Inspection on 09/02/09 for Frome Care Village

This inspection was carried out on 9th February 2009.

CSCI found this care home to be providing an Adequate 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

Frome Care Village 23/11/09

Frome Care Village 29/09/09

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 27/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Riverview Nursing Home Styles Hill Frome Somerset BA11 5JR     The quality rating for this care home is:   one star adequate 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: Justine Button     Date: 1 0 0 2 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 Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 30 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.csci.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Riverview Nursing Home Styles Hill Frome Somerset BA11 5JR 01373474199 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) : PSP Healthcare Ltd care home 60 Number of places (if applicable): Under 65 Over 65 0 0 60 0 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category physical disability Additional conditions: 60 60 0 24 The maximum number of service users who can be accommodated is 60. The registered person may provide the following category of service only: Care home with Nursing - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) - maximum of 24 places Dementia (Code DE) Mental disorder, excluding learning disability or dementia (Code MD) Date of last inspection Brief description of the care home Riverview Nursing home was purchased by PSP Healthcare LTD in 2008. Riverview Care Home can be found just off styles Hill road, set in its own grounds. It is situated on the outskirts of the town of Frome near to Asda superstore. Shops, banks, pubs and Care Homes for Older People Page 4 of 30 Brief description of the care home restaurants are near by however transport would be needed to reach these facilities from the home. The home is currently situated in two separate buildings (although both are situated on the same site) The Parsonage and woodlands. The parsonage is an older building with facilities situated over two floors. The upper floor being accessed by staircase and lift. There are 34 bedrooms spread over the two floors. Both floors have a range of living and dining spaces. The parsonage currently provides care and support predominantly for people who have dementia. The woodlands has 24 single en-suite bedrooms again spread over two floors. This building was constructed in 2000. Again there are a range of living and dining facilities on both floors. The lower floor being accessed by stairs or a passenger lift. Woodlands provides care and support for those people with nursing needs. The two homes share some facilities such as laundry and kitchens. There are accessible gardens surrounding both homes. The home is managed by Michele Course, who is registered with us. In addition both The parsonage and Woodlands have a head of care who is responsible for the day to day running of both buildings. The current fee levels range from 600 pounds per week to 1200 Pounds per week. This information was given to us on the 26/02/09. PSP Healthcare are in the process of changing the name of the service from Riverview to Frome Care Village. As such some of the documentation relating to the home has already been changed. To aid the reading of this report and to avoid confusion Frome Care Village will be used for the remainder of this report. Care Homes for Older People Page 5 of 30 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key unannounced inspection was carried out over two days by one inspector. The Manager was available on the day of the inspection. The inspector would like to thank the manager and the duty staff for their time and hospitality shown to the inspector during their visit. The focus of this inspection visit was to inspect relevant key standards under the CSCI Inspecting for Better Lives 2 framework. This focuses on outcomes for service users and measures the quality of the service under four general headings. These are: excellent, good, adequate and poor. These judgment descriptors for the seven chapter outcome groups are given in the report. Care Homes for Older People Page 6 of 30 As previously stated Riverview now to be called Frome Care Village was purchased as a going concern by PSP Healthcare in 2008. This is the first inspection for this service since PSP has purchased the home. Prior to the PSP take over, the two homes were registered as separate homes and as such had separate inspection reports. This has now been amalgamated and the whole home is considered as one registration. This report therefore relates to all areas of the home. The last inspections under the previous owners for both of the homes raised issues with regard to the quality of care and support for some time. As such PSP Healthcare have had to address a number of concerns raised at previous inspection. Records examined during the inspection were five service user care and support plans as part of the case tracking process, medication administration records, maintenance records, the homes Statement of Purpose, staffing rosters, menus, the homes complaints file, staff recruitment files, staff training records, quality assurance processes and staff supervision records. The inspector also conducted a tour of the premises. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The following is a summary of the inspection findings and should be read in conjunction with the whole of the report. What the care home does well: What has improved since the last inspection? Since taking over the home significant improvements have been seen in the majority of areas. Information relating to the home have been updated and now provides information for anyone thinking of moving into the home. Care planning process has improved although some additional developments are recommended. Health care needs are now met and staff can more readily identify when people needs change. Staff are significantly more proactive in seeking the support and help of other healthcare professionals Social and recreational opportunities have significantly improved with opportunities now being aviable to all. Care Homes for Older People Page 8 of 30 Staff recruitment procedures have improved with all staff now having all required checks in place. Staff training opportunities have also significantly improved with all staff having now completed all mandatory training. NVQ training and further training opportunities are now being developed. Induction training for new staff is now in place. Staff are now supported through a system of supervision and staff appraisals. The environment has improved especially in The Parsonage. Continued improvements are planned for this area of the service. Quality assurance system are now in place to ensure that the home continues to develop and improve the standard of care and support offered. The quality assurance systems in place actively seeks and considers the views of people living at the home and other stakeholders such as family and Friends 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.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have the information they need to enable them to make an informed decision about moving to the home. The home will ensure that people are appropriately assessed before a placement is offered. All people living at the home have been provided with a copy of the terms and conditions of their stay. Trial visits are offered. Evidence: The home has developed a statement of purpose and information for people thinking of moving into the home. A copy of this information was viewed. This document Care Homes for Older People Page 11 of 30 Evidence: provides all the necessary information and is supplemented with a range of photographs. The Aqaa received prior to the inspection states that this information is also available on request in braille, audio cassette, CD and large print format. New placements at the home have been limited since the home was purchased to enable improvements to be made. As such it was difficult to assess any preadmission assessments made by the home. The documentation for the assessments however was viewed and this contains all necessary information. This assessment will ensure that the home can meet the needs of the individual prior to moving in. It should be noted that the home charges a fee of 47.95 pounds for the completion of these assessments and the development of the initial care plan. Details of these charges are specified in the contract. In addition to the preadmission assessment the homes asks the individual (if possible) and or a family member to come to visit the home to ensure that all parties are happy for the placement to proceed. The home also ask family members to complete a booklet which details information about the individual during their life so that staff have a feel for the person as an individual and can assess their social needs. Assessments are also sought by the staff at the home from other health care professionals or social worker. The home provides each individual with the terms and conditions of their stay (contract). The contract viewed clearly sets out the fees payable, payment terms, notice periods and any additional charges. Fees stated in the contract do not include any Registered Nurse Care Contribution (RNCC). This is a sum of money paid by the government for anyone with a nursing need. Fees do not include hairdressing, visitors meals, newspapers, alcohol, private treatments such as physiotherapy or chiropody, taxi fares, toiletries, dry cleaning and escort duties. A suggested sum of a 100 pounds is paid to the home on admission to cover these costs. Invoices for these items are invoiced monthly and Notification is given when the monies are used up. The contract states that a trial period of four weeks is in place. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning process has improved since PSP purchased the service. Staff now need to ensure that these are consistently developed in all areas and for all individuals living at the home. The home is meeting the peoples health care needs although again this needs to be consistently delivered in all areas. Improvements in the management of medication have been seen, however, some minor developments are still needed to ensure that this is delivered in line with best practice. Evidence: Since PSPS healthcare took over the running of the home in 2008 significant staff training has been put into place to ensure that staff can develop their skills in order that the standards of care and support provided rises. Consideration should be given to the fact that PSP have owned the home for only six months and the management Care Homes for Older People Page 13 of 30 Evidence: and staff should be congratulated on the improvements made so far. Despite these improvements some areas require further developments and continued improvement. Four people were case tracked during the inspection and their care plans reviewed. An additional two care plans viewed but the care was not case tracked. Case tracking involves identifying individuals at the beginning of the inspection and comparing the care and support they receive with the needs identified in the care plan. The majority of the plans had been completed with the individual and or their representative. All contained a range of appropriate assessments and associated care plans. Some of the care plans were clear and detailed however some lacked clarity and did not give clear guidance to staff on how to meet the identified needs of the individual. For example, one care plan was viewed for one individual who had dementia and as such could show some challenging behavior to wards staff particularly when staff were trying to deliver personal care. The care plan for this individual for this area was very clear informing staff of the techniques that they could use to divert the individual or agreed strategies on what to do if the behavior continued. This individual also had some difficulties during meals and being able to recognize what was on the plate. The care plan very clearly stated to staff the equipment that was used for the individual to aid and promote Independence. In addition the plan stated that staff