Inspection on 10/03/09 for Fryers House

This inspection was carried out on 10th March 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fryers House 13/03/08

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Fryers House Fryers Close Botley Road Romsey Hampshire SO51 5TA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Beverley Rand     Date: 1 0 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Fryers House Fryers Close Botley Road Romsey Hampshire SO51 5TA 01794526200 01794515443 fryershouse@lcdisability.org Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Leonard Cheshire Disability care home 20 Number of places (if applicable): Under 65 Over 65 0 physical disability Additional conditions: 20 The maximum number of service users to be accommodated is 20. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability (PD). Date of last inspection Brief description of the care home Fryers House is a purpose built home for up to twenty service users with physical disabilities and nursing needs. Fryers House is owned by Leonard Cheshire, a charitable organisation operating throughout the country and providing a range of services for people in need of care and support. The home is located on the immediate outskirts of Romsey, Hampshire, where the local town centre is easily accessible and the Cities of Southampton and Winchester can be accessed by local transport. Care Homes for Adults (18-65 years) Page 4 of 27 Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Before we visited the home we looked at the Annual Quality Assurance Assessment (AQAA) which had been completed by the manager, the previous inspection report and any other information provided since the last inspection. We sent out, and received a number of completed surveys. We received thirteen from service users, ten from staff, five from relatives, two from care managers and on for a healthcare professional. During the visit to the home we spoke with two service users, two staff members and the manager. We also looked around the home and spent some time sitting in the main lounge area and observing everyday practice. We saw that staff and service users interacted warmly with each other, and there was joking and laughter. Current fees are agreed between the home and local funding authorities. Care Homes for Adults (18-65 years) Page 6 of 27 Care Homes for Adults (18-65 years) Page 7 of 27 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users move in knowing the service can meet their needs. Evidence: The AQAA stated that, prospective service users are encouraged to visit and test drive the home to see if it suits their requirements before moving in. The manager also undertakes an assessment of individual needs. We looked at two of these assessments and found them to be detailed, including health checks completed when service users moved in. Care Homes for Adults (18-65 years) Page 10 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans are in place for service users so that staff can support them consistently. Service users make choices on an everyday basis. Evidence: The AQAA stated that there is a, team nursing and keyworker system in place and review of paper work to ensure that all service users have a detailed and informative individual service plans to reflect the care and support required by the service user and to instruct and guide staff, this includes risk assessments. Individual medical and social plans are kept separately at service users request for confidentiality of medical and personal care needs. We looked at the support plans for two service users and found they included a good level of detail, for example, what support was necessary to enable a service user to clean their teeth. There were clear risk assessments and thorough, individual guidelines for techniques such as hoisting. Support plans included details of the support needed with regard to healthcare, dietary needs, communication, allergies, activities and so on. Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: Twelve of the completed service user surveys showed that people chose what they did during the day and the evening. A relative sent us a survey and had written that, the care home support, (my relative) to live the life they choose so far as it possible having in mind their disability). Another relative told us that the home, lets every disabled person there live the life they wish to. It is led by the manager and this disseminates to all the staff. Residents always get care and respect at all times. Throughout the day of the inspection, we saw service users making choices about what they wanted to do, where they wanted to go, where they spent time within the home, what they wanted to eat and what they wanted to spend their money on. Service users undertake activities which may have a level of risk, but risks are identified and minimised. Staff showed a knowledge of the service users preferences as detailed in the support plans and we saw that a nurse asked a service user if they wanted to continue watching television or whether they would like to listen to a particular musicians music in their room. Care Homes for Adults (18-65 years) Page 12 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users undertake activities of their choice. Relationships are supported and promoted. Daily routines are flexible and individual and service users enjoy their meals, which they choose. Evidence: The home seeks the views of service users with regard to the activities they wish to undertake, whether they be group or individual activities. There is a weekly craft activity held in both buildings where service users can make things such as cards. Other in house activities include baking, gardening, birthday parties and barbecues. Trips out include visiting local attractions as well as going further afield. This was confirmed by talking with staff and service users. During the inspection we saw that service users were