Inspection on 31/10/08 for Froome Bank

This inspection was carried out on 31st October 2008.

CSCI found this care home to be providing an Good service.

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 10/08/07

Froome Bank 10/10/06

Froome Bank 29/12/05

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Froome Bank Tower Hill Bromyard Herefordshire HR7 4QN     The quality rating for this care home is:   two star good service 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 assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sarah Blake     Date: 0 3 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Froome Bank Tower Hill Bromyard Herefordshire HR7 4QN 01885483469 01885489421 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Janet Elizabeth Morgan Type of registration: Number of places registered: Shaw Healthcare Ltd care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Froome Bank was purpose built 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 and each unit has its own courtyard garden. The service provider for Froome Bank is Shaw Healthcare Ltd who took over control of the home from Herefordshire Council in 2004. During 2005 they completed a major refurbishment project. The accommodation is laid out in two self-contained units which each has nine places. One of the units, known as the Pink unit provides 9 places for older people with general, age related care needs. The other, known as the Blue unit provides 9 places for people who have care needs due to having a dementia illness. 9 0 Over 65 0 9 Care Homes for Older People Page 4 of 27 Brief description of the care home The weekly charges as stated in the Service User Guide are from £359.00 to £372.40. A copy of the current inspection report can be viewed at the home. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We spent a day at the home talking to the people who use the service and the staff, and looking at the records which must be kept by the home to show that it is being run properly. These include records relating to the care of people who use the service. Because people with dementia are not always able to tell us about their experiences, we have used a formal way to observe people in this inspection to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing five people who live at the home for two hours and recording their experiences at regular intervals. This included their state of well-being, and how they interacted with staff members, other people living at the home, and the environment. Care Homes for Older People Page 6 of 27 The service had previously completed an Annual Quality Assurance Assessment (AQAA). The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. The information from these sources helps us understand how well the home is meeting the needs of the people using the service. What the care home does well: What has improved since the last inspection? What they could do better: 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 4. Care Homes for Older People Page 8 of 27 The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a good range of information to assist people to decide whether or not they wish to live at Froome Bank. Peoples needs are assessed before they move into the home, so that staff know what care needs to be provided. Evidence: We received six completed survey forms from people who live at the home. They all told us that they had been given enough information to help them decide whether or not they wished to move into Froome Bank. One person said it was recommended by a friend, and I was given lots of support by staff. The homes Statement of Purpose and Service User Guide were seen, and both were up to date, and contained all the information which the home must provide for the people living there. The home also provides people with a leaflet called Welcome Pack, which includes a summary of the information in the Service User Guide, and Care Homes for Older People Page 11 of 27 Evidence: tells people who their key worker will be. We looked at the records for two people who had recently moved into Froome Bank. Senior staff from the home had visited the people before they moved in, to carry out an assessment of their care needs and to make sure that the home was able to meet their needs. We saw that the assessments were thorough and included information about peoples individual likes and dislikes. The information in these assessments about care needs was detailed, and therefore staff are able to provide the right care as soon as people move into the home. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a good standard of care to the people who live there. Medication is managed safely. Staff treat people with respect. Evidence: We looked at records for three people who live at the home. The records were thorough and included detailed information to help the staff to provide care in such a way that peoples wishes and choices are respected. We saw that one persons care plan had been drawn up with the involvement of their family, and included details about whether the person prefers a male or female carer. We saw that care plans had been reviewed regularly, and that up to date information had been included. For example, staff had needed to use a handling belt to help someone to get out of their chair, but ten days later their needs had changed and a hoist was required to help them to move. The risk assessment and care plan showed clearly that the situation was being closely monitored, and told staff how to use the equipment to help the person to move safely. Care Homes for Older People Page 13 of 27 Evidence: We saw that people had been weighed regularly and that the charts clearly showed whether they were gaining or losing weight. The home uses a nutritional assessment to determine whether people are at risk of malnutrition, and we saw that nutritional supplements are used when required. We saw records which showed that the home calls in healthcare professionals such as District Nurses and GPs when necessary. One person told us they always get the doctor to me if Im poorly. When people were unable to manage their own medication, we saw that they or their representative had signed a form to give staff permission to take responsibility for their medication. We saw that medication is stored safely, and that records of the administration of medication were accurate and up to date. On the day of the inspection, we saw staff treating people with respect and ensuring that their privacy and dignity was maintained whenever personal care tasks were being carried out. We saw records which showed that staff are careful to treat each person as an individual. One persons care plan included the sentence staff to reassure X (name of person living at the home) that she is loved by her family and not forgotten about. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a range of activities for people to take part in, but recognises that some people prefer to spend time on their own. Some activities are specifically planned to meet the needs of people with a dementia illness. A varied menu of nutritious food is available. Evidence: The home employs a part time activities co-ordinator, who plans a varied range of social and leisure opportunities for the people who live there. We saw photo albums, called Precious Memories, showing people involved in activities such as making laminated placemats, flower arranging and cake decorating. People who live at the home told us that they had recently been entertained by children from a local school, who had provided a choral recital for harvest. We saw examples of craft work displayed in the lounges, and in the lobby there were some beautifully displayed Christmas wreathes and decorations made by people living at the home for sale. On the day of the inspection, staff were working with people carving pumpkins, in preparation for a Halloween party that evening. Care Homes for Older People Page 15 of 27 Evidence: One person who lives at the home told us that she looks forward to the Pub Club on a Wednesday evening, where local volunteers put on a pub quiz for the people living at Froome Bank. As part of the inspection, we spent two hours on another day in the lounge in the Blue unit, where people with a dementia illness live. We used the Short Observational Framework for Inspection (SOFI), as explained in the summary at the beginning of this report. During the two hours, we saw staff spending time with a group of people who live in Blue unit, sitting round a table playing card games and chatting about their childhood and early work experiences. We saw that staff gently encouraged people to join in the conversation, but were sensitive to those who did not wish to. We looked at menus for the month, which showed a varied range of meals, with two choices of main course at lunch time, plus a vegetarian option. On the day of the inspection, the main meal was fish and chips or minced lamb pie, with rice pudding to follow. At supper time, people can choose from soup or either of two light meals, such as omelette or quiche, followed by a cold pudding. The meals are provided to the home by external caterers who supply the hospital, and this means that people have to make their choices the day before. One person told us the foods not to my liking, but its not uneatable. The staff try hard to make the food look appetising, but it does look like mass produced food, and we saw that some people did not even want to try their minced lamb pie. The manager told us that this is an area which she would like to change, but there are no facilities within the home for cooking meals, so the current system cannot be altered. Each lounge has a kitchenette, where drinks and snacks can be prepared at any time. We saw that the fridges had notices on them, encouraging people to help themselves to cold drinks whenever they wish. On top of the fridges we saw plasticwrapped portions of cake and biscuits, for people to eat whenever they are hungry. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a complaints procedure which is available to everyone who uses the service. People know how to raise issues which concern them. Staff recruitment helps to protect people who live at the home by ensuring that only suitable staff are employed. Evidence: The home has a clear complaints procedure, and this is included in the Service User Guide and is also displayed in the reception area of the home. In our surveys, everyone told us that they knew how to make a complaint, and knew who to speak to if they had any concerns. One person told us I feel safe. It is home to me. We have received one complaint about the home during the past year. We asked Shaw Healthcare to investigate the complaint, and let us know the outcome. They did so, and we have seen records which show that the complaint was resolved satisfactorily. The home has good procedures for recruiting staff. When the home employs new staff, there are checks which must be carried out to ensure that unsuitable people are not employed. These include a Criminal Records Bureau (CRB) check and two written references. We looked at the files for three new members of staff, and saw that these checks had been carried out. Care Homes for Older People Page 17 of 27 Evidence: We spoke to two members of staff, and they showed a good understanding of how to protect people from abuse. Training records showed that staff receive training in the protection of vulnerable adults. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a safe and comfortable environment for people to live in. Infection control is well managed. Evidence: Froome Bank is a purpose built home, next to the Community Hospital. Because it is purpose-built, it has wide corridors and all the rooms are accessible for wheelchairs and hoists. However, the new manager is very aware that the atmosphere could seem rather clinical, and she has started trying to make it more homely. The lobby has a welcoming feel, with two armchairs by a fireplace and items of craftwork for sale. There is a lounge/dining room for each unit, and these are spacious and decorated in neutral shades, with plenty of armchairs grouped so that it is easy for people to chat. Each lounge/dining room has its own kitchenette, with facilities for making drinks and light snacks. We saw that people had made their bedrooms homely with their own ornaments and furniture. Although some of the bedrooms are quite small, they are well laid out to make the most of the space. The manager has managed to find storage space for wheelchairs by keeping them in Care Homes for Older People Page 19 of 27 Evidence: the outer lobby area with a curtain in front of them. She has also designated a small room as storage for the hoist and other equipment such as the chair scales. The manager has plans to make one of the quiet rooms into a room where people can sit with their visitors. This room leads out into the garden which is currently mainly laid to grass, with a small seating area. The manager plans to extend the seating area and buy new patio furniture for next summer. We saw that a fully glazed door had been covered with translucent film. The manager explained that the staff had noticed that one of the people living at the home