Inspection on 17/10/08 for Francis House

This is the latest available inspection report for this service, carried out on 17th October 2008.

CSCI found this care home to be providing an Good 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

Francis House 24/01/06

Francis House 03/05/05

Francis House 01/11/04

Francis House 04/06/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Chandos House

Cherry Orchards Camphill Community Ltd

Broadreach

Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Francis House Dennington Swimbridge Barnstaple Devon EX32 0QG     The quality rating for this care home is:   two star good 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: Andrea East     Date: 1 7 1 0 2 0 0 8 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 Adults (18-65 years) 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 Adults (18-65 years) Page 2 of 29 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Francis House Dennington Swimbridge Barnstaple Devon EX32 0QG 01271830030 01271830904 info@francishouse.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Assisi Community Care Limited Name of registered manager (if applicable) Mr Michael Crumpton Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 past or present alcohol dependence Additional conditions: Age range 25 years plus Date of last inspection Brief description of the care home Francis House is an inter-denomination Christian home providing care for up to 40 men who have problems relating to the use of alcohol. The homes philosophy of rehabilitation is based on an abstinence model where service users are offered an opportunity to explore an alcohol free future. All service users are expected to contribute to community living with personal skills and commitment. Accommodation is offered in two buildings, Francis House and Clare House and is mainly single occupancy. The grounds comprise of nearly seven acres, and include trout ponds, vegetable gardens, greenhouse and lawned areas. Frances House are unable to offer places via court orders. The range of fee are from #335 to #750 and do not include, chiropody, hairdressing, transport, magazines and paper, toiletries and some external activities. A copy of the inspection report in kept in the office for individuals to see. Care Homes for Adults (18-65 years) Page 4 of 29 care home 40 Over 65 0 40 Care Homes for Adults (18-65 years) Page 5 of 29 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: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 2 Star. This means that people who use the service experience Good Quality Outcomes. The Inspection Site visit was carried out over one day, through into the evening. A range of documents including staff files and individuals files, policies and procedures were examined. People were spoken to in the homes lounge and dining areas and in their private rooms. People spoke to the expert by experience and part of those discussion are detailed in the report. Members of staff were also spoken with. The homes manager was present throughout the inspection. Feedback about the home was also received through survey questionnaires and the homes Annual Quality Care Homes for Adults (18-65 years) Page 6 of 29 Assurance Assessment. What the care home does well: What has improved since the last inspection? 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 29 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 29 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 new to the service or planning to come into the service can be assured that their needs will be fully assessed prior to living at the home. Evidence: Assessment information was viewed for three people. Information held on file included details of the persons past history, current concerns and issues and what other services this person may have been involved with. People said they had visited the home prior to moving in and one person had lived at the home before moved out and then returned. The manager said that people were welcomed into the home on a trial basis as part of an initial and ongoing assessment of their needs strengths and goals. One person was just starting an introductory period in the home and the manager and staff descried positive ways this person would be monitored and assessed. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: The manger said that the assessment of peoples needs were obtained formally through written documentation and informally through individual discussions and participation and observation in group or individual counseling sessions. Assessment documentation was not as clear or easy to read as it could be. Information had been gathered and collated from a number of sources and different recording systems that had evolved over time. Assessment documentation could be improved by being part of one clear care planning system that identifies needs, sets goals and makes clear how those goals will be achieved. Assessment documents needed to be simplified into one easy to read format. Care Homes for Adults (18-65 years) Page 11 of 29 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 were supported by staff who had access to detailed care plans and assessments that provided information on peoples care needs and personal goals. People were supported in making choices and taking risks in their every day lives, although this was not always reflected in the care records. Evidence: Three peoples care plans were looked at and discussed with the manager. Plans of care identified goals and overall objectives that people were working towards as well as detailing individual personal and health care needs. Separate notes were maintained that detailed all health care appointments, hospital appointments and involvement in activities inside and outside of the home. