Inspection on 06/03/07 for Friarn House Residential Care Home

This inspection was carried out on 6th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Friarn House Residential Care... 31/01/06

Friarn House Residential Care... 13/09/05

Friarn House Residential Care... 17/02/05

Friarn House Residential Care... 22/07/04

Friarn House Residential Care... 25/03/04

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

CARE HOMES FOR OLDER PEOPLE Friarn House Residential Care Home 35 Friarn Street Bridgwater Somerset TA6 3LJ Lead Inspector John Hurley Unannounced Inspection 6th March 2007 09:30 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 Friarn House Residential Care Home DS0000050730.V321209.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. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Friarn House Residential Care Home Address 35 Friarn Street Bridgwater Somerset TA6 3LJ 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) 01278 445115 Westcare (Somerset) Ltd Mr John Whitehouse /Alan Farakas Care Home 16 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Registered for 16 persons over the age of 65 years in categories DE(E) and OP. Date of last inspection Brief Description of the Service: Friarn House is a large terraced house situated in Bridgwater and is within easy access of the town centre and local facilities. The home has a good sized enclosed garden. Parking is limited to the surrounding streets. Friarn House is registered with the Commission for Social Care Inspection to provide personal care for up to 16 service users over the age of 65 years, who require care by means of old age or dementia. The home is not registered to provide nursing care. The registered providers are Mr and Mrs Whitehouse. The registered manager is Mr Whitehouse. The fees payable vary from £360 to £500. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of Friarn House of 2007. The last inspection took place of the 22 of June 2006. The inspection took place over two days and last 8 hours in total. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology, which included paper surveys of service user their relatives a completed pre-inspection questionnaire from the registered provider and a site visit to the service. Comments from service users and relatives were positive, indicating they were very satisfied with the quality of the service they receive. A tour of the premises was made, interaction between staff and service users observed as well as care practices that included the administration of medicines and the serving of food. The inspector toured the building, spoke with staff on duty and spoke with five-service users, one visiting professional and two relatives during the course of the inspection. They all provided a very positive account of the home. The inspector sampled service user documentation along with records relating to staff and other records required by regulation. What the service does well: Friarn House provides older people, who have dementia, with a safe, comfortable and homely environment. The home continues to take appropriate steps to ensure that the assessed needs of service users can be met. The manager operates a thorough preassessment ‘package for prospective service users. Care needs are clearly identified in individual care plans and these are kept under review. Staff interactions with service users were observed to be kind and respectful. Assistance was offered in an ‘unhurried’ manner. The staff are knowledgeable with regards to the individual needs of the service users. Staff spoken with stated that Friarn House was a ‘nice place to work’. Staff were positive about the training opportunities available to them and were positive about the support they received from the management team. Service users spoken with informed the inspector that they were ‘happy’ living at the home and that they liked their bedrooms. Service users also commented Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 6 on the kindness of staff. Comments about the food were also positive. One comment was that ‘there is always plenty to eat’. Service users at the home benefit from good support and input from appropriate healthcare professionals. 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. The summary of this inspection report can be made available in other formats on request. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 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 Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has thorough pre-admission procedures that provide information and opportunities to assist the service user when making a decision about moving in. Care assessments are clear, concise and generally reflect the needs of the individual. Service user’s are protected by a contract that specifies terms and conditions of occupancy and includes the complaints procedure. EVIDENCE: There have been no changes made to the Statement of Purpose or Service user guide since the last inspection. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 9 The service user the inspector spoke with confirmed that they had been given opportunities to visit the home and had documented information with which to make an informed choice. They further confirmed that they had been consulted about their individual needs and how they would like them to be met. The manager takes appropriate steps to ensure that the needs of prospective service users can be met by the home. Prospective service users are fully assessed by the manager, who will visit the prospective service user in their home or hospital. Assessments from other relevant health care professionals are obtained where available. Evidence to support this was seen in the care plans that were sampled. The assessment documentation that was sampled evidenced that care plans had been developed from the initial assessment of need. The inspector noted that the initial assessment need made by the home needs to reference all behaviours noted on the pre admission assessment documentation, the registered manager acknowledged this point. Intermediate care is not a feature of this service. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 10 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. 