Inspection on 13/12/05 for Frome House

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Frome House 08/08/06

Frome House 17/06/05

Frome House 18/01/05

Frome House 17/08/04

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

CARE HOMES FOR OLDER PEOPLE Frome House Cranleigh Court Road Yate South Glos BS37 5DE Lead Inspector Gillian Underhill Unannounced Inspection 13th December 2005 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 Frome House DS0000035230.V272244.R01.S.doc Version 5.0 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. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Frome House Address Cranleigh Court Road Yate South Glos BS37 5DE 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) 01454 866046 01454 866822 terri-bryant@southglos.gov.uk South Gloucestershire Council Mrs Teresa Bryant Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate 31 service users aged 65 years and over requiring personal care only. 17th June 2005 Date of last inspection Brief Description of the Service: Frome house was purpose built in the 1960s to provide accommodation, personal care and support for 31 older people. It is operated by South Gloucestershire Council. The home is situated off a busy main road in a residential area of Yate, South Gloucestershire. It is a short walk to shops and is within easy reach of the towns main shopping centre where there are a full range of community facilities. There is a regular bus service to Yate town centre and to the centre of Bristol. The accommodation consists of a two storey building which is fully accessible to service users. There are ramps, a passenger lift and a staircase. All the homes bedrooms are single. Each bedroom has a wash hand basin. The home has gardens that are well maintained and are easily accessible. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 6 Specialist training for staff to be considered. A procedure to be developed for when service users go out for the day and take prescribed medication with them. During reviews the service users to be reminded that they may have a key to their bedroom if they wish. Consideration to be given to the merits of employing a laundry assistant during the weekend period. The duty rosters to be signed by the registered manager confirming that all shifts have been worked. Evidence to be provided that all staff receive regular 6 monthly fire drills and training. 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. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 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 Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. The home’s statement of purpose and other associated documentation are detailed and comprehensive in content. No service user is admitted into the home without receiving a full health and social care assessment, however the Registered Manager should confirm in writing that the home is suitable for the purpose of meeting the service users needs in respect of their health and welfare. Service users needs are met, and any specialist nursing input is accessed from the primary health care team. However staff may benefit from gaining a greater awareness and understanding of Multiple Sclerosis and Epilepsy through the provision of specialist training. EVIDENCE: The home’s statement of purpose was examined and was found to have been updated in November 2005. Service users families are able to access a copy of Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 9 this document, which offers clarity and detail on the home’s aims, objectives and care philosophy. Since the last inspection in June 2005, there have been 5 new admissions into the home. All necessary documentation had been accessed from the funding agencies, which includes assessments, and Care Management Care Plans. The homes “ in House “ care plans are developed after the first initial review at 4 weeks. Service users and/or their relatives are invited to visit Frome House, prior to admission. The inspector was told that the service user or their relatives do not receive confirmation in writing that having regard to the service users assessment the home is suitable, and can meet their needs in respect of his/her health and welfare. There is every indication that the home has the capacity to meet the assessed needs of individuals admitted to the home, and this was evident from the feedback from a visiting District Nurse on the day of the inspection. None of the service users have pressure sores, and care staff have received training on diabetic care. There are ample aids and adaptation around the home, however one service user is currently awaiting an assessment for a Stand Aid. One-service user has Multiple Sclerosis, and one other has been diagnosed with Epilepsy, for which none of the staff have received training. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The service users health, personal and social care needs are comprehensively set out in individual care plans. Health care needs are monitored carefully by a competent staff team, and further assisted by an excellent working relationship with health care professionals. Service users who have been prescribed medication are protected by the home’s policies and procedures, but the manager was advised to develop a procedure for service users who go out for the day and take their prescribed medication with them. Details of all medication, including creams or gels, prescribed to service users who self medicate to be recorded into their care plan and monitored carefully. Service users are treated with dignity and respect, and this was confirmed by a number of service users during the inspection. Even though it is acknowledged that keys are offered to service users at the point of admission, and during their first review, the manager has been advised to remind service users at all subsequent reviews that keys to lock their bedroom doors are available. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 11 EVIDENCE: Four care plans were examined which had been generated from comprehensive assessments. Files were in good order and contained some excellent and appropriate detail. Monthly reviews had been completed by the key workers and those seen were up to date and concise. Some service users, who were able, had signed their care plan agreeing that the content was factual. Risk assessment are completed, but generally not until after the first review. The health care needs of service users are monitored carefully by staff, and evidence of this was found in the individual case notes and care plans. Staff access the Primary Health Care Team, and other health care professionals when necessary, and service users who have been diagnosed with diabetes have their health care overseen by the District Nurse, who had also provided staff with the necessary training and supervision. A number of service users are incontinent, but none have pressure sores. Medication is administered from a blister pack dispensing system, which the Duty Manager said was satisfactory for the home’s needs. Medication