Frome Care Village

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

At the last inspection in May 2023 the provider was in breach of regulation 18, Staffing, of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because they had failed to ensure there were sufficient numbers of suitably qualified, competent and skilled staff on duty. The provider had made some improvements but not enough to meet the breach of regulation. Improvements had been made regarding the deployment of skilled staff across the home. However, the Woodlands unit did not have enough staff on duty to meet people’s needs in a timely way. Staff knew how to recognise and report abuse, they told us they would not hesitate to report any concerns to the registered manager. Staff received safeguarding training. Individual care plans contained risk assessments which gave staff guidance about how to minimise risks. During the assessment site visit we observed people mostly being supported in line with their care plans and risk assessments. There were systems in place to share learning across all of the providers homes. Where people lacked mental capacity to make specific decisions, it was not always clear what process was followed to assess people’s capacity and who was involved in any best interest decision made. People were supported to see healthcare professionals as required. However, health and social care professionals shared the difficulties in making appointments and accessing care records. We observed that the home was clean and staff had access to appropriate personal protective equipment (PPE). Maintenance staff carried out a series of health and safety checks, however these had not been consistently completed. Medicines were mostly safely managed. However, minor discrepancies were highlighted on the day of the site visit which had not been picked up by the providers quality monitoring processes.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were grateful for the action taken since the last inspection and said things had improved. One person told us their care was much better. Other comments included, “Staff here show they care and will go above and beyond to residents.”; “They are making changes to improve things all the time and the staff work as a team not individuals.” and “The staff do go on a lot of training days which takes them away from the home.” They gave an example where a staff member had come in on their days off to support a very personal visit.

Staff had worked to make improvements and they spoke of working together as a team. They told us they had confidence in the changes being made and felt more positive in reporting matters.

Policies and procedures were in place to support people’s safety and ensure lessons were learnt when things went wrong. The provider had acted upon some areas identified at the last inspection. However, they had not improved their quality monitoring process to ensure areas identified for improvement were acted upon.

People felt safe at the home and looked comfortable and relaxed with staff who supported them. One person told us the home supported them to attend a hospital appointment. We observed another person being supported to the hospital for an appointment during the site visit. Another person told us, “I really like it here. The carers are really sympathetic and helpful.” Relatives said they felt informed and had no concerns about access for their loved one’s health needs. They told us, “The staff let me know when I arrive whether a good or bad day. I always see the same staff around…she always looks well kempt” and “They keep her skin ok, there is a good GP and the home contact them…has chiropody and eyes checked.”

Staff told us they were confident action would be taken by the nurses and care practitioners if they reported any concerns in relation to people’s presentation.

External professionals told us communication had improved at Frome Care Village. They told us that people they support were positive about the staff and the home. However, we were told about difficulties in getting information promptly from the provider. One professional commented, “They want two weeks’ notice and paperwork is sent from the central office…They (staff) are not allowed to communicate, only admin can.” We discussed this with the provider who told us they had a policy regarding planned reviews. They said this was in place so people’s care was not impacted by a staff member having to stop undertaking care tasks to support an unexpected review. They planned reviews so they can had a supernumerary staff member available for these within 2 weeks of the request. They confirmed this policy did not include advocates, healthcare professionals and social visits. During this assessment, the policy was added to the providers website to ensure a clear understanding. The provider told us about their process to undertake an admission to Frome Care village. This did not always include an in-person pre-admission assessment. Professionals told us this process was not always effective and additional reviews were requested, following admissions to the home.

Processes were in place to ensure people could keep up to date with their appointments and health needs. Staff were able to support people to attend appointments where needed and the management team were working with external bodies to drive improvement at the service. Records showed people were supported healthcare professionals when required.

People felt safe at the home. People’s comments included, “It’s safe here. All the doors are key coded”, “I am well treated here” and “The carers are really kind.”

Staff told us the home was a safe place to live and work in. They knew how to identify safeguarding concerns and who to report those to. Staff told us action was taken if/when they reported any concerns. One member of staff said, “Yes, I think it’s a safe place for people to live in. The staff here do everything to maintain safety.” Staff told us they had received training in safeguarding people. One member of staff said they had never seen anything which concerned them but if they did, they would, “Report straight to the manager. Confident action would be taken.” Staff spoken with understood the principle of the Mental Capacity Act 2005. They told us about the process of making decisions in people’s best interests, where people lacked the mental capacity to do so.

