Care Home: Friston House

What the care home does well Friston House is welcoming and has a relaxed and inclusive atmosphere. Residents enjoy living in a modern, clean and comfortable environment. There are ample communal areas for people to enjoy, including attractive garden areas. Residents benefit from a full assessment of their needs and they or their representatives are encouraged to look around the home before they move in. The home is effective in helping residents to settle in. Residents are treated with respect and there are arrangements in place to protect and maintain their privacy and dignity. Services that provide social and nursing care must be sensitive to people of different cultures, age, gender, faith, disability and sexuality. Throughout the service, there was evidence of a good awareness and understanding of equality and diversity issues, which translated into positive outcomes for residents. There was a full activities programme organised to which residents of all levels of capacity had equal access. The home had the use of a specially adapted mini bus, which ensured people could also access leisure and recreational activities available in the wider community. Friends and relatives are welcome to visit and could do so at any reasonable time. Regular meetings and quality assurance exercises take place to enable everyone to express their views and offer suggestions for further improvement. Training for staff was taken seriously. The service clearly invests in the development and performance management of staff to ensure residents are in safe hands at all times. The home is sensitive about issues surrounding the illness and death of residents and has firm plans to further improve end of life services offered to people who live there. What has improved since the last inspection? Daily records now clearly reflect that staff are following the guidelines in a resident`s plan of care and give sufficient detail on which to base the individual`s monthly review. Residents risk assessments, which protect their welfare and provide safe systems of work for staff to follow are now current and up to date. Superseded assessments are archived to avoid any confusion and possible harm. There has been a review of staffing levels and the way staff are deployed in the home, particularly on the second floor. This better meets the needs of people living there. A further part time activities organiser has been employed to increase the opportunities for people to be involved in meaningful diversional and social activities inside and outside the home. The home`s matron is now supernumery to the staffing rosters, which gives her greater flexibility and the opportunity to offer additional support to staff during busy times. What the care home could do better: It was strongly recommended that solid bars of soap and other toiletries are not left in bathrooms, which can lead to their communal use and which has the potential to compromise infection control procedures in the home. Staff and residents would benefit from the provision of more general storage areas in the home to ensure that large items of equipment can be stored safely and thus reduce or eliminate any potential for trip hazards. All staff should have a current photograph in their staff files to further enhance the home`s robust recruitment procedures designed to protect residents from harm. CARE HOMES FOR OLDER PEOPLE Friston House 414 City Way Rochester Kent ME1 2BQ Lead Inspector Marion Weller Key Unannounced Inspection 3rd March 2008 09:30 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 Friston House DS0000069285.V359335.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. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Friston House Address 414 City Way Rochester Kent ME1 2BQ 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) 01634 403556 01634 400646 sue.watson@barchester.com Barchester Healthcare Home’s Ltd Vacant post Care Home 81 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (60) of places Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. From time to time service users who are below the age of 65 years, whose assessed needs can be met, may be admitted for nursing care. Date of last inspection Brief Description of the Service: Friston House Care Centre is a modern purpose built establishment situated within a residential area approximately 3 km from Rochester. The home is within easy reach of the M2 and M20 motorways. It is located near to a main bus route and there are railway stations in Rochester and Chatham. The home is an 81-bedded unit providing care and nursing to older people. In addition the centre is registered to provide services for up to 21 older people who have Dementia within a dedicated unit. Accommodation for residents is arranged over two floors with the addition of a separate single storey annexe. Access to the first floor is by passenger lift. The home has a central courtyard and several patio areas for service users and visitors use. Lawns surround the main building and visitor parking is available to the front of the premises. The home employs registered nurses and care staff working a roster, which provides 24-hour cover. Ancillary staff for administration, catering, maintenance and housekeeping duties are also employed. The home has two dedicated activities staff. A hairdresser and chiropodist visit the home on a regular basis. There is an additional charge for these services. Current fees range from £945 to £1012 according to assessed personal need. Please contact the manager for further information. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This was a key unannounced inspection of Friston House. The site visit was conducted by Marion Weller, Regulation Inspector between 9:30 am and 4:00 pm. During that time the inspector spoke with several service users, the manager, the matron and other members of the staff team. Some judgements about the quality of life within the home were taken from observations and conversation. Some records and documents were looked at. The annual quality assurance assessment (AQAA) sent to us by the service before the site vist was also used to inform our judgements. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. In addition, a tour of the building was undertaken. As part of the inspection process, surveys were sent out before the visit to some people living at the home, their relatives and other care professionals involved with the home. Responses indicated people were generally very satisfied with the standard of care the home provided. Statements made included: “Excellent and caring staff. ” “There are a lot of activities to take part in every day” “ Higher level of care than I have seen elsewhere” “Excellent Environment” And “As far as I am aware residents are offered choices that enable them to live the life they choose” One respondent felt that the noise of call bells summoning the attention of staff was very annoying and could have the potential to disturb residents confined to their rooms and for whom there was no respite. Two others were concerned that food was sometimes not hot enough to enjoy when transported from the main kitchen to their bedrooms. Both issues were discussed with the manager who stated her intention to investigate these concerns further. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 6 This is the first inspection since the service was re registered from Westminster Healthcare to Barchester Healthcare in January 2007. This followed the restructuring of Barchester Healthcare and its wholly owned subsidiaries and was as a result of a change in company number only. There were no structural management or service changes. The home has therefore retained its quality rating and inspection frequency. The home has seen the appointment of two new managers since the last inspection. The current manager took up post in January 2008 and was transferred from another Barchester Home in the area as the result of an internal management reorganisation. The home is in the process of consolidating recent changes and making future plans for further improvement. The manager and staff gave their full co-operation throughout the inspection. What the service does well: Friston House is welcoming and has a relaxed and inclusive atmosphere. Residents enjoy living in a modern, clean and comfortable environment. There are ample communal areas for people to enjoy, including attractive garden areas. Residents benefit from a full assessment of their needs and they or their representatives are encouraged to look around the home before they move in. The home is effective in helping residents to settle in. Residents are treated with respect and there are arrangements in place to protect and maintain their privacy and dignity. Services that provide social and nursing care must be sensitive to people of different cultures, age, gender, faith, disability and sexuality. Throughout the service, there was evidence of a good awareness and understanding of equality and diversity issues, which translated into positive outcomes for residents. There was a full activities programme organised to which residents of all levels of capacity had equal access. The home had the use of a specially adapted mini bus, which ensured people could also access leisure and recreational activities available in the wider community. Friends and relatives are welcome to visit and could do so at any reasonable time. Regular meetings and quality assurance exercises take place to enable everyone to express their views and offer suggestions for further improvement. Training for staff was taken seriously. The service clearly invests in the development and performance management of staff to ensure residents are in safe hands at all times. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 7 The home is sensitive about issues surrounding the illness and death of residents and has firm plans to further improve end of life services offered to people who live there. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Friston House DS0000069285.V359335.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 Friston House DS0000069285.V359335.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1356 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service have all the information about the home they need to make an informed decision about whether the service is right for them. The personalised needs assessment means that individual’s diverse needs are identified and planned before they move into the home which ensures residents are appropriately placed and they can be confident that the home can meet their needs. EVIDENCE: The home’s statement of purpose has been revised to reflect the new managers details, changes in the home’s registration and service type to better inform potential and existing residents about the range of services the home offers. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 10 Comprehensive literature and information about the service is either given or sent to all prospective residents, including a copy of the home’s statement of terms and conditions prior to them making a firm decision to move in. In addition, all residents are offered details of a free advocacy service with the literature sent. There is a high value placed on responding to peoples need for information, reassurance and support. A mystery shopper regularly phones the home on behalf of the provider to ensure that staff are following best practice in relation to giving people all the information they need about the services offered. The results of these exercises are sent to the manager in the form of a written report highlighting areas where the service does well or needs to make improvements. The home scored highly on a recent exercise. The Provider has an informative web site which includes comprehensive details about the service offered at Friston House for people who require information but who may not initially wish to contact the home directly. The manager, matron or a trained senior member of staff visits prospective residents prior to admission to make a decision as to whether the home can meet the person’s needs. Information is obtained from other parties, including relevant health care professionals to assist in assessments. Samples of pre admission assessments were inspected in resident’s files and were found to be detailed and comprehensive. Prospective residents and their families are invited and encouraged to come to the home for a visit, coffee or lunch and inspect the service prior to making their final decision to move in. One survey respondent spoke of their pleasure at being given a pot plant and a ‘welcome’ card to the home on their arrival. The home does not provide intermediate care. Friston House DS0000069285.V359335.