with a dementia illness had sometimes seen her reflection in the glass at night and been frightened by it, so the manager had covered the glass to prevent this happening. This shows that peoples individual needs are recognised and the home takes steps to meet those needs. At the previous inspection, we reported that some people had expressed concern about the height of the drop outside the Blue unit, and whether the fencing is adequate to prevent people climbing on it and falling. The manager told us that a risk assessment has been carried out and that there is no risk from this to people living at the home. In our surveys, most people told us that the home is always fresh and clean. One person living at the home told us that their bedroom is always spotlessly clean. On the day of the inspection, we saw that staff were using gloves and aprons where necessary, and were practising good infection control. The home was clean and tidy, and although the laundry is small, we saw that the staff take care to make sure that clean and dirty laundry are kept well away from each other. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are not always enough staff on duty to meet peoples needs in a timely manner, especially at night. Staff receive training to give them the knowledge and skills needed to provide care to the people who live at Froome Bank. Evidence: During the inspection, we saw that staff were kind and considerate, and spoke sensitively to people. One relative told us the staff are brilliant and someone who lives at Froome Bank said you can have a chat with the girls. We saw that staff were spending time chatting with people, and encouraging them to join in general conversation. We looked at staff records, which showed that the home has a good recruitment procedure and that all the necessary pre-employment checks are carried out before people begin work at Froome Bank. The home is part of Shaw Healthcare, and some of the staff records are held centrally at their Head Office. We looked at training records, which showed that most people have up to date training in areas such as adult protection and manual handling. The home uses a colour coded training matrix, which the manager uses to make sure that staff receive the correct training. Staff attend training on dementia care with the local Department of Mental Care Homes for Older People Page 21 of 27 Evidence: Health for Older People (DMHOP). During the inspection we saw that staff appeared to have time to spend with people and that, when people needed help to go to the toilet, the staff were kind and patient, and did not hurry people. We saw that staff assisted people with their mobility needs using good manual handling techniques. In our surveys, people told us that there are not always enough staff on duty. One person living at the home told us we need more staff with help in the morning to get dressed. During the inspection, another person told us the night staff dash in and turn the bell off. They say I cant come now, Im busy. They dont like us to ring unnecessarily. We spoke to staff, one of whom told us that when the day staff come on duty, the night staff are running round like headless chickens. The rotas showed that there are two staff on duty at night. At the time of the inspection, there was at least one person living at the home who needed the help of two people to move. This means that, when staff are attending to this person at night, there is no other member of staff available to assist anyone else in the home. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager is planning to make changes which will ensure that the home continues to be managed in the interests of the people who live there. Health and Safety is given a high priority and is well managed. Evidence: The AQAA which we received from the home was detailed and gave us a great deal of useful information about how the home meets the needs of the people who live there. Froome Bank has had two changes of management in the past eighteen months, and this has meant that some people have felt unsettled. The new manager has only been at Froome Bank since September this year, although she is an experienced manager, having previously run another Shaw Healthcare home. One member of staff told us that the staff team has found the changes difficult and are hoping that this manager will stay longer than the previous manager, and will bring Care Homes for Older People Page 23 of 27 Evidence: some stability to the home. In a survey, one member of staff commented on the inconsistent management. One of the people living at the home told us its good to have someone new who will make sure things are done properly. The manager explained to us some of her plans to improve the service, including more training for staff in the specific needs of people with a dementia illness, and improvements to the environment. The manager also told us that she will be using the quality assurance system to assist her in planning, although she has not yet had time to start using it. In the AQAA, the home told us that We listen to concerns and ideas that residents have about home life. We carry out regular residents and relatives audits. We saw records which confirmed this. We saw records which showed that staff receive regular supervision, and this was confirmed by staff members in surveys and in discussions on the day of the inspection. One new member of staff told us its really useful for me to be able to talk things through. We looked at the records for the management of Health and Safety, and saw that these were fully completed and were up to date. In discussion, the manager showed a good understanding of the principles of risk management within the home. The home looks after small amounts of money for some people who live at the home. This money is kept securely in individual wallets and we saw that records and receipts are kept for all transactions. Care Homes for Older People Page 24 of 27 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, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 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 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes 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 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 27 You should review the deployment of staff, especially at night, in relation to the needs of people at any particular time. This is so that people have their needs met in a timely manner. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.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 © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!