Inspection on 20/12/05 for Fremington Manor

This inspection was carried out on 20th December 2005.

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

The inspector 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 15/01/07

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 Unannounced Inspection 20th December 2005 10:00 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.V270709.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V270709.R01.S.doc Version 5.0 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.V270709.R01.S.doc Version 5.0 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 30th June 2005 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 service users. The registration categories cover service users requiring nursing care and service users with elderly mental health or physical disability needs. 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. Local shops are within walking distance and a regular bus service runs to and from the local town of Barnstaple. Respite care is available. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was the second inspection of the current year and was undertaken by two inspectors over the course of one day. The standards met at the previous inspection on 30 June 2005 were not inspected on this occasion, it is therefore recommended that the reports be read together to gain a full understanding of the service provided. The inspectors interviewed 15 residents in depth; others were met in the communal sitting rooms, dining room and in their private rooms, some were unable to communicate effectively. Four relatives were spoken with as well as one visiting G.P. 13 members of staff, including the registered manager were also interviewed. The inspectors toured the premises and a number of records were inspected including residents’ care plans, medication and health and safety records and staff recruitment files. Finally, the outcome of the inspection was discussed with the registered manager and deputy matron. What the service does well: Residents spoken with described the staff as “kind and caring people”, “Wonderful” and “very good”. One resident said, “I couldn’t find fault”. Relatives spoken with were happy with the overall care provided and also praised the staff, one said, “Nothing is too much trouble for them”, another commented, “Mum gets excellent care here. The staff are very respectful”. The staff team appeared respectful and caring and have a good understanding of the residents’ needs. Some lovely interactions were observed between residents and staff during the day, for example, staff spent time with residents, and were seen to share jokes, enable residents’ choice and deal with needs in a sensitive way. One G.P and two relatives felt that residents’ health needs were well met; the G.P said, “The care here is second to none. I am entirely satisfied with the care my patients receive”. One relative told an inspector, “I have no concerns. I am confident in the staff.” Residents were happy with the food, comments included, “The food is always good” and “We get three delicious courses!” Complaints are dealt with in a robust and open manner. The owner and senior staff co-operated in a positive way during a recent complaints investigation by CSCI. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 6 Quality assurance systems ensure that residents and relatives are encouraged to voice their opinions and share ideas for improvements. What has improved since the last inspection? 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. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 7 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.V270709.R01.S.doc Version 5.0 Page 8 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): Standard 3 was met at the previous inspection EVIDENCE: Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 9 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 Detailed care plans and staff knowledge ensure that residents’ health and personal care needs are met. Care is offered in such a way as to ensure residents’ privacy and dignity is maintained. Aspects of poor practice compromise the safe management of medications. EVIDENCE: Seven care plans were looked at. These were comprehensive and individualised with excellent Life Stories in some relating to residents’ needs as individuals. There was good attention to detail and emotional issues. One care plan gave clear and relevant instructions to staff when working with a resident who could be aggressive. Two diabetic care plans were examined, both contained the necessary information and an annual diabetic check had been undertaken for one. The nurse in charge of the wing was to establish whether the other resident needed an annual check. All plans were signed as discussed with the resident/relative as able. Short-term goals were also identified and addressed. Each plan had been appropriately reviewed. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 10 Risk assessments were generally good and related to behavioural and situational risks, including the use of bedrails. Where bedrails are identified for use, consent is obtained for the resident or relative. A visiting G.P spoke highly of the nursing care provided at the home and expressed complete confidence in the staff. A resident spoken with described how good the staff had been during her recent illness, she said, “They really are wonderful”. Relatives were completely satisfied with the overall care provided at the home. Care plans showed excellent liaison with the health care multidisciplinary team with staff being pro-active and aware of any potential changes in resident’s health care needs such as mood, breathing or pressure care. Staff are aware of the wider need for specialist referral such as CPN and those spoken with had a good knowledge of the residents’ overall needs. Good documentation of visits such as to the chiropodist, GP or physiotherapist. Staff were able to discuss communication issues relating to dementia and knew individual residents’ needs whilst relating their practice to essence of care. Medication systems were well developed – with records of receipts, resident’s photo on each Medicine Administration Records (MAR) and newly required disposal procedures in place. Some handwritten entries weren’t dated and signed by two staff to verify the accuracy of the entries and some codes had not been used to indicate why medicines had not been given. Drug fridge temperatures are noted daily, however not all medicines with a limited ‘shelf life’ had been dated when opened to ensure safe use. One domestic said they had spent time with one resident who was a bit ‘depressed’, just time to chat. Relatives said that the staff were marvellous when they phoned from abroad and brought the resident to the phone when they phoned back. Staff were attentive to preserving residents’ dignity especially if they had short term memory loss or very limited mobility or capacity. Staff were aware of any words which could be degrading such as ‘bib’ rather than apron. There was good attention to confidentiality and excellent interaction between staff and residents throughout the inspection. All residents spoken to said that they were treated well. Staff were seen to assist at mealtimes in a sensitive way. One resident said ‘what more could you want?’ Less vocal residents were seen to be included in conversations. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 11 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): 14 Residents are enabled to express their wishes and make decisions. EVIDENCE: One carer said that one resident had a cold but had wanted to get up so was helped to be comfortable by the fire and given regular hot lemon. There were records showing that the residents’ choice was the focus of discussions with relatives when the resident in question was living with dementia. Throughout the care planning process records showed attention to resident choice such as in having a catheter, what clothes to wear and information giving. ‘We can’t do better’ said one resident and ‘we are really looked after’. Another resident said, “It is lovely here. I have no worries”. There was signed consent and discussion about any restrictive measures such as bed rails or wheelchair straps. Staff were seen to promote resident independence with gentle encouragement and support. Residents who were able were seen freely moving about the Home. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 12 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 The procedures for responding to concerns or complaints are good. EVIDENCE: The Commission has received one complaint since the last inspection. The Commission investigated this complaint, and found areas were up-held or unresolved on this occasion. Three residents when asked said that they felt that they could talk to any staff and be listened to. Two relatives said they had no cause to complain. The Home has a good complaints procedure, which involves the complainant filling in the form in his or her own words to ensure good recording. The Matron then addresses each issue and investigates as necessary. Records showed that each complaint had been well followed up, documented and feedback given to the complainant on the findings. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 13 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): 26 The standard of the environment within and around this Home is very good, providing residents with an attractive, clean, and homely place to live. EVIDENCE: The Home was clean and hygienic throughout. Two relatives and all residents spoken to were able to say that this was normally the case. There were plenty of gloves and aprons available in the nurse’s offices. Staff spoken to, including one cleaner who had received specific training, were aware of universal procedures to reduce the risk of infection. The management of various infections was well documented in care plans. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 14 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 Sufficient numbers of staff are currently employed, with an appropriate variety of training and skills, to meet residents’ needs. One aspect of the recruitment process is not robust and could put residents at risk. EVIDENCE: Staff said staffing levels were generally good although mornings were a bit hectic sometimes. Staff were seen to spend time with residents and were unhurried during the inspection. Two residents did say that more staff would prevent the “waiting” at times but both were happy with the overall care provided to them. Two relatives spoken with were happy with the staffing levels and felt that their relative’s needs were fully met. One RGN said that the Home ‘was keen for staff to complete NVQ training and ‘encourages it’. Most of the staff have achieved an NVQ qualification, either 2 or 3, and other carers were in the process with 2 applying for funding. One staff recruitment file was inspected on this occasion; the majority of information required was available, however a reference from the last employer had not been obtained. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 15 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 & 38 The home is well managed and there are good systems in place for involving residents and their representatives in the running of the home The safeguards to ensure residents’ personal monies are correctly managed are not entirely robust. The health and safety of residents is in the main being promoted. EVIDENCE: The registered manager has been in post for many years and has good support from the owner and the deputy matron. Staff described the ‘good team working’ and ‘friendly atmosphere’ as a strength of the home. One RGN said that the manager was very supportive and anything discussed would remain confidential. Two relatives spoken with were happy with the management of the home. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 16 One staff member is responsible for maintaining the quality assurance system at the Home. Questionnaires are sent to residents and relatives annually who may fill these in anonymously as they wish. All current residents have an advocate. The results are recorded and actions taken as necessary. There are regular coffee mornings which relatives may attend which can be used for discussion and expressing views. The Home has recently become involved with the Essence of Care programme, which is a recognised quality assure tool. Staff spoken to were very enthusiastic and have devised specific issue questionnaires such as dementia, which ask relatives and staff what they would like to know about the condition prior to training sessions. Two staff visited another Home to enable them to research what could be useful at Fremington. The inspector looked at 4 records and storage of residents’ monies at the Home. Some residents are able to manage their own finances with the help of their families. The Home has a petty cash system and residents usually pay in cash or invoices are posted directly to relatives or if the funds are below a certain amount. The records were itemised and clear. Residents have access to lockable storage. Although there were no serious discrepancies only one set of records was correct. There are two maintenance men, who are responsible for fire safety checks. Fire equipment was checked and correct; a Devon Fire & Rescue inspection in May 05 found satisfactory standards. The maintenance records were looked at and the Home confirmed that they are dealing with any recommendations made by specialists such as lift enhancements. Wheelchairs were formally checked regularly for faults, last in June 05 and daily by staff. All hoists were checked and correct. Some portable appliances needed inspection; the maintenance persons responsible for this testing require the appropriate training. The Home will send CSCI a copy of the electrical wiring certificate. All staff have had Food Safety refreshers as appropriate. Accidents were well recorded and the manager checks through these to see if there is a pattern. Food is labelled and dated before storing in fridges and freezers. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 17 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 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 18 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 OP29 Regulation 19 Sch 2 Requirement The registered person shall not employ a person to work at the care home unless he/she has obtained in respect of that person information and documents specified in paragraphs 1 to 7 of Schedule 2. (In this instance, two references must be obtained, one from the previous employer.) The registered person shall ensure that persons employed at the care home receive training appropriate to the work they are to perform. (This is in relation to PAT testing.) Timescale for action 31/02/06 2. OP38 18 1 (a) (i) 28/03/06 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 OP9 Good Practice Recommendations It is recommended that 1) hand-written entries on medication administration sheets are dated and signed by DS0000061790.V270709.R01.S.doc Version 5.0 Page 19 Fremington Manor 2. OP35 two staff, to verify the accuracy of the entries; 2) code should be used to indicate why a medicine has not been given; 3) a system should be established to enable monitoring of medications’ shelf-life once opened. You should ensure there is a clear audit trail to ensure each resident’s personal monies are correctly managed, with accurate records kept relating to transactions and balances. Fremington Manor DS0000061790.V270709.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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.V270709.R01.S.doc Version 5.0 Page 21 - 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. 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