should explain to the individual where food was using a clock technique. The plan gave clear guidance to staff on the frequency that they should be ensuring the safety of this individual as they were unable to make use of the nurse call bell to summon help from staff. The individual had been assessed as being at high risk of falls. For another individual who had a pressure ulcer (sometimes called a bed sore) the care plans were not completed to their fullest extent. The care plan for the pressure ulcer did not give clear progression of the wound and it did not contain photographs or tracings. These are required in order that when different staff members dress the wound they can assess the progression or deterioration and evaluate the treatment or care and support given effectively. Photographs, clear care plans and tracings were available for other individuals Had pressure ulcers. Good nutrition is paramount in the healing and prevention of pressure ulcers. A nutritional assessment had been completed for this individual but the wound had not been taken into account when completing this. The assessment was therefore inaccurate. A regular change of position is also required to aid in the healing of pressure ulcers. The care plans did not specify how frequently this individual should be supported by staff to change position. The charts used for this individual to monitor the document the change of position demonstrated that the individual was sitting in one place for significant periods of time. Care Homes for Older People Page 14 of 30 Evidence: Other elements of the inconsistent completion of the care plans was seen. For one person who is a diabetic the care plan was very clear on the individual normal blood sugar levels and clear guidance was given to staff on the action to be taken if they found the levels outside of these normal limits. In one care plan seen they clearly stated the individual abilities with regard to their personal hygiene and how they liked the care to be given. In the care plans for another individual no such details were available. These discrepancies were discussed with the home manager and heads of care at the end of the inspection visits. It was agreed that some staff had taken on board recent training on care planning more easily then others. It was agreed that the management would do additional work to ensure that all the care plans were completed in a consisting manner. It was clear from the care plans seen that staff had improved their communication with other health care professionals. Staff are now seeking the help and advise of GPs, Community Nurses, dietitians and speech and language therapists. Feedback from health care professional confirmed this. A number of people at the home are frail and as such staff had introduced charts to record such things as amount of fluids taken and frequency of positional change. The majority of the charts viewed had been accurately completed and demonstrated that staff had delivered appropriate care and support. Staff hand over was observed in one of the buildings on the first day of the inspection. This demonstrated that the nurse in charge was very clear about in identifying to the staff coming on duty who had not been drinking well that day. The nurse in charge then allocated a specific staff member the duty of ensuring that these people were offered hourly fluids. This is significant improvements on previous inspections with staff now clearly able to identify and act on healthcare needs. It was noted that not all people in the communal areas and in their rooms had access to fluids at all times (it was available in some areas although not others). Drinks rounds are conducted throughout the day and no person appeared to be dehydrated. One person living at the home however told me she was thirsty and I had to go to the kitchen to get her a drink. Staff need to ensure that drinks are available at all times to everyone living at the home. It was noted during the case tracking process that staff had supported individuals to meet personal hygiene needs including oral hygiene. All people we spoke to during the inspection had nothing but praise for the personal care they received from staff. One relative we spoke to said that her mother had been at the home since July 2008. The relative continued to say the minute I walked in I got a good feel. Staff talked to you, they did not in all the places I visited. Michelle, the manager and all the staff very approachable. Anything I am unsure of I would feel able Care Homes for Older People Page 15 of 30 Evidence: to ask. Mum always looks clean, tidy and very well cared for. Staff were seen interacting kindly to residents and were seen knocking on doors before entering. People living at the home spoken to during the inspection confirmed that staff treated them with respect and helped to maintain their privacy when delivering personal care. The homes procedures for the management and administration of medication were examined at this inspection. The home uses the monitored dosage system (MDS) with pre-printed medication administration records (MAR). The registered nurse on duty administers medicines. Medicines were found to be securely stored. Creams in use, seen in individuals bedrooms, had been marked with an expiry date however the MAR chart not been signed to confirm that the creams had been applied as per the Prescription. This is recommended. On viewing the MAR charts it was evident that at least one person was an insulin dependant diabetic. On one occasion the blood sugar for this individual was low. Staff had taken appropriate action in response to this. The preprinted MAR charts are delivered by the pharmacy on a monthly basis. There may be occasions during the month that these have to be amended say for example when a GP visits and changes the dose required or introduces a new medication. When this occurs staff have to hand write the new drug onto the medication record. It is good practice that when this occurs the hand written entry is checked by another person to ensure it is accurate. This reduces the risk of drug errors. For at least one person living at the home a GP had