Inspection on 20/10/08 for Brendoncare Froxfield

This inspection was carried out on 20th October 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Brendoncare Froxfield 07/12/06

Brendoncare Froxfield 06/01/06

Brendoncare Froxfield 04/08/05

Brendoncare Froxfield 04/03/05

Brendoncare Froxfield 11/08/04

Brendoncare Froxfield 11/03/04

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: Froxfield Brendoncare Home Littlecote Road Froxfield Nr Marlborough Wiltshire SN8 3JY     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: Susie Stratton     Date: 2 1 1 0 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 32 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 32 Information about the care home Name of care home: Address: Froxfield Brendoncare Home Littlecote Road Froxfield Nr Marlborough Wiltshire SN8 3JY 01488684916 01488686042 hharding@brendoncare.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Hilary Joan Harding Type of registration: Number of places registered: The Brendoncare Foundation care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability terminally ill Additional conditions: No more than 2 physically disabled residents at any one time No more than 3 persons in receipt of terminal care at any one time No more than 4 persons requiring dementia care at anyone time. The staffing requirements shall be as agreed on the Notice of Proposal dated 9 January 2003 Date of last inspection 4 0 2 3 Over 65 0 44 0 0 Care Homes for Older People Page 4 of 32 Brief description of the care home Froxfield Brendoncare is part of a registered charity, the Brendoncare Foundation. They operate a small group of homes, all based in southern England. Froxfield Brendoncare is purpose built, with a second floor in one part of the home. There is a lift between the floors. The home originally opened in 1986. It has been extended several times since then. All residents have single bedrooms. A number of these have en-suite facilities. There are also assisted bathrooms and wcs for general use. There are communal areas within the home. Outside, residents have access to an attractive, well kept garden. The home is in the village of Froxfield. This is on the A4, within easy reach of both Marlborough and Hungerford. Car parking is available on site. There is a bus stop at the end of the road. The manager of the home is Mrs Hilary Harding. She is supported by deputies, nursing and care staff as well as an administrator, receptionist, activities coordinator and ancillary staff. The current fee levels are 798 pounds to 896 pounds a week. Fees do not include such items as hairdressing, newspapers, chiropody and sundries bought from the homes shop. A copy of the service users guide is available in the front hall and each residents bedroom. Care Homes for Older People Page 5 of 32 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: As part of the inspection, 30 questionnaires were sent out and 22 were returned. Comments made by the people in the questionnaires and to us during the inspection process have been included when drawing up the report. The homes file was reviewed and information provided since the previous inspection considered. We also received an annual quality assurance assessment from the home. This was their own assessment of how they are performing. It also gave us information about what has happened during the last year. We looked at the quality assurance assessment, the survey and reviewed all the other information that we have received about the home since the last inspection. This helped us to decide what we should focus on during the visit to the home. Care Homes for Older People Page 6 of 32 As Froxfield Brendoncare is a larger registration, the site visits took place over two days. Both the site visits were conducted by one inspector, however we refer to this person as we throughout the report, as the report is made on behalf of the Commission for Social Care Inspection. The first site visit was on Monday 20th October 2008, between 11:15am and 4:30pm. The second site visit took place on Tuesday 22nd October, 2008 between 9:40am and 1:10pm. The Manager, Hilary Harding was on duty on the first day of the inspection and the acting manager was on duty for both days of the inspection. The acting manager was available for the feedback at the end of the site visits. During the site visits, we met with nine residents, two visitors and observed care for ten residents for whom communication was difficult. We toured all of the home and observed care provided at different times of day. We reviewed care provision and documentation in detail for seven residents and reviewed certain aspects of care and documentation for a further two residents, across all parts of the home. As well as meeting with residents, we met with the training manager three registered nurses, five carers, one of the activities coordinators, the cook, the maintenance man and two laundresses. We observed a lunch-time meal and an activities group. We reviewed systems for storage of medicines and observed a medicines administration round. A range of records were reviewed, including staff training records, staff employment records, accident records and complaints records. What the care home does well: What has improved since the last inspection? What they could do better: Residents would benefit from improved consistency in care planning, to ensure that all people who have mental health needs and all diabetic residents have care plans to direct staff on how their needs are to be met. Where residents are at risk of pressure damage, specific care plans relating to how the individuals risk is to be reduced should be developed, rather than referring to the risk in a range of different care plans. Where residents are prescribed drugs which can affect their daily lives such as painkillers or aperients, care plans should be further developed to assist in the evaluation of the Care Homes for Older People Page 8 of 32 effectiveness of such treatments. Where residents care plans indicate that they need dietary supplements, there needs to be evidence that they are receiving these supplements, to ensure that they are receiving the dietary supports that they need. Where residents need thickening agents in their drinks, the persons care plan should state the consistency needed for their drinks, to ensure that the person can swallow safely. Records relating to urinary catheters should be improved to include all relevant details, so that registered nurses can know that all factors relating to the safe use of these types of appliance have been considered. As part of the review of the homes meals service, which is taking place, more healthy options for soups and yogurts should be considered. 