People looked very relaxed and comfortable with staff who supported them. We noted that one person was extremely animated and happy when staff walked past and interacted with them. Staff treated people with empathy, respect and dignity, addressing them by their preferred name which everyone seemed to appreciate and responded to.

The provider and management team recognised their responsibilities to raise safeguarding alerts when needed for people in their service. For example, where a person was placed at potential risk through a poorly planned discharge to a new healthcare setting this was raised with the local authority safeguarding team and CQC. Mental capacity assessments and best interest decisions were in place, although the process taken by staff to assess the person’s capacity was not always clear. For example, how the information had been presented to the person, and whether this had been completed at various times of day. It was also not clear who was involved in any best interest decision made. Where needed, appropriate applications were completed to authorise a person being deprived of their liberty.

People and relatives raised no concerns about how risks were managed at the home. One relative told us, “My mum has been here (several years) and even though she has been bed bound for much of that time, she has never had a pressure sore…that’s good care!”

The home cared for some people with complex needs who could be unsettled or anxious. One member of staff said they had not received any specific training on how to best support people who were experiencing distress. The provider told us in the provider information return, “On each shift we will plan to ensure that we have someone from the leadership team present to support with the higher needs of the running of the shift…”

During the assessment site visit we observed people mostly being supported in line with their care plans and risk assessments. Staff were observed supporting one person in a way which was not outlined in their care plan. Pressure relieving equipment was being regularly checked to ensure it was set at the correct setting for the individual using them.

Individual care plans contained risk assessments which gave staff guidance about how to minimise risks. For example, for one person who was said to be at risk of choking on food. Staff were instructed to make sure the person was sat in the correct position before offering them food. Another person had a diabetic management plan in place detailing the actions the staff should take if they became unwell. Positive behaviour care plans were in place for people who could become anxious and place themselves and others at risk. One care plan we saw contained possible staff interventions which may alleviate distress. However, measures which staff told us about were not included in the care plan. The care plan did not clearly identify positive day to day things that could prevent distress. Staff had regular handovers and daily meetings with heads of departments to enable information sharing, especially regarding changes and risks.

People raised no concerns about the environment during our site visit.

Maintenance staff told us about the safety checks they carried out. They said they were provided with anything they needed to make sure the building was maintained to a safe standard.

The home was tired and worn in some areas. However, the provider had a redecoration plan in place.

Maintenance staff carried out a series of health and safety checks. Records were kept of all checks such as water temperatures, visual lift checks and tests of the fire detecting equipment in the home. However, the provider had identified checks had not been consistently completed for the first three months of 2024. This put people at potential risk of the environment not always being safe.

People and relatives told us there were not enough staff deployed on the Woodland unit to meet people’s needs. They told us, people were still receiving personal care at lunchtime and because the staff were so busy, they felt it was task orientated. Comments included, “She is often in bed still at 11.45” and “Staffing seems lower sometimes, some empty beds, I think they are short of staff…staff are good, non-disagreeable, caring but they have too much to do.” People were complimentary about the staff who supported them. One person told us, “Staff are excellent.” Another person said, “Staff always ask what I want.” People and relatives raised no concerns about the staffing levels on the Parsonage unit. A relative told us, “The staff have a good mix of skills and they are good with the challenging behaviour of some of the residents.’ Another said, “I can visit any time, …and I do as I come early mornings, afternoons and evenings.” Health and social care professionals raised concerns about the staffing level and access to social activities for people. Comments included, “The Woodlands appears to have a low staffing ratio based on the number of residents living there…There was a general lack of activity and social stimulation for residents in The Woodlands when I visited last. Often, residents’ basic needs are met only.” And “I have been sent the daily records for two residents and it is not recorded that any activities have been offered aside from taking them to communal areas of the home.”

Staff had mixed views about if there were enough staff to meet people’s needs promptly and consistently. Staff spoken with on the Parsonage unit told us they had enough staff, including for people who required 1 to 1 care. One member of staff said, “It’s OK at the moment, we have enough staff.” Staff on the Woodlands unit did not think they had enough staff to provide consistently good care One member of staff told us they are usually still supporting people out of bed at 12.15pm every day. Another staff member said, “The people here can get average care, not always good, only average. It depends on staffing; having two staff on one floor is really hard as we are full. People will sometimes need to wait to get up, wait for meals, drinks or for care.” Staff told us they received regular training which was appropriate and relevant to their role. Training was a mixture of face-to-face sessions and online training.

