Inspection on 07/12/06 for Brendoncare Froxfield

This inspection was carried out on 7th December 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 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Froxfield Brendoncare Home Littlecote Road Froxfield Nr Marlborough Wiltshire SN8 3JY Lead Inspector Susie Stratton Key Unannounced Inspection 09:50 7th December 2006 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.V302361.R01.S.doc Version 5.2 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.V302361.R01.S.doc Version 5.2 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 www.brendoncare.org.uk The Brendoncare Foundation 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) 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.V302361.R01.S.doc Version 5.2 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 6th January 2006 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 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 £750 to £799 a week. Fees do not include such items as hairdressing, newspapers, chiropody and sundries bought from the home’s shop. A copy of the service users’ guide is available in the front hall and each resident’s bedroom. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included visits to the service and takes into account the views and experiences of people using the service. As part of the inspection, 25 questionnaires were sent out during the late summer of 2006 and 14 were returned. Comments made by residents and their relatives in questionnaires, during the inspection and from relatives, GPs and social workers, who were contacted after the first site visit, have been included when drawing up the report. The home also provided information requested by the CSCI prior to the inspection, relating to residents and staff. As Froxfield Brendoncare is a larger registration, the site visits took place over two days, on Thursday 7th December 2006 between 9:50am and 3:45pm, and Thursday 25th January 2007 between 9:55am and 1:30pm. The first site visit was unannounced. The manager was on duty for both the site visits. During the site visits, the inspector met with twelve residents and observed care for twelve further residents who were unable to communicate. The inspector reviewed care provision and documentation in detail for nine residents, two of whom had recently been admitted. The relatives, GPs and social workers (if applicable) of these residents were contacted, to gain their opinion of the quality of care provided. As well as meeting with residents and visitors, the inspector met with: the training manager for the home, three registered nurses, four carers, the chef, a cleaner, the laundress, the maintenance man, the activities coordinator, the receptionist, and the administrator. The inspector toured all the building and observed a lunch-time meal, two activities sessions and a medicines round. Systems for administration of medicines and the clinical room were inspected. A range of records were reviewed, including staff training records, staff employment records, maintenance records and financial records. What the service does well: Froxfield Brendoncare provides a well maintained, pleasing environment for residents. This includes a safe, well maintained garden, which is wheelchair accessible. All equipment needed to support residents’ nursing and care needs is provided. Staff spoken with were enthusiastic and were fully aware of the residents’ needs. Training is supported by the providers, and staff reported on how much it helped them in their practice. The activities coordinator is enthusiastic in her role and is keen to develop and expand links with the local community. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 6 Persons spoken with and who contacted the CSCI expressed their appreciation of the home. One person reported “When searching for a home for my relative, my family visited nine homes in our area; we reduced the choice down to three, and settled on Brendoncare; we have every reason to suggest that we made the right choice.” Another person reported “The home welcomes visitors” One person said that their relatives were “very contented”. Several people commented on the staff, one said “They always listen and act” another “Staff are always cheerful and caring”, another “If I ask for anything, its always done” and another “I have great respect for all the staff at Brendon Care and find them most helpful and kind at all times.” What has improved since the last inspection? What they could do better: Three requirements and five recommendations were identified at this inspection. All service users who are assessed as being at risk of pressure damage must have a care plan to direct staff on actions to take to reduce the risk of damage. Such care plans should also state how often each individual needs to have their position changed. Full records of changes of position must be maintained for each service user assessed as being at risk of pressure damage at night, not just during the day, as risk of pressure damage does not reduce for a resident at night. Where a resident is assessed as needing a dietary support or supplement, there must be full evidence that they are receiving this support/supplement as directed in their care plan. Any records of dietary intake should specify what the service user has been given to eat, not just general phrases such as “lunch” or “supper”, so that an assessment of the nutritional content of meals eaten can be made. Where residents are having their fluid intake recorded, this should be totalled once every 24 hours, to aid review of the adequacy of their fluid intake. Where a resident is having their behaviours observed by use of a behaviour record, a risk assessment for these Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 7 behaviours should also be carried out, to ensure that all risks presented to the person by the home environment are considered. A monitoring system for commode buckets should be put in place, to ensure that any deteriorated buckets are promptly disposed of and replaced. 