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. 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 32 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 32 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. Residents will have full assessments performed, so that they can be assured that the home can meet their needs. Evidence: During the inspection, we met with a range of residents, some of whom had been admitted recently. One person reported that a member of their family had visited the home on their behalf another person reported that their relative had visited the home several times. All people who responded in the questionnaire felt that they had been given enough information about the home, to enable them to make a decision about coming in to the home. Two people reported that they had been visited in hospital by a member of staff from the home, before their admission. The acting manager reported that she or a member of her staff always went out to assess residents prior to admission and gained as much Care Homes for Older People Page 11 of 32 Evidence: information about their nursing and care needs as they could. Staff reported that they were given good information about prospective residents needs. The chef reported that she was told about any special dietary requirements. The activities coordinator reported on the good liaison between the manager and herself, so that she could know a persons needs before admission. The manager reported in her annual quality assessment that the home are planning during the next year, to include a preadmission mental health assessment on all prospective residents. We met with one person who had been admitted very recently. This person could not recall much about the admission process. Staff reported that they were working with the person, getting to know what nursing and care they needed and that, as for many residents, the person needed time to settle and adapt to living in a home. Care Homes for Older People Page 12 of 32 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. Residents living in Froxfield Brendoncare will have generally have their nursing and care needs met, although some developments are needed to ensure consistency in care planning. Evidence: Froxfield Brendoncare cares for older people who have a range of nursing and care needs and many of the residents have complex needs relating to their condition. The home also has a small dementia care unit where people who have prime needs relating to dementia care live. All residents have assessments completed and where a need or risk is identified care plans are developed to inform staff of how needs are to be met. The manager reported in her annual quality assessment that during the past year, they have concentrated on improving person-centered care planning. Records and discussions showed that residents and their relatives were consulted about how the home planned to meet their needs. One resident was able to report in detail about how the home met their specific Care Homes for Older People Page 13 of 32 Evidence: mobility needs. One person reported staff know what they are doing and another they do all they can to make residents comfortable. Very frail people who were nursed most or all of the time in bed had clear care plans, which identified why they spent most or all of their time in bed. Such people had monitoring charts to ensure that they had their positions changed regularly and were offered regular fluids. These charts were all fully completed at the time care was given, to provide evidence that the home were meeting peoples needs. Some areas of care planning need attention to ensure consistency in nursing and care provision. Some people were assessed as having a risk of pressure damage, this was generally referred to in different care plans, sometimes mobility, sometimes skin care, sometimes in night care plans. This had the effect that not all interventions observed to be carried out, were documented. Other directives conflicted, for example for one person, in one plan it stated they were to have their position changed every two to three hours and in another every three to four hours. When their turn chart was reviewed, the person was being turned every three to four hours. Some residents needed a urinary catheter in place. For some residents the clinical reason for the catheter was documented, for others it was not, although staff spoken to knew why the catheter was indicated. The clinical indicator for catheters needs to be documented so that registered nurses can continue to assess the need for such an appliance, which can cause urinary infection. Some records relating to catheter changes were completed in full, with date of change of catheter, the size of catheter, water in the balloon and batch number. Others did not include such details. All invasive appliances need full details of such relevant matters, so that in the event of any problem, relevant bodies can be informed. Where a catheter had been inserted in hospital, not the home, this should be recorded to inform all the registered nurses. Staff had noted that some residents found difficulty in eating or were loosing weight. In such cases, their records stated that dietary supplements were to be given, for example once a day. When these peoples fluid charts were reviewed, none of them showed evidence that they had been offered such supplements. The registered nurse in charge reported that they would investigate this matter, to ensure that people were given care in accordance with their care plan. Froxfield Brendoncare cares for some residents who also have mental health needs and has a small dementia care unit. Observations of care showed that such residents were relaxed and none of the residents were observed to show