Frome Care Village

Frome Care Village provides care and accommodation for up to 60 older people in two separate buildings. Woodlands provides nursing care in a purpose-built building and The Parsonage is an adapted building for people living with dementia. At the time of the inspection there were 51 people living at the service.

People’s experience of using this service and what we found

Quality assurance systems in place were not always effective at identifying concerns or areas for improvement. The provider had failed to implement and sustain improvements. This is the 3rd consecutive time the overall rating for the service has been rated less than good.

There were not always enough staff on duty and staff were not always appropriately deployed to support people in a timely and person-centred way on the Woodlands unit. This impacted on waiting times, daily routines, including mealtime experiences, activities, and attention to personal care needs.

There were mixed views about staff's skills, competency, and training. Staff training was overdue according to the provider’s records. The Provider had invested in a bespoke in-person training programme but some staff acting in clinical roles had not completed training in line with their policy. There was 1 qualified registered nurse on duty for 41 people with assessed nursing needs. We did not find evidence that people's clinical needs had been negatively impacted by this.

We were not assured the provider was promoting safety through the layout and hygiene practices of the premises. Some areas of the premises were not clean. Cleanliness had improved by the second day of the inspection.

People received their medicines in a safe way. However, some improvements were needed to the way people’s medicines were managed and recorded.

Some routines were not person centred. We have recommended that daily routines are reviewed to ensure person-centred care and support is consistently delivered to people living at the service.

People spoke positively of the culture of the service, which was described as calm, and friendly or jolly. Most people expressed satisfaction with their care.

The manager was open, and willing to listen and act on any concerns.

The service worked in partnership with other professionals. Work was underway to improve working relationships and communication with some external professionals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence, and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people. We considered this guidance as there were people using the service who have a learning disability and or who are autistic.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 04 July 2022). The service remains rated requires improvement. This service has been rated requires improvement for the last 3 consecutive inspections.

Why we inspected

We received concerns in relation to the management of the service and staff competencies. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of the full report.

The provider has taken action to mitigate some risks identified.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Frome Care Village on our website at www.cqc.org.uk

Enforcement and Recommendations

We have identified breaches in relation to staffing levels and staff training, and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Frome Care Village provides care and accommodation for up to 60 older people in two separate buildings. Woodlands provides nursing care in a purpose built building and The Parsonage is an adapted building for people living with dementia. At the time of the inspection there were 47 people living at the service.

People's experience of using this service and what we found.

Systems and procedures were in place to reduce the spread of infection. The environment in Woodlands was clean; however, we identified some concerns regarding cleanliness and fridge temperature monitoring in The Parsonage.

Staffing had improved, there were domestic staff vacancies and these were in the process of being filled. There were some gaps in recruitment practices. People were happy with how their medicines were managed. Medicines were stored securely; action was required to ensure medicines were stored at the correct temperature. Incidents were reported and monitored. Risks to people were assessed and mitigated.

Some improvements were still required to ensure the systems in place to monitor the service were fully effective. The provider had action plans in place to drive service improvement. Communication systems had improved. Staff felt supported by the provider. There was a positive culture and atmosphere at the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 18 October 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found some improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Frome Care Village provides care and accommodation for up to 60 older people in two separate buildings. Woodlands provides nursing care in a purpose built building and The Parsonage is an adapted building for people living with dementia. At the time of the inspection there were 55 people at the service.

People’s experience of using this service and what we found

The environment where people were living was not always safe from the risk of fire, well maintained or clean. Governance systems had not ensured that all areas of the service were monitored and improvements made where shortfalls were identified.

Accidents, incidents and safeguarding concerns were reported and managed. Systems within the service were not always effective in communicating these outcomes.

Procedures were in place to ensure the risk of infections were managed and reduced. Medicines were administered safely. Safe recruitment procedures of new staff were in place. Staff felt supported by the provider.

Staffing changes and shortages had impacted on the service however the provider was working to address these.

