Inspection on 15/01/07 for Fremington Manor

This inspection was carried out on 15th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fremington Manor 26/01/09

Fremington Manor 20/12/05

Fremington Manor 30/06/05

Fremington Manor 09/02/05

Fremington Manor 23/08/04

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

CARE HOMES FOR OLDER PEOPLE Fremington Manor Fremington Manor Fremington Barnstaple Devon EX31 2NX Lead Inspector Dee McEvoy Key Unannounced Inspection 09:30 15th January 2007 X10015.doc Version 1.40 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 Fremington Manor DS0000061790.V308867.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 Older People. 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. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fremington Manor Address Fremington Manor Fremington Barnstaple Devon EX31 2NX 01271 377990 01271 859067 fremingtonmanor@medscape.com 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) Two Rivers Investments Ltd Mrs Kathleen Deal Care Home 70 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (21), Old age, of places not falling within any other category (70), Physical disability over 65 years of age (21) Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Kate Deal is the Registered Manager Registered for 50 in the category OP for Nursing Care Registered for 21 in the categories OP, MD [E] and PD [E] for residential care 13th September 2006 Date of last inspection Brief Description of the Service: Fremington Manor is a large house set in extensive grounds; care has been provided here since 1985. The original building has been converted for use as a care home and a large purpose built extension has been added. The home is registered to care for 70 residents. The registration categories cover people requiring nursing care and older residents with mental health or physical disability needs. There are Registered Nurses on duty throughout the day and night. There are 39 single rooms within the home, 23 of which have en-suite facilities. There are 15 double bedrooms, 10 of which have en-suite facilities. The home has completed work to extend the accommodation to Benedict wing by adding 4 en-suite double rooms, which would be used for married couples or others wishing to share, or people wishing to enjoy a larger living space. Local shops are within walking distance and a regular bus service runs to and from the local town of Barnstaple. Respite care is available. The average cost of care ranges from £306.00 to £500.00 per week for residential care and from £481.00 to £633.00 for nursing care, depending on individual needs. Comprehensive fee levels are available in the home’s Statement of Purpose. Additional costs, not covered in the fees, include chiropody, hairdressing, dry cleaning and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports, is available to prospective and current residents. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 5 Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took one day to complete and was undertaken by two inspectors. There were 60 residents living at the Home at the time of the inspection. In order to understand the experiences of people using this service, the inspectors looked closely at the care planned and delivered to seven residents. During the course of the day the inspectors met with a number of other residents around the home and spoke with 11 in some depth about life at the home. Time was also spent observing the care and attention given to residents by staff. Twelve staff members were spoken with including the manager and 4 relative were also interviewed to hear their views about the home. As part of the inspection CSCI surveys were sent to residents, relatives, staff and outside professionals. Completed surveys were received from 13 residents; 8 relatives, 12 staff and 5 health and social care professionals expressing their views about the service provided at the home. The inspectors toured the premises and inspected a number of records including residents’ assessments and care plans and records relating to medication, recruitment and health and safety. The manager had completed a pre-inspection questionnaire prior to the inspection, which provides general information about the home. The registered provider was available for feedback at the end of the inspection and was keen to ensure that the home continues to maintain good standards of care for residents. A random inspection was carried out in September 2006 to look at various issues raised in a complaint. The outcome of that inspection is referred to in the relevant sections of this report. A copy of the random inspection report can be obtained from CSCI on request. What the service does well: Residents were asked what the home did best, comments from residents included, “Everything!” - “The staff are really wonderful”, “The food is excellent” and “It is a lovely place to live”. Relatives’ comments included, “Very happy with the care and attention” and “It’s all going well”. Professionals felt that residents were well supported by staff who understood their needs. Residents and their families have the information needed in order to make a decision about whether the home will be “right” for them. All private residents Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 7 are issued with comprehensive terms and conditions, which sets out rights and responsibilities. Residents said they were treated with respect by the staff team and were able to make decisions about their daily lives. Relatives felt welcome at the home and can visit at any time meaning that residents are well supported; one relative wrote, “We are always well received” People rated the food highly and main mealtimes offer a pleasant and sociable occasion for residents. Meals are varied, well balanced and nicely presented. Residents feel their concerns and opinions are