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who live in the home have detailed plans of care. They can be confident that their health, personal and social care needs are clearly identified and will be met. They benefit from the home’s approach to maintaining and developing good multidisciplinary working and are further protected by the home’s policy and procedures with regard to the handling and administration of medication. EVIDENCE: Each resident has a plan of care based on the home’s pre admission assessment. Efforts have been made to further improve care plan content since the last inspection. The home has now adopted the Barchester Healthcare format. Contents of resident’s files on this inspection were found to be comprehensive and detailed. Care plans had been developed with the resident or their representatives help and had been signed by them to evidence their involvement and agreement to the plan. Care Plans also addressed people’s wishes during periods of serious illness or at the time of death. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 12 Residents’ daily monitoring records were being maintained and content had improved, they clearly reflect that staff are following the guidelines in a resident’s plan of care and give sufficient detail on which to base the individual’s monthly review. Care plans were being regularly reviewed with changes recorded and actioned. The requirement issued at the last inspection has been met in full. Risk assessments were completed and covered the prevention of falls, maintenance of skin integrity and use of bed rails. Risk assessments that had been superseded are now archived in a timely manner to eliminate any confusion and to ensure staff receive clear direction. The requirement issued at the last inspection has been met. Staff had a good understanding of residents needs. Records indicated the home had a good working relationship with specialist and local health care professionals, supporting residents in their health care needs. Specialist mattresses and other aids were seen in use and staff evidenced a sound knowledge of tissue viability care and followed treatment plans closely. One survey respondent said, “My relative has been bed bound for nearly a year, her skin is in excellent condition. This shows good care”. A health care professional said, “I have particularly noted that moving and handling residents is excellent here, aids are used when necessary to secure peoples safety and welfare and are always used appropriately”. Another health care professional reported “ With regard to tissue viability, individual needs are met here by the provision of pressure relief, maintenance of an adequate diet, appropriate continence care to prevent tissue breakdown and to aid healing when necessary” Trained nursing staff administers medication in the home. An appropriate policy and written procedures are in place for the storage and administration of medication. Medication records inspected were sound with no unexplained gaps. Records evidenced a photo of residents to aid identification. Facilities are available for the proper storage and administration of controlled drugs. Drug balances and records were checked and found to be accurate. There are procedures in place for trained staff to hand over keys/ stock balances between shifts. A sound and positive result to this standard, which clearly benefits residents. Changes have been made in the staff-working pattern on the first floor nursing unit. Staff are now split into two teams ensuring a more efficient use of care hours to meet resident care needs. There is increased care staffing levels in line with the occupancy and dependency levels of residents. The Matron now has increased supernumery hours away from the rosters to support all of the nursing units. The requirement issued at the last inspection has been met. From observation and discussion with residents it was clear that staff treated residents with respect and promoted their privacy and dignity. A health care Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 13 professional responded to a survey question on this subject by saying, “ every member of staff appears to respect the residents. Confidentiality is excellent, for example I have never heard staff discussing residents in the corridor where they can be overheard” Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Social activities and opportunities for mental stimulation are well managed by dedicated and motivated staff that provide daily variation and interest for residents of all capacities both inside and outside the home. Residents are enabled to maintain contact with friends and family who are made welcome in the home. Meals provided are wholesome and offer both choice and variety EVIDENCE: Residents spoken with were happy with the flexibility the home offered in regard to meeting their personal preferences. For example, residents have the choice of receiving their visitors in the day lounges or in the privacy of their own room. Tea/Coffee is available on a tray service to a residents room. People are free to choose what time they get up and go to bed, also taking meals if they chose to in their rooms. The manager stated that resident’s Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 15 rights and wishes are always respected even when in conflict with relatives and well-meaning friends. Family and friends are made welcome and know they can visit the home at any reasonable time. The manager stated that resident’s visitors are always welcome to have lunch at the home if they wish. Since the last inspection a residents coffee lounge has been introduced. This is a dedicated area for residents to invite their visitors along to for self-service refreshments and is located at one end of the main dining room. A full activities programme is arranged which includes cultural and religious activities. Church services are available in the home for those wishing to attend. Written handouts detailing forthcoming activities and events in the home and in the community are provided a month in advance to all residents. Copies were seen in bedrooms and displayed around the home on notice boards. The home has its own wheelchair friendly transport. Following the opening of the dementia unit at the home the full time activities co-ordinator attended specialist tarining in providing activities for clients with specific needs. A further part time activities organiser has been employed since the last inspection, a volunteer comes into the home to undertake one to one visiting sessions with those residents who are bed fast and who would like a visit. The home has close links with the local community, local schools visit and provide entertainment for people living in the home. A Friston House newsletter for residents is available on a monthly basis. A lot of hard work goes into producing it and making it as informative, fun and user friendly as possible. Efforts are made to ensure meals offered are to residents liking and the subject is regularly included in residents meetings. Menus seen were seasonal, wholesome and varied. The cook regularly consults with residents. Staff members were seen sensitively helping and supporting residents at meal times. Alternatives to the main meal were always made available. Two survey respondents said they were concerned that food was sometimes not hot enough to enjoy when transported from the main kitchen to their bedrooms. This was discussed with the manager who stated her intention to investigate the concern. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 16 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. 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 a visit to this service. Residents are protected from any potential for abuse and have access to a clear complaints procedure which they or their representatives understand and know how to use. They further benefit from having their views and concerns listened to and acted upon without delay. EVIDENCE: The home has a comprehensive complaints procedure in place and complaints continue to be responded to promptly and in accordance with procedures. The complaints procedure was clearly on view in the home and there were 24-hour fast feedback forms in reception for people to raise concerns and receive a prompt response. Information given by the manager indicated that the home had received 7 complaints since the last inspection. None were substantiated. Records kept included details of investigations and actions taken. All complaints had been responded to within twenty-eight days. Residents appeared at ease talking with staff that clearly listen to their views and concerns. A survey respondent said, “Any concerns reported to the Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 17 management team are acted upon promptly” and “ We always raise our concerns, equally they are always acted upon” Kent and Medway’s Adult Protection Policy has been adopted by the home. Procedures were in place for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The manager confirmed that any allegation of abuse would be referred to the concerned agencies without delay. Staff all receives training in safeguarding adults and are aware of ‘Whistle blowing’. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a safe, well maintained, and clean environment in which good standards of décor and furnishings are maintained. We are confident that the two areas for improvement in this outcome area will be managed by the service and resolved. EVIDENCE: The people who live in the home and their visitors benefit from the ease of access afforded by the premises. There is a passenger lifts to the second floor. There are ample and attractive outside areas and enclosed patio gardens. All of which provide a safe environment for residents and visitors with ample space to wander about. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 19 The courtyard garden is now in need of a facelift and plans are well underway to bring it back to its former glory. Outside contractors are working on landscaping the area, adding raised flowerbeds and making it more wheelchair friendly and accesible by people of all capacities. Residents spoken with were happy with their bedroom accommodation and found the communal areas very comfortable. The manager said there is an ongoing programme of redecoration and refurbishment in place. Several bedrooms had been redecorated and refurbished since the last inspection. Residents’ bedrooms had been personalised and reflected their individual tastes and interests. All but four bedrooms in the home are ensuite and there are ample assisted bathroom / shower rooms to meet residents needs. Assisted bathrooms are spacious and clean but would benefit from more general storage being provided elsewhere in the home. Large items of the home’s equipment have to be stored in them when they are not in use to avoid placing them in corridors where they would potentially cause trip hazards to residents. It must be time consuming for staff to constantly move things about and when the bathroom is in use, equipment of this size has to be placed elsewhere, possibly in corridors or residents rooms for short periods. At the last inspection the previous manager of Friston House stated that one room was to be kept vacant on each floor to use as general storage. In the home’s AQAA the manager states that the home would benefit from more general storage. This is an area for improvement that the service has recognised and needs to improve. We are confident the provider will revisit this. Panamatic sluicers are in situ for disposal of waste continence aids. The home’s equipment is serviced regularly and is well maintained. The home was found to be completely odour free and pleasant. There are sound policies and procedures in place for infection control. Staff spoken with are aware of good practice in this important area. Despite this, a bar of soap and shampoo had been left in an unlocked communal bathroom on the dementia unit, which if accessed by a number of individuals is an infection control issue in a nursing home. The manager undertook to ensure this oversight is to cease. A high number of pressure relieving mattresses were seen in use and an ample number of hoists. As good practice demands, hoist slings are individual to the resident who requires the piece of equipment. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by a dedicated staff team who are well supported and supervised and have a good awareness of residents needs. The home continues to effectively train and develop its staff to their full potential to ensure residents’ needs are met at all times. Residents are protected from any potential abuse by the home’s robust recruitment procedures. EVIDENCE: Since the last inspection the manager has undertaken a comprehensive staffing review. The requirement for the home to do so is now met. Some residents and their relatives had raised insufficient staffing levels during the last inspection as an area of particular concern. The staffing review led to an increase in staffing hours and significant changes in the way staff are deployed in the home, particularly on the second floor where the dependency of residents remains high. The home’s matron is now also supernumery to the staffing rosters, which gives her greater flexibility and the opportunity to offer additional support to staff during busy times. An additional part time activities organiser was employed to increase the opportunities for people to be involved Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 21 in meaningful diversional activities and to allow staff to concentrate on their care duties. A volunteer now comes into the home to undertake one to one visiting sessions with those residents who are bed fast and who would like a visit and thus further eases the pressure on staff. These changes better meet the needs of people living at Friston House and need time to consolidate. Duty Rosters are kept on each unit and staffing levels were said by the manager to be more appropriate to the needs of the current residents. In the absence of the manager the nurse in charge has the autonomy to increase staffing levels to meet resident’s needs. Staff files were correct for content and met the requirements of regulation. A clear staff identification photo however was seen on only one file of the four inspected. The home follows Barchesters recruitment procedures, which are robust but have been using photocopies of staff passports as proof of staff identity. Schedule 2 of The Care Home’s Regulations 2001 does require a recent photograph of the person working in the home. Some photocopies seen of staff passport photos were small, indistinct and badly photocopied. It is recommended that proper photographs be obtained of staff members. A comprehensive induction programme is in place for new staff which informs and directs them how to do their job and is in line with Skills For Care and Barchesters own policies and procedures. Mandatory and update training is regularly arranged for staff. The home has a dedicated home trainer who has 2 days a week allocated for staff training. In addition to the statutory training for staff the home uses a CD Rom training programme for health and safety, food hygiene, POVA and customer care. Friston House is also a member of the Medway college partnership and has access to a large amount of external training, which staff frequently attend. For example, 4 staff members have just completed their four-day first aid certificated training. A training matrix was available to see, which gives a clear overview of staff training, completed, booked and updates due. Training courses were advertised on staff notice boards inviting individuals to attend. The home exceeds the 50 of qualified care staff that the standard demands and is intending to further improve on this number. All Staff receive individual and group clinical supervision and have appraisals where their personal development and training needs are identified and addressed. Residents spoken with and survey respondents spoke highly of staff and said they were kind, caring and skilled. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from an experienced and competent manager who is well supported by a staff team who have consistently sought to improve the service and the outcomes for residents at Friston House. Residents’ financial interests are protected and their welfare promoted through regular maintenance and equipment safety checks and the home has policies, procedures and systems of work in place, which supports their best interests. EVIDENCE: The home has seen the appointment of two new managers since the last inspection. The current manager took up post in January 2008. Sue Watson was transferred from another Barchester Home in the area as the result of an internal management reorganisation. The home is in the process of Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 23 consolidating recent changes and making plans for further improvement to the service and the home’s environment. Some staff spoken with were a little concerned by the recent run of management changes but on investigation they appear to have been managed well and resulted in limited operational disruption to residents or staff. The new manager is a qualified nurse with over 17 years experience in managing nursing home’s. Sue Watson has been registered by us previously and is currently preparing documentation to make application for registration at Friston House. It was clear throughout the inspection she had the resident’s welfare at heart and demonstrated openness and honesty. She has a strong focus on promoting equality and diversity issues and promoting residents rights, especially in the areas of dignity, respect and fairness. Both the manager and matron operate an open door policy at the home and regular resident meetings are held to ensure the home is run in their best interests. The home demonstarted good quality monitoring systems internally and Barchester Healthcare regularly undertakes customer satisfaction surveys. Residents and relatives are made aware of the results and any actions to be taken as a result of the exercises. Resident’s rights and best interests are safeguarded by the home’s policies and procedures. Documents are accessible to staff and regularly reviewed. It was noted that a policy exists for volunteers in the home who go through the same robust recruitment procedures as paid staff. The Home’s administrator is responsible for the residents finances. The Barchester policy is that the home does do not hold residents money and relatives are invoiced monthly. Effective management of financial procedures are adopted to ensure the home’s financial viability and the long term security of resdents. Public liability insurance cover is in place and displayed within the entrance to the home along with their current registration certificate. The home has two maintenance staff who are responsible for numerous aspects of health and safety and form part of the health and safety team at the home reporting directly to the manager. The home continues with maintenance checks and regular servicing of equipment to protect residents from harm. The manager has a written refurbishment and redecoration plan in place. Staff spoken with had a sound understanding of emergency procedures to further protect residents. Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 24 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 4 X 4 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Friston House DS0000069285.V359335.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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