charts were examined and staff administering medication had appropriately signed all. Staff with responsibility for administering medication have received training. None of the service users self medicate, except one person who applies Ibuprofen Gel, however the care plan does not include evidence of this in order for staff to monitor the effect of the application. There are no DDA’s currently in use. The medication policy and procedure was examined and was comprehensive in details, but the duty manager was advised to develop a procedure for when service users go out for the day, and take their medication with them. All medication no longer required is returned promptly to the Pharmacist, and appropriate records of this transfer have been maintained. Odd tablets found on the floor and mislaid by service users are contained in a jar, and are also returned to Pharmacy. All bedrooms are of single status and doors have numbers and the name of the service user occupying that room. Only a small number of people have keys, Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 12 but the duty manager said that on admission, and at the first review this facility is offered. Staff were observed to be polite and friendly towards service users, who in turn were relaxed and settled in their company. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 13 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 and 15. The manager makes every effort to provide suitable activities and recreational interest for the service user group, but also acknowledges that more resources would increase the availability and frequency of specific activities. . Service users are actively encouraged to maintain contact with family and friends. Service users receive a wholesome and balanced diet, in pleasing surroundings, with staff available to assist them if necessary. EVIDENCE: Activities are arranged on a regular basis, and up to date information about leisure pursuits had been placed on the notice board in the foyer. Eight service users are going with staff to the Hippodrome to see ‘Scrooge’, and parties and other Christmas events are also being arranged. Service users can participate in twice weekly bingo, and monthly exercise to music sessions. There is also a weekly church service. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 14 Staff also spend time with service users, and regularly take them out to the shops, and other local facilities. A volunteer is currently being pursued who has an interest in making baskets and cards. Two staff said they felt that an Activities Organiser would be beneficial, particularly as the service users group are becoming more dependant, which limits the amount of time staff are able to concentrate on organising service users leisure activities and interests. Three sets of relatives were consulted during the day of the inspection, and all said that Frome House provided excellent care, and accommodation. They also said that the whole staff team were friendly and approachable. Visitors on the day of the inspection said they were always welcomed into the home. Service users are able to see their visitors in private, and there is also a small kitchenette where either service users or visitors are able to make hot or cold drinks. Service users are able to select meals of their choice on a daily basis, and staff ask each person what they would like to eat prior to meal times. On the day of the inspection the food being prepared looked appealing and wholesome, and pastries and cakes had been cooked for serving later in the day. Five service users were consulted, and each person said they enjoyed the meals provided and had no complaints. There are 4 weekly rotating menus, prepared by the cook, but overseen by the manager. Hot and cold drinks are available throughout the day. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 15 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. Service users and their relatives are confident that their complaints or concerns will be listened to, and acted upon. From the systems in place it would indicate that service users are protected. EVIDENCE: From the evidence in the complaints log there have been no complaints raised since the inspection in June 2005,by either service users or their relatives. When asked service users said they felt staff always listened to them and would assist them in resolving any concerns or worries they may have over service delivery. Although the home has a vulnerable adults policy & procedure, this was not examined during the course of this inspection, nor were staff asked if they were aware of the content of the said documentation. The manager said there have been no incidents or allegations of abuse towards service users, but demonstrated that should allegations be made then this would be followed up promptly and action taken to safeguard the interest of the service users. One staff member explained that she had cause to “Whistle Blow” and was completely satisfied with the outcome. All newly appointed staff had completed a satisfactory police check and evidence of this was found on file. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 16 Standards 18.5 & 18.6 were not covered during this inspection. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 17 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, 22, 24 and 26. Service users live in a safe and well-maintained environment, with specialist equipment to maximise their mobility and independence. The home is clean and hygienic, with a functioning laundry area. [The responsibility of staff regarding laundry tasks will be commented on in the relevant standard box] EVIDENCE: Frome House is well maintained throughout, with individual bedrooms decorated in line with the requirements and individual choice of service users. The external grounds are kept tidy and safe, with seating provided for when individuals want to spend time in the garden. Access into the grounds is assisted by the use of rails and a ramp. There are no CCTV cameras, but the main entrance door has a call system, which is in good working order. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 18 Service users can access all parts of the home, and for this purpose a passenger lift and grab rails have been installed. A referral to occupational therapists can be made if necessary. Two service users have use of a ‘stand aid’ devise, and there is also a ‘parker’ bath, floor slide sheets, hoist and banana board to aid the mobility and transfer of service users. Frome road is clean and free from offensive odours. All clothes and bedding are washed on the premises, in the home’s laundry room. A laundry assistant has been employed to work Monday to Friday, and during the weekend care staff have this responsibility. All staff consulted said that this additional task presents some difficulty, because during the night shift care staff are not always able to allocate time to iron service users garments ready for wearing the following morning. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 19 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. Service users needs are currently being met by the numbers and skill mix of staff employed in the home, however some consideration should be given to employing a laundry assistant during the weekend period in order to lessen the work pressure of both night and day staff. The manager is very aware of the fluctuating dependency levels of service users and monitors the situation carefully. The manager is consistent in putting forward her staff for vocational training, and the process of working towards a minimum ratio of 50 trained care staff is ongoing. The recruitment process is thorough, and is based on equal opportunities, and ensures the protection of the service users. EVIDENCE: During the morning period there are 4 care staff on duty, and the same number during the afternoon period. There is an hour between 3 to 4 pm when only 2 care staff are on duty, but the manager said this is a relatively quiet period, when most service users are resting. Staff on the whole agreed with this but also said that dependency levels are increasing, and occasionally service users needs vary. Duty managers are always ready to assist when Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 20 necessary, but they too have added responsibilities, particularly since a clerical vacancy currently exists. A laundry assistant has-been employed to work Monday to Friday, but staff feel that this is a resource, which needs to be increased. There are currently 3 vacancies for care staff, and one for night staff. There is also a vacancy for a kitchen domestic, all of which have been advertised. Interviews for the night-time vacancy took place during the day of the inspection. The staff roster showed which staff are on duty at any time during the night and day and in what capacity, however the rosters have not been signed confirming that shifts have actually been worked. The duty roster must be signed confirming that all identified shifts have been worked. Two care staff have completed NVQ level 2, and four more have recently commenced this vocational training. All domestics have completed NVQ level 1. Five new staff have been recruited since the last inspection in June 2005. Each individual file was examined and contained all necessary details, including references; previous work history, identification and police check records. All files examined were in good order. Mangers have received training on the interviewing and recruitment process. Staff training files were examined and were in good order and for the large part up to date. All statutory training had been made available. Other training received by staff had been recorded and included continence care, dementia care and medication awareness. Each staff member has a separate training proforma on file. Specialist training for staff has been commented on in standard 3 comment box. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 21 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): 32, 33, 36, 37 and 38. The management style ensures that the atmosphere in the home is open, positive and inclusive. Quality assurance systems have been implemented, which suggests that the home is being run in the best interest of the service users. All staff are appropriately supervised. Record keeping is effective and efficient. From the standards covered during this inspection there is evidence that the manager ensures as far as possible the health, safety and welfare of service users and staff, however records must offer evidence that all staff receive regular 6 monthly fire training and drills. EVIDENCE: Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 22 A competent duty manager, who was conversant with the office administration and of meeting the home’s objectives, aided the inspection process. Later during the day the registered manager came on duty and was interested in the inspection feedback and was very open to listening to suggestions to maintain the already good practice in the home. Quality assurance monitoring systems are in place and surveys are sent twice yearly to relatives and staff, and quarterly to service users. All completed forms are sent to the team manager, with a copy placed on the homes notice board, and then later discussed in service user, and staff meetings. Staff say they receive regular one to one supervision, and this was evidenced by the log maintained of dates of supervision sessions. Staff say they receive a copy of the notes taken during such sessions, which always covers service users and training and development needs. All supervisors have received the appropriate training. A number of records were examined during the inspection and were all found to be in good order, well maintained and up to date. Those records examined were: Statement of Purpose, records of staff employed, recruitment files, copies of duty rosters, record of food provided, missing persons procedure, care plans and the homes fire log. Around the home there is evidence of safe practice, with staff mindful of safe working practices. Staff have received training on moving and transferring, first aid, and basic food hygiene. All chemicals used are securely stored under lock and key, and all fire fighting equipment has been maintained on a regular basis. Safety procedures have been posted on notice boards. The home’s fire log was examined, and although there was evidence that annual fire training has been made available to staff, there was no evidence to suggest that training is carried out on a regular 6 monthly basis, as recommended in the Avon Fire Log. Standards 38.3, 38.5 & 38.6 were not fully covered during this inspection. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 23 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 X X 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 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X 3 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 X 3 3 X X 3 3 2 Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 24 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 2 Standard OP37 OP38 Regulation 17 Schedule 4 23 (d) Requirement The duty roster to be signed by the Registered Manager. All staff to receive 6 monthly fire drills and training and evidence of this should be recorded into the appropriate log. Timescale for action 06/01/06 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP4 OP9 OP10 OP27 Good Practice Recommendations Staff to receive specialist training to increase their awareness of specific disabilities of service users. A procedure to be developed for when service users go out for the day and take prescribed medication with them. Service users to be reminded during each review that they can access a key to their room if they choose Consideration to be given to employing a laundry assistant during the weekend. Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Frome House DS0000035230.V272244.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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