Inspection on 30/06/05 for Fremington Manor

This inspection was carried out on 30th June 2005.

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 15/01/07

Fremington Manor 20/12/05

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 Barnstaple Devon EX31 2NX Lead Inspector Dee McEvoy Announced 30 June 2005 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 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 D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Fremington Manor Address Fremington, Barnstaple, Devon, EX31 2NX 01271 377990 01271 859067 Telephone number Fax number Email 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 65 Category(ies) of OP Old Age [65] registration, with number MD(E) Mental Disability over 65 [21] of places PD(E) Physical Disability over 65 [21] Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Staffing & environmental conditions for registration issued on 14.2.1996 remain Registration for 50 in the category OP for Nursing Care Registered for 21 in the categories OP, MD(E) and PD(E) for Residential Care Date of last inspection 9/2/2005 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 65 service users. The registration categories cover 50 service users requiring nursing care and 21 service users with elderly mental health or physical disability needs. The home has recently received planning permission 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 D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place on Thursday 30th June 2005 from 09.5017.15. There were 58 residents living at the Home and one admission expected that day. One inspector focussed the inspection on Manor Wing, the other concentrated on Benedict Wing. In all six service users were case-tracked and care plans looked at in depth. Fourteen staff were spoken with in depth including the manager and provider; fourteen residents (four were unable to communicate effectively) and eight relatives/visitors were also spoken with. Nine comment cards were received from residents and six comment cards from relatives in respect of the service. The inspectors took lunch with two residents and two relatives. The inspectors toured the premises and a number of records were inspected including the pre-inspection questionnaire, training, complaint and accident records and staff recruitment files What the service does well: What has improved since the last inspection? All staff have received adult protection training and demonstrated a good understanding of the issues ensuring residents are protected. Benedict Wing has a new shower room and bathroom and four new call bells have been fitted in communal areas to ensure that residents can alert staff when needed. Improvement has been noted with the recruitment procedure; current practice was robust ensuring residents are safe safeguarded. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 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 standard(s) 1 & 3 Residents receive clear information about the home and its facilities and services. The admissions process is well managed ensuring that resident’s needs are assessed prior to moving into the home. EVIDENCE: The Statement of Purpose is comprehensive containing all the necessary information to assist prospective residents with their choice of home. The document contains all the necessary information plus an interesting historical summary of Fremington Manor as well as comments about life in the home from residents and relatives. Three residents’ assessments were inspected. The home’s assessment process and documentation is good and ensures that there is a proper assessment prior to people moving into the home. Where possible a registered nurse will visit people before admission. One visitor said that the recent admission of their relative had been managed well by the home, “Staff are very kind and helped my relative to settle in.” Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 & 10 Individual care plans have been developed but not all aspects of health; personal and social care needs are identified or planned for. In the main the privacy and dignity of the residents is maintained. EVIDENCE: Carers complete resident personal care task sheets. Three RGNs said that information contained in the care plans was passed to carers via verbal handover and a work board. A new carer was not fully aware of residents’ needs or names but felt that they had been well supported by other staff earlier in the week. Care plans are set out in a good format but action, goals and reviews are vague and often unrelated to each other. Evaluations of care were often brief, not showing whether care had been appropriate or successful in meeting residents’ needs. A diabetic plan was comprehensive but unclear as to whether diet controlled although staff were aware, and night sedation was recorded as an action with no explanation. One care plan did not record that the resident had a certain type of infection. Risk assessments and Manual Handling assessments were good. Files are numbered rather than named, making them hard to access. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 10 Health professional visits are lost within the daily notes and unclear. Some wound care records were poor with long gaps between ‘pink skin’ and ‘pressure sore’ care. One wound was discussed in daily notes not in the care plan. There were a few social histories completed and resident care plan involvement forms were available but not always filled in. One relative confirmed that they had recently been shown a plan, another was unaware of the care plan but said, “I was asked lots of questions when ‘he’ moved here”. Residents and relatives were generally happy with the overall care provided, one relative wrote, “We are delighted with everything here.” Standard 9 was not fully inspected. No residents self medicate at present. Staff confirmed that they would complete a risk assessment if a resident wished to do so. Staff treated residents respectfully, crouching to chat, ensuring they were warm enough and knocking on doors before entering. All residents who were able said that they felt that their privacy and dignity was maintained. One resident said that they were treated as “an individual”. All residents responding with comment cards said they were well cared for and their privacy was respected. One resident would love a bath and to soak alone but had not been offered. Staff said that residents would not be left alone bathing. Some residents would be able to have privacy during bathing if they wanted. One shared room lacked the appropriate screening to maintain privacy and dignity. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 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 standard(s) 12, 13 14 & 15 Social activities are well managed providing daily variation and interest for people, however further consideration needs to be given to developing activities for residents who lack capacity. Residents could be more fully enabled to express their wishes and make decisions. Residents enjoy meals, which are nutritious and appealing, taking into account, the likes and dislikes of individuals. EVIDENCE: The activities organiser is doing a wonderful job engaging residents with regular and varied events each day. An activities timetable is available and all residents responding with comment cards felt that the home provided suitable activities. Residents were enjoying a coffee and current affairs morning, including relatives and later card making. One resident proudly showed a variety of crafts made by them during the art sessions. External entertainers are also booked and ‘pat dog’ visits regularly; this was said to be popular with many of the residents. There are detailed records, which state if residents prefer not to join in. These are not then shared with the care team or related to individual care plans to ensure that recreational interests and needs are fully met. It was unclear whether all residents and capacities were included in the activity programme, although it was noted that individual one to one time is available to some residents one morning a week. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 12 Residents were not always asked where they would like to sit, four residents said that they had been taken to the lounge but didn’t normally; another remained in a wheelchair all day. They were unable to hear the discussion but had to be quiet to allow the activity to continue. One resident said that they were not told when someone moved into their double room, ‘they just arrived’. One resident had requested a GP but records said that they had to wait. The entry did not say if they had then seen a GP as they had asked. Resident choice had been clearly acknowledged in one incidence with staff acting as the resident’s advocate. Relatives praised staff for the warm welcome and the overall care provided at the home. Food was well prepared and presented. Kitchen staff visit all residents and offer various choices before each meal. Two relatives were eating with a new resident. Staff were attentive during the meal. Food was served individually from serving dishes. All residents spoken with and those responding with comment cards were happy with the food; comments included, “The food is wonderful” and “We have good quality food, the kitchen staff are very dedicated.” One resident who required a special liquidized diet said, “My food is always presented nicely”. The food stores within the home were well stocked with fresh meats, cheeses, fruits and vegetables. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16 & 18 The home has a satisfactory complaints process with evidence that complaints are listened to and acted upon. Residents are protected from the risk of abuse or harm by well-informed staff. EVIDENCE: Residents spoken to felt that they could talk to the matron and staff about any issues, one said, “They would listen.” Relatives responding with comment cards were aware of how to complain but one relative spoken with said that they were not completely confident that complaints/concerns would be addressed with the appropriate action (This relates to concerns about staffing levels, refer to standard 27.) The complaints record showed that one complaint was dealt with very well with sensitivity, the focus on the residents’ wishes. One resident said that staff had told her not to talk to an inspector ‘or the home would close’. All staff spoken to were aware of the Alerters’ Guide and Protection of Vulnerable Adults procedure. All staff, including kitchen staff and domestics have received adult protection training to ensure residents are safeguarded. All residents responding with comment cards and those spoken with during the inspection felt safe living at the home. One resident said, “The staff are very kind”, another, “We are well looked after.” Most care plans included consent and discussion before bed rails were used. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 22, & 26 Residents living at the home enjoy a clean, comfortable and well-maintained environment. Consideration needs to be given to the specialist equipment available in order to maintain independence and choice. EVIDENCE: In addition to the existing accommodation, four spacious rooms with en-suite facilities have almost been completed and will be registered with the Commission before available to prospective residents. The matron said that there is a clear maintenance policy for equipment and staff have direct access to the maintenance man. Four new call bells have been fitted in communal areas since the last inspection to ensure that residents and relatives can alert staff to any needs. A shower room and new bathroom have been completed for Benedict Wing since the last inspection. One resident said they would prefer a bath but did not have the adaptation, which they had used prior to admission so had showers. Another resident spent the entire day in a wheelchair rather than an Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 15 appropriate chair. She was not asked where she would like to sit (Refer to standard 14). All areas of the Home were very clean and residents confirmed that this was usual. The home has a team of dedicated domestic staff. Two residents praised the laundry service, one said, “ The laundry service is very good, my clothes are kept nicely.” The laundry was clean, well equipped and organised. One carer complained that there was a lack of easily accessible gloves and toilets and bathrooms did not all have supplies. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The deployment and number of staff available is not always sufficient to meet the needs and preferences of the residents in a timely way. Recruitment procedures have improved ensuring residents are protected. In general residents benefit from having caring and friendly staff, most of whom have a good understanding of their needs. EVIDENCE: The inspector sat for over half an hour in each lounge and no carers came in although domestics and relatives were visible. Two relatives said that they often have to use the bell for residents to find staff. Domestics were assisting with drinks although they did not know residents’ needs. Domestics have to take the meal trays but are unaware of residents’ nutritional needs or diets. A resident had slumped over and a domestic helped them. Many residents needed two carers to assist with mobility and a resident said that finding another took time although staff said that they work in pairs in the morning. One recently appointed carer was alone for much of the day supervising around 20 residents; many were unable to use their call bells. (Other carers were upstairs.) The carer was unclear as to care needs and had read one care plan (Refer to standard 7). Residents consistently said that staff were ‘very nice’ and ‘sweet girls’. Two relatives were happy with the staff, who offered tea and were friendly but that there were not enough. One resident was often not ready until late morning and two staff said that some were in bed late due to lack of staff. Another four residents commented on low staff levels, one saying they had waited 45 minutes for assistance and had to wait at least 3 or 4 times a week but staff Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 17 were ‘always apologetic and lovely’. A resident and one relative said that the staffing levels that day were not usual or the numbers attending coffee morning. Three staff agreed. Four relatives responding with comment cards were satisfied with the staffing levels but another relative spoken with and two responding with comment cards felt that there were not always enough staff on duty. Following a meeting with the owner at the inspection, it was agreed that staffing would be increase by one carer in the morning and one in the afternoon. The recruitment procedure has improved since the last inspected. The recruitment files of two newly appointed staff were inspected. Both contained the necessary records to ensure the protection of residents. One carer said that they had received an excellent induction initially but it was felt that the expectation on her to understand and meet residents’ needs was unrealistic (refer to standard 7). Although the carer felt supported, closer supervision would be expected of a junior member of staff. The deputy matron and a registered nurse are responsible for staff training, which is generally well organised, and developing to ensure that staff understand residents’ needs. Dementia training is currently being planned. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 & 38 The health and safety of residents is in the main being promoted. EVIDENCE: Trained staff work with and direct care staff daily but staff do not receive supervision on a formal basis. Standard 38 not fully inspected on this occasion. An in-house Manual Handling trainer ensures that all mandatory training is up to date. Three staff are in need of food hygiene training, which is booked for July. Fire training was booked for later in the month. Ancillary and domestic staff have received infection control training. Fridge temperatures are not consistently recorded and some meats and other foods stored in fridges and freezers had not been labelled or dated. This was discussed with the chef, who is responsible for the kitchen. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 3 x x 2 x x x 2 STAFFING Standard No Score 27 1 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 2 x 3 Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 20 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 7 Regulation 15(2) (b) Requirement The registered person shall keep the residents care plans under review. (To ensure changing needs are met.) (Previous timescale of 6/4/05 not met) Details of any plan relating to the resident in respect of nursing, specialist health care and or nutrition must be kept. (This relates to wound care, diabetes care and infections.) The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of the service userensure that at all times suitable, competent and experienced persons are working in the care home in such numbers as are appropriate for the health and welfare of service uses. (Previous timescales of 6/4/05, 20/8/04 and 19/4/04 not met) Timescale for action 10/8/05 2. OP 8 17 (1) (a) Sch 3: 3 (m) 10/8/05 3. OP 27 18 (1) (a) 25/8/05 Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP 7 OP 10 OP 14 OP 22 OP 26 OP 38 Good Practice Recommendations It is recommended that all staff are aware of the needs of residents that are in their care. It is recommended that issues relating to privacy are addressed (Refer to text) It is recommended that residents are enabled to fully express choice and control (Refer to text) It is recommended that specialist equipment in the home is reviewed to maximise residents independence and choice. It is recommended that gloves are available to staff in toilets and bathrooms. It is recommended that food is labelled and dated before storing in fridges and freezers. Fremington Manor D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Suite 1, 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 D54-D06 S61790 Fremington Manor V227083 300605 Stage 4.doc Version 1.30 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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