CARE HOMES FOR OLDER PEOPLE
Frith House Steart Drive Burnham-on-sea Somerset TA8 1AA Lead Inspector
Kathy McCluskey Unannounced Inspection 10:15a 28 November 2006
th 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 Frith House DS0000015978.V316703.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. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Frith House Address Steart Drive Burnham-on-sea Somerset TA8 1AA 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 782537 01278 782537 Somerset Care Limited Mr Paul Gerard Cullis Care Home 80 Category(ies) of Dementia - over 65 years of age (22), Old age, registration, with number not falling within any other category (80) of places Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. One named person under the age of 65 years within the registered number of 80 beds Up to three persons between the ages of 55 - 65 years within the registered numbers of 80 beds. Within the maximum registered numbers of 80, the home may accommodate up to 22 service users in the category of DE(E). Date of last inspection Brief Description of the Service: Frith House is situated in a quiet residential area of Burnham-on-Sea, near the sea front and town centre. It is registered with the Commission for Social Care Inspection (CSCI) to provide care for 80 people over the age of 65 requiring personal care, including 22 persons with dementia care needs. The home is not registered to provide nursing care. Somerset Care Ltd own Frith House; the Registered Manager is Mr Paul Cullis. The home is purpose built and has accommodation on two floors, accessed by a passenger lift. Each bedroom has an emergency call system and a vanity unit (in the old build) - all rooms in the new build have en-suite facilities. Since the last inspection, the commission have agreed an application from the home to increase numbers from 62 to 80 service users. There are lounges and sitting areas found on both floors. The home has a pay phone for service user use. There are dining areas on the ground floor and first floors of the new build. The home also provides a bar/lounge where service users may smoke if they wish to do so. Frith House offers a respite facility and also a day care provision for up to ten service users. There is a separate unit within the home to accommodate up to 22 service users who have dementia. Social Services have contracted all of these beds, 30 beds in the main unit plus 5 ‘step up/step down beds’ The home’s current fee range is between £361 & £500 per week. Additional charges include; newspapers/magazines, hairdressing, mini-bus trips, holidays, chiropody, continence products, toiletries and transport for appointments. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This Key inspection was carried out in line with the Commission for Social Care inspection (CSCI) framework ‘Inspecting for Better Lives 2’ (IBL2). This unannounced key inspection was conducted over one day (9hrs) by CSCI Regulation Inspectors Kathy McCluskey and Jane Poole. As part of this inspection, the commission sent out comment cards to healthcare professionals on 3rd October. At the time of this report no completed comment cards have been received and no concerns have been raised by healthcare professionals. A selection of completed CSCI comment cards were received from relatives and service users. Responses to questions were positive. Other comments received from relatives were; ‘we are very pleased with the care’, ‘everything is always perfect’, ‘it really is a care home’, ‘my relative enjoys the meals very much’ The registered manager Mr Paul Cullis was available throughout the inspection. The inspectors were able to meet with many service users and staff. A tour of the premises was carried out where communal areas and a number of bedrooms were seen. Records were examined relating to service users, staff, medicines and health and safety. The inspectors would like to thank service users, staff, and the registered manager for their time and cooperation with the inspection process. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the service does well:
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 6 Frith House provides a comfortable and well-maintained environment for service users. The home has undergone a major period of building and refurbishment which is now complete. The home is effectively managed by an experienced and appropriately trained registered manager who promotes an open and inclusive style of management. Prospective service users are provided with the information they need to enable them to make an informed choice about moving to the home. Visits to the home are encouraged and prospective service users are fully assessed by senior staff prior to a placement being agreed. In addition to long term care, the home offers other facilities which includes a short stay respite facility and day care for up to 10 service users seven days a week. Frith House also offers five ‘step up, step down’ beds. These beds are funded by social services and their purpose is to reduce unnecessary admissions to hospital or residential care (step up) and to facilitate early discharge from hospital of patients who are clinically ready to transfer, but are needing a further period of rehabilitation (step down). People using these contracted beds will have received a multidisciplinary assessment, which clearly identifies their individual care needs and recognises that the step up step down bed is a means to achieving the agreed outcome. The usual placement is for 6 weeks. Service users have access to appropriate healthcare professionals and service users confirmed that they were treated with respect and that their privacy was respected. Service users did not express any concerns about the care they received and all stated that the staff were ‘very kind’. Many service users stated that ‘staff were very busy’ and they ‘don’t have time to sit and chat to you’. During the inspection, the inspectors were able to meet with a social worker who confirmed that they were very satisfied with the care their service user received. The social worker also stated that the home kept her fully informed of any changes or concerns. The home’s procedures for the management and administration of service users medication are good and have improved since the last inspection. The home offers a varied and wholesome menu. The inspectors were informed that the home had recently introduced Somerset Care’s corporate menus. The registered manager stated that, after a period of time, feedback would be sought from service users to ensure that they were satisfied with the choices of menu available. The registered manager informed the inspectors that the preferences of service users would always come first. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 7 Service users spoken with at this inspection were very positive about the meals at the home and stated that ‘there is always plenty to eat’ and that ‘there are choices for every meal’. The home has appropriate systems in place to enable service users, staff and other stakeholders to raise concerns. The home operates an effective quality assurance programme which seeks the views of service users, staff and other stakeholders. the results of a recent survey and results were discussed with the inspectors. Comments from service users and relatives regarding the care and service offered by the home were very good. The home’s area manager/responsible individual maintains close contact with the home and visits frequently. As part of these visits, monthly reports are completed. Regular meetings are held for service users, staff and visitors. Minutes are maintained. The home has a wide range of policies and procedures which are reviewed annually by the company. The home follows robust procedures for staff recruitment. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors to the home. What has improved since the last inspection? What they could do better:
Two requirements and seven recommendations have been raised as a result of this inspection. The first related to the home’s care planning systems;
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 8 Care plans examined did not always reflect/identify the assessed needs of service users and there were no clear instructions for staff as to how needs should be met. Not all care plans had been personalised to reflect the preferences of service users and there was no evidence of service user input. Daily entries recorded by staff did not provide sufficient information as to the well-being of service users. Specialised mental health needs had not been clearly identified for service users on the dementia unit. The registered manager informed the inspector that all care plans were in the process of being updated though due to staffing issues at the home, this had taken longer than anticipated to complete. Although the inspectors acknowledged the work the home was doing to address these issues, given that the home is currently using a high percentage of agency staff and recruiting new staff, it is imperative that sufficient information is available for staff to ensure that the needs and preferences of service users can be fully met. A requirement has been raised that this is addressed within a given timescale. The second requirement related to care staff working on the dementia unit. The inspectors were informed that the home does not have a designated staff team for this unit. On examination of records and discussion with staff it was ascertained that not all staff had received training in caring for older people with dementia. Given that service users, staff and the inspectors raised concerns about staffing levels at the home, good practise recommendations have been raised. Although service users did not raise concerns about the assistance/care they received and all commented on the kindness of staff, nearly all service users spoken with stated the following; ‘Staff were very busy’ and they ‘don’t have time to sit and chat to you’. This was also observed by the inspectors during the inspection. Service users who were dependant upon staff to mobilise, informed the inspectors that ‘I have to wait for staff’ and ‘they are very busy so I don’t like bothering them’. One service user who was spoken with in their bedroom, informed the inspectors that they ‘would like to go to the lounge and be with other people’ but that they ‘didn’t like to ask the staff as they are so busy’. Similar issues were identified at the last inspection. It has again been recommended that the home reviews staffing levels and deployment to ensure that service users feel confident in requesting staff assistance and that their preferences/right to choose is upheld. The inspectors were able to observe the lunchtime experience for service users on the main unit and dementia unit. Service users arrived at the dining room at approximately 1230hrs and lunch was starting to be served at 1300hrs. Some service users, who were dependant upon staff to mobilise, felt that they were ‘taken to the dining room too early’. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 9 In the main dining room, staff’s time was taken up with serving meals and it was not clear to the inspector how service users were monitored during this very busy time. It has been recommended that an audit should be carried out to ascertain all service users views on any waiting time at meal times. (this was raised at the last inspection 14/02/06). It has also been recommended that serious consideration is given to the employment/deployment of additional care support staff during meal times so that care staff can be free to monitor service users and ensure that all care needs are met. The home also needs to ensure that staff are effectively deployed on the dementia unit and that service users are able to make a more informed choice about their meals. As previously mentioned, during this inspection staff were not observed spending quality time with service users and there was a developing ethos of staff being ‘too busy’. As the home’s activities co-ordinator is on long term leave, it has been recommended that the home gives serious consideration to the employment of additional staff, in the absence of the activity co-ordinator, to ensure that service users have the opportunity to engage in social activities. It has also been recommended that current staffing levels are reviewed to ensure that the psychological/social needs of service users are met. 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. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 10 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 Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 11 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 and 5. Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home takes appropriate steps to ensure that the home is able to meet the assessed needs of prospective service users. Service users and their representatives are provided with the information they need to enable them to make an informed choice about moving to the home. EVIDENCE: The home has produced a Statement of Purpose and Service user Guide which are made available to service users, prospective service users and their representatives. Copies are also available in the reception area of the home. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 12 These documents have been updated since the last inspection to reflect the changes in maximum numbers of service users, environment and special rate dementia provision. The home ensures that prospective service users are fully assessed prior to moving to the home. Assessments are carried out by the registered manager or by other senior staff at the home. Copies of pre-admission assessments were seen in the care plans examined. Assessments from other professionals were also in place. The inspectors were able to meet with a number of service users who had not lived at the home for very long. These service users confirmed that they had visited the home before moving there and had been provided with sufficient information about the home. The home also offers respite and day care services. Some service users confirmed that they had utilised this provision before deciding to move to the home on a permanent basis. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 13 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a computerised care planning systems in place, which requires improvement. Service users have access to appropriate healthcare professionals and service users are treated with respect. The home’s procedures for the management and administration of service users medication are good and have improved since the last inspection. EVIDENCE: The home has been using a computerised care planning system for almost a year. The computer is password protected and can only be accessed by authorised staff. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 14 With the assistance of the registered manager, the inspectors were able to view five service user care plans. One care plan appeared to be fully reflective of the service user’s assessed needs and had been personalised with the individual’s preferences. The remaining care plans did not contain sufficient information pertaining to assessed needs and did not contain the individual’s likes and dislikes. One care plan for a service user in the dementia unit did not clearly identify assessed needs relating to their specialist mental health needs and there were no clear instructions for staff as to how needs should be met. These issues were discussed with the registered manager at the time. The registered manager informed the inspector that all care plans were in the process of being updated though due to staffing issues at the home, this had taken longer than anticipated to complete. Although the inspectors acknowledged the work the home was doing to address these issues, given that the home is currently using a high percentage of agency staff and recruiting new staff, it is imperative that sufficient information is available for staff to ensure that the needs and preferences of service users can be fully met. A requirement has been raised that this is addressed within a given timescale. Staff access the computer on a daily basis to record entries for each service user. A selection of these entries were shown to the inspectors. Information recorded was limited and did not give a clear overview of the service users day. The registered manager informed the inspectors that he was aware of this deficit and had recently raised this with the staff team. The registered manager agreed to take further action to ensure that sufficient information was recorded. From the information made available to inspectors, it was not clear how service users were involved in the care planning process. The registered manager stated that where appropriate, service users and/or their representatives would be provided with a ‘hard copy’ of their care plan. This should be kept under review to ensure that service users have the opportunity to be fully involved in deciding how their care should be delivered. All service users are registered with a GP. Records of visits by all healthcare professionals are maintained. The registered manager confirmed good support from visiting healthcare professionals. During the inspection, the inspectors were able to meet with a social worker who confirmed that they were very satisfied with the care their service user received. The social worker also stated that the home kept her fully informed of any changes or concerns and it was implied that the home would benefit from more staff.