restless or noisy behaviors. The home maintains incident records and these document any complex behaviors shown by the residents. A review of this file showed that whilst such Care Homes for Older People Page 14 of 32 Evidence: behaviors did occur from time to time, such occurrences were not frequent. One resident was observed to wander at times during the inspection. Staff approached this person in a kindly and supportive manner, giving them time to express their needs. One of the carers spoken with showed a very detailed understanding of this individuals needs and of the different interventions that the home had tried to support the person. Where residents had care plans relating to their dementia care needs, these were very clear and detailed and written in a measurable, non-judgemental style. However not all residents who had additional mental health care needs had care plans to direct staff on how to meet such care needs and this is needed, so that all staff can be made aware of how residents who have such needs are to have them met. During the inspection, we met with one of the residents who was a diabetic and reviewed their records. Staff spoken to were very aware of how this persons needs in relation to their diabetes was to be met. However the persons care plan was generalistic in tone and did not reflect what staff reported about how the resident, their GP and they found it effective to manage their condition. A clear care plan, which reflects all these factors is needed, so that a person unfamiliar with this persons complex medical care needs would be informed of how they were to be met. Registered nurses reported that the home have very close working relationships with residents GPs. They also employ a part-time physiotherapist, who works with staff at all levels to support residents. This person reported that they were able to work flexibly, for example if a resident needed to be seen in the evening. Staff reported that by having a physiotherapist visiting regularly, residents retained their mobility and that they felt more supported in their roles. The physiotherapist completes clear reports of their interventions in residents records. The home is also regularly visited by a chiropodist who also completes full records in residents records. Where indicated, the home liaises with other professionals, such as the tissue viability nurse and community psychiatric nurse. During the inspection, we observed that all personal care was given behind closed doors. All staff knocked prior to entering residents rooms, including on the dementia care unit. Residents were clearly wearing the clothes they preferred. One resident liked to wear smart clothes during the day and was very well turned out, with staff enjoying the fact that they liked to take a pride in their appearance. The laundress reported that clothes very rarely went missing and that she had time to make small repairs such as sewing on buttons. We observed a medicines round during the inspection. The registered nurse performed Care Homes for Older People Page 15 of 32 Evidence: their duties in an organised and planned manner. They read the medicines administration record, checked the medication and gave it to the resident, always locking the medicines trolley when they were not with it. The registered nurse then stayed with the resident to support them in taking their medication, signing the medicines chart when the person had taken their prescribed medication. The home has a clinical room and trolleys for the storage of medication. These were maintained in an orderly manner. Controlled Drugs were correctly stored and full records maintained. There was a full audit trail of medicines received into and disposed of from the home. The home has commenced drawing up care plans relating to medication. Currently these care plans list side effects but do not consider why the person is prescribed certain drugs, such as mood altering drugs or aperients. This is advised so that the continued effectiveness of such drugs which can affect activities of daily living can be assessed. Care Homes for Older People Page 16 of 32 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. Residents will be fully supported in exercising choice in social engagement and largely supported in their choice and quality of meals. Evidence: People who responded in questionnaires commented very favourably on the activities. One person reported that the person arranges enjoyable events, another we have excellent support in this field and another I take part in everything. One person we spoke to commented on the terrific outings and another person that the activities person was to take them out shopping shortly. The home employs two part-time activities persons, who lead in different areas. One of the activities persons is happy to work flexibly during evenings and weekends and can also drive a minibus, which they reported they hired regularly. For residents who do not come out of their room, the activities person visits them, to support them as they wish or just to sit with them for a while. The other activities person was observed leading a music and movement group during the inspection, they were supporting and encouraging residents to take part. Many of the residents clearly found the group highly enjoyable. Care Homes for Older People Page 17 of 32 Evidence: Very clear records of activities participated in are maintained, including assessments of whether the resident benefited from the activity. The activities staff maintain records of residents likes and interests, which they add to as more becomes known about peoples past lives and what they currently liked to do. The activities person reported that staff in the home are happy to support them and also that they are consistently informed about changes in residents conditions that they would need to know about. The home are fortunate in being supported by the Friends of Brendoncare, who will support events such as the garden party. Visitors were observed going into and out of the home throughout the inspection. Some visitors came in to assist their relative to eat at mealtimes. Records showed that staff keep in close contact with residents families, including the use of E-mails where residents