Inspection on 29/12/05 for Froome Bank

This inspection was carried out on 29th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Froome Bank 31/10/08

Froome Bank 10/08/07

Froome Bank 10/10/06

Froome Bank 21/07/05

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 Gill Goldfinch Unannounced Inspection 29th December 2005 3:00 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 Froome Bank DS0000060777.V268153.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. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Froome Bank Address Tower Hill Bromyard Herefordshire HR7 4QN 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) 01885 483469 01885 489421 Shaw healthcare Ltd Ms Helen Margaret Ammonds Care Home 18 Category(ies) of Dementia (9), Old age, not falling within any registration, with number other category (9) of places Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st July 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. Within the last year a major refurbishment project has been completed. Application was approved by CSCI for the Provider to change the registration categories for the home 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 refurbished accommodation is laid out in two self-contained nine place units each providing a specialist service. Froome Bank was purpose built 12 years ago as part of the Bromyard Community Hospital complex but is selfcontained 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 DS0000060777.V268153.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately 4 hours of one day in December 2005. Discussion was held with the registered manager. The assessment of residents care needs, medication systems, activities provided for residents, complaints and protection, some aspects of the staffing arrangements and some areas of the management and administration of the home were inspected. One of the requirements issued at the previous inspection relating to staff supervision had not been fully met. This has been repeated in this report with new timescales. Conditions of registration relating to social and recreational activities have not been fully met due to recruitment difficulties. Both units were fully occupied on the day of inspection. What the service does well: What has improved since the last inspection? What they could do better: Improvements could be made in the recreational and social activities provided for residents. Further training is required for staff in the specialist area of dementia care. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 6 Supervision of staff requires further improvement especially at management level. Maintenance of fire safety records requires improvement. 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 DS0000060777.V268153.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 Froome Bank DS0000060777.V268153.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): 3 Arrangements are in place to carry out a full assessment of residents needs to ensure the home is suitable for them and can meet their care needs. EVIDENCE: Thorough assessments were carried out on residents prior to their moving into the home, and, due to the specialist needs of the residents, relatives and friends were consulted. The assessment documents for the last two people admitted to the home were inspected. These contained good detail of each individuals specific care needs. The assessments formed the basis for each individual care plan. Some of the care plans seen had not been signed by the service user or their representative. (See Recommendation). Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 9 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): 9 There were policies and procedures in place for the safe administration of medication. EVIDENCE: Clear guidance was provided for staff through policy, procedure and training on receipt, recording, storage, handling, administration and disposal of medicines. The home uses ‘Boots’ monitored dosage system. The registered manager stated the pharmacist provided good support to the home. All staff responsible for the administration of medication had undertaken training in the safe administration of medicines. Medication used on a daily basis was being appropriately stored. Medications in need of refrigeration were suitable stored. Fridge temperatures were being monitored and recorded. Controlled drugs were appropriately stored and the controlled drugs register showed they were being administered appropriately. Records of the administration of medication were checked and found to be in order. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 10 Residents are able to take control of their own medication if they wish, within a risk management framework. There were records kept of use of homely remedies. There was a protocol in place for the use of medication prescribed on an ‘as and when required’ basis. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 11 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 and 13 Residents’ social, cultural, religious and recreational interests and needs were established as part of the initial assessment and written in the care plan. Condition of registration made by CSCI for the registered provider to review the social and recreational facilities provided by the home and address any shortfall below the National Minimum Standard had not been met. The home maintains links with the local community and residents are encouraged to maintain existing links and develop new ones as they wish. Visitors were welcome in the home. EVIDENCE: The social, cultural, religious and recreational interests and needs of residents were recorded. However, there was little written evidence that residents were able to regularly take part in daily meaningful activities. The registered manager told the inspector that resources had been provided for the recruitment of additional staff but that such recruitment was proving difficult. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 12 Given this situation it has not been possible for the home to consistently provide meaningful social and recreational activities for residents. This is detrimental to their quality of life. (See Requirement). Staff had not received any specialist training in the provision of activities for older people with dementia type illnesses. Information about the home indicated that visitors were welcome to visit. The home has a ‘League of Friends’. A lack of resources is currently preventing the home from meeting these standards. However, the registered manager is working hard to creatively address this issue. Recent community involvement in the home included: • • • Christmas carol service provided by the local school Visit to Bromyard to see the Christmas lights Music workshop Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 13 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 The home has a satisfactory complaints system, and there are systems in place to ensure the protection of residents from abuse. EVIDENCE: A complaints procedure was available in the home. The registered manager confirmed that a copy of the complaints procedure is provided to each resident and their representatives at the time of admission. A record of complaints was being kept. There was documentary evidence that a complaint received on 26/12/05 concerning food had been appropriately documented and responded to, had been reported to CSCI, and was being investigated. There were policies and procedures in place for the protection of services users from abuse. The registered manager confirmed that any allegation of abuse would be investigated and any action taken recorded. All staff had received training in the protection of vulnerable adults. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 14 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): These standards were not inspected during this inspection. EVIDENCE: Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 15 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): 27,29 and 30 Staffing levels agreed at registration of the dementia care unit were not being achieved due to recruitment difficulties. However, reliance on the use of agency staff has been reduced since the last inspection due to the successful appointment of bank staff. Recruitment policies and practices ensure staff are thoroughly checked prior to employment, providing good protection to residents. A staff-training programme is in place with some training being undertaken since the last inspection; specialist training in dementia care has not been adequately provided. EVIDENCE: The home continues to have difficulty recruiting staff. This has been an ongoing problem over the past two and a half years. In respect of the change in registration Shaw Healthcare have aimed to staff the home in line with the Residential Forum guidance on staffing levels taking into account the higher dependency levels of residents with dementia related needs. Unfortunately at the time of this inspection these staffing levels were not being achieved because of recruitment difficulties. However, there was less reliance on agency staff than at the previous inspection due to the successful recruitment of bank of staff. The dementia care training provided to staff has to date consisted of one day. This is insufficient to assist staff in obtaining the skills and understanding necessary to provide for the care needs of those living on the dementia care Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 16 unit. (See requirement). At the time of inspection the dementia care unit was fully occupied. In addition there were team leader vacancies in the home reducing the effective management support available to staff. The inspector was told that dementia care training was booked for the registered manager but was cancelled. This is to be rearranged. The home has a comprehensive staff recruitment procedure in place. A selection of staff files were inspected. These were found to contain all necessary information as required under Schedule 4, Regulation 17(2) of The Care Homes Regulations 2001. New staff receive a structured induction training within the first six weeks of employment, plus additional in-house training, and access and support with the NVQ programme. Training records show that there are regular opportunities for staff to have a range of mandatory and optional training, in order that they have the necessary skills for their work. However, as staff and in particular the registered manager have not yet been provided with the specialist training needed in dementia care this Standard cannot be fully met. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 17 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): 33,35,36 and38 The home has a formal quality assurance program that measures its success in meeting the aims, objectives and statement of purpose of the home. There are systems in place to ensure residents’ financial interests are safeguarded. Management systems are in place to ensure the health, safety and welfare of residents and staff are promoted and protected. Requirement made at the previous inspection relating to staff supervision was not being fully met. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 18 EVIDENCE: Quality and assurance and quality monitoring systems were in place. Feedback was actively sought from all interested parties about the services provided. These included residents, staff, relatives and professionals visiting the home. This is undertaken through the use of questionnaires and residents meetings. These are audited regularly by Shawhealth Care. There is regular review of policies and procedures to ensure they are in keeping with any changes in legislation or good practice guidance. Residents are encouraged to handle their own finances except were they state they do not wish to or lack the capacity to do so. In such instances there are safeguards in place to protect the interests of residents. The registered manager stated that in instances where it is necessary for an individual to have an appointee to act on their behalf an independent person was always used. There was evidence of use of advocates in the home. Secure facilities are provided for each resident for the safe keeping of valuables. Records and receipts are kept of any possessions handed over for safekeeping. These were inspected and found to be in order. Receipts and records are also kept of any financial transactions these records were also inspected and were without error. There was evidence that health and safety issues are addressed in this home, with written policies, procedures and risk assessments, provision of necessary equipment and staff training. The Health Authority undertakes some aspects of maintenance of the building with records being held by them. The fire safety records were inspected. The Health Authority undertakes fire safety checks with records being held in the home. The registered manager confirmed that the fire alarm test is carried out weekly. The test had not been recorded in the fire record as having been carried out since 19/10/05. (See Requirement). Requirement made at the previous inspection relating to staff supervision was not being fully met. There was evidence on staff files that staff in the home were receiving supervision. It was disappointing to hear that the registered manager had received only one individual supervision session since the last inspection. As stated in the previous report staff supervision is an essential element of staff support, particularly at times of change. This issue should be addressed as a matter of urgency. (See Requirement). It is to the credit of the registered manager that she has begun to establish a system of supervision for staff at a time of great change and with recruitment as problematic as it has been. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 19 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 X X 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 X X X X X X X X STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 2 X 2 Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? YES 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 OP27 Regulation 18 Requirement Continued efforts must be made to recruit and establish a sufficiently large core staff team to provide for the care needs of residents. Arrangements must be made to establish an effective staff supervision system for all grades of staff including the Registered Manager. Previous timescale of 31/10/05 not met. Arrangements must be made to ensure the identified social and recreational needs of residents are met. Arrangements must be made to ensure that staff at all levels receive training necessary to meet the specialist needs of residents living on the dementia care unit. Arrangements must be made for the accurate and regular recording of all fire safety tests. Timescale for action 01/03/06 2. OP36 18 01/03/06 3 OP12 16 01/03/06 4 OP30 18 01/03/06 5 OP38 17 29/12/05 Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations All residents and/or their representatives should sign their individual care plan. Froome Bank DS0000060777.V268153.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Hereford Office 178 Widemarsh St Hereford Herefordshire 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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