Inspection on 06/01/06 for Brendoncare Froxfield

This inspection was carried out on 6th January 2006.

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 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

Brendoncare Froxfield 20/10/08

Brendoncare Froxfield 07/12/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Froxfield Brendoncare Home Littlecote Road Froxfield Nr Marlborough Wiltshire SN8 3JY Lead Inspector Susie Stratton Unannounced Inspection 10:30 6 January 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Froxfield Brendoncare Home Address Littlecote Road Froxfield Nr Marlborough Wiltshire SN8 3JY 01488 684916 01488 686042 hharding@brendoncare.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Brendoncare Foundation Mrs Hilary Joan Harding Care Home 44 Category(ies) of Dementia (4), Old age, not falling within any registration, with number other category (44), Physical disability (2), of places Terminally ill (3) Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. No more than 3 persons in receipt of terminal care at any one time No more than 2 physically disabled residents 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 4th August 2005 Date of last inspection Brief Description of the Service: 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 a purpose built, two storey home. There is a lift between the floors. The home originally opened in 1986. It has been extended since then. The home includes a small dementia care unit. 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, 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 Harding, she is supported by deputies, nursing, senior care and care staff as well as an administrator, receptionist, catering, domestic, laundry and maintenance staff. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 10:30am and 4:15pm on Friday 6th January 2006 in the presence of the registered nurses in charge. During the inspection, the Inspector met with eleven residents and observed care for seven who were unable to communicate. The Inspector reviewed the notes of nine residents, toured the home, observed a lunchtime meal and an activities group. As well as the two registered nurses in charge of the home, the Inspector met with three care assistants, the chef, the administrator and one domestic. The Inspector reviewed medicines records and storage systems, the fire log book, maintenance records, menus, training records, the duty rosters and supervision records. What the service does well: What has improved since the last inspection? All three requirements and four of the five recommendations had been addressed. All medicines administration records had been fully completed. British standard signage is now used on room doors were oxygen was in use. Oxygen cylinders were all fully secured. Where residents are assessed as being at risk of falls, assessments are now made of the resident’s footwear. Care plans for diabetic residents now document blood sugar levels and actions to be taken when the resident’s levels are outside these areas. Key worker and frequent care records are completed. Records show that staff receive supervision six times a year. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 6 What they could do better: 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 DS0000015909.V269012.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 & 5: The home does not offer intermediate care, so standard 6 is N/A Residents’ nursing and care needs are assessed prior to admission by persons qualified to do so. The home are able to meet the nursing and care needs of residents. Pre-admission visits to the home are supported. EVIDENCE: The records of one recently admitted resident were reviewed. Assessments had been completed in detail and reflected what the resident told the Inspector. The resident said how helpful it had been for them to meet with the manager before their admission so that they and their family could ask about the home and care provided. Discussions with residents, staff, observations of care and reviews of notes showed that the home could meet the needs of the residents. Many of the relatives spoken with said that they had been too unwell to visit the home before their admission, so members of their family had visited the home to review if it would meet their needs. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Residents are generally protected by clear assessments and care plans, which direct care. Residents at risk of pressure damage may be at risk as turn charts indicated that they were not being moved at the frequency specified in care plans. Residents are treated with respect, this includes residents who are frail and dying. All medicines are safely stored and records maintained. EVIDENCE: All residents have assessments of their needs, these are regularly reviewed and include manual handling, dietary assessments and risk of pressure damage. Where care needs are identified care plans are drawn up, these care plans are regularly reviewed and signed either by the resident or their relative. Care plans are kept with the resident in their own rooms, so that the resident, staff and relatives can have access to them when they want to. Care plans are clear and very individualised. Care plans relating to mental health care needs are particularly clear, are written in non-judgemental language and direct staff on actions to be taken meet residents’ individual needs and protect them. Where residents have been assessed as having dietary care needs, they specify any prescribed dietary supplements to be used. It was observed that staff were giving these supplements in accordance with care