At this assessment site visit we observed there were insufficient numbers of staff on the Woodlands unit. This impacted on the time people had to wait for support, daily routines, mealtime experiences, activities, and attention to personal care needs. For example, we observed staff still supporting people out of bed at 12.15pm and staff had little time for social interaction with people. Staff and relatives confirmed this was normal and said it was task orientated. The manager told us they did not have a full team on the Woodland unit, with one short, because staff were attending training. We looked at the staff rota for the month of June 2024 and on 12 occasions they were one member of staff short. The majority of people on the Woodland unit required two staff members to undertake their personal care needs. Care staff were busy undertaking tasks. The main people chatting to people were the domestic staff and a couple of people said the maintenance person was always very chatty and cheerful. We observed limited meaningful activities or occupation for people on the Woodlands unit during the morning of our site visit. For some people, the mealtime experience was not person centred or sociable. Although the meal was ready to be served at 12.30pm, some people were still in bed and were supported with their lunch much later. On the Parsonage unit we observed there were enough staff to support people with personal care and to spend time socialising with people. Staff supported 10 people to have their lunch in the garden. Staff were very attentive to people’s needs and everyone appeared to enjoy the experience. There were no other organised group activities throughout the day although a few attempts by individual staff were made, for 1 to 1 activities.

At the last inspection, we found the provider in breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider failed to ensure there were sufficient numbers of suitably qualified, competent and skilled staff on duty. Although improvements had been made by the provider, with the registered nurse being supernumerary and overseeing both units with a care practitioner on each unit. We found there were still staff shortages on the Woodland unit where there was a high level of dependency with the majority of the 24 people there requiring two staff to undertake their personal care needs. A care practitioner and 5 care staff were allocated for the Woodland unit during the day. The staff rota showed in June 2024, 12 days where there were not 5 staff on duty. The provider told us on these occasions the housekeeping team would undertake hostess duties to support the care staff. We observed the housekeeping team supporting with drinks and meals when we visited. However, people were still waiting to have personal care at lunchtime. Therefore, the provider remains in in breach of Regulation 18 The provider told us in the provider information return, “We look at the staffing levels, funding and the experience of the team… An allocation list will go out to the team every evening where the skill mix of the staff will be taken into account to ensure that the needs of the family members are met effectively.” The provider had a procedure guiding staff in the event of staff absences.

People and relatives praised the cleanliness of the home. Comments included, “It’s much cleaner now, and they are gradually getting new furniture”; “Her room is clean”; “His room is clean, never a smell” and “Room is clean.”

Housekeeping staff told us they had access to equipment and quality cleaning products to enable them to ensure good infection control practices were in place. They confirmed they had cleaning schedules in place. Staff said they had access to personal protective equipment.

The service was clean. People’s rooms had pictures and ornaments and several people had their own fridges which they said family kept stocked with things they liked. We observed housekeeping staff carrying out cleaning tasks on the day of the assessment. There was appropriate personal protective equipment (PPE) available throughout the home which we observed carers wearing when supporting people.

The home employed a dedicated housekeeping team. There were comprehensive cleaning schedules and checklist were completed to show tasks had been completed.

People raised no concerns about their medicine management. One person told us, “They look after your medication. You get the right meds.” We observed staff administer medicines during our site visit. They spent time with people, were informative and ensured they had a drink with their medicines to help them take them safely.

We discussed with staff how they ensured medicines were administered with the required gap between their doses. Staff told us, they would record on their notes and pass it over to the next staff member administering medicines. There was not a formal system in place to ensure people’s medicines were administered with the required time gap between them.

Medicines were mostly safely managed but there were a few areas which required improvements. This included, monitoring more consistently the temperature where medicines were stored and taking action when these temperatures were outside of the recognised range. Staff had not always consistently signed handwritten entries on the medication administration records and completed changes in people’s medicines documents fully. Following our last inspection improvements had been made to ensure nurses administering medicines had their competency assessed. However not all staff had had their annual competency assessment completed at the time of our assessment. Where medicines were prescribed 'when required', staff had recorded the times of administration for these medicines.