listened to and acted upon and that they can influence the development of the home. Adult protection procedures and staff awareness protect resident from harm. Good systems are in place to ensure that residents’ monies are administered properly. Residents were happy with the general environment, comments included, “This is a beautiful house and the gardens are really lovely”. Some residents said they enjoyed the garden and took daily walks, weather permitting. All residents spoken with were happy with their private accommodation. Staff felt training was a particular strength of the home; staff are offered training, which is relevant to their role and ensures that good practice is maintained. The management team, including the provider and registered manager, ensure that action is taken to meet requirements identified by CSCI, meaning that improvements continue to benefit residents. What has improved since the last inspection? What they could do better: When asked, several residents said there was “nothing” to improve at the home. Others had suggestions about areas of improvement important to them. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 8 In order to fully protect every resident’s rights, terms and conditions of residency should be given to all residents. Pre-admission assessments, care plans and risk assessments should contain all the information staff need to provide individual care to residents. The home is registered to care for people with a mental health need but not for residents with a dementia type illness. The home has admitted one resident whose primary needs they cannot safely meet. There are some issues with the ordering, recording and safe selfadministration of medication, which must be addressed to avoid placing residents at risk. Some residents, relatives and staff felt that activities and occupation at the home could be improved. Activities need to be resident-focussed and better planned. The home should help residents get involved in more activities and outings and provide stimulation appropriate to their individual capabilities. The number and deployment of staff should continue to be monitored to ensure that residents’ needs are met in a timely way and that they have opportunities to have their social and psychological needs met. It is recommended that all staff receive regular supervision to ensure that their performance and practice is monitored and that staff meetings are resumed to encourage teamwork and good communication between all staff, including night staff. Areas of health and safety need to be improved in order to fully protect residents and staff. 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. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 4 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents and their relatives have access to detailed information about the home to help them make an informed decision about whether the home is right for them but some residents’ rights may not be fully protected by the current contractual arrangements. The assessment and admission process is generally well managed to ensure that the home can meet the needs of the majority of residents. However, residents with a dementia type illness cannot be assured that their needs will be met by the home. EVIDENCE: All residents returning CSCI surveys said that they had received enough information about this home before moving in so they could decide if it was the right place for them. The home’s Statement of Purpose is very detailed and gives prospective residents a good idea of the services available at the home. Copies of the Statement of Purpose and the latest CSCI report are kept in reception and are freely available to all residents and visitors. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 11 Three residents responding with surveys said they had not received a contract. This was discussed with the manager who said that all privately funded residents receive a contract from the home; socially funded residents have a contract with the funding authority. The provider and manager agreed that terms and conditions should be issued to all residents to ensure that they were aware of their rights and responsibilities. Information to be included would be details about rooms to be occupied, overall care and services provided, arrangements for reviewing care and any restrictions of freedom. Seven care files were looked at and the deputy matron described the admissions process. All files contained copies of a pre-admission assessment containing basic information relating to the residents’ needs. A further assessment is completed once the resident has been admitted to home, which is more detailed. However it was noted that sections relating to mental health, communication, preferences and social needs were sometimes less fully detailed than other areas. Four care files included discharge information from the hospital, which was useful to staff. The family of 2 residents had provided very detailed information about the residents, most of which had been transferred into the care plan on admission. Where possible, a senior member of nursing staff will visit prospective residents to talk about their individual needs and give information about the home. One relative confirmed this. If the resident is admitted from outside of the county or the admission is of an urgent nature, the home will gather information over the phone from relatives and other professionals. One senior member of nursing staff said that they were not always informed about new admissions until “paperwork” arrives on the desk. One resident was clearly placed out of the Home’s registered category. This resulted in the resident being placed at risk of harm, which is evidenced by the Home’s risk assessment for this person and the inspector’s observation of care, (including an incident which could result in harm), and care records. The Home cannot fully meet the resident’s needs. A review of this resident’s care had not been undertaken and additional resources were not in place to meet individual needs. This was discussed with the manager and senior nursing staff during the inspection. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place for informing staff about residents’ care needs, although a lack of detail in some care plans may lead to inconsistencies in care and a risk that some residents may not receive all the care they need in their preferred way. The home takes appropriate action to ensure that the health care needs of the residents are met. Some areas of the management of medication are not satisfactory and could put residents at risk. The dignity and privacy of residents is respected by staff and is generally well supported by good care practice. EVIDENCE: Eight residents responding with surveys said they “always” received the care and support they needed and five said they “usually” receive the support required. Residents spoken with were happy with the care provided overall. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 13 Comments from residents included, “All very good here”, “The care is excellent” and “This is a lovely place”. All relatives contacted were satisfied with the overall care, as were five health and social care professionals. One relative wrote, “My mother has improved greatly since being here”, another said, “We are very pleased with the care and attention”. One social worker commented, “The family have been delighted with the care”, another wrote, residents “have been supported with a good standard of care”. Relatives supported these observations. Staff spoken with were aware of residents’ needs in general. Seven care plans were looked at to check how care is planned and delivered. The Home uses a pre-typed template to identify certain needs for each resident. One care plan included good details about the resident’s preferred personal care routine and encouraged the independence and participation of the resident; another include good detail about the resident’s preference with regards to dietary and continence needs. However, not all care plans contained clear summaries of needs and some actions and goals were not individualised outside the template format, which could mean that preferences and needs may not be consistently met by all staff especially agency staff. Action and progress records relating to some residents’ mental health needs, for example depression, self-harm, aggressiveness and dementia/confusion did not give enough information for staff to give consistent and safe care. One resident had been identified as likely to self-harm and the action to address was “To encourage OT activities” but no details about what activities would be meaningful or enjoyed or how often they were to be offered was recorded to ensure that needs could be met appropriately. Another resident constantly calls out but does not appear to want anything in particular. Staff were aware of this and were reassuring and kind to the resident but this behaviour and the necessary staff response was not mentioned in the care plan. Care plans had been reviewed regularly but one had not been recently reviewed to reflect the change in care needed by the resident, although staff spoken with were aware of the changes. Some care files contained inappropriate comments such as ‘lost dentures so needs puree’, ‘wandering as usual’ and ‘ensure has call bell’ although two residents could not use one. There were no further actions relating to the above. Daily notes were sometimes brief stating, “care as plan” and did not reflect the actual care given. Other important information is “lost” within daily notes, such as changes in mobility and continence needs. One staff member felt that the record keeping could be better. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 14 Not all care plans showed involvement with the resident or representative and 5 residents said that they had not seen their care plan. Risk assessments were generally good with the exception of two relating to mental health needs, which did not clearly identify risks and the action to reduce or manage the risk, for example where there is a possibility of a resident self-harming. The majority of residents said that they “always” receive the medical support they required. One G.P responding with a survey was happy with the overall standard of care at the home and felt that staff communicated clearly and understood residents’ needs. One relative said that the staff were “nice girls” and “sorted the resident out when they were ill”. The Home has a close relationship with local surgeries and there are regular GP rounds. Residents have access to other health care professionals and services such as palliative care nurse specialist, optician, dentist, and chiropodist and out patients services. Records of multidisciplinary visits were good although some did not detail the outcomes, such as visits by care managers or Community Psychiatric Nurse (CPN), which may assist staff when reviewing or evaluating care. Records showed that staff take appropriate action and were observant to residents’ health needs, calling the GP promptly. Sample results and tests were clear and acted upon. One resident said ‘this’ll do me for the rest of my life, the staff are friendly’ and the relative said that the resident was always well cared for. During a random inspection in September 2006 two issues relating to health care, namely pressure area care and continence, were looked at. Care relating to these needs was found to be satisfactory. The medication system was inspected. Only registered nurses administer medication within the home. There were good assessments relating to selfmedicating with family involvement but no residents have chosen to do this at present. Medication received by the home is recorded