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 15 The home’s procedures for the management and administration of service users medication were examined at this inspection and no concerns were raised. The home uses the monitored dosage system (MDS), with pre-printed medication administration records (MAR). MAR charts examined had been appropriately completed. Photographs of service users were in place to aid identification. There was clear information in place to advise staff on the use of ‘as required’ medication. Service users spoken with informed the inspectors that staff offered assistance with personal care and other activities of daily living in a kind and sensitive manner. All confirmed that their privacy was respected. Service users did not express any concerns about the care they received and all stated that the staff were ‘very kind’. Many service users stated that ‘staff were very busy’ and they ‘don’t have time to sit and chat to you’. This was also observed by the inspectors during the inspection. Staff were heard communicating with service users in a kind and respectful manner. When assisting service users with a task, staff were heard explaining the process to service users before assisting them. The inspectors did not observe social interactions between staff and service and did not observe staff sitting and chatting with service users during this inspection. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s arrangements for ensuring service users have the opportunity to engage in activities and social stimulation needs improving. The home ensures that service users can receive their visitors in private and that their visitors are made welcome at the home. The home needs to review its’ arrangements for enabling service users on the dementia unit to make informed choices around meals. Staffing levels/deployment on the main unit during meal times should be increased. Service users benefit from a wholesome and varied menu and are able to enjoy their meals in comfortable surroundings. EVIDENCE: Service users informed the inspectors that care staff carry out various activities ‘when they have time’ as the activities co-ordinator is currently on long term leave. Service users said that they played cards, bingo and tabletop skittles.
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 17 The registered manager informed the inspectors that service users recently enjoyed a ‘harvest supper’. Some service users enjoyed a holiday in Weymouth during the summer. As previously mentioned in this report, during this inspection staff were not observed spending quality time with service users. Service users informed the inspectors that staff were ‘very kind’, but always ‘very busy’. Service users indicated that staff ‘don’t have time to sit and chat with you’. This was also confirmed by staff spoken with. In the absence of the activity co-ordinator, it has been recommended that the home gives serious consideration to the allocation of additional staff to assist service users with social activities. Service users spoken with confirmed that their visitors were made to feel welcome at the home. Service users stated that they could choose where to see their visitors and could choose the privacy of their bedroom if they wished. All visitors to the home are required to sign in and the reception area of the home is staffed during ‘office hours’. Service users who were able to mobilise independently, informed the inspectors that they could choose where to spend their day and a few service users were observed moving freely around the home. Service users who were dependant upon staff to mobilise, informed the inspectors that ‘I have to wait for staff’ and ‘they are very busy so I don’t like bothering them’. One service user who was spoken with in their bedroom, informed the inspectors that they ‘would like to go to the lounge and be with other people’ but that they ‘didn’t like to ask the staff as they are so busy’. Similar issues were identified at the last inspection. It has again been recommended that the home reviews staffing levels and deployment to ensure that service users feel confident in requesting staff assistance and that their preferences/right to choose is upheld. The home offers a varied and wholesome menu. The inspectors were informed that the home had recently introduced Somerset Care’s corporate menus. The registered manager stated that, after a period of time, feedback would be sought from service users to ensure that they were satisfied with the choices of menu available. The registered manager informed the inspectors that the preferences of service users would always come first. Service users spoken with at this inspection were very positive about the meals at the home and stated that ‘there is always plenty to eat’ and that ‘there are choices for every meal’. The inspectors were able to observe the lunchtime experience for service users on the main unit and dementia unit. On both units dining tables were attractively laid with tablecloths, napkins, condiments and menus. Comfortable seating was in place for service users. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 18 On the main unit, the dining room is very large and pleasant. The inspectors observed service users waiting for their meal and chatting with other service users whilst enjoying a drink of their choice. Service users arrived at the dining room at approximately 1230hrs and lunch was starting to be served at 1300hrs. Some service users, who were dependant upon staff to mobilise, felt that they were ‘taken to the dining room too early’. The inspectors noted that meals were being served by care staff. The main choice of the meal was given to the service user and then staff provided each table with dishes containing potatoes and vegetables. Some service users were able to help themselves from the dishes and some required the assistance of staff. The inspectors noted that some service users, who had been provided with their main dish, had to wait a considerable period of time before they received the dishes of potatoes and vegetables. Although the mealtime experience for service users did not appear rushed, the inspectors felt there were insufficient staff to effectively ‘manage’ this. It was not clear to the inspectors how 5 care staff, 1 care support and one day care assistant could monitor service users effectively, including those in their bedrooms, given that their time was taken up with serving meals to potentially up to 68 service users (this includes the unit’s maximum numbers of 58 service users and up to 10 day care service users). This was discussed with the registered manager at the time of the inspection and it has been recommended that the home gives consideration to the employment/deployment of additional care support staff during meal times so that care staff can be free to