Inspection on 01/06/09 for Florence House

This inspection was carried out on 1st June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Florence House 17/07/07

Florence House 12/03/07

Florence House 18/10/05

Florence House 17/05/05

Florence House 09/11/04

Florence House 18/05/04

Florence House 24/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Florence House 220 Park Road Peterborough Cambridgeshire PE1 2UJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Bhavna Keane-Rao     Date: 0 1 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Florence House 220 Park Road Peterborough Cambridgeshire PE1 2UJ 01733315900 01733702272 florencehouse@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Park Road Baptist Housing Association Ltd care home 21 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Florence House is a charitable organisation owned by Park Road Baptist Housing Association Ltd situated in a residential area of Peterborough, close to the Central Park. The registered manager is Mrs Olim. Accommodation for 21 elderly people is provided on two floors in 17 single rooms and 2 double rooms, all with ensuite facilities. The home has a large lounge and dining room with a lounge area. There are attractive gardens to the front and rear of the property. The home is near to the city centre of Peterborough has a wide range of shopping and leisure facilities. There are good road and rail links from Peterborough to London and other major cities. The fees range from £420 to £450 per week Copies of CQC reports are made available to residents and relatives upon request. 0 Over 65 21 Care Homes for Older People Page 4 of 24 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: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. We made an unannounced visit as part of our key inspection. It started at 9.30am and lasted four hours and fifteen minutes. Throughout this report, the terms we and us refer to Care Quality Commission (CQC). As part of our review and assessment of the service, the owner completed a selfassessment questionnaire called the Annual Quality Assurance Assessment (AQAA). The information from this, as well as that which we hold about the service, was used to plan the visit and produce this report. The main method of inspection that we used was case-tracking. This involved choosing three residents, and checking the care they receive through looking at their Care Homes for Older People Page 5 of 24 records, chatting with them, the care staff, any visitors and observing care practices. Our visit to the home focused on whether key standards had been met and how people feel about the service provided. The care received by three people was followed in detail to check that their health, safety and welfare needs were fully met and that they were supported to maintain their dignity, autonomy and choice. We spoke with the manager, staff on duty and the people in the lounge, including those whose care we were following closely. People talked and communicated about their experience of living at the home. Any comments we received are mentioned in the main body of this report. We looked at residents care plans and general house and staff records. And we observed the way care was given to the people. We saw some areas of the home and watched the lunch time meal being served to and taken by the people who live there. The manager was present throughout our visit. Care Homes for Older People Page 6 of 24 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 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 Older People Page 7 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 24 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them 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 have enough information for them to choose if they want to live at the home. Evidence: We saw the homes statement of purpose and service user guide which gave good information to resident about the home. We were told that they, along with a copy of the homes in-house annual report, are given to all residents interested in moving into the home. The latest inspection report is available on request. The manager told us that she made sure they had enough information before they moved into the home to believe they would be comfortable. Residents that we spoke with were able to confirm this to be the case. One person told us, I visited the home on a number of occasions before I moved here. The day I moved here the manager was waiting for me to say welcome. It was really nice. Information about residents from these initial assessments is used to help to write their care plan. Care Homes for Older People Page 9 of 24 Evidence: The home does not offer respite care. Care Homes for Older People Page 10 of 24 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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. The homes safe medication practices, detailed care plans and input from other health care professionals helps provide appropriate care for residents. Evidence: We looked at the three residents care plans. They all contained risk assessments, and information on how the peoples health and personal needs were to be met, be it with challenging behavior or with nutritional issues. The care plans showed, and staff confirmed, that all the residents healthcare needs are now met, with liaison with GPs and healthcare professionals as necessary, especially where the resident has special needs such as nutritional or medication issues. The plans also record how staff should support people with challenging behavior. Staff said they find it easy to follow any plans for the peoples care. The care plans showed that the staff review residents plans regularly although not all the residents are able to participate in creating or reviewing them. Some people have relatives to take an interest in the persons provision of care given by the staff. Care Homes for Older People Page 11 of 24 Evidence: Staff showed us that they had a knowledge of safe medication practices and how to deal with medical conditions such as diabetes, and said they do not give out medicines without being trained to do so safely. Residents were seen to be treated with dignity and respect at all times during the inspection visit. This included being assisted with their meals in a dignified manner, approved safety locks fitted to bathroom and toilet doors. The people were at ease with the staff and responded affectionately to them during our visit. The manager and staff told us that with the dementia training gave them a greater understanding in supporting residents dignity and respect. Care Homes for Older People Page 12 of 24 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. 