Random inspection report
Care homes for older people
Name: Address: Frome Care Village Styles Hill Frome Somerset BA11 5JR one star adequate service 10/02/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Justine Button Date: 2 9 0 9 2 0 0 9 Information about the care home
Name of care home: Address: Frome Care Village Styles Hill Frome Somerset BA11 5JR 08702869464 Telephone number: Fax number: Email address: Provider web address: riverview@psphealthcare.com www.aalenhouse.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : PSP Healthcare Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 0 60 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Conditions of registration: 60 60 0 24 The maximum number of service users who can be accommodated is 60. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) - maximum of 24 places Dementia (Code DE) Mental disorder, excluding learning disability or dementia (Code MD) Date of last inspection 1 0 0 2 2 0 0 9 Care Homes for Older People Page 2 of 13 Brief description of the care home Riverview Nursing home was purchased by PSP Healthcare LTD in 2008. Riverview Care Home can be found just off styles Hill road, set in its own grounds. It is situated on the outskirts of the town of Frome near to Asda superstore. Shops, banks, pubs and restaurants are near by however transport would be needed to reach these facilities from the home. The home is currently situated in two separate buildings (although both are situated on the same site) The Parsonage and woodlands. The parsonage is an older building with facilities situated over two floors. The upper floor being accessed by staircase and lift. There are 34 bedrooms spread over the two floors. Both floors have a range of living and dining spaces. The parsonage currently provides care and support predominantly for people who have dementia. The woodlands has 24 single en-suite bedrooms again spread over two floors. This building was constructed in 2000. Again there are a range of living and dining facilities on both floors. The lower floor being accessed by stairs or a passenger lift. Woodlands provides care and support for those people with nursing needs. The two homes share some facilities such as laundry and kitchens. There are accessible gardens surrounding both homes. The home is currently has an interim a manager, Ms Jill Holmes . In addition both The parsonage and Woodlands have a head of care who is responsible for the day to day running of both buildings. The current fee levels range from 600 pounds per week to 1200 Pounds per week. This information was given to us on the 26/02/09. Care Homes for Older People Page 3 of 13 What we found:
The reason for this inspection was to review concerns received by us with regard to the care and support afforded to people living at Frome Care Village and the outcome is as follows: The last key inspection was conducted in February 2009 at this time the home was assessed as adequate (one star). Since this time the registered Manager has left employment at the service. During the inspection we met with the new temporary manager Ms Jill Holmes. Prior to this inspection concerns were raised to us with regard to care and support afforded to people living at the home. These concerns related to continence care and lack of appropriate equipment and supplies , the number of people with pressure damage as a result of poor care and staffing numbers. The concerns raised to us related to the area of the home providing nursing care. This inspection therefore was spend predominately in this area. What the care home does well:
At t last key inspection conducted in February 2009 it was reported that Peoples rights to privacy and dignity are respected by staff. Visitors to the home are encouraged and made welcome by staff and are now invited to attend events. All the people spoken to were very satisfied with the standard of the food served at the home. Individual preferences were known and catered for by care staff and the cook. Residents could choose to have their meals in the dining room or in their own rooms. The kitchen records were well kept and the kitchen clean and tidy. The home has a clear complaints policy that residents and visitors are aware of. Policies and procedures are in place to protect residents from the risk of abuse, including staff training and robust recruitment policies. The home, on the whole, was clean, tidy and free from unpleasant odours. People are able to bring in furniture and personal belongings to personalise their private room. Recent improvements to the overall decor of the home were seen. Resident and staff meetings have been held and the views of those living and working in the home are being taken into account by the manager. The majority of relatives said the atmosphere at the home was warm, caring and friendly, people living there confirmed that they shared this view. Staff were observed to be courteous and appropriately friendly towards people. One person described staff as supportive but not intrusive. People living at the home are seen as individuals and the home tries hard to accommodate their individual needs and characters. One person said that nobody wants to be in a residential home but if you have to this is as good as it gets. Care Homes for Older People Page 4 of 13 The home provides a good induction to all new staff to ensure that they are confident in their role and feel well supported. All staff have attended all necessary mandatory training. Both of these areas ensure that staff can meet the needs of people living at the home. What they could do better:
The home now keeps a file separate from the main care plans of all people with wound or pressure damage. The file for the nursing area was viewed. This demonstrated that five people had wounds or pressure damage. The documentation for the wounds was viewed. The wound care plan for one individual showed that the individual had along standing wound. The wound care plan stated the dressings that staff were using in an attempt to heal the wound. In February 2009 the wound was described as being 1cmx 1cm. Staff had taken a photograph of the wound in April 2009. Staff had written statement following each dressing change however none of these statements described the size of the wound. It would be expected that staff would take frequent tracings, measurements and photographs of the wound in order to ascertain if the dressing being used was effective and to consider if alternative treatment was required. This had not been completed in this case. The wound care plan for another individual was viewed. This was a relatively