monitor service users and ensure that all care needs are met. On the dementia unit a dining room is available on each floor, each accommodating up to 11 service users. As previously mentioned, tables were attractively laid, condiments, menus and choices of drinks were available. Meals arrived in a hot trolley and were served by care staff. The inspectors noted that service users were not offered the potatoes and vegetables in serving dishes like those in the main unit. Lunch was plated up and given to service users. The rationale for this was not clear because as in the main unit, it was felt that staff could assist service users to choose from the serving dishes if it was deemed not safe or appropriate to leave the dishes on the tables. Staff spoken with on the dementia unit informed the inspectors that service users had been able to make their choice of lunch in the morning (service users on the main unit make their choices the day before). Service users spoken with just before lunch could not recall what they had ordered or what the choices were. Given the needs and abilities of service users, it has been recommended that the home reviews its arrangements to ensure that service users on the dementia unit are able to make an informed choice about what they eat. The home should also ensure that care staff on the dementia unit are allocated to each floor in appropriate numbers. During lunch time, the inspectors noted
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 19 that only one member of staff was available on the first floor whilst two carers and the care supervisor were on the ground floor. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 20 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate systems in place to enable service users, staff and other stakeholders to raise concerns. The home takes appropriate steps to reduce the risk of harm or abuse to service users. The home needs to ensure that the contact details of appropriate external agencies are identified on the whistle blowing policy. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The inspectors noted that the whistle blowing policy, contained within the new staff induction handbooks, did not identify the contact details of the commission or any other external contacts. The whistle blowing policy should therefore be updated. Staff and some service users spoken with during the inspection informed the inspectors that they would always raise concerns if they had any. The inspectors examined the home’s complaints records. Since the last inspection the home have received two complaints and the inspectors were able to see that these had been fully investigated by the registered manager
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 21 and that the complainants had been satisfied with the outcome of their complaint. The home’s robust recruitment procedures reduce the risk of harm or abuse to service users. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 22 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Frith House provides a purpose built, clean and comfortable environment which has benefited from major refurbishment. Service users have the privacy of their own bedrooms and a choice of communal areas. The home has a range of aids and adaptations in place to promote independence. EVIDENCE: Frith House has undergone a major period of building and refurbishment work which is now complete. The home is now registered with the commission to provide personal care for up to a maximum of 80 service users. Within the
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 23 maximum numbers of 80, the home has a specialised dementia unit, which can accommodate up to 22 service users. All newly built bedrooms meet with the national minimum standards for size and have been fitted with an en-suite toilet with level access shower. Eighteen of the existing bedrooms have also been extended to provide this provision. The main dining room has been extended and refurbished and the kitchen, laundry and staff facilities have also benefited from improvements. The home is purpose built and is arranged over two floors. A shaft lift gives access to the first floor. Call bells and grab rails are conveniently sited throughout the home. The dementia unit has been designed using the latest research in respect of the environmental needs of people who have a dementia. There are assisted bathing facilities, raised toilets and mobile hoists available throughout the home to assist service users. All bedrooms are for single occupancy and a number were viewed at this inspection. Bedrooms appeared comfortable and it was apparent that service users are encouraged to personalise their rooms. All service users spoken with at this inspection informed the inspectors that they were very happy with their bedrooms. All bedrooms are fitted with a lock and service users are provided with a key. Locks can be over-ridden by staff in the case of an emergency. Bedrooms are also fitted with lockable storage. The home has a number of lounge areas and service users were observed utilising some of them. There is also a small lounge which is fitted with a bar area. Service users are permitted to smoke in designated areas. The home also has a hairdressing salon, small shop and activities room. All areas seen at this inspection were warm, clean and free from malodours. Staff have access to appropriate protective clothing and hand washing facilities were seen to be appropriately sited throughout the home. To ensure the safety of service users, upstairs windows have been restricted and wardrobes secured to the wall. Hot water outlets are fitted with thermostatic valves to reduce the risk of scalding. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 24 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is currently using a high ratio of agency staff, though the registered manager is working hard to ensure consistency of care for service users. Service users would benefit from an increase in staffing levels. The home’s staff recruitment procedures have improved and now reduce the risk of harm or abuse to service users. EVIDENCE: Since increasing in size, the home has been carrying out major staff recruitment drives. The home is currently using high numbers of agency staff to cover deficits. The registered manager stated his commitment to ensuring that service users receive continuity of care during this period and informed the inspectors that the home always attempts to have the same agency carers. The inspectors were informed that current staffing levels were as follows; In the main unit (up to 58 service users), during the morning there is a care supervisor, 5 care staff and 1 care support. Afternoons are covered by a supervisor and 5 carers. Two care support staff come on duty at 1600hrs. During the night there are 2 carers and a supervisor.