People were supported by staff who were kind, caring and committed. Staff were responsive and attentive to people’s support needs.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was good (published 2 December 2020).

Why we inspected

We received concerns in relation to the management of safeguarding, staffing and infection control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Frome Care Village on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 15 (Premises and equipment) and Regulation 17 (Good governance) at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People and staff had been showing symptoms of COVID- within in the home. At the time of the inspection everyone had tested negative and there had been no confirmed cases. We were assured the provider was keeping people safe. We found the following examples of good practice.

Staff had received training in infection control, including how to safely put on and take off personal protective equipment (PPE) such as gloves, aprons, and face coverings. One staff member told us, “Every Thursday evening we have access to a live event on social media where our clinical team do updates and remind us about how to use our PPE.” We saw staff wearing appropriate PPE and changing their PPE when moving from room to room.

The provider completed a risk assessment for visitors so that people were still able to see their relatives. At the time of the inspection visiting was restricted to Wednesday afternoons in one-hour slots. One staff member told us, “We want people to visit their families safely, but we do give priority to people who on at the end of their life.” Another staff member told us, “We also support people to use phones and other technology to keep in touch because some relatives can’t visit as they themselves are shielding.”

Staff told us visitors entering the home had to complete a declaration that included recording their temperature. Visitors were also asked to wash their hands and wear full PPE including gloves and boiler suits. Staff worked in dedicated areas of the building and entered through separate entrances. Staff recorded their temperatures, washed their hands and had them checked under an ultraviolet light before using hand sanitiser and then putting on gloves.

The home was split into two houses and staff could isolate each floor within the houses. The registered manager told us, “People living in Woodlands were happy to self-isolate and staff encourage people living on Parsonage as much as possible.” Adding, “We have a dedicated corridor in each house that is zoned off for anyone who tested positive.”

The registered manager had regular contact with the local commissioning team to monitor the outbreak. The registered manager told us, “They are happy with the way we are managing the outbreak.”

The provider was not admitting people to the home currently because they had not had any referrals due to COVID-19. The registered manager told us they had vacancies, but no one would be admitted without a negative test first. The registered manager ensured regular testing was carried out, weekly for staff and monthly for people living in the home.

Staff we spoke with were confident and knowledgeable about how to protect people from the risk of infection. The provider had recently recruited four extra domestic staff to support the current team and ensure the cleanliness of the home is well maintained.

Further information is in the detailed findings below.

Frome Care Village is a “care home”. People living in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

There is a registered manager for the service this is a legal requirement. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The inspection took place on 18 April and 19 April 2018 and was unannounced for the first day and announced for the second day.

People spoke positively about the quality of the meals. One person said, "I always enjoy my meals here and there is always a choice." There were arrangements to make sure people's nutritional needs were catered for and meals were relaxed. However, this could be improved by looking at providing opportunities for some people to choose to have a shared and more social meal experience.

Ongoing improvements to The Parsonage had helped to make the environment suitable for people living with dementia. However, the top floor would benefit from the creating of a more light and airy environment.

People told us they felt safe living in the home. One person said, "I always feel safe here because there are always staff around when you need them." There was an environment which promoted independence and recognised the right of people to live the life they chose. Staff had a real understanding of people living with dementia specifically around how this could impact on people's communication and behaviour.

Staff supported people in a caring, compassionate and sensitive way. They recognised the importance of treating people with respect. One person told us, "You cannot fault the staff they are so caring and kind."

Staffing arrangements had improved since our last inspection with improved retention and recruitment of staff. There was consistency and continuity in the providing of care as a result of this improvement.

There was an approach, to ensure people particularly those with complex mental health needs were supported by specialist services with the home recognising the importance of working with other health and social care professionals.

The provider and registered manager were actively promoting a culture where people could be confident of receiving quality care which met their needs. They recognised the importance of having skilled and trained staff in providing consistent care to people living in the home.

People and staff spoke positively of an approachable management where they felt listened to and encouraged to be part of the home and how decisions were made and care provided.