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.V302361.R01.S.doc Version 5.2 Page 8 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.V302361.R01.S.doc Version 5.2 Page 9 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 & 5. The home does not offer intermediate care, so 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. All prospective residents have detailed assessments of their nursing and care needs performed prior to admission. Pre admission visits for prospective residents or their supporters are encouraged. EVIDENCE: All prospective residents are assessed by the manager or her delegate prior to admission. Assessments are made by registered nurses. One resident said that they had met the manager before they came to the home, and commented how useful this had been to them. One other newly admitted resident was not able to communicate but a registered nurse and a carer were both aware of full details of this resident’s nursing and care needs. A full and detailed pre-admission assessment is completed, those seen reflected what the residents said, what the inspector observed and what staff reported. Where additional assessments are needed, for example from a hospital specialist, Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 10 copies are obtained, to inform staff. On the second day of the site visit, the manager was planning to admit a new resident. It was noted as good practice that she was not going to do this until certain equipment needed by the resident was available and the resident’s contract had been agreed. Where additional care needs are identified after admission, for example mental health care needs, assessments from relevant professionals are sought. One newly admitted resident said that they had been able to visit the home and look at their room as well as having tea before deciding to be admitted to the home. Many of the residents were too frail to visit the home prior to admission. Most said that a relative had visited the home and reported back to them. One relative reported “The whole team could not have been more helpful, especially the manager, the finance officer and the receptionist – we made the choice for our relatives but felt confident that this was the best place for them (we looked at six other nursing homes).” Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents’ nursing and care needs are assessed and care plans developed to direct staff on how to meet assessed needs. Frail residents who are at risk of pressure damage and who have nutritional needs could be put at risk by inconsistent record keeping and monitoring systems. Residents are supported by effective working relationships with healthcare professionals. There are safe systems for the administration of medicines. Residents’ privacy and dignity is upheld. EVIDENCE: As Froxfield Brendoncare is a care home with nursing, they care for a range of residents, some of whom have highly complex nursing and care needs. Several residents were able to comment on the nursing and care provided. Residents and their supporters were generally satisfied with the care provided. Eight of the people who returned questionnaires stated they always received the care and support that they needed and six stated they usually did. Many Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 12 people commented on the helpfulness of staff. Two persons commented particularly on how the resident’s condition had improved. One person reported “My health has improved considerably since being a resident” and another “Staff have done wonders with my relative since they were admitted. Now my relative is able to move around slowly with a zimmer frame and is eating”. Eight persons reported that they always received the medical support they needed and six that they usually did. One resident described how they had agreed a care plan for their night care with staff. This was fully reflected in their records. All residents had full assessments of their nursing and care needs. All residents were assessed for risk such as manual handling needs, risks of pressure damage and nutritional needs. Care plans were then developed to direct staff on how to meet the resident’s needs. These were regularly evaluated, together with the service user or representatives. Most of the care plans were very comprehensive and detailed. For example, one resident who was observed to have flexion contractures had a clear care plan about how these contractures were to be managed. Staff were observed to comply with the care plan in practice. However, there continues to be a lack of consistency in the development of care plans to prevent pressure damage. While some residents who were at high risk of pressure damage had care plans in place, others only had a list of equipment to be used and others did not have a care plan. For example one resident was observed to have risk to their pressure points between their knees but they did not have a care plan to direct staff on how risk was to be reduced. Care plans are indicated for all residents who are assessed as having a risk of pressure damage, to direct staff on how risk is to be reduced. Equipment is a factor but not the only factor in prevention