going out and records showed Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: their activities. Service users have choice as to whether they join in with activities or not. One of the service users told us when we arrived that it was, the best place Ive lived and that the care and activities were good. Another service user told us that, they will arrange for you to go out if you want to. We saw that a service user had a pet which staff supported with its care. We saw evidence that the home supports relationships with friends and family. The AQAA says, all relatives and friends are welcome to have meals when they are at the service and are invited to stay for events such as birthday parties, barbeques and Christmas day lunch. We spoke to a service user about the food and they confirmed that they had choice and that breakfast was provided at the time which met their individual needs. A staff member who undertook a lot of the cooking, demonstrated how they spoke with service users each week about what food they liked or did not like, and that service users could name a meal of their choice which would be the main menu choice on a given day. We looked at one support plan with particular regard to food preferences and spoke with staff about these needs. The staff and manager were fully aware of the individual needs and went to great lengths to ensure they were met. The manager told us that the home had good links with dietitians and nutrition nurses. Some of the service users have specific equipment which is used for nutrition and training has been provided for staff. Care Homes for Adults (18-65 years) Page 14 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care needs are met. Evidence: The AQAA says that, there is no set routine set, by us as staff, only what the service user desires. These are person centred and unique to the individual. As previously detailed we looked at the support plans for two service users. The plans clearly showed that service users needs were met in ways they preferred. Plans identified whether service users had a preference for whether male or female staff worked with them. Health care plans showed evidence of involvement from professionals such as dentists, chiropodists, and opticians. Records showed that service users see their GP. Weight is monitored on a regular basis. There were thorough instructions in the plans regarding the use of special equipment. The AQAA states that, we now have a consultant Physiotherapist that works with us and she links into the physiotherapy assistants to promote maintenance physiotherapy. Further, they also link in with Southampton wheel chair services to ensure there wheel chairs are maintained and altered as the service user requires. This promotes and encourages independence for the service Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: users ensuring that they maintain good seating posture and ability to continue to use their wheel chairs. There is specialist equipment throughout the home, such as ceiling hoists. The homes medication policy means that only nurses administer medication. We were told that all the nurses had completed advanced training and a dedicated nurse undertakes the ordering of medication. Medication is audited regularly. We looked at the records of medication administration and there were no gaps. However, whilst the medication administration record showed how many tablets had been received into the home in any given month, they did not account for what was left from the previous month. We found two examples which showed that there were more tablets in the home than there should have been according to the records. Whilst monthly records could be checked back to ascertain how many there should be, such a system would not encourage staff to notice if there were tablets missing. The manager agreed to address this. We also looked at the records for controlled drugs and found that the records matched the stock held. The manager told us that the controlled drugs cupboard was new and that it met current storage regulations. Care Homes for Adults (18-65 years) Page 16 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users feel able to complain. Policies are in place to protect service users. Evidence: The manager told us in the AQAA that staff have robust training in complaints and safeguarding adults. Service users are given a welcome book when they move in which includes the complaints procedure. We spoke with a service user who said they would feel able to complain. The majority of completed service user surveys showed that people knew who to talk to if they were unhappy and/or knew how to complain. Two surveys showed people neither knew who to talk to or how to complain. Three surveys from relatives agreed that they knew how to complain, two said, no, but one of these had verbally mentioned something they were unhappy about and the issue had been addressed by the manager. The person went on to say they were happy with the way their issue was dealt with and that there was a good outcome. We looked at the complaints log and saw that complaints had been actioned according to the homes procedure. Safeguarding adults procedures are in place and the manager is aware when to make a referral to the local authority adult services. The home supports service users with their personal money and there are records in place. We looked at the money held and the records for three service users and found they matched. Care Homes for Adults (18-65 years) Page 17 of 27 Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users live in a clean and homely environment. Evidence: The home is a purpose built service separated into two units for the varying physical and health care needs of the service users. It is spacious and is decorated and furnished in keeping with the needs of the residents. The home has equipment placed throughout the home to meet the residents physical disabilities. Entrances provide level entry and many doors open automatically when floor sensors are activated. The bedrooms are larger than the size noted in the national minimum standards and are equipped with overhead tracking hoists and ensuite facilities. En-suite basins are able to be moved up and down, so that they can be set at the level needed for the service user living in the room at that time. Bathrooms are equipped with specialist baths. Bedrooms were personalised and service users can choose their colour schemes. A service user told us that they were pleased with their room and that it was cleaned every day. Some of the bedrooms have doors onto the patio. Some service users have an area of the garden which they can maintain themselves, whichever building they are in. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: The home has many storage cupboards which were incorporated into the design when the home was built. Nine of the completed service user surveys agreed that the home was, always fresh and clean, three said, usually and one said, sometimes. The home has equipment in place to minimise the risk of infection such as equipment for disposing of clinical waste, sluice facilities, laundry facilities in both buildings, disposable clothing and hand gels for staff. We saw large supplies of protective clothing. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are supported by well trained and qualified staff. Robust recruitment procedures protect service users. Evidence: The manager told us that the home has covered shifts with agency workers on a regular basis, but that this has decreased. The reason for this was that the service was new and the strategy for recruitment was designed a certain way. The manager also said that agency staff had been trained in mandatory areas and the agency provided evidence that the staff had had the appropriate checks. We looked at rotas which showed how the staff team was comprised. Staff usually work in one of the buildings on any particular shift, although they can move between the buildings in an emergency. A typical rota shows nine support staff on duty in the morning (for the whole home), six in the afternoon and three at night. There are two nurses on duty throughout the day and night. Staff undertake cooking and cleaning tasks at present. An administrator has been recruited since the last inspection. A person is employed three days a week to undertake maintenance tasks but the hours are flexible to the needs of the home. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: In response to the question on the service user survey, do the staff treat you well?, nine replied, always, three said, usually and one said, sometimes. Comments included, it depends who is on and, they are always kind and fun. In response to the question, do the carers listen and act on what you say?, four replied, always, five said, usually and three said, sometimes. New staff undertake a two week training programme and the manager told us that they also complete two weeks of shadowing. We looked at training records which are audited monthly. The manager told us that she meets with the training co-ordinator regularly and that a lot of the training can be done within the company as they have a training centre. The mandatory training programme includes fire safety, first aid, infection control and moving and handling. Other training includes areas such as challenging behaviour, working in an empowering way and specialist subjects which reflect the individual needs of the service users. At the time the AQAA was completed, fifteen out of eighteen care staff had achieved the National Vocational Qualification in care, level 2 or above. Staff confirmed that there was lots of training and that new staff shadowed for two weeks. The recruitment files of three newly appointed staff were seen and these were found to hold all the specified documents required when employing staff to work with vulnerable people. Evidence of an application form, two references, criminal records bureau disclosure and protection of vulnerable adult checks, were in place for each new member of staff. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well run based on the best interests of the service users. Evidence: The manager is a Registered General Nurse and has a Diploma in Health and Science Studies. She is currently studying for the Leadership and Management for Care Services Award, which replaces the Registered Managers Award. She continues to update her training and has completed the organisations induction for managers. The manager demonstrated that she has an understanding of the needs of people who need nursing care, who have physical disabilities, and of her roles and responsibilities in ensuring their needs are met. The service consults service users about the way the service is run on a daily basis. The AQAA states that, the service users have become more proactive in the management of the service and verbalise their wishes and aspirations. The organisation produces newsletters for service users, regarding the home itself and Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: the organisation of Leonard Cheshire. We saw these publications were available in the hallway. The home undergoes a monthly audit by a representative of the organisation and copies of the report are sent to the manager. We received a number of completed surveys, as identified in the summary, and the majority of these were positive about the home. The home is maintained with regard to health and safety. The home has maintenance contracts in place and we saw up to date certificates for equipment such as the hoists, nurse call system and the tailift on the mini-bus. Potentially hazardous substances were stored in a locked cupboard, although the manager did agree that the key may need moving, pending a risk assessment. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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