families live at a distance. Staff reported on the good links with the local community, particularly the local church, who come regularly to give communion. They also have close links with the Roman Catholic priest and the Methodist church. Residents reported that they could chose how they lived their lives. One resident reported that I dont like to go to bed early and they dont say anything about that, another resident reported that staff fit in with me getting up and going to bed, Ive set up the pattern and records showed that another resident who did not wish to get dressed every day had their wishes respected. One person reported that all their furniture in their room was their own and how important this was to them. On the dementia care unit, all of the rooms were highly personal, with a wide range of residents own possessions, including one room where the resident had brought in their own piano. The carer on duty reported that as the rooms looked so personal, they were very much the residents own private space and it tended to stop people who may wander from going into other residents rooms. People made a range of comments about the meals. Of the 16 people who responded to this section of the questionnaire, one reported they always, six usually, eight sometimes and one never liked the meals. Comments by people included we would like more variety, food to be hotter, more choice of vegetables cooked properly, fresh cooking every day, less sandwiches at night another, variety is the spice of life, making sure the food is HOT, less sandwiches at night and one person described the food as mediocre. However several people did also report that they found the food good or very good. The acting manager has recently performed a survey of peoples opinions about the meals and was putting an action plan in place to improve the meals, particularly the evening meals, at the time of the inspection. During the inspection, we observed a mealtime. Meals are organised so that people Care Homes for Older People Page 18 of 32 Evidence: who eat in their room or need assistance to eat in their rooms receive their meals first. We observed staff supporting residents at mealtimes. We observed one care assistant supporting a resident in trying to give themselves their own meal, using appropriate utensils, praising the person when they did feed themselves and only taking over when the resident indicated that they were tired. All care staff were observed to consistently sit with the resident when assisting them to eat their meal, encouraging them to talk and observing that they were swallowing safely. We met with the chef, she reported that they cooked most foods up from raw ingredients. They showed a good knowledge of individual residents preferences and was prepared to provide individual meals for residents where they had specific preferences. It was noted as good practice that residents who needed a puree or liquidised diet could exercise choice of what they ate at mealtimes. The soups provided are a pre-prepared dry mix. When we looked at the ingredients, they contained high levels of salt and sugar, which is not advisable for diabetics or people with a heart condition. The yogurts did not appear to be live, which is also preferable for frail older people. Some residents needed thickening agent in their drinks to enable safe swallowing. It is advisable that their records use the accepted terminology of syrup, custard or jelly to describe how thick the person wished or needed their drinks to be. Care Homes for Older People Page 19 of 32 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. People using the service will be supported by a service which listens to their complaints and takes action to ensure that they are safeguarded. Evidence: The home has a complaints procedure, which is displayed in the main entrance area and is available in the service users guide. All of the people who responded to the questionnaire reported that they knew how to make a complaint. One person reported to us that they would confide in the home manager, another I always find someone, another if Im not happy I get [the deputy manager] or [the manager] and they sort it out really well and another oh yes, you can talk to the managers quite easy and theyre ready to change it. All of the staff who responded to the questionnaire also reported that they knew what to do if a person had complaints about the home. One staff member reported that there were policies and procedures in place that cover all areas, another refer them to the line manager and another this is a subject which is covered by training and of course by experience. Concerns should be dealt with as soon as possible in an understanding manner. We have not received any complaints about the service since the last inspection. We looked at the complaints log and it showed that the home deals with formal complaints Care Homes for Older People Page 20 of 32 Evidence: in accordance with their own procedures. Comments from residents and staff indicated that people do raise issues of concern at times, relating to the service. It was reported that such matters are dealt with locally and addressed at the time. The manager reported in her annual quality audit that they are planning during the next year, to develop a record of such informal complaints and concerns, to further improve review of quality of service provision. The home has a policy and procedure on safeguarding adults. One safeguarding alert has been raised since the last inspection, this was raised by the home on behalf of a vulnerable person. The home were asked to investigate the matter, which they did. As noted in Standard 7 above, the home maintains record of incidents as well as accidents. Such records documented any aggression between residents or residents and staff. As would be anticipated in a home which has a dementia unit, some such incidents do occur from time to time. By review of these records, the manager identifies any common themes and takes action to address matters. The records showed that there were no incidents of physical aggression between residents and that most incidents related to verbal aggression or aggression by residents towards staff. Individual records provided evidence that correct