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. Residents are happy living at the home, staff were attentive to their needs and they have choice in various aspects of their lives. Evidence: We were shown that there are various activities which happens. We saw a member of staff playing a game of dominoes with a resident. However we did not see any other activities being undertaken by the staff on the day. Staff told us some of the activities are pre-planned and others are organised as the residents want and decide, depending, on their mood that day. During our visit we saw staff sitting next and chatting to people whilst they sat in the lounge. The day was mild and sunny, one residents had a visitor who took them out into the garden and then out. However we did not see any other residents being escorted outside. The manager told us that some of the residents have visitors. The visitors book confirmed that people do visit. We were told that occasionally an entertainer visits the home and there is also a Bible reading session on a weekly basis. Residents told us they really enjoyed small animals brought in from the New Ark Farm, which they had Care Homes for Older People Page 13 of 24 Evidence: visited previously. In her self assessment form, the manager said, we have greatly improved the range of activities offered. The activities for the month is displayed on the notice board. This is also displayed in the residents bedrooms. We saw that residents were able to make their choices known such as where they wanted to sit or move around the home and when to get up or go to bed. However there is no choice as to when they can have a bath. The manager said there was a slot allocated to individual resident per week. If the resident did not want a bath at that particular time then they would have to wait until the following week at the designated time. The manager stated that this was to ensure that there was a routine and everything ran smoothly. However this is unacceptable and shows that the home cannot respond flexibly to residents varying need. In the response to the draft inspection report, the provider has stated that alternative arrangements are always offered. Residents told us and we could see that they are happy living at the home, and that they love the staff. Residents showed, as they moved around the home, that they were free to come and go as often as they wanted. We were told, by residents and staff, that everyone enjoyed the meals provided. One person said it is always tasty and varied. Care Homes for Older People Page 14 of 24 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are not always protected or safeguarded by the homes polices and procedures. Evidence: Neither we nor the manager has received any complaints since the last inspection. The manager told us, this in her self assessment. Residents and staff told us that the manager is approachable and that she would sort out any problems. None of the residents showed that they were unhappy in any way with the manager or the staff; during our visit, they showed they were very comfortable with the staff interacting with them. Residents were seen to interact with staff in a positive manner and smiled at them frequently. One resident said, Theyre all lovely. When we asked the manager about the note in her communication book with reference to safety checks, eg Criminal Records Bureau for a member of staff, we were told that this person was a catering assistant and so had not been checked for any criminal convictions previously. But that the manager was going to get a CRB check done for her. After further discussion it was noted that this was the case for all four of the catering staff. Also that they had all worked at this home for at least over a year. The issue of safety checks was discussed at the last inspection visit. The manager was upset that this oversight had placed residents at a potential risk of abuse. She told us that she would deal with is by the end of the week. Care Homes for Older People Page 15 of 24 Evidence: We have been told in the AQAA that Because of the increasing incidence of dementia we will need yet an extra person (volunteers possibly) to sit with some of our residents at night to reassure them and talk to them whilst others are receiving personal care by the other staff. At present the manager has said that none of their volunteers have had a CRB check done. It is important that all the staff and volunteers, who have regular contact with residents, especially if they are going to be sitting with the residents at night time, must have a safety check. This will help to reduce the risk of abuse. In response to the draft inspection report, the provider has advised that if they proceed with use of volunteers for overnight care, then they will ensure that appropriate checks are undertaken. We spoke to the staff about how to protect residents and in case of allegations of abuse. One member of staff said I know all the staff here they would not lie, but the residents would because of their condition. Of the three staff spoken with, two staff, after prompting, said they would report it to the manager. No one was able to give an explanation as to what the whistle blowing procedure was and why it was important in safeguarding people. When we checked the staff records we noticed that all the staff had been trained in safeguarding vulnerable adults. However they were not able to demonstrate they had a knowledge of safeguarding adults. The manager told us that she was aware for the need for further work to enable staff to put theory into practice. The manager was going to discuss this with her staff at handover on the day of the visit. Also she was going to ensure that this is reviewed at the next staff meeting. In the AQAA, under future plans and what we can do better we are told that there was no need for further improvement identified at present. The above examples of discussions with manager and staff clearly demonstrates that there is room for further improvements. The manager told us that she had training on the act of Parliament that became law in 2008, Mental Capacity Act, that gives people who have capacity the right to make decisions and choices whenever possible and when things should be done in their best interests. She was aware of the need to ensure that all her staff are trained in this. Care Homes for Older People Page 16 of 24 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, 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. 