visited and altered the prescribed medication. Staff had not re written the new prescription in full merely changed the dose on the existing entry. This had not been checked by a second person. It is recommended that staff rewrite the prescription in full and ensure that this is checked by a second staff member. As previously stated this will reduce the risk of medication errors. Care Homes for Older People Page 16 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of activities at the home has improved since PSP Health care have acquired the service. Visitors were seen to be visiting the home on the day of the inspection. All stated that they are made welcome at any time. Choices are available to people living at the home. Improvements have been seen in the standard of food. Mealtimes are a pleasant experience. Evidence: Since taking over the service in 2008 PSP Healthcare have reviewed and improved the provision of social and recreational opportunities. On the first day of the inspection five people who have dementia were observed in one of the lounges with the activities organiser looking at multi sensory equipment including bubble tubes and lights. Soft music was playing and lavender fragrance was being used. Interactions between the activities organsier and the people living at the home were excellent. The people living Care Homes for Older People Page 17 of 30 Evidence: at the home appeared to enjoying this activity. Additional people were seen in the lounge area watching the newly purchased large screen TV. Staff were observed frequently coming into the room and interacting with people. Again these interactions were observed to be good with staff appearing to have very positive relationships with the people living at the home. One lady with the support of staff was observed setting the tables for lunch. This gave this individual a sense of purpose. This lady told us that she liked to help. In the afternoon people were observed making valentines decorations for the forth coming Valentines day meal and charity auction. The home has developed an activities programme which includes 1:1 time, gardening and what the papers say, reminiscence, quiz, music and dance. Staff were also observed manicuring peoples nails. The home has visiting hairdresser and clergy of most denominations. These activities and social interactions are a vast improvement on previous inspections at the home. One staff member commented that she was surprised at how the development of activities and social opportunities had such a positive effect on the lives of people living at the home particularly those people with dementia. The staff member continued to say that people living at the home now demonstrated less aggressive behaviours and appeared to be happier. The staff member put this down to people having a sense of purpose and well being. The home have developed a key worker system. This system links an individual staff member with a person living at the home. This staff member will take a special interest in the individual getting to know their individual likes and dislikes well and be a point of contact between staff, individual and family. At the last inspection, prior to PSP taking over the service it was identified that meals and mealtimes required improvement in some areas. We viewed the meals in both areas of the home over the two days of the inspection. Everyone we spoke with said the food was very good or excellent. One resident said there is always a choice and if you dont like that they will do you something else One relative stated that she felt the standard of food had improved considerably especially the range of fresh vegetables which are now available. The food served on both days of the inspection looked and smelt appealing with a range of vegetable available. A choice of meal was evident. A four week rolling menu has been developed including a cooked breakfast and a hot option in the evening. At the last inspection it was found that a number of people required staff support at meal times. This remains the case however staff now sit down when they support people to eat. This allows staff to ensure that they have the time to spend with people during meals and ensures that meal times are a pleasant experience for all. This time also allows staff to monitor dietary intake more effectively which will promote the Care Homes for Older People Page 18 of 30 Evidence: general health of people living at the home. A number of people living at the home have difficulty in swallowing or require specialist diets, for example if they have skin damage or have experienced weight loss. Concerns had been expressed to us prior to the inspection with regard to the provision of specialist diets and one person who had experienced some weight loss. The concerns identified that supplements and specialist diet was not available at all times during the day but particularly in the evening. On the day of the inspection this was not seen to be the case with a range of specialist diets and supplements available throughout the day according to the individuals assessed needs and in line with care plans. As previously stated in the report staff need to ensure that people have access to fluids at all times through out the day. Although a choice of meals is available at all times and a written menu is on display it could not be confirmed how all people living at the home make choices in this area. Some people living at the home cannot verbally express their choices. Staff could develop a system were they plate up the choices and show these to people who can then make a choice. Alternatively staff could develop pictures and photographs of the food again enabling people to have a greater understanding on what is being offered. On the second day of the inspection the meal in woodlands was viewed. As previously stated the meal looked and smelt appealing. It was noted however that all people living at the home were wearing food protectors. Whilst it is appreciated that this may be required for some people the use of this equipment for all did have add a rather institutional feel to the meal. Staff need to consider how this impacts on