appropriately and storage facilities are secure. Medicine Administration Records (MAR) were looked at. Some gaps on MAR charts suggested medicines had not been given and there was no explanation as to why they were not given. Improvement needs to be made in the administration of ‘as needed’ medication. For example, one drug had been prescribed following discussion Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 15 with the GP about a resident’s aggression. There were no details of events, behaviour or possible triggers and actions to minimise aggression and the need for medication. The process for deciding to give the drug was not clear. The sedative was being given for reasons such as ‘too active’, ‘wandering’, ‘in another resident’s room’ or ‘anxious’ and daily notes recorded ‘sleepy today’ on a few occasions. This is not appropriate. One regularly prescribed tablet was not given due to being ‘out of stock’, which could put residents at risk. This should not happen. Several residents commented on the friendly approach of the staff. One relative said, “The staff are very caring and understanding”. Staff were very kind to residents and three staff were particularly gentle assisting a resident using a hoist. Staff were heard to use residents’ preferred names and were generally attentive and sensitive to residents’ needs and requests. Staff were seen to knock on residents’ doors before entering and maintaining privacy. A relative confirmed that this was usual practice. Staff use ‘care in progress’ signs on doors to promote privacy and dignity during care giving. Relatives and visiting health professionals said they could see residents in private. It was noted that ‘communal toiletries’ are kept in some bathrooms, which is not very satisfactory as it may present a risk of cross infection and may not reflect individual preferences. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is adequate provision for social fulfilment for some residents, but more specific recreational opportunities suited to residents’ individual needs and capacities would support a better quality of life. Family and friends are always welcome ensuring that residents have supportive relationships. Residents are enabled to express their wishes and make decisions. A balanced and varied diet is provided which takes into account residents’ dietary needs and preferences. EVIDENCE: The home employs an activities organiser for 20 hours a week. A weekly craft class, movie afternoon and an exercise and relaxation session are part of the week’s activity. Coffee mornings are regularly held and a monthly communion is available. The Home also organises external entertainers such as musicians. However, residents are not always aware of what is going on. One resident “I am not aware of any activities” and another thought a newsletter would be a good idea. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 17 There were no records available of how staff are meeting the leisure and social needs of each resident individually. Some residents spend all their time in their rooms and although the activities organiser does 1:1 sessions weekly, there is not enough time to give all resident quality time on a regular basis. One resident had no stimulation or staff contact other than during tasks during the inspection. One relative felt that there was “little evidence that residents in bed are occupied or stimulated”. The matron said that staff did spend one to one time with residents but that this was not recorded. Staff felt that they would like more one to one time with residents to do little things like that chat, go for a walk or just sit and listen. This was not seen during the inspection although staff were kind and friendly to residents as they went about their work. Some residents spoken to said that there wasn’t much to do, one said “It can be very boring at times” and one said that staff did not have time to talk, which was a shame, as other residents could not have a conversation with them. Four of the care plans had no social information about the resident other than ‘likes gardening’ “likes TV” or “encourage OT activity” but this had not been used to plan meaningful care. One plan had detailed information from the family but no action was being taken to assess their leisure/stimulation needs and how they would be met. Another resident ‘liked one to ones’ and had a history of depression but action taken by staff had not been recorded. Staff were aware that one resident liked to be kept busy and had at times helped them do household chores, although there were no set goals or regular activities for them to do meaning that they spent most of the time walking around the Home alone. This had been identified as a risk. The rapport between this resident, who had limited understanding, and staff was excellent, showing care and kindness but interactions were brief and usually only if a staff member happened to be passing or the resident was not sitting quietly. Residents were enjoying hairdressing day and there was a nice atmosphere during the inspection with staff chatting to residents as they passed. Staff should ensure that residents are happy to have their hair done in communal areas as at least 6 residents were in the lounges or having lunch with rollers in. Residents’ responses to surveys show that 9 were happy with the activities arranged by the home. 4 felt that activities were suitable “sometimes”. Three staff identified “occupation and stimulation” as an area for improvement. All relatives contacted said that they felt welcome at the home and all said they were kept informed of important matters concerning their relative. Several relatives and friends were seen to visit residents throughout the day; four were spoken with. One said, “I can come and go at any time”, another Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 18 said that staff had been wonderful through