Inspection on 03/11/05 for Dr French Memorial Home Ltd

This inspection was carried out on 3rd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Dr French Memorial Home Ltd 16/09/06

Dr French Memorial Home Ltd 14/07/05

Dr French Memorial Home Ltd 14/12/04

Dr French Memorial Home Ltd 27/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Dr French Memorial Home Ltd 13 Nether Street Finchley London N12 7NN Lead Inspector Tom McKervey Unannounced Inspection 3rd November 2005 10:40 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 Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 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. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Dr French Memorial Home Ltd Address 13 Nether Street Finchley London N12 7NN 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) 020 8445 4353 020 8445 4353 Dr French Memorial Home Limited Florence Somers Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30) of places Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users Limited to 30 people of either gender who fall into the category of old age (OP) and who may have dementia (DE(E)). One specific service user who is under 65 years of age can reside in this home. The condition will need to be reviewed when he vacates the home. 14th July 2005 Date of last inspection Brief Description of the Service: Dr. French Memorial Home is a care home registered to provide care for 30 older people, some of whom may have dementia. The home has charitable status and is run by a voluntary committee. The stated aim of the home is; “To support residents to continue living as independently as possible by receiving care and support consistent with their incapacities and disabilities”. The home consists of a large two-storey, detached building. An extension has been built on either side of the original house. There are 24 single bedrooms and 3 double bedrooms, located on the first and second floors. Fifteen single bedrooms have en-suite facilities, and there are eight communal toilets, three bathrooms and a shower. On the ground floor, there are two lounges, a dining room, a hairdressing salon, an activities room and two offices. There is a large, secluded, attractive garden at the rear of the premises and a car park at the front, which is secured at night by railings and gates. The home is situated near the busy Tally Ho Corner in Finchley, North London and there are good public transport links. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed in five hours. The registered manager was present throughout the inspection and fully cooperated in the process. The inspection included a tour of the premises, talking to six residents individually, and three relatives. Two staff were also spoken to at length and brief discussions were held with several other staff, including carers, cleaners and catering staff. Residents’ case files and other documents pertaining to the efficient running of the home were examined as part of the inspection process. What the service does well: What has improved since the last inspection? New lighting has been installed in the car park, which further improves the security of the home. Five bedrooms and the staff toilet have been redecorated. A programme of replacing all thermostatic valves in residents’ bedrooms is underway. Information technology training has started for staff, which will improve presentation of care plans and progress notes, and a computer has been provided for staff to practice these skills. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 6 A programme of training in adult protection for all staff has been carried out, and a total of nine staff have begun National Vocational Qualification training at Level 2 & 3. The practice of wedging bedroom doors open has ceased 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. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 7 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 Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 & 5. Standard 6 does not apply. Residents and their representatives are able to make an informed decision about the suitability of the home from being provided with good information and the offer of trial visits. There are good assessments of service users to ensure that the home can fully meet their needs. EVIDENCE: The records of three recently admitted residents were examined. They contained contracts of terms and conditions, including the fees charged. All relevant parties signed the contracts. At the time of the inspection, a resident whose mental health had deteriorated, had been referred for in-patient psychiatric assessment by a consultant. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 9 The case files contained comprehensive assessments by a care manager, hospital staff, where appropriate, and the manager of the home. Care plans and other documents, showed that residents’ needs were thoroughly assessed. A high level of satisfaction with the service was evident from discussions with residents and relatives. Relatives who were spoken to, confirmed that they had selected this home after visiting the home and reading previous inspection reports. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Residents enjoy a high standard of personal and health care. Care plans are clear and provide good guidance for staff in how best to meet residents’ needs. EVIDENCE: Three care plans were examined. They contained thorough assessments, goals and objectives of care and the care plans were reviewed monthly. The residents’ case files showed a range of healthcare appointments, for example; G.Ps, district nurses, opticians and dentists. One resident was being treated in hospital and one was having a psychiatric assessment at the time of the inspection. Also during the inspection, the G.P was attending to a resident who had acquired a rash. One resident has MRSA, and the manager was able to demonstrate that proper control of infection measures were in place to provide appropriate care. The medication and administration of medicines records, (MAR) were found to be in order. However, a recommendation is made that the signatures of staff who are authorised to administer medication are recorded on the MAR sheet folder. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 11 The residents stated that they were always treated with dignity and respect by the staff, especially when personal care was being given. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Residents are able to exercise choice about their lives and are provided with stimulating activities The regular meetings between the residents and staff provide an opportunity for residents to be consulted about how the home is managed, and to express their views. EVIDENCE: There is an activities organiser employed at the home, who provides a varied activities programme, including bingo, arts and crafts, music and reminiscence. During the inspection, a poetry reading session was taking place, which was attended by several residents. Three relatives were spoken to during the inspection. They said that they were always welcomed by staff and could visit at any time. Meetings are held every three months with residents, which provides an opportunity for them to express their views about how the home is run, and to raise any concerns they might have. These meetings are minuted. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 13 The residents who were spoken to, described the range of choice available to them; for example, time of going to bed, and choosing what activities to join in. The menus were very varied and nutritious in content. The residents said that they were very satisfied with the food and that they could choose alternatives to the menu if they preferred. There was ample food available, including fresh fruit and there were records to show that food was stored and prepared safely. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 There are good systems in place to address service users’ concerns and complaints, and there are also adequate procedures to protect service users from potential abuse. EVIDENCE: The home has an appropriate complaints procedure. One complaint had been recorded since the last inspection, which had been resolved satisfactorily. The residents and relatives stated that they were very satisfied with the service and had no complaints. The manager is an accredited trainer in abuse awareness, and has recently completed a programme of training in this subject for all the staff in the home. Staff who were spoken to, demonstrated awareness about adult protection issues. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 24, & 26 Residents live in an attractive, homely and generally well maintained home. However, there is a potential risk to residents’ safety in areas where bedroom doors do not fully self-close, and where radiators are not covered. EVIDENCE: Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 16 A tour of the premises was carried out. The home employs its own handyperson who is responsible for general maintenance and repairs. The furnishings, lighting and décor, provide a very pleasant and homely environment. The garden, which is also accessible by wheelchair users, looked well maintained and particularly attractive. The security of the home provided by the new railings and gates at the front of the building, has been further improved by new lighting. Several bedroom doors on the ground floor did not fully self-close, which could present a risk of fire spreading, and some radiators still did not have covers to protect residents from burns. In addition, the water in some bedrooms was not sufficiently hot. At the time of the inspection, a contractor was installing new thermostatic valves in some bedrooms. However, the manager stated that not all bedrooms were included in this programme. Requirements are made to address these issues. Otherwise, the home was very well maintained. Several bedrooms were visited. They were individually decorated to a high specification, and there were a number of personal effects in the rooms. At the time of inspection, the home was very clean and tidy and there were no offensive odours. There is a control of infection policy in place, which had been updated recently. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28, 29 & 30 Residents’ needs are being met by a group of staff who are properly recruited and receive training in all areas of care. EVIDENCE: The manager provided evidence that six care staff had commenced National Vocational Qualification level 2 training, and three senior care staff had started on Level 3. Other staff training included dementia care, computer skills, and induction for new staff. One new person had joined the staff team since the last inspection, and an examination of their records, showed that they had gone through proper recruitment procedures, and had been vetted appropriately. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 36, 37 & 38 EVIDENCE: There was a relaxed and friendly atmosphere in the home during the inspection, and staff were observed engaging residents in conversation and activities. The minutes of residents and staff meetings showed that they were involved in the running of the home. There was evidence that staff receive regular supervision to support them in their work. The manager was currently reviewing the home’s policies and procedures, several of which the inspector examined. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 19 The fire logs showed that the alarms were being tested weekly in different zones in the building and fire drills took place. However, a requirement is made under Standard 19 regarding fire doors and radiator covers. Cleaning materials were stored safely and securely, and there were records of regular health and safety checks. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 20 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 X 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X 2 4 X 3 STAFFING Standard No Score 27 X 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X X 3 3 2 Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP19& OP38 Regulation 13(4)(a) Requirement Timescale for action 31/03/06 2 OP19 13(4)(a) 3 OP38OP19 13(4)(a) The registered person must ensure that all radiators have covers. This requirement is restated from the last inspection. The previous timescale was 30/12/05. The registered person must 31/03/06 ensure that all bedrooms have a supply of hot water at the appropriate temperature. The registered person must 31/12/05 ensure that bedroom doors are enabled to self-close. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The registered person should record the signatures of staff who are authorised to give medication. Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Dr French Memorial Home Ltd DS0000010424.V259182.R01.S.doc Version 5.0 Page 23 - 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. 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