Frome Care Village provides nursing and residential care to people who are living with dementia and people who have nursing care needs. There are two parts of the village one part being The Parsonage which is divided into three "houses" each supporting people who are living with dementia and are at differing stages of their illness. The other part of the home is called Woodlands and supports older people who have care needs because of physical disability and needs which can be associated with old age. At the time of our inspection there were 50 people living in the home. The home is registered to provide care and support to 60 people. There was a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

There was differing understanding from staff about their responsibilities to report any concerns about possible abuse. Two members of staff which included a senior member of staff did not understand that incidents of aggressive behaviour, which may occur and could be viewed as abuse, should be reported to the local safeguarding team for investigation.

We identified two incidents which whilst incident reports had been completed had not been referred to the local authority safeguarding team or the commission. These two incidents were referred to the local authority safeguarding team at the time of the inspection. They judged the incidents did not warrant further investigation and that there were no ongoing concerns about the health and welfare of the people concerned. This decision reflected the actions taken by the provider.

There were failures to ensure the arrangements for the administering of covert medicines were safe and ensured people received their medicines in a way that was effective. Covert is where people receive medicines disguised in food or drink. There was no clear instructions and agreement about how medicines were to be administered in these circumstances.

There were administering errors in that records of administration of medicines had not been completed. This had included a medicine that required a signature from the staff member administering the medicine.

Arrangements for the use of slings (these are used to help move people when needing a hoist) did not ensure the risk of cross infection was alleviated in that there was a risk slings could be used for more than one person.

The arrangements for the monitoring of the quality of the service were not always effective in identifying areas for improvement.

People told us they felt safe living in the home and how they were confident about the skills of care staff. Staff were benefitting from training which looked at the values around how care for people living with dementia was to be provided.

People told us they were satisfied with the availability of staff. One person told us "I feel safe with them (staff) around all the time." Staff said how they felt there was sufficient staff on duty and able to respond to people's needs in a timely way. We observed staff being available and responding promptly to people.

Staff had received training specific to supporting people living with dementia. This had led to staff commenting how their confidence had improved and having a greater understanding of the needs of people living with dementia.

The registered manager had, as required, made applications under the Mental Capacity Act 2005 and obtained authorisations under Deprivation of Liberty Safeguards (DoLS) arrangements. Where people lacked capacity their rights were upheld and their health and welfare protected.

We identified a number of improvements since the last inspection. Healthcare professionals we spoke with were positive about the care provided by the service. People had access to community health services and their GPs when this was requested. There were good relationships with outside professionals and people had access to specialist support and advice.

The service ensured people's nutritional needs were met and took action to address any concerns about people's physical wellbeing and ensure they were able to have a healthy diet suited to their needs.

People spoke of respectful staff who recognised their right to privacy and upheld their dignity. We observed how staff responded to people's anxieties and distress in a calm, thoughtful and sensitive way. People and relatives spoke of staff as being "Caring and kind." and "Treating my relative with respect."

We observed staff using touch as a way, when appropriate, to comfort and re-assure people. Staff demonstrated an ability to support people in a caring and sensitive way and were accepting of people's behaviour.

We observed positive interaction between staff and people living in the home. There was a relaxed and warm environment. People and their relatives told us visitors could visit at any time. One relative told us "We are welcome to visit any time."

People felt able to voice their views or concerns about the service. One person said, "I have never had to make a complaint but would if I needed to. I am sure they would listen and do something about it." The service was open to receiving comments and taking action where this was needed to improve the quality of care.

Care planning and approach of staff reflected person centred care. Staff recognised individual needs, choices and wishes and care was based on those needs. There was a respect for people's routines and preferences.

The registered manager promoted an open inclusive environment where people and staff felt able to voice their views.

The environment and culture of the home resulted in people and staff being able to feel involved and valued as individuals and staff. There was an environment enabling people to receive a service which recognised their needs.

We found a breach of the Health and Social Care Act 2008. You can see what action we told the provider to take at the back of the full version of the report .