk assessment was updated to reflect the changes in the persons behaviour in relation to the administration of medication. We looked at where medication is housed. We saw that controlled drugs are currently not stored in a way that complies with the regulations for the storage of controlled medication (this has recently changed, and the service was complying with the previous requirements). We also looked at medication requiring refrigeration. This medication is housed in a fridge which also stores food. We found medication in the fridge which should have moved to a warmer environment once opened, still being stored in the fridge. We watched how staff treated people living in the home. We saw that staff treated people very well, and with great dignity and respect. We saw people living at Framland feeling very able to go to staff and ask questions and ask for help, and we saw that staff responded kindly and promptly. We saw examples of staff treating people with dignity. Some moving and handling techniques can be undignified, and we saw staff making sure that the dignity of those using a hoist was not compromised. Care Homes for Older People Page 15 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Framland experience a good daily life. Evidence: We saw that staff respect the routines of people living at Framland. People are not hurried to get up for breakfast, and we saw people gradually getting up and getting their breakfast. We saw a range of food and drinks on offer for breakfast. People living at Framland were seen being offered and accepting breakfast cereals, toast, porridge, fruit juice, tea,coffee and a cooked breakfast. They were able to have as much or as little as they wished. We saw that some of those who were unwell had their breakfast taken up to them in bed. We saw people using the choice of lounges, and enjoying the pets that have been accepted into Framland. There is currently a canary, two dogs and a cat that reside there. We saw people undertake their own activities such as knitting, and we saw that staff support people in taking part in planned activities such as skittles, catch ball, and reading the newspaper. Over the Christmas period, people living at Framland went to see a pantomime, and a Christmas party was provided. The owner of the home told us that the Christmas party was such a success he hopes to have a different themed Care Homes for Older People Page 16 of 28 Evidence: party each month. We looked at the care plans in relation to social activities and we saw that although there are communal activities available, there is less attention paid to meeting the individual social needs of people living at the home. Care plans document well how health needs are to be addressed, but dont document how staff will support the social needs of each person. We were told by a relative who was visiting the home the same day as our visit, that she was made to feel welcome each time she came, and could come at any time to see her parent. She told us that she felt staff provided good care to her relative. We talked to the cook and looked at the four week menu planner. The cook clearly knew what people liked and disliked. The menu provided a good variety of food not only for the main meal at lunchtime, but also for the teatime menu. People who live at Framland were enthusiastic about the food provided. Two people who live at Framland have their food liquidized to help them eat. The cook acknowledged that the food is not liquidized separately onto the plate so that the person can distinguish the different food groups. One person who completed the have your say survey said they wanted their food liquidized separately. The cook agreed that this was good practice and said she would do this in future. Care Homes for Older People Page 17 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at framland are well supported and protected by management and staff. Evidence: People living at Framland feel able to talk to staff and management if they have a concern or complaint about any aspect of life in the home they are unhappy about. These concerns are often dealt with informally. There is a formal complaints policy which has been used, however of the two formal complaints neither were upheld. A copy of the complaints policy is on the notice board in the home. The manager and staff have a good understanding of how to safeguard people who live at Framland from abuse. Staff know to inform the manager if they have any concerns about the behaviour of other staff or residents that may be impacting on the safety of people who live in the home. The manager was very aware of her responsibilities under the Safeguarding policies and procedures, to inform outside agencies such as social services if there were any concerns that a residents safety was being compromised, however staff were less clear on this. Care Homes for Older People Page 18 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in Framland live in a homely, safe and well maintained environment. Evidence: We saw that people living at Framland, live in a safe, homely and well-maintained environment. The home has three lounges, one of which does not have a television allowing people the choice to watch T.V. in the other two lounges or have a quiet space to sit and relax in. New lounge chairs have recently been bought with residents helping to chose the colour of the chair they wanted to use. The dining room is set out to enable small groups of people at different tables. People were seen coming into the dining room, and the more independent ones chose where they wanted to sit. The tables are laid nicely to improve the dining experience. We looked at the bedrooms of people case tracked during the visit. We found these to be clean and tidy and well maintained. People had