peoples dignity and self esteem. Any soiled clothing could be changed following the meal. In addition it was noted that orange squash was the only drink available. Staff need to ensure that at least water is also on offer. Visitors were seen visiting family and friends throughout the day of the inspection. Care Homes for Older People Page 19 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Complaints are dealt with in line with the homes policy and procedures. People living at the home are aware and comfortable in expressing any concerns. People living at the home are protected by the homes policies and procedures. Staff have received recent training in the prevention and recognition of abuse. Evidence: Feedback from people living at the home when asked do you know who to speak to if you are not happy? All people stated that they would speak to a staff member or the manager if they had any concerns. Comments from relatives included A wonderful home no complaints. The Home has a complaints procedure that is clearly written and contains the contact details for CSCI. All the complaints are dealt with in line with the homes policy and procedure. The policies and procedures regarding protection of residents are of a good standard, which include complaints,recognising signs of abuse and whistleblowing. These policies are currently being reviewed and up dated. The home has copies of the local abuse polices and procedures. Abuse training is included in the staff induction programme. The training matrix was viewed as part of the inspection process and this showed that Care Homes for Older People Page 20 of 30 Evidence: staff had received abuse training. Staff spoken to during the inspection all now have a increased knowledge of the action to be taken should issues be identified. Staff recruitment files were viewed during the inspection. These contained all necessary checks. Care Homes for Older People Page 21 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Improvements to the enviroment have been seen particulalrly in The Parsonage. These improvements are set to continue. People are able to personalise their bedrooms. The home is fitted with an appropriate range of aids and adaptations. The standard of cleanliness is overall good hwowever some areas requiredattention on the day of the isnpection. The home has systems in place to reduce the risk of the spread of infection. Evidence: Improvements to the environment particularly in the older building the Parsonage have been seen. When PSP purchased the service some of the environment was in a poor state of repair and not fit for purpose. We were told on the day of the inspection that PSP healthcare have submitted plans to the local planning department to totally re develop the site. This will include a new nursing home for people currently living at the home. Close care flats and bungalows will also be available. This redevelopment will Care Homes for Older People Page 22 of 30 Evidence: require substantially investment from PSP Healthcare. Despite this planned redevelopment PSP have recongnised that these plans may take some time to reach conclusion and that investment was required in the existing buildings to ensure that they are fit for purpose and that people currently living as the home need to live in a pleasant and an environment which is suitable. Investment in the current buildings has therefore been made. The upper floor of The Parsonage was closed on the day we visited. This is undergoing total refurbishment. This refurbishment was not viewed on this visit. Some of the bedrooms on the lower floor have been decorated and new furniture has been purchased. Some corridors have been decorated and new carpet laid. A new lift was installed in March 2007. Archways have been knocked into the wall between the dining area and lounge on the ground floor giving a feeling of light and airiness that was missing previously. New furniture has been purchased in all communal areas. Wide screen TVs are also available in the lounges that have them. This enables people living at the home to view them more easily. All redecoration and refurbishment that has been completed has been done so to a high standard. Woodlands was constructed in 2000 and was purpose built and so the the refurbishment in this area was less critical. Despite the work already completed and being undertaken PSP have recognized that this remedial work needs to continue and have provided us with a schedule of work that is set to continue into this year. It is advised that PSP Healthcare consider the use of signs/pictures in the dementia unit to assist people with orientation. The home employs domestic staff. The standard of cleanliness on the day of this inspection was good in some areas but only adequate in others for example some carpets in woodlands required cleaning and hoovering. There were no malodours in the home on both days of the inspection. Equipment such as adjustable beds have been replaced as required and the manager told us that they have all the necessary equipment to meet the needs of people living at the home. The home takes appropriate steps to reduce the risk of the spread of infection. Liquid soap and paper hand towels are appropriately sited throughout the home. Staff have access to a good supply of protective clothing. We sampled a few bedrooms and it was evident that people are encouraged to personalise their private space. Care Homes for Older People Page 23 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels appear appropriate to the needs of people currently at the home but these should be kept under review. The home promotes ongoing training training for staff and ensures that all staff received training appropriate to their role. The home follows robust procedures for staff recruitment. Evidence: Since taking over in 2008 PSP Healthcare have recongised that in order to improve the quality of care and support that people living at the home receive, they needed to develop the skills and competencies of the staff team. In view of this considerable time and effort has been put into place to provide all staff with the training that they require. The staff