This inspection took place on 16 and 17 September 2015 and was unannounced.
Frome Care Village is registered to provide nursing care for up to 60 older people. There are two separate units: The Parsonage provides support and nursing care for people living with dementia and Woodlands for people who need nursing care because of physical health needs.
At the time of our inspection Woodlands was closed for building and refurbishment work. People who had lived in Woodlands had moved to The Parsonage during the period of work.
Since our last inspection as part of the improvements made by the service The Parsonage has been divided into four separate and distinct “houses”. Wood house provides personal and nursing care, Wells House provides care for people with early onset dementia, Catherine House and Somerset House provides care and support for people who have later stage dementia.
There is a registered manager in post. 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 and associated Regulations about how the service is run.
Some people were restricted through the use of equipment such as pressure mats, bed rails and bucket chairs. There was a failure to ensure people’s rights were protected and decisions made for the use of such equipment was in their best interests.
We noted comments made by people who had moved temporarily to The Parsonage about the lack of communication about possible return date and progress of the refurbishment. This reflected a failure by the registered manager and provider to ensure people were fully informed and updated about returning to their accommodation at The Woodlands.
Improvements have been made in the staffing arrangements of the service which has led to a safer and more responsive service. People told us “There are always staff around if I need a hand.” and “The staff are there when I need them.”
The provider had improved their practice in responding to possible safeguarding incidents and revised their policy so it is clearly stated the responsibilities of staff when they had concerns about possible abuse.
Staff understood and demonstrated an understanding of what could be considered abuse and told us they would report any concerns to the registered manager or other organisation under whistleblowing arrangements.
People told us they always received their medicines when they were needed. One person told us “I get my tablets at the right time they make sure I take them as well.” There were the appropriate arrangements for the storage, management and administration of medicines.
Arrangements were in place to protect people in the event of an emergency and also identified potential risks to people’s health and welfare and how they could be alleviated.
There had been substantive and significant improvements in the environment of the home including the establishing of “houses” which reflected the particular needs of people living with dementia. All parts of The Parsonage had benefited from on-going redecoration and refurbishment.
There was a calmer, more relaxed atmosphere in the service with people being “happier” and “calmer”. People were benefiting from this calmer atmosphere through less agitated or distressed behaviour and improved interactions between people and staff.
People told us they could make choices about their daily routines and how they spent their time. One person said “It is up to me what I do staff respect it is my choice.” Staff demonstrated an understanding of people’s right to make their own choices as well as how decisions could be made in people best interest.
There were inconsistencies in ensuring the effective management of the care needs of people who had diabetes specifically those who were diet controlled. We have recommended the service consults guidance about supporting people who have diabetes.
People had access to community health services as well as specialist services for people who had complex or specific needs such as those related to nutritional or mobility.
There was evidence through care plans, daily records and conversations with people and staff how care was responsive to people’s needs. Staff had identified changes in people’s health and made referrals for specialist advice and support.
Staff received regular one to one supervision and training to ensure they had the necessary skills to provide safe and effective care.
People told us they found staff “Caring and kind” and “I have lived here some time and never found fault with the care. It is absolutely brilliant.”
A relative told us “Staff are compassionate and considerate.” During our inspection we observed staff supporting and assisting people in a caring and sensitive manner.
Changes were being made in how activities were being provided. There was increasing focus on individual meaningful activities although there were mixed views from people about the quality of the activities.
Staff spoke positively about the supportive and open approach of the registered manager. The registered manager was making improvements in ensuring people received person centred care which recognised the importance of staff and people interacting in a valued and empowering way.
Staff told us how morale had improved with better team working and one staff member told us “There have been a lot of changes they are all for the better.”
Improvements had been made in the quality assurance arrangements with new care planning arrangements to support quality assurance monitoring. New incident reporting procedures had been put in place and audits had identified small improvement in the number of incidents and falls over a three month period.
We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.