difficult times. Staff offered them tea and coffee. All residents responding with surveys felt that staff listened and acted on what they said. Residents were given choice throughout the day and all residents said that they were able to choose when they got up or went to bed. One plan recorded how a resident liked a lie in and their preferences about care should they become ill. Comments from residents included, “I am enjoying life here” and “I have a lot of freedom here”. Meal provision was generally very good and comments and surveys from residents’ showed that the majority “always” liked the meals served at the home. One resident said that they “sometimes” enjoyed the meals and specific comments were shared with the provider and manager to ensure that the resident’s experience of meals could be improved. There are choices and the chef goes round to all residents in the morning and asks them about supper and tomorrows lunch. Hot choices are available for supper and the chef said ‘have what you want’ to residents spending time with them. The only negative aspect would be that there were no menus or a menu board and residents at two tables had forgotten what they were having. There are three dining rooms at the home; the inspectors ate lunch with residents in two of the dining rooms, including one designated for residents who require support throughout mealtimes. Meals were well presented and served in congenial surroundings with lovely laid up tables with condiments and drinks. Staff knew residents’ likes and dislikes and were attentive. Residents requiring assistance were helped in a discrete and sensitive way. There was lots of chat and laughter during lunchtime and it was obvious that mealtimes offered a good opportunity to socialise. Residents were checked on in the lounges and offered cups of tea or coffee and snacks throughout the morning. The random inspection in September 2006 looked at concerns raised by a complainant that the quality of food was poor at the home. The outcome of that inspection found that all residents were happy with the food provided and a varied and nutritious diet was offered to residents. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Staff understand the principles of adult protection and procedures are in place, which helps to protect residents from abuse. EVIDENCE: The Commission has received one complaint since the last inspection. A random inspection was undertaken in response to the complaint and the provider and manager worked in an open and productive way with the commission in order to resolve issues. Residents spoken with and those responding with surveys knew who to speak with should they have any concerns or complaints. The Home has a comprehensive complaints system using a format, which the complainant can fill out in detail. All staff can access the forms, which are then passed to the Matron to action. There are clear timescales and complaints are well managed. Relatives felt that they could talk to any member of staff. One said ‘any little hiccup and the Home will sort it out’. 7 complaints have been received by the home during the last 12 months, which were investigated and resolved by the manager. Residents spoken with felt well cared, describing staff as “ friendly”, “kind” and “pleasant and polite”. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 20 All staff spoken with and those responding with surveys were aware of the Protection of Vulnerable Adults procedure. Records show that staff, including kitchen staff and domestics received adult protection training to ensure residents are safeguarded. Staff spoken with were aware of their responsibility to raise any concerns about residents’ welfare. The home has dealt with adult protection issues appropriately in the past by working with statutory agencies to investigate any allegations or concerns. Lots of residents have safety rails fitted to the beds. Although there are risk assessment records in the care files these are not always discussed with the multidisciplinary team or family but signed only by a staff member. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a good standard of accommodation that is attractive, clean, homely and well maintained. EVIDENCE: All residents spoken with were happy with the accommodation provided, one resident said, “This is a lovely big place”, another said, “I appreciate the grounds, the gardens are lovely”. The gardens around the home are accessible and used by many of the residents, weather permitting. The Home is lovely and warm and provides residents with several spacious communal areas. One resident was particularly happy with all the comfortable chairs and another said they enjoyed sitting by the “cosy fire”. There is lots of space and residents using electric chairs can move around easily. Call bells were available for residents in the communal areas on long leads to ensure they can alert staff to their needs. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 22 Residents’ rooms seen were personalised with sentimental items, photographs and small pieces of furniture. One resident commented that there were no clocks showing the correct time throughout the Home and it did appear that this was true. The home is not registered to provide care for people with dementia, although there are some residents who have needs related to this condition. The current environment, including security, is not suitable to meet their needs. One resident has left the home unsupervised placing them at risk. The home is generally well maintained inside and out; with a full time maintenance person employed and records of planned and routine maintenance are kept. There were fresh flowers around the Home and all areas were clean and hygienic. Residents said the home was always or usually fresh and clean. The laundry service was very good with residents’ property being returned in individualised boxes to residents’ rooms. All relatives said that the laundry service was good. The home deals with clinical waste appropriately and there were adequate hand washing facilities and protective gloves and aprons were available to maintain infection control standards. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are generally sufficient to ensure that residents’ needs are met in a timely way. Residents are supported by skilled, experienced and friendly staff who have been recruited robustly in order to protect their welfare. EVIDENCE: Residents were very positive about the staff team, comments included, “Staff are extremely pleasant and helpful”, “Staff are happy and respectful” and “Marvellous ladies!” Residents felt that staff were “always” or “usually” available when needed. The manager and staff felt that generally staffing levels were good. Three of the eight relatives responding with surveys felt that insufficient staff were on duty at times, one wrote, “Staff are very good but appear overworked”. The Home were down 2 staff on the day of the inspection due to sickness although they had tried to cover with agency staff and nursing staff on duty had been re-deployed. Staff said that there were often shortages at the weekends and on Mondays due to last minute staff sickness. However, there was good management of sickness levels including monitoring and disciplinary action as necessary involving the provider. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 24 During a random inspection in September 2006 to look at concerns raised with the Commission, staffing levels were satisfactory and staff reported that there had been a consistent improvement to staffing levels. Three staff recruitment files were looked at. These were clear and contained all the required documentation including satisfactory police checks. Appropriate action had been taken by management to address any disciplinary issues and the matron also took into account staff welfare. Residents, relatives and health professionals were confident that staff had a good understanding of individual needs. The pre-inspection questionnaire shows that around 40 of staff have achieved a nationally recognised qualification in care (NVQ), some staff spoken with were hoping to start NVQ training later in the year to further their skills and knowledge. Various training has been undertaken since the last inspection including mandatory training (see standard 38) and other relevant training included adult protection and dementia. Staff felt that they could access appropriate training as they wished and the majority felt that they had the necessary support to do their job well. One staff member is currently running Dementia Care training following the Alzheimer’s Society programme and 20 staff have attended. Staff have enjoyed this, commenting that it was ‘brilliant’. Staff have also attended a pressure care workshop. All staff said they had received induction training to help them understand how to work safely and respectfully with residents. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 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, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are systems in place to ensure that the home is well managed and that residents and their representatives are involved in the development of the service. Good systems are in place to ensure that residents’ personal monies are correctly managed. The health and safety of residents is generally protected by the systems in place, but attention is needed to some areas to ensure residents are fully protected. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 26 EVIDENCE: There is a good management structure in place to ensure that the home is well managed. The registered manager has good support from the owner and the deputy matron. The registered manager is a Registered General Nurse and has been in post for many years. The manager keeps her clinical practice up to date by attending occasional training days and completed some management training in 2002. The manager is reluctant to commence the Registered Managers’ Award, which is an expectation for all registered managers. The vast majority of staff, 10 of the 12 contacted, expressed their confidence in the management of the home. The manager goes around the Home every morning saying hello to residents with the morning papers and post, which residents enjoy. The Home has a quality assurance system, which enables residents, relatives and professionals to ‘have their say’ about how well the home is performing and what improvements could be considered. The annual satisfaction questionnaire is due shortly and the results will be audited and a summary shared with all interested parties, including CSCI. The residents’ finance system was inspected and three residents’ records were looked at. These were all correct and cash is kept securely with relevant receipts and itemised records. The Home does not act as appointee for any resident. There is a petty cash system should any resident not have any funds at any time and all residents have a representative to whom the Home can request more funds regularly. Residents have lockable storage in their rooms. Residents can request cash whenever they want and one resident goes out regularly to the local shops. Some staff and one relative felt that younger staff required more supervision to ensure they are completing care appropriately. There was evidence that staff comments about staff performance were taken seriously and acted upon to ensure a good standard of work. The Home has not had regular staff meetings for a while and this was commented on in the questionnaires completed by staff as something that could be improved. The Home have now started these up again and the first is the week of the inspection. Two senior staff said that meetings had petered out due to lack of attendance and that they