Inspection on 04/08/05 for Brendoncare Froxfield

This inspection was carried out on 4th August 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

Brendoncare Froxfield 20/10/08

Brendoncare Froxfield 07/12/06

Brendoncare Froxfield 06/01/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Froxfield Brendoncare Home Littlecote Road Froxfield Nr Marlborough Wiltshire, SN8 3JY Lead Inspector Susie Stratton Unannounced 4 August 2005 th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Froxfield Brendoncare Home Address Littlecote Road Froxfield Nr Marlborough Wiltshire SN8 3JY 01488 684916 01488 686042 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Brendoncare Foundation Mrs Hilary Joan Harding Care Home with Nursing 44 Category(ies) of DE Dementia (4) registration, with number OP Old Age (44) of places PD Physical Disability (2) TI Terminally ill (3) Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 3 persons in receipt of terminal caare at any one time 2. No more than 2 physically disabled residents at any one time 3. No more than 4 persons requiring dementia care at any one time 4. The staffing requirements shall be as agreed on the Notice of Proposal dated 9 January 2003. Date of last inspection 4th March 2005 Brief Description of the Service: Froxfield Brendoncare is part of a registered charity, the Brendoncare Foundation. They operate a small group of 7 homes, all based in southern England. Froxfield Brendoncare is a purpose built, two storey home. There is a lift between the floors. The service originally opened in 1986. It has been extended since then. The home includes a small dementia care unit. 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. All residents have single bedrooms. A number of these have en-suite facilities. There are also other bathrooms for general use. There are communal areas within the home. Outside, users have access to an attractive, well kept garden. The manager of the home is Mrs Harding, she is supported by deputies, nursing, senior care and care staff as well as an adminstrator, receptionist, catering, domestic, laundry and maintenance staff. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on Thursday 4th August 2005 between 10:10am and 4:00pm, in the presence of Mrs Harding, registered manager. During the inspection, the Inspector met with three registered nurses, five care assistants, the administrator, the receptionist, one of the chefs, the laundress and a domestic. The Inspector also met and spoke with twelve residents, three relatives and observed care for nine residents who were not able to communicate. Records of nine residents were inspected in detail. The Inspector toured the home, including the laundry and reviewed records, including medicines records, financial records, the fire log book, training records, supervision records and accident records. What the service does well: What has improved since the last inspection? What they could do better: All medicines administration records must always be completed at the time of administration, so that the home can provide evidence that residents’ Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 6 prescribed medication has been given to them and if not, why not. This matter was also identified at the previous inspection and action is needed to ensure it is addressed. Approved signage must always be put on doors where oxygen is in use or stored to ensure safety of all involved, in the event of a fire. Oxygen cylinders must always be securely stored, to prevent risk from heavy, unstable objects, to residents and staff. Consistency in record keeping should be improved to ensure that all residents who are assessed as being at risk of pressure damage have a care plan in place, directing staff on how risk is to be reduced, including pressure relieving equipment. Where residents are assessed as being at risk of falls all assessments should include assessments of their footwear. Care plans for diabetics should always detail the resident’s blood sugar levels and what actions staff are to take if their levels fall outside these levels. All frequent care records and key worker records should always be completed. The home should continue to develop their systems for staff supervision, to ensure that all staff receive supervision on their roles, six times a year. 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. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 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 standard(s) 3, 4, & 5 The home does not provide intermediate care. Residents’ nursing and care needs are assessed prior to admission. The home can demonstrate that it can meet the needs of residents. Prospective residents and relatives are encouraged to visit the home prior to admission. EVIDENCE: Residents are assessed by the manager prior to admission. Assessments are completed in detail and reflect the resident’s care needs. Residents are admitted on the basis of a months trial, one resident who had said that they were not sure about coming into a home, said that appreciated the months’ trial, it had helped them to settle in and assisted them in deciding to remain in the home. Residents or their representatives are encouraged to visit the home prior to admission. One relative said that they had looked round several homes but had decided that this home would suit their relative best. The home cares for residents with a wide range of nursing and care needs. Discussions with staff, observations of care and reviews of documentation showed that the home were able to meet the range of needs for residents in the home. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 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 standard(s) 7, 8, 9, & 10 Residents in the home have detailed care plans in place and their healthcare needs are met. Systems for safe administration of medicines are in place although some residents could be put at risk as the home cannot demonstrate that all residents have been administered their medicines and if not, why not. Staff respect residents’ rights to privacy and work to ensure they are treated with dignity. EVIDENCE: Most care plans are of a high standard, they detail residents’ needs in full and reflect care needs as described by the resident and as observed during the inspection. Records show that medical advice is sought when residents need it and that there is access to other healthcare professionals. Registered nurses and care staff spoken with knew the needs of their residents and worked in accordance with care plans. Consistency in care planning should be developed further. Some residents who were assessed as being at risk of pressure damager had care plans detailing how risk was to be reduced, others did not, some detailed the equipment which was in use to prevent pressure others did not. It was observed that all relevant equipment was provided, even where it was not documented. Where residents are assessed as being at risk of falls, some Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 10 assessments included assessments of footwear but others did not. Where residents have diabetes, care plans do not specify blood sugar levels required for stability and what actions to take if the resident’s blood levels fall outside these levels. All diabetics have their blood sugar levels monitored and a record of the rotation of injection sites maintained. Most residents who require frequent care have this monitored regularly, however a few resident who had such charts in their notes did not. Most residents had their key worker records completed regularly but some did not. All registered nursing records were regularly completed. All medicines were safely stored. Controlled drugs were correctly stored and all relevant records maintained. Where medicines administration record needed to be changed by hand, these had been counter checks and the record signed. The home continues to have an issue with non completion of some medicines administration records, a total of eight non-completed records were noted across the home. Efforts to improve performance are needed, if records are not completed, the home cannot demonstrate that residents have been administered their drugs and if not, why not. All staff, including domestic staff were observed to knock prior to entering residents’ rooms. The domestic was observed to ask residents’ permission to vacuum their rooms. One frail resident said that they left the door of their room open and that “staff are always coming in to see if I’m alright”. The home cares for some residents with complex mental health care needs and these residents were treated with the same respect as residents who were fully able to communicate. Staff called residents by their preferred names, avoiding the use of generic terms of endearment such as “love”. Residents commented on the high standards of the laundry and how they always got their own clothes returned to them promptly. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 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 standard(s) 12, 13, 14 & 15 The home runs a full activities programme and relatives are encouraged to visit. Residents said that it was up to them who they spent their days. Meals are attractively presented and residents who need assistance to eat their meals are fully supported. EVIDENCE: An activities session was observed taking place during the morning and the activities coordinator was taking some residents out of the home during the afternoon. One resident said, “We get plenty of activities here”. A church service was held during the inspection and residents could also take communion in the privacy of their rooms with family of they wish. All residents have social needs care plans and individual records of activities participated in are maintained. Visitors are encouraged and those spoken to during the inspection said that they could come into the home when they wanted and stay as long as they wished to. Residents said that it was up to them when they got up and went to bed. One resident had said that they did not want to get dressed that day, and this was respected. Residents could eat their meals with others in the dining room or in their rooms as they wished. Residents also said that it was up to them if they participated in activities or not. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 12 Meals are provided in a large dining room where residents can sit together making it a social occasion. A choice of drinks is offered with meals. Residents gave a range of opinions about the meals, one described meals as “not bad at all”, another said they were “not very exciting”, another that meals “varied” but that they did the fish “very well”. The home cares for some very frail residents and many need full assistance to eat their meals. Mealtimes are managed well, with staff being given enough time to assist residents with their meals. Staff were observed to sit with such residents, encouraging and supporting them in taking their meals. Meals, including liquidised meals, were attractively presented. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 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 standard(s) 16 & 18 The home has a complaints procedure, which works in practice. Staff showed an awareness of supporting vulnerable adults. EVIDENCE: The home has a complaints procedure, which is on display. Records show that few formal complaints have been made to the home. Staff maintain a communication record in residents’ notes, in which they document a range of matters, including informal concerns, raised by residents or their relatives. This means that all staff can be made aware of where a person is not happy with the service and actions to be taken to meet the person’s needs. One resident said, “I tell the nurses if I’m not happy” another said, “If I’m not happy, I tell the senior person”. One resident said that they had asked to have their morning tea later and said that this had taken place; this was fully documented in their records. Care and nursing staff spoken with were fully aware of the need to support vulnerable adults. Training had recently been given to staff on preventions of abuse. All staff are given a copy of the local vulnerable adults procedure. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24 & 26 The home is well maintained and clean throughout. A range of communal facilities are offered for residents and all have their own bedroom. Equipment required for nursing and care is in place. There are effective systems to prevent the spread of infection. EVIDENCE: Froxfield Brendoncare is a well maintained home. The home has a pleasant, enclosed court-yard garden, which is wheelchair accessible. There is a dining room, a large sitting room and a smaller sitting room. A range of communal bathing facilities are available and disabled wcs are provided. All residents are accommodated in single bedrooms, some of which have ensuite facilities. All relevant equipment is provided to support persons with complex needs, including hoists to aid manual handling, pressure relieving mattresses and chair cushions. Residents with complex manual handling needs are nursed in variable height beds. All residents had been left with access to their call bells. Residents said that staff responded when they used their bell. One resident said “”If I ring the bell, they come” another said that staff “usually” came Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 15 promptly. One resident said that they could not use their call bell, but they shouted and staff came, this was observed to take place during the inspection. An electric monitoring system is in place so that the manager can assess response times when the call bells are activated. The home was clean throughout, including all equipment used for nursing and care. Effective systems were in place for the management of laundry, including potentially infected laundry. Staff were observed to work within infection control guidelines, to prevent the spread of infection. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 & 30 The home is appropriately staffed by a stable team. Training, including NVQ, is supported. Recruitment practice includes all relevant checks on prospective employees prior to employment. EVIDENCE: The home are required to comply with a Staffing Notice, which sets out minimum levels of staff, a review of the rosters showed that they were doing this. The home have over the past two years succeeded in recruiting staff so that they are now fully up to establishment and only one agency staff has been needed during the past month. A core of staff have been in post for many years and know the home and its systems. Newer staff said that they had been fully supported during induction. NVQ training is encouraged and over 50 of care staff are trained to NVQ 2 or above. Full pre-employment checks are carried out on all prospective staff, including CRB and pova clearance. Training programmes are in place for all staff and a range of different training opportunities are offered, aimed at supporting staff in meeting residents’ nursing and care needs. Full individual records of staff training are in place. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 36 & 38 The manger is an experienced manager and registered nurse. Residents are protected by safe, regularly audited systems for the management of their moneys and staff induction and supervision systems. Systems to ensure the health and safety of residents and staff are in place, however lack of correct signage on doors where oxygen is stored could put persons at risk in the event of a fire and oxygen cylinders are not properly secured to prevent risk of accident. EVIDENCE: Mrs Harding is an experienced nurse and manager. In the two years that she has been in post, she has improved and developed systems across a wide range of areas in the home. Safe systems are in place for residents’ moneys and finances, full records are maintained, including receipts. All accounts are regularly audited. An induction programme is in place for staff, which staff said they had found supportive. Staff receive appraisal after their induction programme and regularly thereafter. Records showed that not all staff have yet received supervision six times a year, but good progress is being made. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 18 Staff are regularly trained in all areas relating to health and safety. The fire log book is fully maintained as required advised by the fire brigade. Some residents have been prescribed oxygen. Signage is in place on doors but it is not approved British Standard signage, so in the event of a fire, fire officers would not be properly advised of where oxygen is placed in the home. Two of the oxygen cylinders were not placed in secure carriers or restrained. As oxygen cylinders are very heavy, to ensure resident and staff safety, oxygen cylinders must always be fully secured at all times. All equipment is regularly serviced. Full records of accidents are in place, these fully describe circumstances of the accident. Accident records are regularly audited, to reduce risk to residents and staff. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x 3 3 x 2 Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) 17(1)(a), 3(3)(i) Requirement All medicines administration records must always be fully completed at the time of administration. (Unmet requirement from the previous inspection) British Standard signage must always be placed on room doors where oxygen is in use or stored. Oxygen cylinders must always be fully secured. Timescale for action 30 September 2005 2. 3. 38 38 23(4)(a) (c)(v) 13(4)(c) 30 September 2005 30 September 2005 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 8 Good Practice Recommendations Where service users are assessed as being at risk of pressure damage, care plans should be in place for all such service users directing staff on how risk is to reduced. Plans should include all equipment to be used. Where service users are assessed as being at risk of falls, all care plans should include an assessment of the service users footwear. Care plans for diabetic service users should always document blood sugar levels and actions to be taken when D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 21 2. 3. 8 8 Froxfield Brendoncare Home 4. 5. 8 26 the service users levels are outside these areas. All frequent care records and key worker records should be fully completed, in accordance with the homes policies. Records should be available to show that all staff have received supervision six times a year. Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 22 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Froxfield Brendoncare Home D51_D01_S15909_Froxfield_V241056_040805_Stage4.doc Version 1.40 Page 23 - 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. 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