Inspection on 21/07/05 for Froome Bank

This inspection was carried out on 21st July 2005.

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

Froome Bank 31/10/08

Froome Bank 10/08/07

Froome Bank 10/10/06

Froome Bank 29/12/05

Froome Bank 04/03/05

Froome Bank 06/09/04

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

CARE HOMES FOR OLDER PEOPLE Froome Bank Tower Hill Bromyard Herefordshire HR7 4QN Lead Inspector Denise Reynolds Announced Inspection 21 July 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Froome Bank Address Tower Hill Bromyard Herefordshire HR7 4QN 01885 483469 01885 483469 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Shaw healthcare Ltd Mrs H M Morgan Care Home 18 18 Category(ies) of Old Age registration, with number of places Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Within three months of the date of registration the providers will carry out a review of the social and recreational activities provided. Any shortfall below the National Minimum Stanards detailed in the Statement of Purpose will then be addressed within six months of the date of registration. Date of last inspection 4 March 2005 Brief Description of the Service: Froome Bank is operated by Shaw healthcare Ltd who took over control of the Home from Herefordshire Council on 2nd June 2004. In the weeks leading up to this inspection a major refurbishment project had been underway; some work was still in progress. An application had been submitted to CSCI by the Provider to change the registration categories for the from 18 places for older people with general age related needs (OP) to 9 places in this category and 9 places for people over 65 with care needs due to dementia illnesses. The accomodation is laid out in two self contained nine place units and the intention is for each of these to specialise.~This application has subsequently been approved by the Commission. Froome Bank was purpose built 12 years ago as part of the Bromyard Community Hospital complex but is self contained with its own front door. It is within walking distance of Bromyard town centre although the route is not flat. The building is situated so that the garden looks out over lovely countryside views. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on a weekday and lasted from just after breakfast until mid afternoon. The inspection was announced to ensure the presence of the Registered Manager and representatives of Shaw healthcare. This was so that the upgrading of the building and the application to change the registration could be discussed. Questionnaires and pre paid envelopes were left with the Manager to distribute to staff. Seven replies were received. The inspector was given copies of the Home’s resident and relative questionnaires from June 2005. During the inspection 3 residents and one person’s visitor were spoken to individually and the Inspector joined three people at their table for lunch. There was also discussion with the Manager. During the day staff were busy with re organising the medication room following redecoration as well as looking after the residents. For this reason they were not removed from their work to speak to the inspector but were asked to fill in and return the staff questionnaires in the pre paid envelopes provided and to encourage colleagues to do so as well. A sample of care records were looked at and these residents were met and spoken to. More time than usual was spent looking around the building, this was to see what work had been completed and what was still being done. Observations made throughout the visit contributed to the overall impression of what life at the Home is like from the residents’ point of view. What the service does well: The impression gained by spending time in the Home, speaking to residents and observing residents and staff together was that it is a friendly place to live. Residents said that staff are caring and treat them very well. They said they like the staff. Agency staff working at the Home on the day of the inspection said it is a Home they enjoy working at because they are made to feel part of the team. The care records and observation provided evidence that staff are attentive to residents’ care needs, for example they are good at keeping an eye on health problems that might need attention. The records of a new resident showed Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 6 how carefully staff had noted down the help she needed during the first few days. The accommodation is very attractive, light and airy. Furnishings, fittings and equipment are of a very good standard. Things like the décor have been done with care, for example, a lot of though has gone in to making it helpful to people with memory and orientation problems as well as looking attractive. It is a credit to the Manager and staff that they have maintained a good level of care and worked on developing care records whilst also having to cope with workmen in all parts of the building. This was something else that some residents expressed their appreciation for. What has improved since the last inspection? What they could do better: There is scope for further improvements to the care plans and assessments to guide staff in knowing what care each person needs and how they can provide this. The Provider has made arrangements for staff to have further training to help them with this. The provision of ‘cook/chill’ food from an outside caterer limits the flexibility and choice available to residents and the Registered Manager has very limited influence over the variable quality of food After a long period of being short staffed there are signs of improvement but agency staff are still used more than is desirable. It is important that the Home establishes a large enough staff team to provide more consistency for residents. This is even more important when the new dementia unit begins admitting more residents. Staff have gone through a long period of change. There were indications that though committed and enthusiastic this has taken its toll on staff. This highlights the need to have structured staff support/supervision arrangements so that staff at all levels have chance to discuss their work, training needs and any concerns with their manager. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 7 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. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 The Home obtains the information they need to make sure that they can meet the needs of a person moving in to the Home; developing the detail obtained will enhance their knowledge of people’s needs and preferences. EVIDENCE: Social services department assessments are obtained for funded residents and there is an assessment format that the Home uses for all prospective residents whether funded by a local authority or self funded. The information looked at for 2 people who had most recently moved in, one as an emergency, contained good basic information and this had been used to form the basis of the ongoing care plan. Daily recording was good. For example, the notes for one of the people who had recently arrived gave a clear picture of how they had settled in during the first few days and things that staff had noticed about the care they needed. The Home’s assessments would benefit from more specific details being included about some things, for example rather than just saying that the person like watching TV, reading or listening to the radio it is helpful to what sorts of things they like and whether they need special assistance (e.g. large print books or loop system). This will be even more important when the Home Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 10 is catering for more people who find it hard to understand, remember and explain what they want. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 10 The care plans at the Home have improved to provide much better information to help staff give residents consistently good care and with further development will stand the Home in good stead for meeting the needs of residents less able to express their wishes themselves. People living at the Home are treated with respect by friendly staff. EVIDENCE: Residents told the inspector lots of very positive things about the Home – they like the staff very much and described them as caring and friendly. One person said ‘they are excellent’. Sitting eating lunch with 3 resident it was noticed that there was a very relaxed atmosphere. Throughout the day staff were polite, patient and gentle with residents. The residents and relatives who had completed the Home’s quality assurance forms had all rated the standard of personal care as good or very good. There had been an improvement in the quality of the care plans. The organisations standard format had been established for each person and in general provided good information about each person’s care needs. Some very good risk assessments were seen showing the thought that had gone into helping residents stay as independent as possible. There was good evidence in Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 12 the care records that staff notice changes in residents’ health and involve healthcare professionals promptly. As with the assessments there is scope to build on what has already been achieved by developing the information about how people’s needs are to be met. For example • • One person ‘s plan said she has pressure relieving equipment but does not specify what this is. Records show that one person regularly declines when staff offer assistance to go to the toilet – the care plan needs to give guidance about how they should deal with this. There was evidence that the plans are being reviewed more often, though not all have been done monthly. Shaw healthcare’s regional Training Manager has got dates arranged to do staff training about care planning, this should be beneficial in helping staff with this part of their job. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 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 standard(s) 15 The external catering arrangements limit the flexibility and choice of food for residents and the ability of the Manager to influence quality. EVIDENCE: The food for the Home is provided by the same outside caterer as for the hospital. It is not freshly cooked on site but is ‘cook/chilled’ and delivered to the Home daily where it is reheated before serving. The Home has very limited say in the menus although the Manager hoped that the variety will improve in future due to more frequent changes. The meal on the day of the inspection was well balanced and quite tasty; the residents the inspector was sitting with said they enjoyed it although the meat in the one choice (lamb casserole) was tough for even for the inspector to chew and one of the residents left most of hers for this reason. A recent improvement was the introduction of a cooked breakfast on Saturday mornings. The mealtime itself was very sociable and unhurried. It was good to hear conversations going on between residents and with staff. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) these standards were not inspected during this inspection. EVIDENCE: Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 The accommodation has been upgraded to a very good standard. When all the basic work and finishing touches are completed the Home will provide residents with comfortable, well-appointed and safe surroundings in the years to come. EVIDENCE: The accommodation was nearing the end of a major facelift. The building has been redecorated throughout and new carpets and curtains provided. New wash basins have been fitted in bedrooms with taps that are easier to use and shaver points have been lowered to a more suitable height for people who need to sit down while shaving. Bathrooms have also been upgraded with improved assisted bathing equipment. Mechanised sluicing equipment has been installed in the sluice rooms in accordance with good infection control practice. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 16 Lighting in residents’ bedrooms, corridors and communal rooms has been improved to provide better lighting levels as well as creating a more homely impression. The kitchenette area in each unit has been re fitted with new cupboards and white goods. Décor has been thought about with care. Residents staying in the same rooms have been able to choose their new décor. The communal rooms have been decorated in neutral, calm colours to help create a relaxed atmosphere. Doors and corridors have been painted to assist in orientation following consultation with experts in dementia care environments at Stirling University. Two separate outside spaces, one for each unit, have been created. Safety railing has been erected to minimise the risk of falls to the adjacent car park grounds which is at a lower level. Once the gardening work is completed both areas will provide safe and attractive places for people to sit outside. Minor works were in hand to complete the project and it was anticipated that these would be finished within one or two weeks. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The planned staffing levels should enable staff to provide a good standard of care to the residents provided that these are achieved without over reliance on agency staff. The dementia training to be provided to staff will help equip them for the potential increased demands on them; this needs to be backed up by effective management support at all levels. EVIDENCE: During the last two years the Home has experienced staff recruitment problems which at one stage led to them limiting the number of residents in the Home. At the time of this inspection the Home was still needing to use agency staff on a regular basis but the Manager reported that most staff vacancies would soon be filled and that the agency were cooperative in providing the same staff most of the time to help limit the number of different faces for residents. The staffing levels submitted by Shaw healthcare in respect of the change in registration are in line with the Residential Forum guidance on staffing levels and take into account the likely higher dependency levels of residents with dementia related needs. The Provider has indicated that new admissions to the dementia unit will be carefully staged over a period of weeks to enable staff to get to know new residents and to get used to the new arrangements in the Home. The intention was for staff to work as two teams, one in each unit, to provide residents with consistency but for there to be some flexibility to allow movement between the teams from time to time. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 18 Staff feedback reflected continued concerns about staff shortages and the use of agency staff. This underlines the importance of any increase in resident numbers to full occupancy being carefully planned and managed in line with the necessary staffing levels. Arrangements are in hand for the Manager to go on a four-day dementia course provided by a specialist company. Other staff will do the Shaw healthcare in-house dementia course which has been developed using information from specialist sources such as the Bradford Dementia Group and Stirling University. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 The provision of structured staff supervision during a time of significant change at the Home would contribute to the success of these changes and help ensure that residents receive care from a well supported and motivated team. EVIDENCE: Little progress has been made in developing individual staff supervision and the Manager has not received regular supervision either. This is an essential element of staff support, particularly at times of change and should be addressed as a matter of urgency. Staff reported that they would appreciate increased levels of support although they recognised that this is not always easy when everyone is so busy. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x 1 x x Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 27 Regulation 18 Requirement Continued efforts must be made to establish a sufficiently large core staff team to minimise the need to use agency staff. Arrangements must be made to establish an effective staff supervision system for all grades of staff including the Registered Manager. Timescale for action 31st October 2005 31st October 2005 2. 36 18 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. Refer to Standard 3 7 15 Good Practice Recommendations It is recommended that the detail recorded in pre admission assessments is developed. it is recommended that the detail recorded in the care plans continues to be developed, particularly in respect of how particular aspects of a persons care will be met. Continued efforts need to be made to increase the degree of influence that the Manager of the Home has over the quality of food and the degree of flexibility and choice for residents. Froome Bank E52 E02 S60777 Froome Bank V239269 210705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Hereford Area Office 178 Widemarsh Street Hereford HR4 9HN 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. 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