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. The care planning and review of existing plans demonstrate how needs are being met but more needs to be done in relation to individual risk assessments. Good links with health professionals have been maintained to enable service users’ health needs to be met. The home has a good medication management system ensuring the safety of service users but there needs to be a clear rationale for the administration of medication via the per required needs route. EVIDENCE: The inspector sampled the service user documentation and found that care plans are maintained for each service user. These include details of individuals’ needs, daily routines and preferences. Care plans were generally thorough and included detailed directions to staff of the level and type of Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 11 assistance to be provided to each person. The inspector noted that there was little evidence that risk assessments relating to individual behaviours had been robustly completed. Feedback from visiting professionals given via questionnaires informed the inspector of the good professional relationships that have been maintained. They further confirm that the service user attend appointments and have their health care needs met through partnership working. Service users are able to meet privately with visitors in their bedroom or one of the lounges. Interaction between staff and service users was friendly and respectful. Through discussion with the service user the inspector established that the care staff fully respected their privacy and dignity and that they were not made to do anything they did not wish to, such as attending activities or having meals in the dining room. They further confirmed that all personal care was provided in the privacy of their bedrooms or bathrooms. The care plans and associated documents supported these representations. Medicines are well stored. The administration of medicines was observed and correctly carried out. The MAR-sheets were appropriately completed and signed, checked by supervisors in each shift daily and the control drugs and records were also appropriately maintained. There are no clear rationales for the administration of medication via the per required needs route. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 12 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. 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. The pace of life generally suits the service users expectations and aspirations. Visitors are welcomed and service users are assisted with maintaining contact with relatives and friends. The food is home cooked and appears to offer a balanced diet. EVIDENCE: Service users were observed in a number of different locations following selfdirection. They choose when to get up and when to retire. They have free access to their bedroom and communal facilities. Service users spoken with indicated that they were happy with their life in the home and confirmed having freedom of movement within the home. They further commented that staff support them in following their preferred lifestyle. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 13 One service users care plan indicated that they like to attend church. Whilst other service user go out and about supported by staff this service user does not attended church. The registered manager agreed to look into this issue. One service user informed the inspector that they wished to go out unaccompanied. The inspector looked at this individuals file and found that there was sufficient documentary evidence to suggest that this would be a significant risk to the individual. Visitors were observed entering or leaving the home. All visitors were warmly welcomed. The inspector spoke with one relative who spoke highly of the home. All meals are cooked freshly at the home. The inspector was able to meet with the cook during the inspection. A four-week menu was seen. Meals appeared varied and wholesome. Service users spoken with at the inspection were positive about the food and stated that there was ‘always plenty to eat’. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 14 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. 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 service user’s felt confident that any complaints or concerns would be listened to and taken seriously. Further training with regards to local vulnerable adult procedures would be helpful. EVIDENCE: A complaints procedure is in place. The service users who the inspector spoke with informed them that they felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the manager and staff are very approachable and will deal with any issues, no matter how minor, there and then if they could. The home keeps a record of any complaints made. There have been no issues recorded at the home, similarly there have been no complaints made directly to the regulator. Through discussion with the staff on duty the inspector established that staff will report any concerns of suspected abuse. As there was some debate about who to report issues (with regards to the local vulnerable adult procedures) the inspector considers it would be helpful if staff had the opportunity to have some refresher training with regards to this issue. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,26, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In general the service users benefit from comfortable surroundings. Service users can personalise their private space. Service users do not benefit from the walk in shower room as it is still to be completed. A number of maintenance issues may put the service user at risk of harm. EVIDENCE: Friarn House, although not purpose built, appears suitably adapted to meet the needs of service users. Accommodation is arranged over two floors. Access to the first floor is via two staircases. One is fitted with a stair lift. The home would not be conducive to those service users who required a wheelchair to mobilise. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 16 The home has a well-maintained garden with seating for service users. Service users have access to a very comfortable dining area, good size lounge and conservatory. A small ‘quiet’ room is also available to service users and visitors. The home has 14 single bedrooms, 11 of which are fitted with en-suite toilet facilities and 1 double bedroom, which also have an en-suite toilet. All bedrooms are fitted with a wash hand basin as a minimum. A selection of bedrooms was seen at this inspection and it was evident that service users are encouraged to personalise their rooms. Service users who were able to express a view informed the inspector that they liked their rooms. The inspector observed many of the beds had bedrails but was informed none of these were used. It would be helpful if these were removed if the safety of the service user was not compromised by such an action. The inspector noted that several of the sash windows in the service users rooms were propped open, as the sash operating system was not working. One service user had recently trapped their hand in window when they were trying to open it causing cuts and bruising. An evaluation of the incident had not been undertaking, no updated risk assessment of the sash windows had been undertaken and this incident had not been reported to the Commission. During the tour of the building the inspector noted that an electrical box, which is part of the stair lift, was broken exposing the electrical terminals. They further noted that one of the handrails on the first floor stairs was extremely loose and could poise a significant risk to those service users who use this area. These matters were brought to the attention of the registered manager during the inspection. A nurse call system is sited throughout the home. All areas of the home seen were very clean and free from malodours. The home takes appropriate steps to reduce the risk of the spread of infection. Staff hand washing facilities are appropriately sited throughout the home. The walk in shower room that has been completed when commissioned, was found to have a fault with the way the water drained away. This needs to be rectified in order for service users to benefit from this facility. Service users have access to private and communal spaces in the home. Outside there is a large and safe patio area accessed via the conservatory Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 17 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. 