had had to chase staff to do training sessions as and when they could fit staff in rather than at a meeting. They will ensure that staff attend meetings especially enabling night staff to attend as Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 27 one commented that there was a night/day staff divide, which resulted in a lack of team work. In order to ensure residents are safe and good practice is maintained, staff receive mandatory training such as manual handling, infection control and fire safety. Good records are available, which highlight when training is needed. Fire safety appears to be generally well managed; the fire log showed that equipment was regularly checked and serviced, but during a tour of the premises an inspector noticed that a stair gate had been placed across a fire exit to restrict one resident’s movements. This was immediately removed once brought to the attention of the manager and must not be replaced. Staff felt that they had enough manual handling equipment to practice safely and the Home are currently obtaining another hoist. The outcome of a random inspection also found that the necessary specialist equipment was available to assist staff with the manual handling needs of residents. A recent visit by an environmental health officer found standards generally satisfactory within the home. The maintenance person carries out a regular tour of the building to check for health and safety hazards, however, during the inspection there were some health and safety issues, which could result in harm to residents in general. The storage of substances hazardous to health was not secure and one cleaning product was out in a communal bathroom. Electrical fuses were accessible in one area and a fire exit and access to the attic needs to be made clear and safe. Windows have secure restrictors in place and radiators are covered to reduce any risk to residents. A range of servicing and maintenance records was seen at this inspection; all were satisfactory including the electrical periodic report and landlord’s gas safety certificate. Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 2 1 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 1 Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? NO 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 OP4 Regulation 12 (1) Requirement The registered person shall ensure that the care home is conducted so as - (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate, treatment, education and supervision of service users. The home must not admit residents with needs outside of the category of their registration. Timescale for action 26/02/07 Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 30 2. OP9 13 (2) 3. OP12 16 (m) The registered person shall make arrangements for the recording, 05/03/07 handling, safekeeping, safe administration and disposal of medicines received into the Home. This relates to; • Ensuring that a clear procedure is in place for the use of ‘when needed’ medicines • Al prescribed medicines must be available for administration • Codes must be used to identify why a medicine is not given as prescribed. The registered person must 02/04/07 consult residents about their social interests and make arrangements to enable them to engage in local, social and community activities. The registered person shall after consultation with the fire authority provide adequate means of escape. All fire exits must be kept free from obstruction at all times. The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. This relates to • The safe storage of chemicals harmful to health; • The security of electrical fuse boxes. 12/02/07 4. OP38 23 (4) (b) 5. OP38 13 (4) (a) 19/02/07 Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 31 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 OP2 Good Practice Recommendations It is recommended that all residents (where possible) are given contracts and are made aware of the terms and conditions of their stay at the home in order to fully protect their rights. It is recommended that pre-admission assessments be thoroughly completed and include all areas of individual needs such as communication needs and social and spiritual interests. It is recommended that information in care plans be more detailed to include details of how individual residents prefer their care to be given and all information should be regularly reviewed with the involvement of residents or representatives. It is recommended that risk assessments be developed further to ensure clear instructions are available for staff to reduce risks. It is recommended that a multidisciplinary approach be taken when using bed safety rails and that consent is obtained from residents or their representatives. It is recommended that parts of the environment be reviewed, in particular security, in order to ensure that residents with a dementia type illness are safe. It is recommended that staffing numbers and deployment be kept under review to ensure that residents’ needs and preferences are met. It is recommended that the registered manager undertakes periodic training to update knowledge, skills and competencies, particularly in relation to the management of the home. It is recommended that all staff receive regular supervision in order to monitor performance and identify training and support needs for individual staff. Regular staff meetings should be established to ensure that good communication between all staff, including night staff, is encouraged and supported. 2. OP3 3. OP7 4. 5. 6. 7. OP18 OP19 OP27 OP31 8. OP36 Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Devon Office Unit D1 Linhay Business Park Ashburton Devon TQ13 7UP 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 Fremington Manor DS0000061790.V308867.R01.S.doc Version 5.2 Page 33 - 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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