plans. Where Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 10 residents needed to be encouraged to drink fluids, this was monitored by the use of fluid charts. These charts were regularly completed. It was noted ad good practice that one carer promptly asked a more senior carer for support when a resident who usually took fluids well, was reluctant to do so. Consistency needs to be improved in relation to prevention of pressure damage, in some parts of the home, if a resident is assessed as being at high risk of pressure damage, a care plan is drawn up, in other parts of the home equipment used to prevent pressure damage is documented on the risk assessment, but a care plan is not drawn up, in other parts of the home, care plans are not drawn up if the resident is assessed as being at risk of pressure damage. Two residents had care plans which stated that the resident must have their position changed two to three hourly, however their turn charts did not indicate that this was taking place and both showed that the residents at times did not have their position changed for over four hours. Staff also do not consistently document that the resident’s position was changed, some charts only document how the resident’s personal hygiene needs had been met or that the resident has been “repositioned”. Residents at risk of pressure damage must have their positions regularly changed. Residents’ notes show that the home regularly consults with residents’ GPs and other relevant professionals such as the tissue viability nurse or community psychiatric nurse when residents need external healthcare support. All records relating to wound care and management of residents with diabetes are clear. All medicines are safely stored and all records completed in full. Where a resident wishes to self-medicate, a risk assessment is regularly completed. Night care plans include reference to any prescribed night sedatives and some mental health care plans include reference to mood altering drugs. It is recommended that this is extended to all care plans to ensure that where residents are prescribed drugs which may affect their daily lives or medical conditions, such as bowel management preparations, anti-fitting medication or pain killers, to assist in assessing the effectiveness of such treatments. It was observed that staff consistency knocked on residents’ room doors prior to entry. Many of the residents’ rooms were highly personal in appearance, reflecting the resident’s likes and preferences. Residents commented on the quality of the laundry service, how well and promptly their clothes were laundered. One resident described the laundry service as “excellent, very prompt, very nicely done, due to the caring person who looks after it.” Many of the residents in the home are very frail. Such residents looked comfortable, with clean night clothes, well manicured nails and brushed hair. Where frail residents were mouth-breathing, their mouths were clean and looked moist. It is recommended that end of life care plans be developed, so that the home can ensure that they are meeting resident’s individual wishes. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Residents are supported by a varied activities programme and individual social care plans. Visitors are encouraged and residents who are able can go out of the home. The dining room is an attractive area and a varied menu is available. EVIDENCE: Residents said how much they enjoyed the activities. One resident described the activities as “fun”, another said that the activities coordinator was “jolly good” and another said that the activities for December had been “very well done”. An exercise class was taking place during the inspection. The activities coordinator was supportive, encouraging residents in taking part. All residents have clear activities care plans in place, these are individualised and regularly evaluated. One resident said that they appreciated going out of the home on short trips with the activities coordinator. Another resident said that they were supported in continuing to practice their religion. Relatives and visitors are encouraged. Residents said that their visitors could come whenever they liked. The home maintains a record of communication with relatives, to inform staff of discussions with relatives. Where a resident was not able to consent to a procedure such as urinary catheterisation, this record provided evidence that the staff had discussed the procedure and reasons for it with the resident’s relative. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 12 Residents said it was up to them when they got up and went to bed. One resident said that some days they went to the dining room for lunch but on other days they did not feel like doing this and that the home let them choose what they preferred to do. One resident said that they did not like mixing and they appreciated not being asked to join in activities. Residents ate their meals in the main dining room or their own room. The dining room was an attractive area, with table cloths, attractive cutlery and glasses. Residents who wished to have a pre-lunch sherry could do so. Meals are attractively presented this included liquidised diets. A choice of meals is offered and smaller snacks are available if residents did not want the main meal. Staff are available to support residents who need assistance to eat their meals. One resident described the meals as “very good”, another said they were “adequate”, another said that they enjoyed the meals and another described the meals as “quite good”. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Residents are protected from abuse by the systems in the home. EVIDENCE: Staff are regularly trained in abuse awareness. Both registered nurses were aware of actions to be taken to support residents and protect them from abuse. The home has a whistleblowing procedure which the registered nurse in charge was able to give examples it working in practice. Observations of care indicated that staff were aware of risks to vulnerable adults. Where residents needed restraints such as safety rails, the need for such equipment was regularly evaluated. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24 & 26 The home is well maintained. A range of communal facilities are offered for residents and all have their own bedroom. Equipment required for nursing and care is in place. Systems are in place to prevent the spread of infection, however residents in one part of the home could potentially be put at risk by one deteriorated piece of equipment. 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. One resident described their bed as “Comfortable” All residents had been left with access to their call bells. Residents said that staff Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 15 responded when they used their bell. One resident said they “never had any difficulty in getting help” from the staff. The home was clean throughout, including all equipment used for nursing and care. One resident commented particularly on how pleased they were with the standards of cleanliness. 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. There is an ample supply of sterile gloves for aseptic procedures. All sterile disposable items were within their expiry dates. One of the drip trays under a bed pan rack in one sluice room had lost its plastic covering and the under metal was exposed, showing some rust. As such, this could not be cleaned properly and presents a risk to cross infection. Some of the commode buckets and urinals were stained, probably due to age, they were clean. An audit of commode buckets and urinals is indicated and any stained items should be disposed of. The lids of two of the washer disinfectors were beginning to show signs of lime-scale on their undersurfaces, the lime-scale should be removed before it develops further and provides a surface for micro-organisms to grow. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 The home is appropriately staffed by a stable team. Training, including NVQ, is supported. 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 rosters also show that staff are prepared to support the home by working flexibly in the event of unplanned staff absence such as sickness. The use of agency staff is low, where they are used, rosters show that the same person is used, to ensure consistency to residents. The home supports training and over 50 of care staff are trained to NVQ 2 or above. A standard induction programme is in place, this conforms to Skills for Care. All staff have an individual training programme drawn up, so that managers can review if staff have the training to meet residents’ needs. Where training is needed to meet residents’ specific nursing and care needs, this is accessed and cascaded to other staff. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 36 & 38 Residents are protected by staff who are regularly supervised. There are systems to ensure the health and safety of residents and staff. EVIDENCE: The home has a system to ensure that all staff are regularly supervised and receive an annual appraisal. Records are individual, detailing the areas covered. Systems are in place to ensure the health and safety of residents and staff. All staff are regularly trained in areas such as manual handling, fire safety and health and safety. The home’s fire log book is fully maintained, to provide evidence of regular checks on the fire safety system. There are systems to ensure that all equipment is regularly maintained. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 3 3 3 3 3 3 x 2 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x x x x 3 x 3 Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 19 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 13(4)(c), 17(1)(a) Requirement Service users must always have their position changed on the frequency specified in their care plan. Full records of changes of position must be maintained for each service user assessed as being at risk of pressure damage. The bedpan drip-tray which was identified during the inspection must be repaired or replaced. Timescale for action 31/03/06 2 OP26 13(3) 28/02/06 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 OP8 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. (This recommendation was identified at the previous inspection, some progress was noted but it had not been addressed in full across all the home) DS0000015909.V269012.R01.S.doc Version 5.0 Page 20 Froxfield Brendoncare Home 2. 3. 4. 5. OP9 OP11 OP26 OP26 Where residents are prescribed drugs which may affect their medical condition or daily lives, they should always have care plans in place relating to the use of such drugs. End of life care plans should be developed for dying service users. All commode buckets and urinals should be reviewed and any stained ones removed, and replaced if indicated. The washer disinfectors should be regularly inspected and any signs of lime-scale on the lid seals removed. Froxfield Brendoncare Home DS0000015909.V269012.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham 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 DS0000015909.V269012.R01.S.doc Version 5.0 Page 22 - 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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