action was taken by staff to ensure resident safety. All staff spoken with were aware of the safeguarding adults policy. This included staff at all levels, such as the laundress and maintenance man, as well as carers and registered nurses. Some staff spoken with clearly had very clear concepts of the importance of this area. For example one carer reported on how they worked with residents who had dementia, to support them in remaining calm and how they ensured that any aggressive behaviours did not escalate. Training records clearly showed that staff all received regular up-dates in the area. Care Homes for Older People Page 21 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by an environment which meets their needs, which is clean and well maintained. Evidence: Froxfield Brendoncare was purpose-built as a care home. The original building has been extended several times. The provider has a policy of continual review of the facilities, to ensure that residents needs can be met in an environment which suits their needs. Currently plans are being progressed to improve the sitting and dining rooms. The manager reported in her annual quality assessment that during the last year they have improved the environment by replacement windows and doors, new thermostatic controls on radiators and putting on magnetic door closures on all residents doors. A range of equipment to meet the needs of people with a disability are provided. The home continues to has invest in new profiling beds, to meet the needs of frail people. A range of different hoists are available to meet the needs of people who were unable to move themselves. One person reported to us that the staff use a hoist and do it correctly. People who were assessed as being at risk of pressure damage had appropriate pressure relieving equipment provided. Where people needed wheelchairs, they were supported in getting a wheelchair which met their individual disability needs. Care Homes for Older People Page 22 of 32 Evidence: The home was clean throughout, with no dust on high or low surfaces. All difficult to reach areas such as the undersides of bath hoists and raised toilet seats, were clean. A domestic was observed performing their role. They worked with care, moving objects to clean underneath them. All of the people who responded to the questionnaire reported that the home was always or usually fresh and clean. One person reported that they were Always impressed with how clean it is kept. Staff were observed to use disposable gloves and aprons correctly. Registered nurses reported that they had sterile gloves and used them to perform aseptic procedure. We visited the laundry and it was maintained at very high standards of cleanliness, with no dust visible in any parts of the room. The laundresses showed a very high understanding of the importance of their role in preventing risks of cross infection. They reported that all staff complied with the homes policies and procedures on the management of potentially infected and infected laundry. It is much to the homes credit that they had no items of unmarked laundry, apart from one single sock. Both laundresses showed an appreciation of how important it was for frail people, particularly people with dementia to have their own clothes promptly returned to them. Care Homes for Older People Page 23 of 32 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents will be supported by a staff group who have been safely recruited, are properly inducted into their role and fully supported by an extensive training programme. Evidence: Froxfield Brendoncare has a stable staff team, many of whom have worked there for many years and are able to work together, to ensure that residents needs can be met. Staff are prepared to work flexibly, to support each other. None of the residents spoken with commented on staff not being available when they needed them. One person reported oh yes, staff come when I ring my bell, another I ring the bell for help, another I shout for them and they always come and another Im left with the nurse call and they come most often, some are better than others. Of the eight members of staff who responded to this section of the questionnaire, all reported that there were always or usually enough staff to meet the individual needs of residents. One person reported I can only comment on the night shifts, and we always have a full team, another person commented on how the duty rotas are reviewed daily, however one person did comment that a few more would always be welcome. During the inspection, we reviewed records relating to newly employed staff. All staff files showed that police checks are carried out, two satisfactory references obtained Care Homes for Older People Page 24 of 32 Evidence: before employment, a full employment history provided, proof of identity shown and that all staff complete a health status questionnaire. All staff are assessed at interview using an interview assessment tool so that their strengths and weaknesses can be obtained. All files were tidy and easy to audit. The home has a training manager, this person supervises all training, including induction. The induction programme complies in full with current guidelines. Comments from staff on the induction depended on how long they had been employed. Staff who had been employed for a long period of time did comment that in the past the induction was non existent, however that this had since improved. One person reported Induction programme in place for all staff now and another I think the induction process has improved greatly. One person spoken with reported that they had recently moved from one role to another but that they had still had a full new induction into their new role, which they were enjoying. Induction records showed that all staff, including ancillary and registered nurses are included in an induction programme. Induction records seen were individually completed. At the end of the induction period, we saw that all staff have a formal review before they are confirmed in post. Once staff have completed their induction, training in National Vocational Qualifications (NVQ) is encouraged. The homes annual quality audit showed that well over 50 of staff are trained to NVQ II or above. One