CARE HOMES FOR OLDER PEOPLE
Florence House 220 Park Road Peterborough Cambridgeshire PE1 2UJ Lead Inspector
Andy Green Key Unannounced Inspection 12th March 2007 10:00 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 Florence House DS0000015170.V333016.R01.S.doc Version 5.2 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. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Florence House Address 220 Park Road Peterborough Cambridgeshire PE1 2UJ 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) 01733 315900 01733 702272 florence.house@tiscali.co.uk Park Road Baptist Housing Association Ltd Mrs Barbara Franco De Olim Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th October 2005 Brief Description of the Service: Florence House is a Christian Retirement Home situated in a residential area of Peterborough, close to the Central Park. The original house was a detached domestic property, which was extended to provide a home for older people. Accommodation for 21 elderly people is offered 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 £350 to £390 per week Copies of CSCI reports are made available to service users and relatives upon request. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Regulation Inspectors, Andy Green and Matthew Bentley undertook this unannounced inspection on 12th March 2007. The inspectors met with the manager, care staff and service users to gather their views regarding the care and support that is provided in the home. A number of records were inspected including care plans, training records, fire records and medication. A tour of the building and grounds was also undertaken. What the service does well: What has improved since the last inspection? What they could do better:
The Statement of Purpose must include the details of the registered manager. The registered person must ensure that all appropriate assessment information is received prior to admission of service users in the home. The registered person must ensure that medication is only administered to the person it is prescribed for. The registered person must ensure that no member of staff commences their employment until at least a POVA First check has been undertaken and that the result has been received.
Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 6 The registered person must ensure that staff receive regular recorded supervision throughout the year. The registered person must ensure that all areas of the home are free from potential hazards to service users including hot water temperature and that extractor fans are free from dust which may pose a potential fire hazard. 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. The summary of this inspection report can be made available in other formats on request. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 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 Florence House DS0000015170.V333016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home produces a variety of information to ensure that prospective service users can decide if they wish to live in the home. However, the home’s pre admission assessment process needs to include more detail. EVIDENCE: There have been no changes to the Statement of Purpose or Service User Guide since the last inspection. However the manager needs to add her details to these documents to ensure that they remain effective and provide up to date information. Consequently a requirement will be made regarding this issue. Prospective service users and their family/relatives continue to be encouraged to visit Florence House as part of the assessment process, prior to admission. This ensures that the prospective service users need’s can be fully assessed and also gives the person a chance to experience life in the home. There are three vacancies in the home and a prospective service user has been assessed for admission to the home in the forthcoming weeks. It is recommended that the manager review the pre admission assessment form to ensure that all information, including mental health needs, have been assessed. The manager stated a service user is being re-assessed by a CPN
Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 9 regarding her mental health needs. It is anticipated that the service user will need to be referred to a more suitable, which will properly meet her needs. The service users family are aware of the situation. The manager was made aware that the home would need to submit an application for variation to the home’s registration if the service user was diagnosed as having dementia care needs. The manager stated that she would inform CSCI regarding the outcome of the CPN’s assessment to ensure that appropriate action is taken. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive appropriate health and personal care to meet their assessed needs however the home must ensure that medication is only administered to the person it is prescribed for. EVIDENCE: Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 11 Three care plans were inspected and a variety of information is in place including personal profiles, specific guidelines for care, Waterlow pressure charts and nutritional monitoring charts. There was evidence of frequent reviews taking place but it was noted, however, that the space for reviews needs to be enlarged so that more information can be recorded. Service users receive regular visits from healthcare professionals including district nurses, GPs, chiropodist and a dentist as required. The care staff in the home assist service users with personal care where necessary. There have been no new contacts with health professionals since the last inspection. The manager and staff in the home are clearly committed to maintaining service users privacy and dignity at all times. This was confirmed by service users on the day of inspection and was observed by the inspector. Service confirmed that they were treated in a dignified and friendly manner at all times and that they were addressed by the name that they preferred. Staff were observed to knock on the service user’s bedroom door before entering. Medication records was inspected and they were accurate. However it was noted that a prescribed cream for one of the service users was being used in another person’s bedroom and that the name of the service user had been changed with the other service user’s name substituted. The manager was advised that this practice must cease and that a requirement would be made regarding this issue. She stated that the cream would be removed immediately and that an appropriate prescription would be actioned via the service users GP. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff provide support to ensure that service users have access to appropriate activities to meet their needs. EVIDENCE: A range of activities, entertainments, outings and access to community events continue to be provided for service users. Individual preferences and interests are recorded in the service users plan. The registered manager stated that a variety of entertainers provide musical events throughout the year. There is also a programme of light exercise for service users who wish to participate. in the garden. Service users often enjoy spending time in the garden with their visitors during the summer months and events/garden fetes are regularly held. A short informal daily act of worship continues to be provided for those who wish to attend and ministers make regular visits from local churches. Relatives of service users frequently visit and there is a friendly atmosphere in the home. One relative spoken to during the inspection was most complimentary about the care and services provided by the staff in the home. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 13 The manager stated that a nutritional survey is being carried out with local professionals to develop improved nutritional screening in the home. Service users, spoken to on the day of inspection, were complimentary about the meals they received. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home has a complaints process to make sure that service users have their complaints or concerns listened to and acted upon properly. EVIDENCE: The home has a full complaints procedure in place, which are included In the Statement of Purpose and Service User Guide. The CSCI contact details are also included. The complaints process is explained to service users and their relatives Staff receive training in the protection of vulnerable adults to ensure that service users are protected from abuse. Staff met during the inspection confirmed this. There have been no complaints received regarding the home and its care and services since the last inspection. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,24,25,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment of the home meets the service users needs. EVIDENCE: The home is kept in a clean and tidy way and is free from odours. All bedrooms are en-suite and there are three bathrooms with WCs, two with shower facilities and one separate WC, which are all located close to the service users rooms and near to the lounges and dining area. Bedrooms seen on the day of inspection were presented in a very homely and comfortable manner and they were personalised in accordance with service user’s wishes. There continues to be a maintenance programme to ensure the ongoing renewal, refurbishment and decoration of the premises. Maintenance issues are discussed and actioned via the regular management committee meetings. The manager stated that bedrooms are redecorated as required. Four bedrooms, the dining room, rear hall and one staircase have been recarpeted. Decoration has been carried out to the dining room, four bedrooms, landings
Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 16 and the exterior of the building. It was noted however, that a wall in one of the service users bedrooms was stained near to his bed. The manager was aware of this issue and she stated that the service user’s hair cream and his preference to sleep with his head against the wall causes the wall to become stained. His relatives are also aware of the issue and their relative’s preferences not have his room redecorated. The attractive gardens are accessible and continue to be well maintained. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Training is provided for care staff so that they are competent to deliver care to the service users they support. Improvements to the home’s recruitment processes must be made to ensure that service users are protected from harm EVIDENCE: The home maintains a staff rota and on the day of inspection the registered manager confirmed that the home is fully staffed at present. The home was well staffed on the day of inspection to meet the needs of service users. There were 4 carers in the morning, 4 carers in the afternoon/evening and 2 waking night staff. The manager was also on duty during the day (9-5) Staff spoken to stated that they receive a variety of training including first aid, moving & handling, fire safety, record keeping and care of hearing aids. Health & safety training and POVA training is also received. NVQ training is well established in the home and there are at least 50 of staff who have completed at either NVQ level 2 or 3. Refreshers/updates to ensure safe practice are provided throughout the year. Training in first aid, continence care and nutrition are being held in May/June 2007. Three staff files were inspected and two contained the required documents and recruitment checks. However, one new staff member’s file did not have an adequate CRB clearance yet received. The manager was advised that a POVA First check must be carried out and that the staff member must be supervised
Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 18 until a satisfactory CRB has been received. Consequently a requirement will be made regarding this issue. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and safety issues identified during this inspection pose a serious risk to service users. EVIDENCE: Since the last inspection there has been a change of manager in the home. The previous retires at the end of March 2007 but she has remained working in the home in a supernumerary capacity to provide a very useful handover and induction period for the new manager. The new manager has successfully registered with CSCI. She was previously the deputy manager for a number of years in the home. She is reviewing processes and procedures to ensure that they are accurate. She will also receive ongoing support from members of the Management Committee who provide regular input. Staff supervision has been infrequent and the new manager is aware of this deficiency and will be developing a new supervision system with the deputy managers. The manager stated that all members of staff would receive regular
Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 20 recorded sessions to monitor their practice and development needs throughout the year. Consequently a requirement will be made regarding this issue. Fire records are kept and recorded regularly. Service contracts are in place for equipment in the home and hard wiring and portable appliance testing (PAT) is carried out. It was noted that PAT tests had been infrequent in some areas of the home but the maintenance person who was carrying out tests stated that all equipment tests were being brought up to date during the forthcoming weeks. It was noted that number of ceiling mounted extractors in bedrooms need cleaning, as there was a build up of dust, which may cause a potential fire hazard. This was pointed out to the manager who stated that they would be cleaned as soon as possible. Consequently a requirement will be made regarding this issue. The baths have thermostatic valves fitted however it was noted that the water temperature in one of the hand basins was high. The manager stated that thermostatic valves would be fitted to all hand basins. Consequently a requirement will be made regarding this issue. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 21 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 2 X 3 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 2 X 2 X 2 Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP1 Regulation 4 (c) Requirement The Statement of Purpose must include the details of the registered manager. The registered person must ensure that all appropriate assessment information is received prior to admission of service users in the home. The registered person must ensure that medication is only administered to the person it is prescribed for. The registered person must ensure that no member of staff commences their employment until at least a POVA First check has been undertaken and that the result has been received. The registered person must ensure that staff receive regular recorded supervision throughout the year. Timescale for action 30/06/07 2 OP3 14(1)(c) 12/03/07 3 OP9 13(2) 12/03/07 4 OP29 19(i)(b) Schedule 2 12/03/07 5 OP36 18 (2) 30/06/07 6 OP38 13(4)(a) The registered person must 30/04/07 ensure that all areas of the home are free from potential hazards
DS0000015170.V333016.R01.S.doc Version 5.2 Page 23 Florence House to service users including hot water temperatures and that extractor fans are free from dust which may pose a potential fire hazard. 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 OP3 Good Practice Recommendations It is recommended that the assessment form used in the home be reviewed to ensure that all appropriate information is obtained prior to admission of service users. Florence House DS0000015170.V333016.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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