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: The individual files and care plans held a large amount of information in a range of formats. The current system could be improved by simplifying the records in one consistent approach that staff could follow. The current system because it is so complex does not make clear how people are consistently involved in their care, supported to take risks or consulted with. People said that they felt supported to make choices. People speaking with the expert by experience gave mixed feedback about how they were involved in their care. They said yes i have a care plan we talk through it every six months or so and my key worker is writing up my care plan we discussed it. They also said I dont have a care plan and no I dont have a care plan I just carry on as normal. One person was observed being supported by staff to re integrate into the community after an initial period in the home. This support included the opportunity for that individual to take responsibility for there care and to plan how best for to remain following there Care plan by not drinking alcohol while in the community. Care Homes for Adults (18-65 years) Page 13 of 29 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 had access to a range of activities in the home and surrounding environment and the community. People were supported to maintain and develop relationships while their right to privacy was respected. People enjoyed a range of foods and enjoyed their meals and meal times Evidence: Care planning assessment and review documents included some records of the activities people participated in, this included the use of a computer room, a large gym, a snooker room, a chapel and a games room. The manager said that the facilities in the home and the use of rooms was led by the people living at the home. This meant that sometimes areas such as the gym were Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: well used while at other times they were not as well used. The home was set in seven acres of landscaped grounds that included lakes that people could fish from. People said that they enjoyed the setting of the home and peaceful surroundings. People speaking with the expert by experience gave mixed views of activities in the home and links with the local community. People said there is no structure here, it is a bit quiet its not like rehab it is a bit of a retreat. The best thing is the peace and tranquility the worst that they needed more activities. While others said this is a care home and a rehab together and I was given a lot of advice I was linked up with outside agencies. The homes Annual Quality Assurance Assessment described the opportunities for personal development and Independence as follows; people are offered choice and variety and an opportunity to participate in the decision making process through suggestion of activities in group discussion at the house meetings and also in meetings with their key workers. People are helped to take up opportunities to advance their educational and vocational interests. Seven out of nine surveys from the people living at the home said that they always made decisions about what they do each day. Surveys said staff ask me if i would like to do things it is up to me to make choices and each day is different i usually make my own decisions on a daily basis. Overall people said that they enjoyed the food, meals and snacks available.One person said the food is brilliant. The expert by experience noted that there appeared to be a choice of foods and that most people enjoyed the food although this was not the case for everyone. Care Homes for Adults (18-65 years) Page 15 of 29 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People received personal health care and emotional support in the way they preferred and required. People were protected from harm by good medication procedures. Evidence: People said that the routines in the home were flexible to suit individual needs and preferences. People said that they attended to their own personal hygiene needs or had minimal support from staff. If more support or guidance was needed this was recorded in assessment and care plans. Peoples needs varied so that some people who Had been at home for a long time wanted very little support from staff in terms of counseling or staff time. Others who were new to the home were taking a more active part in some kind of activity or counseling. One person said that there health had significantly improved since living at the home. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Surveys said that people had access to their doctor and other health professionals as needed. There were good policies and procedures in place for the safe storage and administration of medications that protected people from harm. For those people who wished to look after their own medication this was agreed as part of risk assessment monitored and recorded. The arrangements for people who look after their medications in the evening included staff signing that people had taken medication away from the main storage area. It was not clear from those records if people had then taken the medication. Staff signatures should be to confirm that people have taken medication. This meant that in the event of an accident or emergency staff could not be clear what medication has been taken (not just received but taken). Care Homes for Adults (18-65 years) Page 17 of 29 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. peoples views are listened to and acted upon and people are protected from harm. Evidence: Most People said that they felt listened to and safe and that staff would support them in raising concerns or complaints and addressing concerns. One person said that if they complained to much they got booted out and two people said that they had asked for things to be done but nothing changed. The manager said that they took all concerns and requests for improvements very seriously and did there best to address any issues quickly. The complaints record system had no complaints recorded so that it was difficult to verify the concerns people had raised and how they had been addressed. A quality audit with a questionnaire to every person living in the home is circulated twice a year. So that people can raise concerns this way and they are recorded and it is clear when they are addressed. People said and surveys also indicated that people felt comfortable speaking with their key worker. ( a member of staff allocated to spend time on an individual basis for one to one time with people). They said that the key workers would address any concerns and provide advice. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: Staff training and policies and procedures for staff included how to raise complaints and safeguarding people from harm. Care Homes for Adults (18-65 years) Page 19 of 29 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 lived in a homely comfortable environment that was clean and hygienic Evidence: A tour of the premises was completed with the manager. The home offers a range of areas for recreation, two lounges, a gym, a large dining area, a chapel and extensive grounds including a vegetable garden and ponds. Peoples rooms had been personalized with items of furniture pictures and ornaments. The manager described some of the improvements in the environment which were also detailed in the homes annual quality audit assessment. Improvements included one lounge completely refurbished including rewiring, new carpeting, redecoration and new furnishings. The central heating system had been extended and fluorescent lighting replaced with more homely and attractive lighting throughout the home. Concrete steps that had failed previous health and safety guidance had been replaced with additional safety rails in place. A range of documents related to health and safety were in place including risk assessments for the premises, health and safety policies and training records that Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: showed staff had received training in basic health and safety such as Fire safety. There were a range of systems in place to ensure the premises was maintained as clean and hygienic including staff cleaning rosters and support for people to participate in maintaining the cleanliness of their private rooms. People said that some of the repair work in the home had seemed to go on for a long time. It was observed that repair work seemed to have been started and then stopped. One visitor to the home also commented on the repair work pleased that the home was being maintained but concerned at the time this seemed to have taken. Care Homes for Adults (18-65 years) Page 21 of 29 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 were supported by a trained competent staff team which included the manager and the responsible person for the home. Evidence: The manager confirmed that staff continue to complete a range of training at National Vocational Care level three and above or have the equivalent qualifications. Staff records showed a range of training and competency for staff. There was no consistently completed ongoing record of what and when staff training had been completed, this information was gained through looking at each person file or at a grouped of certificates. One ongoing record would make it easier for the manager to identify when training is needed for specific staff. Three staff files were examined which held a range of recruitment records including police checks, references and some interview notes. Files also showed that staff had received an induction into the home and had been routinely supervised. People said that the staff were brilliant always helpful, providing support and advice. Care Homes for Adults (18-65 years) Page 22 of 29 Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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 lived in a well run service, where their views were taken into consideration and health and safety issues were taken seriously. Evidence: The registered provider and manager have many years of experience in care and running the home. They have also continued to update themselves on current practice issues and have a range of qualifications. There were a range of good systems in place to ensure the affective management of the home including good health and safety practices, good staff training and recruitment and good financial management. There were also systems in place to include the views of the people using the service such as the quality audit questionnaires, regular meetings with staff and other people living in the home in groups and on an individual basis. Feedback about the service was also obtained from visitors and other professionals. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The manager registered provider and staff group have been awarded the Investors in People Award which is due to be reviewed in 2010. This is an award given to business in recognition of the work they do in providing well trained consistent staff and having good systems in place. Care Homes for Adults (18-65 years) Page 25 of 29 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 Adults (18-65 years) Page 26 of 29 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 2 Assessment documents could be simplified into one easy to read format that are clearly linked to care plans and individuals goals. Simplify the care plan and assessment records to show more clearly how people are consistently involved in their care and in making choices. taking risks in their everyday lives. record more fully the activities people participate in and how they are linked to their personal goals, risks and achievements Review the recording of medication in the evening. For those people who are self medicating, introduce a way of recording , when people have taken medication in an evening. (when medication is taken not just when it is removed from the administration area). Record more consistently and in more detail peoples day to day concerns and complaints and the action taken to address the concerns raised. consistently complete interview notes when interviewing potential staff and consistently keep up to date records of all training staff have completed Page 27 of 29 2 6 3 12 4 20 5 22 6 34 Care Homes for Adults (18-65 years) 7 35 consider completing a training matrix so that it is easy to see when staff need training updates Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.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). 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. Care Homes for Adults (18-65 years) Page 29 of 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!