large sore measuring 7cm x2cm in July 2009. No sizes tracings or photographs had been taken since the development of the wound so again it would be difficult for the staff to assess the progress of the wound and therefore review the treatment regime. This individual did have other pressure ulcer which had healed due to the care given by staff. For a third individual the care records for the wound showed that no photographs or tracings had been taken since July 2009. Again it is difficult to assess the progress of the wound and the effectiveness of the treatment given. Photographs for the third individual had been taken on a monthly basis. The remaining person had refused photographs to be taken. This person had only recently been admitted to the home so it was difficult to assess the progress of the wound in this case. Issues with regard to wound care planning have been raised at previous inspections at the home and now need the urgent attention of the staff. During the inspection we spoke to two people in the lounge area of the home. One Lady told us that she has this thing to press when she wants someone. We confirmed with her that she was talking about the nurse call bell. The individual went on to tell us that Last night staff had told her that she was ringing the bell to much the bell. Due to this staff had removed the bell. The individual was quite anxious asking us what she should now do if she wants staff. . The care records were viewed for this individual. These showed that the individual had been admitted to the home ten days prior to the inspection. When people are admitted to the care homes it would be expected that staff would complete baseline assessments and care plans with in a very short period. Registered Nurses are accountable under the Nursing and Midwifery Council to maintain accurate records of the care that they have given. Despite this the records viewed were poor. Moving and handling, oral hygiene, Nutritional, falls risk, urinary continence assessments had not been completed. A needs
Care Homes for Older People Page 5 of 13 assessment had been started however this was not completed in full nor had it been dated and signed. The information received from the local social services department prior to admission shows that the lady had a history of falling at home and that the individual need staff help to access the toilet. It is concerning therefore that a falls risk assessment and continence assessment had not been completed by staff. It is also very concerning that staff had removed the nurse call bell. This could place this individual at significant risk if the lady concerned attempt to access the toilet unaided as she was unable to summon staff support. This issue was raised with the interim manager who agreed to investigate these concerns and notify us of the investigation outcome. The care records for a second individual who ha recently been admitted to the home were viewed. This individual had been at the home for five days. Again it would be expected that baseline care plans and assessments would be completed. This was not the case in all areas. In addition all the care plans and assessments seen to be completed had been done so in pencil. Documentation relating to care are legal documents and so need to completed in black ink. All documentation should also be dated and signed. This was not seen in all cases. A falls risk assessment had been complete. An assessment detailing the moving and handling requirements for the individual had been completed however staff had not completed the individuals weight so it is difficult to ascertain how accurate the assessment was. An accurate weight is required to ensure that the appropriate equipment is used in this area. For example hoist slings come in various sizes and should be used according to the individuals weight. The use of an inappropriate sling may place the individual at risk of falling from the hoist. A urinary continence assessment had not been completed. The care plan for this area stated that the individual had a urinary catheter however the plan did not detail how staff should care for this. A bed rail assessment had not been completed but the falls risk assessment states that these were used. A waterlow assessment (used to assess the risk of developing pressure ulcers) had been completed. This showed that the individual was at risk. The assessment stated that appropriate equipment was in place in the form of a pressure relieving cushion and mattress. Pressure ulcers can also be prevent by a regular change of position. The assessment and plans made no reference to this. This individual had been admitted (see above regarding wound care plans) with leg ulcers. One part of the preadmission assessment stated that the individual had MRSA. This was not reflected in the wound care plan nor was there clear guidance in any other part of the care plan relating to this. It was clear from the pre admission information that this individual was on occasion reluctant to accept the help and care offered by staff. There was no clear guidance in any care plan stating what staff should do if this occurred. At the end of the inspection an immediate requirement was left with the interim home manager to ensure that people recently admitted to the home had a range of completed assessments and associated care plans. Issues with regard to inadequate care planning have been raised at the home at previous inspections. Action is now required by the management of the home to address this issue. During the inspection two people told us that they had got up around 06:00am. At least one of these people stated that it was not her choice to get up that early. One lady stated