of risk of pressure damage. If pressure damage is developed, this can take a considerable period of time to heal, be painful to the resident and present a risk of infection. Some care plans fully directed how often a resident needed to have their positions changed but others did not. As different residents’ degree of risk varies and may be increased at certain times of the day, care plans also need to detail how often their position needs to be changed and when. Frail residents had charts in place, so that staff could document when their position was moved to prevent pressure damage and the fluids and food that they had been given. A review of all of the care charts showed that frail residents had their positions changed regularly during the day, but the records were not well maintained at night and none of the records showed that residents had their positions changed at the frequency directed in their care plan (where they had one), or by their condition, at night. This is of concern as if frail residents who are assessed as being at high risk of pressure damage do not have their positions changed regularly, the likelihood of developing pressure damage is increased. Records were maintained in full for frail residents of their fluid intake, but this was not totalled once in every 24 hours. This is advised, to assess if a resident is taking in sufficient fluids to prevent risk of dehydration. Food charts were also maintained for frail residents. On Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 13 some charts, a full record of meals given was recorded, but others simply noted “supper” or “lunch”. It is advisable that the actual meal given is documented so that clinical staff can assess if the resident has had a well balanced diet. Residents who were assessed as being at nutritional risk had care plans to direct staff on how the risk was to be reduced. This included the use of thickening agents and dietary supplements. Thickening agents were observed in residents’ rooms, and seen being given to residents. Two residents had care plans which stated that they needed to be given certain liquid dietary supplements. However, their fluid and food charts showed no documentary evidence that these were actually being given to residents. The home has good links with local healthcare services, and registered nurses commented on how supportive the local GPs were. GPs who were contacted as part of the inspection process commented favourably on the quality of care given by staff. Records showed evidence of visits from chiropodists. Chiropodists documented treatments given in residents’ notes, so all staff involved had full information on treatments given. The home employs a parttime physiotherapist. Clear records of her interventions were maintained, together with directions for therapies to be continued by staff when she was not on duty. One resident had a very clear care plan about management of a potentially emergency medical condition, which staff spoken with were aware of. A resident appeared to be unwell at lunch-time. The registered nurse promptly checked on the resident’s condition and took appropriate action, to ensure the resident’s comfort and safety. One relative commented on how the home had effectively stabilised a previously unstable medical condition. Another relative reported that “staff have been very helpful over hearing aids, broken specs” and the like, since their relative’s admission. Where residents had mental health care needs, supports were available from local mental health care services. Monitoring charts were put in place if residents showed complex behaviours. One resident had a monitoring chart for wandering behaviours, but an assessment of risk to them of these wandering behaviours had not been carried out. This is advised, so that all risks to the resident presented by their behaviour can be identified and reduced where possible. The home has a clinical room for the storage of medicines and clinical items. All day-to-day medicines were stored in trolleys which were kept fully secured. Full records of medications brought into the home were in place. The home also maintains records of medicines disposed of. By the second site visit all records were being checked and signed by a second member of staff. A medicines round was observed during the inspection and the registered nurse performed medicines administration with care, checking that the resident had taken their medication before signing for it. The registered nurse also carefully checked each medicines administration record, in case prescriptions had changed, rather than relying on previous knowledge. Registered nurses spoken with showed a good knowledge of the action of drugs being administered to Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 14 residents. Where a resident wished to self-medicate, a risk assessment was completed and this was regularly evaluated. It was noted as good practice that all residents who were prescribed drugs which could affect their daily lives, such as mood altering drugs, painkillers or aperients, had care plans drawn up so that the effectiveness of these drugs could be monitored by staff. Residents’ privacy and dignity was upheld. All care was provided behind closed doors. When carers were together performing care such as giving a resident a bath, they were heard to talk to the resident, encouraging them to talk as well, and informing them of what they were going to do. This attitude was also evident amongst ancillary staff. One cleaner was observed to call a resident by their preferred name and to take action by covering them over when they had thrown bed clothing off, to preserve their dignity. The home cares for many frail residents who spend all or most of their time in bed. Such residents appeared comfortable, with clean bedding, well brushed hair and appropriate clothing. One relative commented “Independence is preserved for as long as possible. Dignity and privacy of the residents is paramount.” Another relative commented “They are very good at making sure that someone is got ready it they are going out for the day or have an appointment out of the home.” One resident commented that “I have one carer who looks after me and I’ve got to know her very well” and also said how much they appreciated having this person to perform their personal care. The relative of a male service user said that their relative appreciated having a male carer available to perform their personal care. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported by an activities programme, which meets the diverse needs of different residents. Residents are supported in going out of the home and visitors to the home are encouraged. Residents are able to chose how they spend their days. A range of meals are provided to residents, in pleasant surroundings. EVIDENCE: Froxfield Brendoncare employs an activities coordinator and a full range of activities is provided to residents. The activities coordinator works 28 hours a week. Within these available hours she will work flexibly, providing a service in the evenings and at weekends, depending on need. Nine of the people who responded to the questionnaire reported that the home provided activities which they could take part in, three said they usually did and one that they sometimes did. One resident commented about the activities that “These have made a great difference to my quality and enjoyment of life.” People particularly commented on the music and movement sessions and the garden parties. Relatives said how much they appreciated being able to join in too. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 16 On the day of the first site visit, as it was getting close to Christmas, activities observed included a local school coming in to sing Christmas carols, and an entertainer. The activities coordinator clearly knew all residents individually and supported them in joining in. Carers were also available to assist when needed. The activities coordinator is very enthusiastic in her role. She is currently seeking to further develop links with the local community in the village, including putting the home on the flower roster for the local church. She maintains good records of residents’ past lives and preferences for activities. She further develops these records as information becomes available. As Froxfield Brendoncare is a care home with nursing, a considerable proportion of the residents are unable to leave their rooms, so as well as organising group activities, the activities coordinator ensures that twice a week she sees all residents who are not able or do not wish to leave their room and provides individual activities, such as reading or conversation. Such visits may be brief as the activities coordinator only works 28 hours a week and because some residents have difficulty in concentrating for periods of time or are easily tired. The hairdresser was visiting during the inspection. The home has a separate hair saloon, which is an attractive area. The hairdresser clearly tries to make hairdressing a social occasion, offering residents drinks and magazines and chatting with them. She was also observed to take particular care with one anxious resident, supporting them and asking for assistance when needed, to ensure that the resident could finish having their hair done. As well as home-based activities, residents were also supported in going out of the home. One said “staff take us for a ride outside, I enjoy that”. The activities coordinator is qualified in driving the disabled-access minibus. Other residents go out with their relatives. Several residents commented on how they appreciated visitors being able to come when they liked. One relative described how the home supported their relative’s old friends in coming to visit. Residents spoken to said that they could choose when they got up and when they went to bed. One resident said that they preferred not to get up but that staff had explained to them that it was not good for them to stay in bed all the time. So they had agreed with staff about when they should be got up and when they could go back to bed. One resident said “I don’t like going to the sitting room and they don’t make you here.” One resident did not like to get dressed, preferring to wear their night clothes all the time, and this was respected. One relative said that their relative felt that they were in a hotel, not a care home, because of the atmosphere. As would be expected in a large home, there were a wide range of opinions expressed about the meals. In the questionnaire, one resident said they always liked the meals, ten usually and three sometimes. Comments on the Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 17 meals varied from “excellent” through “good” to “meals vary, some meals are good but not always.” Some residents commented favourably on specific matters, one commented that the tea was always hot, another said they enjoyed the puddings and another the soups. Some people said that they would like more fresh vegetables, some more variety and some improvements in presentation of meals. A choice is offered at every meal. The chef reported that she is informed of all prospective residents prior to their admission and is given information