training matrix was viewed and this demonstrated that all staff have now undertaken all mandatory training. Staff spoken to during the inspection confirmed this. It is clear from the finding of this inspection and feedback received from staff and visiting professionals that some of the registered Nurses need to develop their skills and competencies in line with their accountability under the Nursing and midwifery Council (NMC) guidelines. Now that PSP Healthcare have completed all the basic training it is suggested that they undertake an audit of the skills of the Care Homes for Older People Page 24 of 30 Evidence: current Registered Nurses to ensure that they all have the skills and knowledge to meet the needs of people living at the home. It is advised that the audit should include areas such as care planning, wound management, catheter management, continence management and diabetes management. Since taking over Frome Care Village PSP Healthcare have reviewed all the staff files. All staff now have all necessary recruitment checks including Criminal Record Bureau and POVA checks are in place. A robust system is in place to ensure that all new staff have these checks completed prior to commencing employment at the home. Staff induction has been reviewed and up dated. This now includes all the required elements. Staff rotas were viewed as part of the inspection. These demonstrates that currently adequate numbers of staff are available to meet the needs of the people living at the home. The home however has reduced occupancy due to not taking any new admissions over the last few months. The management need to ensure that as the level of dependency at the home increase that they keep the staffing levels under review and increase these if necessary. This will ensure that the hard work at improving the care and support afforded to people living at the home is not compromised. Care Homes for Older People Page 25 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home currently has a manager registered with us. The home is run with the service users best interests safeguarded by policy, practice and procedures. Attention to the health and safety of service users and staff is of a good standard. A system of staff supervision is in place. Evidence: Since taking over in 2008 PSP Healthcare has recruited a new manager, Michele Course, to the home. This is in addition to the two Registered Nurses who will take the clinical leads for the two areas of the home. Mrs Course has registered with us. Mrs Course is a Registered Nurse with experience in the care of the elderly including work in psychiatric units and with people with challenging behaviour. Care Homes for Older People Page 26 of 30 Evidence: Since taking up her position as manager Ms Course has reviewed and made some significant changes at the home. Ms Course has agreed that there is still alot to do until the home would be providing the level of care and support that she would like. The considerable changes at the home have caused some disruption to staff however this would not be unexpected in a home undergoing change. Ms Course has been instrumental in making the improvements to the home. Staff stated to us that they found her very approachable One staff member stated that she felt that staff now worked as a team and that this was due to the home now having robust leadership. The home has systems in place to monitor the quality of the services and care offered. Copies of the homes internal quality audits were seen. Regular meetings are held for relatives, carers and staff where views are encouraged. All people spoken to during the inspection stated that they would feel happy to raise any concerns with the management. All stated that they thought their views would be listened to. As part of the homes quality assurance programme and as required in the Care Homes Regulations, monthly visits are made by a company representative with written reports completed. Reports were examined during this inspection. We were informed that the home does not act as appointee for any people living there but manages small amounts of spending money for people. We looked at the records relating to this and found them to be well maintained. Details of transactions and balances are maintained in computerised format on an individual basis. Statements are forwarded to individuals relatives or representatives as appropriate, on a monthly basis. A system of staff supervision has been developed and is in place for all staff. Documented evidence was available and staff spoken with confirmed that they were supported. We looked at the homes procedures relating to health and safety. This involved a tour of the premises, observation of practices, discussion with staff and examination of records. All were found to be satisfactory. Care Homes for Older People Page 27 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 30 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 1 7 It is recommended that care plans are completed consitently so that they all provide clear guidance to staff of the care needs of indivduals living at the home. All the care plans should be completed in person centered way clearly detialing the likes, dislikes of the indivdual and how they would like thier care to be delivered. It is recommended that all people at the home have access to fluids at all times It is recommended that all hand transcribed entries on to the Medication Administration record are checked by a second person to ensure the accuracy of the entry. The second person should sign to confirm this has occurred. Staff need to continue to develop system which enable people living at the home to make choices. This could include the development of pictures and photographs. This should include choices with regard to fluids and meals. It is recommended that the management conduct an audit of the competencies of the Registered Nurses to ensure that they have the clinical skill and competencies to meet the needs of the people living at the home. 2 3 8 9 4 14 5 27 Care Homes for Older People Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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