CARE HOMES FOR OLDER PEOPLE
Frensham House 125 New Road Brixham Devon TQ5 8BY Lead Inspector
Sharon Goldsworthy Unannounced 15 November 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. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Frensham House Address 125 New Road Brixham Devon TQ5 8BY 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) Stonehaven (Healthcare) Ltd 01803 857476 01803 857476 Nicholas Paul Ross CRH 14 Category(ies) of Old age not falling within any other category(14) registration, with number Physical Disability over 65 Years (14) of places Dementia over 65 years(14) Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Mr Ross completes his NVQ4 Managers Award Course. Imposed 02.09.2004. Date of last inspection 2nd June 2005 Brief Description of the Service: Frensham House is a detached residential home, which stands in its own grounds and provides care for up to fourteen persons in the category of Dementia over the age of 65 years, Old age not falling within any other category and Physical disability over 65 years of age.The home has two floors with part of the staircase equipped with a stairlift. Access into the home is provided up steps. The home has a communal lounge and a sun lounge at the front of the building; meals are taken in a separate dining room. There are 8 single bedrooms and 3 double bedrooms. One bathroom is fitted with a hoist. 4 of the single bedrooms are situated on the ground floor of the home. A welltended garden is available at the front of the home with chairs and tables provided for service users to the rear of the building there are some off road parking spaces. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and is the second inspection to this home this year. It took place on a Tuesday for the duration of five hours. The inspector met with all staff on duty (including the Manager) and met all residents. Observations of care practice were undertaken as was a tour of the premises, and observation of a sample of records. Further information has been sought from the home in the form of telephone calls with the Manager and records from both the home and the company since this inspection visit. What the service does well: What has improved since the last inspection?
The Manager and staff have made some progress in addressing requirements outstanding from the last inspection. Medication administration practices were observed to be improved and now meet the National Minimum Standards. A hoist has been purchased and is available for use in the first floor bathroom. Several bedrooms have been redecorated in the last year and present as being clean, well presented and cheerful rooms. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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 Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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) None of these standards were assessed at this visit. EVIDENCE: Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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 Residents health, personal and social care needs are clearly recorded in the care planning documentation. EVIDENCE: Three examples of care planning documentation were observed on the day of this visit. One was for a resident who was staying for a short time (respite). Initial assessments and referral documents were in place, but a care plan was not. The Manager acknowledged that a care plan should have been put in place for this person and will ensure that this is done for all future stays, within 48 hours of their arrival. The other two were for existing long term residents. Documentation includes; Life History/Personal Profile and detailed care planning, including records of accidents, health care visits and weekly reviews of the care plan. The home needs to complete detailed risk assessments for all residents, which should include the level of observation, monitoring and assistance required for all daily tasks, the use of stairs, access to the kitchen and laundry and leaving
Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 10 the home. This will allow the Manager to accurately assess the staffing level requirements for this home and the need (if any) for any forms of restraint or specific monitoring required for any particular individual. This will be closely monitored and reviewed by the CSCI for the remainder of this year. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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, 15 The level of appropriate activity and stimulation in this home is poor. Meals are well presented and balanced, but fresh ingredients, fruit, vegetables or milk are rarely used. EVIDENCE: Some recent activities have been arranged in the home, such as reminiscence and exercises and on the day of the inspection, some classical music was playing in the lounge, which the residents appeared to be enjoying. Some special events have been organised to reflect celebrations or special dates on the calendar. However, the level of appropriate activity for people with dementia is very poor. The staff team demonstrated a good knowledge of activities that would prove to be stimulating and interesting and appropriate to this resident group. However, they stressed that they do not currently have any time to spend on activities, due to the level of needs of the current resident group and the current staffing levels. Many residents spoken with stated that they would like to be doing more, and several requested to go on outings and short walks. This they say has never been provided. Following a review of the staffing levels in this home, a full review of the wishes and needs of the current resident group should be undertaken, and an appropriate activity programme should be implemented to reflect this.
Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 12 In the past arrangements have been made to bring pets into the home but this has now been stopped by the Proprietors. The home’s cat that was fed and looked after by one of the residents has now been re-homed and the lady concerned still misses it, which is unfortunate as she suffers from depression. Another resident at the home spends a lot of her time looking for her cat that she was unable to bring with her when she was admitted to Frensham House. The Proprietors have responded to this with the provision of a battery operated cat, which purrs and lies on a cupboard in the lounge. The meal time in the home was observed on the day of this visit. It was unrushed and a positive experience for many, with lots of laughter and chatter at the tables. Residents who took their meals in the lounge, were assisted in doing so, with appropriate levels of support and with sensitivity. Some time was spent with one resident who required a lot of reassurance and encouragement to eat, and several alternative meals were offered to her. Following the meal, all residents spoken with stated that they had enjoyed their meal. The Inspector raised concerns that there was no fresh vegetables, fruit or milk available or used in the preparation of the meal on the day of this visit. The staff confirmed that fresh vegetables and fruit are only purchased on one day a week, and that they are instructed to buy powdered milk only for residents. Staff themselves are purchasing their own fresh milk. Whilst acknowledging that frozen foods can also provide the same level of nutrients and vitamins, they should not be used as a complete substitute to the use of fresh when caring for older people. The provision of fresh fruit must be greatly improved and residents should be consulted about their wish to have fresh milk or powdered. If any choose fresh milk, then this must be provided. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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) None of these standards were considered in detail at this visit. EVIDENCE: The complaints log and policies were viewed on the day of this visit. Policies and procedures are located in the service user’s guide. The complaints log has no complaints recorded since 2003. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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 The home is well presented and maintained, clean and hygienic EVIDENCE: The home is generally well presented and well maintained. The staff in the home have undertaken a lot of redecoration of rooms themselves in the last year, and these present as comfortable, light and cheerful. Residents bedrooms are highly personalised and individual. Both laundry and kitchen areas were clean, tidy, organised and safe environments. The home was clean and free from odour throughout. There were two areas that were pointed out to the Manager, that were of concern. There are many heavily patterned carpets in the communal areas in particular, which are inappropriate for people with dementia, who because of their illness have difficulties with perception and hallucinations, where they are likely to perceive a pattern in the carpet as something else for example. The Manager confirmed that this has been highlighted with the Proprietors and it is their intention to replace these carpets for ones more suitable. The second issue of concern was the use of baby gates throughout this home, mentioned
Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 15 previously in this report. This practice needs to cease immediately. Should risk assessments indicate that any one resident requires additional monitoring or restraint, then more appropriate aids and adaptations must be considered and provided where necessary. A requirement for a ramp to be provided to improve access into the home is still outstanding. This was raised originally by the Commission in May 2004, October 2004 and June 2005. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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, 30 Staffing levels are not adequate to meet the needs of the current resident group. Not all staff are sufficiently trained to meet the needs of the current resident group. EVIDENCE: Staff rotas indicate that only two members of staff are on duty in the afternoons and that one of these is the Manager. The Manager is inevitably busy with administration, telephone calls, meeting with visitors and when required, as on this day can be busy with inspection visits from various agencies. It is for these reasons that Managers must be supernumery to the care staff hours. There are at least three residents who require two members of staff to assist with personal care tasks. When this assistance is being given, this leaves the remainder of the residents unsupervised and therefore placed at risk of harm. Accident records indicate that the majority of accidents are occurring in the afternoons. Two accidents have occurred in the afternoons since this inspection visit, resulting in these two residents being admitted to hospital with serious injuries. Neither of these accidents were observed by staff. This situation is unacceptable. The Proprietors have previously been asked to urgently review the staffing levels in this home, but had not responded to this. The Manager has now responded to the CSCI stating that all residents have been risk assessed and that one additional staff member has been put on the afternoon shifts. The Proprietors are reminded that the safety of the residents in this home is their priority and their responsibility and as such must keep this situation under review with the manager and if
Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 17 appropriate the staffing levels must be further increased. The CSCI will also monitor this situation over the next few weeks and months. Staff on duty were asked about training they had received and any future training care needs. Staff all stated that some training they had received had not been sufficient and had left them feeling incompetent in caring for the residents that they have. Training records and discussions with the Manager confirmed this to be the case. An example of this is First Aid; the manager has received a two hour training course in First Aid themselves and was then expected to deliver training to his staff team. The staff team did not have a resuscitation dummy and so practiced CPR on a cushion! This is clearly not acceptable. The same must be said for the Manual Handling training and Dementia Care training also. The Proprietors are asked to ensure that all staff receive appropriate training from an external provider that is accredited and certificated. Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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) None of these standards were considered in depth at this visit. EVIDENCE: Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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 x x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2
COMPLAINTS AND PROTECTION 3 x x 2 x x x 3 STAFFING Standard No Score 27 1 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 20 yes 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. 2. Standard OP7 OP7 Regulation 15(1) 15(1) Requirement Full and detailed Risk Assessments must be completed for all residents Care Plans must be completed no later than 48 hours following admission of all residents (including short stay/respite) Appropriate levels of activity and social stimulation must be provided for all residents All residents and/or their representatives should be consulted for their choice of menus, fresh vegetables and fruit and milk provision The registered provider must provide a ramp to improve access into the home as clled for in the occupational report.(Previous timescale of 31/01/05, 30/05/05 not met) All baby gates must be removed and if necessary alternatives to be sought and provided to ensure residents safety. Staffing levels need to be reviewed to ensure there are sufficient numbers on duty to ensure the safety of all residents at all times Timescale for action 30/01/06 30/12/05 3. 4. OP12 OP15 16(2) 12(3) 28/02/06 30/01/06 5. OP22 13(4), 23(2) 28/02/06 6. OP22 23(2) 30/12/05 7. OP27 18(1) 30/12/05 Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 21 8. OP30 18(1) 9. OP30 9(2), 10(2) All staff must receive all statutory training that is provided by external training providers and is accredited and certificated. The Manager and Proprietors should seek advice, training and appropriate support from dementia care specialists in order to ensure that they themselves have adequate levels of knowledge and skills to continue to care for this resident group. 30/02/06 30/01/06 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. 2. Refer to Standard OP12 Good Practice Recommendations All residents should be consulted about their views on social and physical activity Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection 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 Frensham House D54-D07 S18354 Frensham House V260011 151105 Stage 4.doc Version 1.40 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