Care Homes for Older People Page 6 of 13 to us during the lunch time meal that she did not like carrots. Carrots had been served with her lunch. The individual told us that she had told staff on several occasions that this was the case but they continued to serve them to her. The individual stated that she would just leave them . Staff however should be aware of the likes and dislikes of individuals at the home and should offer an alternatives at these times. Likes and dislikes should be documented in the plan of care. The concerns raised with us related to continence care. It is clear from the two care plans viewed that continence assessments had not been completed for these individuals. This issue was discussed with the interim manager who stated that when she started working at the home it was clear that there were issues with the use of continence products. Staff had been using the products incorrectly and some people living at the home had not been reassessed for some time and were therefore using the wrong products. The system for ordering continence equipment for new people moving into the home had not been fully completed on all occasions. As a result the home had been running out of products. Staff had been borrowing one persons products for others and therefore the system had failed. Since this had been identified the home has been working with continence nurse from the Primary Care Trust to reassess all people living at the home, staff were receiving training on the correct use of the products and the ordering system had been reviewed. Two people spoken to during the inspection told us that when there was no hot water that morning in which to wash. During the inspection visit we asked one staff member (a cleaner) if there were any issues with the hot water. He told us he did not know. It is concerning that this staff member was cleaning the home without being aware if there was any hot water. We check a sample of en-suite bathrooms, communal bathrooms and toilets. We found that no hot water was available in any of these areas. Another staff member was questioned who stated that there was no hot water that day. This was an ongoing issue and that the hot water comes and goes. The staff member told us that currently they were getting hot water from the kitchen area and carrying it in bowls to the bedrooms. After the inspection we received additional concerns from a local social worker who had been to visit an individual living at the home who had also been told that there was an ongoing issue with hot water at the home. This issue relates to the nursing side of the home only. We are aware that the current boiler system has been problematic Since PSP Healthcare purchased the building in 2008. However are concerned that we had not received notification that the home was without hot water and heating. As a result of this inspection visit we left an immediate requirement asking the management to inform us of the action they were going to take in response to the lack of hot water. We requested that the management team inform us of the action that they were going to take and the interim arrangements that were in place to ensure that the hygiene needs of people living at the were met by the 02/10/2009. We received no response to this immediate requirement. On the 19/10/2009 we telephoned the home to ascertain the action taken in response to the immediate requirement. The interim manager told us that engineers had been out to assess the boilers and that this had resulted in an agreement that the boilers system in the nursing area of the home was in need of replacement. Works to do this would commence on the 21/10/2009. The manager told us that in the interim portable heaters had been provided in each room. That they were measuring the room temperatures on a regular basis to ensure that people were not cold. Hot water could still be obtained from the kitchen area and a risk assessment had been completed
Care Homes for Older People Page 7 of 13 with regard to staff carrying hot water to the bedrooms. It had been agreed that people who would like a bath or shower would go to the area of the home providing dementia care. Wet wipes had been purchased for the use for hands and face washing at other times. We will continue to review the issues with the boilers and hot water. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 8 of 13 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements
These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 9 of 13 Requirements and recommendations from this inspection:
Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours.
No. Standard Regulation Requirement Timescale for action 1 7 15 It is required that 01/10/2009 assessments and associated care plans are completed for the two named individuals who had recently been admitted to the home To ensure that staff are aware of the care needs of all the people at the home. This will help to ensure that staff deliver care in an appropriate way 2 25 12 That the management of the 02/10/2009 home ensure that proper provision is made to ensure that people are able to wash/bathe or shower in appropriate amounts of hot water at a temperature in line with good pratse guidelines. Action plan to address this issue to be forwarded to CQC by 02/10/09 To ensure that people can maintain adequate personal hygiene Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action 1 7 15 It is required that care plans 26/11/2009 are completed
Page 10 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action consistently so that they all provide clear guidance to staff of the care needs of indivduals living at the home. All the care plans should be completed in person centered way clearly detialing the likes, dislikes of the indivdual and how they would like thier care to be delivered. To ensure that staff are aware of the care needs of the indivuals living at the home. To ensure that care is delivered according to the wants and wishes of people living at the home. 2 8 12 It is required that the 26/11/2009 incidents of pressure damage their treatment and outcome are recorded in the plan of care and reviewed on a continuing basis. This should include the use of photographs, measurements and tracings. This will ensure that people are receiving appropriate care, support and treatment of any wounds or pressure ulcers 3 18 12 It is required that the 08/11/2010 management team investigate the concerns with regard to the removal of the
Page 11 of 13 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set.
No. Standard Regulation Requirement Timescale for action call bell from one indivdual. The management must inform The Care Quality Commssion of theactions they have taken in response to these concerns This will ensure the health and safety of people living at the home 4 38 37 The management will inform 26/11/2009 the Care Quality Commission of any events which adversely effects the well being or safety of any person living at the home. This will ensure that appropriate action is made by the management team to any issues identified at the home Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service.
No Refer to Standard Good Practice Recommendations 1 8 It is recommended that the work with the continence adviser continues to ensure that people at the home have and are supported by staff to use the correct continence products Care Homes for Older People Page 12 of 13 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 13 of 13 - 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!