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. The recruitment practices establish the suitability of the prospective employee. The staff have received regular training with regards to the tasks they daily perform on behalf of the service user. There is evidence that new staff receive a structured recorded induction into the care home. EVIDENCE: On the day of the inspection the staff were observed meeting the needs of the service users in a professional and respectful manner. The inspector talked with the staff on duty who were knowledgeable with regards to how to meet the assessed needs of the service user group. The service users themselves confirmed that the staff meet their individual needs in a way that suites them. They further commented that if they use the call system a member of staff will attend to them without too much delay. One service user indicated that it can be busy in the mornings. The staff turnover continues to be low and staff provide good continuity of care. The manager has promoted an ethos that values training and staff were Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 18 able to confirm receiving training to practice safely and for personal development. All staff spoken with had NVQ qualifications. The staff files that were sampled contained sufficient detail with which to establish the prospective employees suitability for the job with the exception of establishing a full employment history, the registered manager acknowledged this point. The home use a number of distance learning materials provided by Red Crier. This is a module approach which means that when a member of staff have completed a module the associated work book is sent to the training provider (Red Crier) who verify the competency of the staff members understanding of the subject before moving on to the next module. Certificates of achievement were observed during the inspection. Statutory training is documented. The registered manager confirmed that all staff have or are due to receive statutory training as and when required. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The home is managed in a person centred way. The service user may be at risk from poor maintenance of the home in the areas identified in this report. The arrangements made for financial considerations suit the service users who live at the home. EVIDENCE: The owner of Friarn House has recently appointed their deputy into the post of homes manager. They have undergone the approval process set out by the Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 20 Commission for Social Care Inspection and have been deemed fit to manage the care home. The manager has a good understanding of the National Minimum Standards required and how they should be met, but more attention should be paid to their responsibilities with regards to the risks associated with the environment (see comments made under standards 19 to 26) and the reporting of significant incidents that effect the well being of the service user. The feedback from the service user confirmed that they felt a sense of belonging living at the home and gave examples of how staff do that little bit extra to help out. They informed the inspector that they can raise issues with the management, can identify who the manager is and are confident that issues are dealt with promptly and effectively. The staff continue to appear relaxed and confident in their roles and demonstrated good understanding and empathy with the service user. Through discussion with the staff and manager it was established that the staff have one to one supervision, the records observed supported this. Through these discussions it was further established that it would be helpful if whole staff meetings were held periodically. The home does not keep cash for service users. The registered manager informed the inspector that if service users require small amounts of cash for personal purchases the home pays for them and then invoices the relative or associated power of attorney. The inspector noted that the home makes good arrangements for the servicing of all equipment in the home for example the servicing of stair lifts, gas safety records and the electrical testing of small electrical appliances. Fire appliances are checked on a weekly basis as well as the monitoring of hot water temperatures in the communal areas. Substances hazardous to health such as cleaning materials are secured appropriately. However the inspection demonstrated a number of weakness’ with regards to health and safety issues mainly relating to the environment and the evaluation of accidents following significant incidents that effect the well being of the individual service user. Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 21 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 3 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 3 3 x x 1 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 2 Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 22 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 OP37 Regulation 37 Requirement The registered manager must ensure that they report all incidents that effect the well being of the service user and staff The registered manager must record the rationale for the dispensing of medication on as required basis so that service user receive their medication in a managed way that prevents maladministration. The registered manager must ensure that unnecessary risks to the health and safety of the service users are identified and where possible eliminated Timescale for action 01/04/07 2 OP9 13(2) 01/04/07 3 OP19 13(4) ( c) 01/04/07 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 OP7 Good Practice Recommendations The registered manager should consider ensuring that all DS0000050730.V321209.R01.S.doc Version 5.2 Page 23 Friarn House Residential Care Home 2 3 OP18 OP32 pre assessment and subsequent care plans are signed by either the service user or their advocate so that they can evidence an inclusive approach to care planning. The service users would be better protected if staff have an opportunity to update their training with regards to the local vulnerable adults procedures. The registered manager should consider holding periodic s staff meetings so that staff have an opportunity to discuss best practice issues that benefit the service users Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Friarn House Residential Care Home DS0000050730.V321209.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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