carer spoken with reported on how much they had enjoyed taking part in NVQ training and that it had helped them to think much more about their role. A registered nurse reported that they felt that carers worked more competently now that so many had been trained in NVQs. All of the staff who completed questionnaires reported that they were given training, which is relevant to their role and kept them up to date with new ways of working. One person reported Opportunity to access trainings is readily available another We have an extensive training programme including many subjects which arent mandatory and another I find management very encouraging to expand our knowledge/roles. Two carers commented particularly on the dementia care training which they felt had given them a detailed insight into the needs of people with dementia. The manager reported in her annual quality assessment that recent training had included dementia, infection control and deaf awareness. The acting manager has qualifications in dementia and reported that they felt that they were able to support people in this area, to ensure that individual peoples needs were met. Training records are clear and evidence the wide range of training opportunities for staff. The training manager reported that training needs were identified during supervision and at management reviews. She would then facilitate training on an individual or group basis. Care Homes for Older People Page 25 of 32 Care Homes for Older People Page 26 of 32 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. People will be supported by a home which is effectively managed, where the principals of health and safety are regularly reviewed and where there is a system for audit of the quality of service provision. Evidence: The manager of the home is Mrs Harding, she is an experienced manager and registered nurse. At the time of the site visits, Mrs Harding was temporarily away from her role, supporting another home owned by the provider. The provider had informed us about this and of the temporary management arrangements put in until Mrs Harding returned to the managers role. An experienced temporary manager is acting into the role. This person is employed by the provider as a relief manager. Mrs Harding retains interest in Froxfield Brendoncare and visits it regularly. On the first site visit, which was unannounced, she was visiting the home. She also performed the annual quality assessment of the home and submitted it to us. The annual quality audit was completed in detailed and included areas for development, as well as the homes Care Homes for Older People Page 27 of 32 Evidence: strengths. The home is regularly visited by a senior manager from the provider, who writes a report of their visit, including any recommendations, if indicated. It was noted as good practice that these visits included out of hours visits. It was discussed that these reports could be further improved if visits included a more detailed review of residents and their care plans, as well as receiving their comments. Such an approach would identify the variability in care planning, as observed during this inspection and enable action to be taken to improve quality and consistency in care planning. Quality audits did include key quality audits such as reviews of accidents, infection rates and incidences of pressure damage. The home has a clear management system for management of residents personal moneys, with a full audit trail of moneys in-going and out-going. All residents have their own computerised accounts, from which additional payments, such as hairdressing or chiropody are debited. The home has secure facilities for management of residents valuables handed in for safekeeping, with full records available of when items were handed in and back. The home has clear systems in place for ensuring the health and safety of residents, visitors and staff. Records show that all staff are trained in mandatory areas such as fire safety and manual handling. This was confirmed by staff spoken with. There are full records to show that all equipment and services are regularly maintained. The home was having a health and safety audit by an external professional at the time of the first site visit. The home needs to use safety rails on some residents beds. Where this is indicated, there are assessments carried out and these are regularly reviewed. Care Homes for Older People Page 28 of 32 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 29 of 32 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 1 7 12 Where residents care plans indicate that they need dietary supplements, there must be evidence that they are receiving these supplements. There needs to be written evidence that care is being given in accordance with care plans to ensure that residents care needs are being met. 31/12/2008 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 7 All residents who have mental health care needs should have a care plan in place to direct staff on how these needs are to be met. All diabetic residents should have full individual care plans about the management of their diabetic condition, this needs to include all matters known by staff. Where residents are at risk of pressure damage, a specific care plan should be developed to direct staff on how risk is to be reduced, rather than referring to the risk in other Page 30 of 32 2 8 3 8 Care Homes for Older People care plans. 4 8 Where residents have a urinary catheter in place, all records should state the clinical reasons for the appliance and include all relevant details of when and who last changed the catheter and specific details relating to the appliance. Care plans relating to medicines which can affect daily lives, such as painkillers, aperients or mood-altering drugs should be further developed, so that effectiveness of such treatments can be evaluated. The home should consider more healthy options for soups and yogurts Where residents need thickening agent in their drinks, care plans should state how thick the drinks need to be to meet the residents needs. 5 9 6 7 12 15 Care Homes for Older People Page 31 of 32 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 32 of 32 - 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!