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 25 The home accepts up to 10 service users for day care each day and the inspectors were informed that an additional carer is allocated for this. In the dementia unit (up to 22 service users), mornings are covered by a supervisor, 3 care staff and 1 care support, this remains the same for the afternoon except that the care support does not start until 1600hrs. Nights are covered by a supervisor and 2 care staff. The home does not currently have a designated staff team for the dementia unit though the registered manager advised that this was something that was being considered. During the inspection on the dementia unit, mainly over the lunch time period, the inspectors noted that one carer was based on the first floor and two carers and the care supervisor were on the ground floor. Staff spoken with informed the inspectors that they often worked alone on the first floor and that if they required any assistance, they had to leave the floor to go downstairs. It has been recommended that the registered person should ensure that care staff on the dementia unit are allocated to each floor in appropriate numbers. As previously mentioned in this report under standard 14, the inspectors were concerned that the numbers of staff on duty in the main unit, over the lunch time period were insufficient and a recommendation has been raised. Throughout the day the inspectors did not observe care staff spending quality time with service users. Service users informed the inspectors that, ‘staff don’t have time to sit and chat’, ‘they are always too busy’, ‘I miss the personal touch and don’t feel cared about’, ‘staff are respectful but they don’t have time to talk to you’, ‘you have to fit in with the staffs’ routines’, ‘staff are very kind but I don’t see much of them’ Some service users indicated that they did not always use the call bells as they ‘didn’t like to bother staff as they were so busy’ It should be pointed out that during the inspection, call bells were responded to promptly by staff. It has been recommended, as at the last inspection, that reassurance should be given to service users who feel unable to use their call bells or ask for help, due to an ethos developing of the staff being ‘too busy’. Staff spoken with during the inspection did not raise any concerns about meeting the assessed needs of service users with the current staffing levels though they did indicate that ‘it was very busy’ and that ‘there is no time to spend with residents’. The inspectors were able to observe staff interacting with service users whilst assisting them with a task. Interactions were noted to be kind and respectful. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 26 The home does not currently have an activities-coordinator. A recommendation has been raised that the registered person gives serious consideration to the employment/deployment of additional staff (refer to standard 12). Staff confirmed that they had been appropriately trained, though one member of staff spoken with stated that although they worked on the dementia unit, they had not received any training in dementia care. Information provided by the registered manager indicated that of the 51 care staff employed, 22 have achieved an NVQ level 2 in care. This equates to 43 which just falls short of the national minimum standards recommendation of 50 . The inspectors examined the homes procedures relating to staff recruitment and the inspectors were able to see evidence that procedures had improved and the requirement raised at the last inspection had been addressed. Four recruitment files were examined and all contained information as required under Schedule 2 of the Care Homes Regulations 2001. Enhanced criminal record checks (CRB) and protection of vulnerable adult checks (POVA) were in place. On commencing employment, all staff undergo an in depth induction programme and undertake ongoing statutory training. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 27 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, 32, 33, 34, 36, 37 and 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is effectively managed by an experienced manager who promotes an open and inclusive style of management. The home operates an effective quality assurance programme which seeks the views of service users, staff and other stakeholders. The home takes appropriate steps to ensure the health and safety of service users, staff and visitors to the home. EVIDENCE: The registered manager is Mr Paul Cullis and has been involved in the care of older people for over 30 years. Mr Cullis has worked at the home in various roles for the past 15 years.
Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 28 Mr Cullis has achieved appropriate management qualifications and is also an NVQ assessor. He has kept himself up to date with both mandatory and other appropriate training courses and holds a certificate in managing health and safety (IOSH) Mr Cullis has effectively managed major changes at the home ensuring that there was little disruption to service users. Mr Cullis communicates appropriate matters to the commission and promotes an open and inclusive style of management. Healthcare professionals, staff and service users were positive about Mr Cullis’ management style. The management structure has experienced some changes in that the home’s deputy manager has been seconded to other Somerset Care Home and a temporary deputy is currently been placed at the home to cover the secondment. The home regularly seeks the views of service users and other stakeholders as part of its quality assurance programme. The registered manager was in the process of analysing the results of a recent survey and results were discussed with the inspectors. Comments from service users and relatives regarding the care and service offered by the home were very good. The home’s area manager/responsible individual maintains close contact with the home and visits frequently. As part of these visits, monthly reports are completed. Regular meetings are held for service users, staff and visitors. Minutes are maintained. Records indicated that the last staff meetings were held in January and September of this year. Relatives/visitors/service user meetings were held in March and June and a further meeting is planned for the dementia unit as the last one was ‘poorly attended’. The home has a wide range of policies and procedures which are reviewed annually by the company. The registered manager ensures that all staff receive formal supervision at least 6 times a year. A selection of records were examined and the inspectors were able to see evidence that an appropriate range of topics are discussed with the full involvement of the staff member. All staff also receive annual appraisals. At the time of this inspection, the home was taking appropriate steps to ensure the health and safety of service users, staff and visitors to the home. This was ascertained through a tour of premises, discussion with staff and service users and on examination of the following records; Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 29 FIRE SAFETY – In-house weekly checks are maintained on the home’s fire detection systems. It was noted that this had not been completed for this week or the previous week. The registered manager confirmed that this would be addressed. Annual servicing was carried out by an external contractor on 17/08/06 and 02/11/06. ELECTRICAL SAFETY – Records indicated that an annual check on the home’s portable appliances was currently in the process of completion. The home has an up to date electrical hardwiring certificate dated 20/09/05. EQUIPMENT SERVICING – Records examined confirmed that the home’s mobile hoists were last serviced on the 05/08/06, assisted baths were serviced on 04/06/06. The home has a ‘rolling’ contract with an external company to ensure that all equipment for the transporting /moving of service users is serviced every 6 months. GAS SAFETY – The home has an up to date annual landlords gas safety certificate dated October 2006. ACCIDENTS - Accidents are appropriately recorded and analysed monthly by the registered manager. Records were examined at this inspection and no traits/concerns were noted. As previously mentioned in this report, to ensure the safety of service users all upstairs windows are restricted, hot water outlets are thermostatically controlled, radiators are low heat surface type and free standing wardrobes are secured to the wall. Staff training records indicated that all staff had received up to date mandatory training relating to health and safety. Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 30 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 x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 x 3 3 3 Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 31 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 OP7 Regulation 12(1)(2)& (3), 15(1) Requirement The registered person shall ensure that the home promotes and makes proper provision for the health & welfare of service users: - Care plans must clearly identify service users assessed needs, including specialised mental health needs. - Care plans must give clear instructions for staff as to how assessed needs should be met. - Care plans must take into account the preferences of service users and should also demonstrate that service users (as appropriate) have been involved in the care planning process. - Daily entries made by staff must contain sufficient information as to the well-being of service users. The registered person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home: - Care staff working in the dementia unit must receive
DS0000015978.V316703.R01.S.doc Timescale for action 10/01/07 2. OP27 12(1)(a) & 18(1)(a) 28/02/07 Frith House Version 5.2 Page 32 appropriate training in dementia care. 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 OP12 Good Practice Recommendations The registered person should give serious consideration to the employment of additional staff, in the absence of the activity co-ordinator, to ensure that service users have the opportunity to engage in social activities. The registered person should ensure that service users on the dementia unit are enabled to make an informed choice around meals offered. An audit should be carried out to ascertain all service users views on any waiting time at meal times. (this was raised at the last inspection 14/02/06) The registered person should explore the developing views of service users that they feel unable to use their call bells or ask for help, due to an ethos of the staff being ‘too busy’. (This was raised at the last inspection 14/02/06) It is strongly recommended that the registered person gives consideration to the employment/deployment of additional care support staff during meal times so that care staff can be free to monitor service users and ensure that all care needs are met. The registered person should ensure that care staff on the dementia unit are allocated to each floor in appropriate numbers. The registered person should review current staffing levels to ensure that the psychological/social needs of service users are met. 2. 3. OP14 OP15 4. OP27 5. OP27 6. OP27 7. OP27 Frith House DS0000015978.V316703.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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