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. Residents live in a homely, clean and comfortable environment which meets with their own wishes and needs. Evidence: The residents told us that the home is clean, tidy and homely. We confirmed this at the inspection visit. There are domestic staff who ensure that the home is kept clean and tidy. The premises, inside and out, are well-maintained. During our tour of the home we saw three bedrooms, which were all very personalised. All bedrooms have a socket for a personal telephone. The residents proudly showed us their bedrooms and family photographs. All the recommendations that were previously made about the environment have been actioned by the manager. The Environmental Health and Fire Safety officers gave satisfactory reports for the home and any issues have been dealt with by the manager and maintenance person. Chemicals are kept locked away safely and the laundry has sluicing facilities in the commercial washing machines. The maintenance man documented any repairs undertaken and all the checks on maintaining the home in a hygienic and safe state are in order. We were shown that clinical waste is disposed of safely. Care Homes for Older People Page 17 of 24 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. 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. Residents who live at the home are cared for by trained staff, to ensure their health and welfare is maintained. Evidence: Residents told us they do not have to wait for staff if they need their attention, and that the staff spend time chatting to them and not being impatient. The duty rotas show that there are enough staff, with a varied skill mix, to meet the needs of the residents. One resident told us Even on their days off the staff come in to see me. Another resident said they cant do enough for me, they are ever so nice. One residents told us that the activity person had just retired and they did not have anyone else undertaking this role. The manager stated that this role will be filled shortly. In response to the draft inspection report, the provider has stated that the retired member of staff is still fulfilling this role in a voluntary capacity whilst another member of staff is being trained up. There have not been any new staff employed recently but a staff member told us that the induction to the start of the new job was thorough. All the staff we spoke with said they felt very supported by the manager and the senior members of staff. They all said they received regular supervision. Care Homes for Older People Page 18 of 24 Evidence: We saw in the staff file, and staff confirmed, that the training programme was supporting them in their caring roles, including understand the needs of residents with dementia. Staff we spoke with said, The trainings pretty good. The manager told us she monitors that the training is appropriate for the staff to care appropriately for the residents and showed that it is up-to-date for the staff team. However please see section on Complaints and Protection where we have noted that staff have not been able to put some of training into context. Care Homes for Older People Page 19 of 24 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are usually protected by effective management. Residents are asked their opinion so that things they are not happy with are changed. Evidence: The manager has achieved her Registered Managers Award to help her manage the staff and service more efficiently. Everyone at the home agreed that the manager keeps an open door policy for residents, relatives and staff to meet and speak with her. She said she does this so she can address their concerns or issues. The manager showed us that they protect residents personal finances, where they are responsible for them. She said, there are secure facilities for the safe keeping of their money, only the administrator or I have access to these. In response to the draft inspection report, the provider has stated that two deputy care managers also have access to the safe. However by not undertaking proper safety checks before staff are Care Homes for Older People Page 20 of 24 Evidence: employed she has placed residents at a risk from harm. These four people have worked at the home for well over a year but have never had a safety checks done. The importance of safety checks had been discussed with the manager at the last inspection. The manager told us she knew she should have done these safety checks. For more information about this please see in this report under section on Complaints and Protection. The manager demonstrated and staff agreed that residents are at the center of any decisions made about the home. The manager has a questionnaire, annual residents review, that she gives out every year to ask for peoples opinion on the running of the home. The provider states, this is done in conjunction with consultations with families, close friends and two representatives of the Management Committee. The responses from the consultations and questionnaires are collated to try to find ways to improve the service. All the staff meet individually on a regular basis with the manager or a designated senior to discuss personal issues, progress at work and training needs. They said they felt it helped and encouraged them to progress and learn more about the work they do and how to do it better. They said they felt well-supported by the manager and are happy coming to work. We saw, records, files and the policies and procedures, that enough measures are in place to maintain the health and safety standards in the home. These include testing electrical equipment, water temperature and fire safety procedures, to protect the people who live in the home and monitor and maintain their health, welfare and safety at most of the times. Care Homes for Older People Page 21 of 24 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 Older People Page 22 of 24 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 1 14 12 Residents should be given choice over their lives especially as to when they have a bath or not. So that they can control what happens to them and when this occurs. 05/07/2009 2 18 12 The manager must protect both residents and staff by ensuring that safety checks are carried out on all members of staff and volunteers So that all members of staff are safe to work with residents and that residents are safe. 04/07/2009 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 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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