brought their own belongings into their room to personalise them. We saw that staff would put on protective clothing such as gloves and aprons when undertaking personal care tasks. Staff were aware of the importance of infection Care Homes for Older People Page 19 of 28 Evidence: control. We saw that at the front door there is a bacterial hand gel for visitors to use, to minimise the spread of germs and infection. We visited on a cold day, and all areas of the home were warm. We noticed that there were signs around the home to help people who experience confusion living at Framland to know where to find the lift, toilets and bathrooms. Care Homes for Older People Page 20 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care needs of people living at Framland are well supported by the skills and staffing level of the home. Evidence: On the morning we visited staff were very busy as a member of staff on the rota had not arrived for duty and had not phoned to say they would not be coming. The manager quickly contacted another member of staff who agreed to come in earlier than her shift to help out. We noticed that some people living at Framland who are more dependent on staff were sitting at the breakfast table for over an hour before being moved to a different room. We were told that this would not normally happen. Once staffing levels were up to the expected number, we saw residents personal care needs being well met. Although staff spoke with people living at Framland when undertaking care duties and acknowledged people when entering and leaving rooms, we did not see staff having much opportunity to sit and talk to people, particularly in the morning when people were more responsive and alert. We saw staff undertaking their duties professionally and were observed to have been well trained in supporting people who have physical disabilities, in using hoists, and equipment which is used to help move people who cant move by themselves. Care Homes for Older People Page 21 of 28 Evidence: We were informed by the AQAA that of the 17 people who are employed in the home, 13 have been trained and received their National Vocational Qualification in Care to a level two or above. We checked staff recruitment records and were satisfied that the manager has ensured all the necessary checks on staff had been carried out prior to staff starting work at the home. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Framlands are well supported by the owner and manager who have high aims for the service. Evidence: Ellie Cant is the registered manager of Framland. We observed Ellies management style during our visit, and found her to be approachable, warm and friendly. She was observed to be supportive of staff and people who live at Framland. We spoke with the owner of the home and the manager who told us of the changes they have made to the home to improve the environment for people who live at Framland. We looked at the visits made by the owner to the home, and the reports he writes about his visits. The owner writes a report each month about his visit, and the reports show that he is spending time listening and talking to people who live there, and acting upon what he sees and hears. Care Homes for Older People Page 23 of 28 Evidence: We spoke with staff who confirmed that they have regular supervision and staff meetings. We checked to ensure that the money held in the home for people who live at Framland is safeguarded through record keeping and accounting, and found good recording systems in place. On the whole, records provided good evidence to show that personal care, health and safety, medication management, and work and recruitment practices were being well managed. Care Homes for Older People Page 24 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 28 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The provider must ensure that controlled drugs are housed in a cabinet that conforms to the Misuse of Drugs Act, Safe Custody. To comply with the law, and keep controlled drugs safe 09/02/2009 2 9 13 The provider must ensure medication that requires refrigeration is not stored with other food substances. To comply with guidance issued by the Royal Pharmaceutical Society, and to ensure that medicines are kept in a safe and hygienic environment. 29/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 The care plans should inform staff and people who live at the home, the reasons why medication has been prescribed Page 26 of 28 Care Homes for Older People to people who live there, and what effects the medication may have. 2 7 The care planning process should start at the point of admission, and care plans drawn up if there is a need identified early on in a persons stay. The manager should look at using the information about the social, cultural, language and emotional needs of people living at Framland more effectively to plan social activities and care that reflect the need of the individual. The cook should ensure that those who have a liquidized diet, unless agreed in the care plan, have their food liquidized in a way that ensures they can still determine the different foods on their plate. The manager should remind staff of the safeguarding process after the manager has been informed of an allegation of abuse. The provider should consider whether more visual and written stimulation for people with dementia might further support their needs. The provider may wish to consider changes in staff deployment to provide further support to people living at Framland in engaging in social activities during times of the day when they are more responsive. 3 12 4 15 5 18 6 22 7 27 Care Homes for Older People Page 27 of 28 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 28 of 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!