about their needs and preferences. She then meets with all newly admitted residents, to discuss what they would like. If residents’ needs change or they ask to see her subsequently, she is happy to do this. There was a range of fresh foods available on both site visits, including fruit and vegetables. The chef cooks nearly all meals from raw ingredients, including cakes and puddings. A mealtime was observed during the inspection. Residents who wished to, went to the dining room. Dining tables were nicely presented with tablecloths, flowers in vases, glasses and crockery, rather than plastic beakers and utensils. Staff were observed to check about preferences with residents. Staff were available to support residents and it was particularly noted that one of the registered nurses was very observant, noticing if a resident lost concentration when eating and thus needed support. Carers were also available to support residents who could not feed themselves and remain in their rooms. Carers were observed to sit with such residents, feeding them with care and engaging them in conversation. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home has a full complaints procedure which is effective in practice. Residents are protected from abuse by the home’s procedures. EVIDENCE: Froxfield Brendoncare has a complaints procedure, which is on display and made available to residents and their supporters in the service users’ guide. One resident reported that the complaints procedure was “clearly set out in the information pack I was given.” Eleven people who responded to the questionnaire stated that they always knew who to talk to if they were not happy and three said they usually did. Some people said that they could talk to anyone if they had concerns and others named individual staff they felt able to talk to. Many residents reported they would speak to the manager, one said “I speak to Hilary if I’ve a problem, I made a comment one day & she explained straight away” and another “If I’m not happy, I talk to Hilary & she sorts it out”. One person reported, “I don’t always make complaints effectively, but I am always received courteously!” The complaints log showed that few complaints have been received by the home. The file showed that verbal as well as written complaints are logged and responded to. Staff spoken with showed an awareness of vulnerable adults procedures, this included ancillary as well as nursing and care staff. All care and ancillary staff Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 19 spoken with reported that they felt that if they raised a concern on behalf of a resident, that they would be listened to and action taken. A review of the home’s training records showed that all staff have been trained on abuse awareness on induction and regularly thereafter. One resident was observed to show an obvious bruise. When a member of staff was asked, they knew all about the bruising, when it was first noted, the likely cause and who had been informed. This was fully supported by the resident’s records. Where restraints such as safety rails or lap belts were in place, a full assessment of need was made and this was regularly evaluated. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 20 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 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home is well maintained. A range of communal facilities are offered for residents and all have their own bedroom. A wide range of equipment required for nursing and care is in place. The home was clean throughout and systems are in place 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 different assisted bathing facilities are available and disabled WCs are provided. All residents are accommodated in single bedrooms, some of which have ensuite facilities. Residents expressed their appreciation of the home environment, one said “home & garden kept to an excellent standard” another reported “The Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 21 home is always warm, a bit too warm if anything.” and another “The home is comfortable”. One resident commented in particular on how they appreciated the view from their window. All room exceed the National Minimum Standards for room sizes and several rooms much exceed these standards. This means that there is space for residents to bring in items of their own if they wish and some rooms were highly personalised, reflecting the individuals’ likes and preferences. 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 were nursed in profiling or variable height beds. The manager reported that an audit had been performed of mattresses and beds since the last inspection and that additional beds and mattresses had been provided. Where residents had communication difficulties, aids had been provided. One resident reported that their aid was always used by staff. All residents had been left with access to their call bells and many commented particularly on how prompt staff were in responding when they used them. One said “I don’t ring my bell very often but they always come” and another “If I ring my bell they come and generally they come very quickly.” The home was clean throughout. One relative commented “The whole place is always very clean & carpets are regularly shampooed” and another that they noted in particular that the home did not smell. A cleaner was observed to perform her role, she was careful in making sure that undersides were cleaned, as well as tops of items. She reported that she had ample supplies of cleaning chemicals. A carer was observed to carefully remove their gloves and cleanse their hands after dealing with potentially infected matter. The home has systems for disposal of waste, including clinical waste. The laundry was clean and had effective systems for the separation of potentially infected laundry from other items. Many residents and their relatives commented particularly on how good the laundry service was. Some residents make use of commodes. On the first site visit, some commode buckets were beginning to show signs of staining. Following discussions with the manager, they had been replaced by the second site visit. A similar observation was made in a different part of the home on the previous system and a monitoring system should be put in place so that this does not arise again. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 22 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, 29 & 30 Quality in this outcome area is excellent. This judgement has been made using available evidence, including visits to this service. Residents are protected by a stable team of staff, with a skill mix to meet their needs. The providers support and encourage staff in training, so that they acquire and maintain the skills needed to meet the residents’ nursing and care needs. The home operates a safe recruitment process to assess the suitability of prospective members of staff. EVIDENCE: Froxfield Brendoncare is required to staff the home in accordance with minimum staffing levels set out by the CSCI. They always meet or exceed these minimum staffing levels. Residents and their relatives expressed a range of opinions about staffing levels. One relative reported “There are occasional staff shortages but generally the care and support is good” and another “When I visit, I have nearly always found staff available.” Many residents commented on the “helpfulness” of staff. One person commented that “the night staff are just as helpful as the day staff.” One relative commented that as their relative was unable to use a call bell “staff are frequently popping in to their room to ensure that they are all right”. However, one person felt that as the dependency of residents in the home had gone up this was affecting carer availability and this person and another commented on how they felt there were not enough staff available at mealtimes, as so many residents needed Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 23 assistance to eat their meals. The manager reported that she was aware that dependency needs had increased recently and that from April 2007, she was being financed to place an additional carer on duty for the morning shift. Only one new carer had been employed during 2006, and no new registered nurses. A review of records and discussions with staff indicated that there was a low staff turnover and many of the staff, at all levels, had been in post for several years. This is unusual for a large care home and will assist in ensuring a consistent approach by staff from all levels in providing nursing and care. One relative commented, “Morale amongst staff seems good.” Care staff spoken with commented on how supportive the registered nurses were and said that if they were concerned about a change in a resident’s condition, they were always listened to. This also applied to ancillary staff. One cleaner was observed to be listened to carefully when they went to tell a registered nurse that they were concerned about the condition of a resident, who appeared to them to be unwell. Several of the staff commented on the supports given to them in training and how much they enjoyed the sessions provided, as they felt it helped them to improve their care practice. Many of the staff have attended dementia training and three senior staff were to attend a five day dementia care course in the New Year. Both registered nurses and care assistants have been involved in the end of life care project run by the local hospice. The manager was organising training for staff to meet the specific nursing and care needs of a prospective admission on the second day of the inspection. Training records were clear and showed that all staff received a full induction on commencing employment. Care staff are supported in undertaking NVQ training and by mid April 2007, all care staff apart from one will be qualified to NVQ level 2 or 3. A wide range of training is provided, both in house and from external trainers. On the day of the second site visit, several staff were receiving health and safety training from an external trainer. Ancillary staff reported that they were provided with training, on the same basis as nursing and care staff. Files relating to the two most recently employed staff and two long-term staff were reviewed during the inspection. All files showed evidence of all required checks, including proof of identity, police checks, two references, past employment history and health status checks. Records of training certificates were held on all files. Staff files were kept in a very orderly manner and are easy to audit. There were systems in place to monitor sickness, and external occupational health support was obtained when needed. Files showed evidence of annual appraisals for all staff. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are supported by an experienced, well qualified manager. Brendoncare regularly reviews quality of care for residents. Residents’ financial interests are safeguarded. All staff are supervised in their roles. There is a clear policy and procedure on health and safety, which is kept to by staff. EVIDENCE: Mrs Harding, the manager has been in post for a period of time She is an experienced manager and is also a registered nurse. Mrs Harding is supported to develop her skills base. One of the reasons that the second site visit was performed over a month after the first site visit, was that she was attending Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 25 courses and seminars in January, to further extend her skills. Several relatives commented on how well managed the home was. One commented in particular on how it had improved since Mrs Harding took over, saying “The home is improving all the time. There were times in the past when I was concerned but now I’m not.” Another reported that their relative “has been here for a long time. The general tone of the place and reliability of the care have steadily improved over the years.” Areas relating to management of the home show a good outcome and once the manager ensures that she always meets all requirements and recommendations from inspections, it could be considered to be excellent in the future. Brendoncare has established systems for reviewing quality of care. An audit of different areas relating to resident care is performed every month. All residents, relatives and other parties such as GPs are surveyed once a year. If issues are identified, the manager is required to develop an action plan to detail how they are to be addressed. The home is also visited at least monthly by a senior manager, and a report made. All staff spoken to at every level, including the manager, reported on how supportive senior managers in the parent company were to them and the home. The home has established systems for management of residents’ monies. All additional payments are dealt with by an invoicing system and no cash is used or stored for residents. Clear records are held, which are easy to audit and clearly show charges for items such as hairdressing. Any valuables handed in for safekeeping are securely stored and there is a full audit trail of items handed in and returned to the resident or their relative. All records were signed and dated. There is an established system for supervision of staff. All new employees are allocated to a mentor, who supports them during their first six weeks of employment. Any new employees are formally supervised at least once during this period and again at the end of their six week induction period. All permanent care staff are allocated to a registered nurse, who performs regular supervision sessions with them. Records of these sessions are maintained and may be performed using observation or individual support. Registered nurses are also supervised and the parent company is currently further developing the system for registered nurses. Systems are in place to ensure the health and safety of residents, visitors and staff. Staff were observed performing manual handling and used equipment correctly, moving residents with care. One resident’s relative commented on how staff always used a hoist when moving their relative. Staff are trained in mandatory areas such as fire safety, infection control and first aid. Accidents are audited both in the home and by the parent company. There are clear systems for regular maintenance of equipment and services, including the hot water systems and testing of electrical equipment. Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 4 3 3 X 3 STAFFING Standard No Score 27 4 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 28/02/07 2. OP7 17(1)(a) S3(3)(k) 3. OP7 17(1)(a) The registered person shall prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met: In that, all service users who are assessed as being at risk of pressure damage must have a care plan in place to direct staff on actions to take to reduce the risk of damage. 28/02/07 The registered person shall maintain in respect of each service user a record which includes a record of any nursing provided to the service user: In that, full records of changes of position must be maintained for each service user assessed as being at risk of pressure damage. This requirement was identified at the previous inspection. Considerable progress has been achieved. It had not been addressed for night duty only. Previous timescale for action was 31/03/06. The registered person shall 28/02/07 DS0000015909.V302361.R01.S.doc Version 5.2 Froxfield Brendoncare Home Page 28 S3(3)(k) maintain in respect of each service user a record which includes a record of any nursing provided to the service user: In that, where a service user is assessed as needing a dietary support or supplement, there must be full evidence that they are receiving this support/supplement as directed in their care plan. 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. 2. 3. Refer to Standard OP7 OP8 OP8 Good Practice Recommendations Care plans relating to prevention of risk of pressure damage should all state how often the individual’s position needs to be changed. Where service users are having their fluid intake recorded, this should be totalled once every 24 hours. Where service users are having their dietary intake recorded, this should specify what the service user has been given to eat, not just phrases such as “lunch” or “supper” Where a service user is having their behaviours observed by use of a monitoring record, an assessment of the risk presented by these behaviours should also be carried out. A monitoring process should be put in place to ensure that all deteriorated commode buckets are promptly disposed of and replaced if their condition begins to deteriorate. 4. 5. OP8 OP26 Froxfield Brendoncare Home DS0000015909.V302361.R01.S.doc Version 5.2 Page 29 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. 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