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Inspection on 17/05/05 for Florence House

Also see our care home review for Florence House for more information

This inspection was carried out on 17th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Care staff showed a good level of understanding of service user`s needs and social history. The home is thoughtfully decorated and is kept to a high standard. Most of the bedrooms open on to a paved patio area. The grounds are beautifully maintained and the house is situated in a no through, private driveway. The manager and her husband take pride in their business and are actively involved in ensuring high standards of care are maintained. They frequently meet with care staff to provide ongoing support and have daily contact with service users. Any concerns are rectified immediately.

What has improved since the last inspection?

Since the last inspection the majority of the requirements and recommendations have been met. Staff training in ongoing and includes statutory and NVQ training. Staff turnover has been low and staff who have left usually return either as bank staff or permanent.

What the care home could do better:

The manager is proactive at the home and offers informal support to care staff. She has daily contact with service users and relatives and responds to any concerns or changes in health status immediately. Although this is strength of the service, the manager is aware that some areas of record keeping do not adequately demonstrate how minimum standards are being met. A key example of this is staff supervision and staff meetings. Hours are spent weekly supporting staff, but this tends to be informal and therefore not recorded. Care staff have regular handovers and respond flexibly to the changing needs of service users. Staff meetings are there fore held less often. Improvements in record keeping have been identified. Evidence of staff training was provided, but staff keep their training certificates and some gaps were identified in staffs mandatory training records.

CARE HOMES FOR OLDER PEOPLE Florence House (Ramsey) Westfield Road Ramsey Cambridgeshire PE17 1JR Lead Inspector Shirley Christopher Unannounced 2 June 2005 @ 10:00 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 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 (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Florence House Address Florence House Westfield Road Ramsey Cambridgeshire PE 17 1JR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01487 812295 n/a n/a Mrs Hilary McDonagh Mr John Anthony Christopher McDonagh Mrs Hilary McDonagh Care Home 14 Category(ies) of Old age not falling into any other category registration, with number of places Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 10 November 2004 Brief Description of the Service: Florence House is jointly owned by Mr and Mrs McDonagh, who have built up the buisness over many years. The current owners have extended the property over the years. Accomodation is provided for up to fourteen service users over the age of 65. All the bedrooms are single and three have ensuite. The majority of bedrooms have external doors opening on to a terraced patio. There is a dining room and seperate lounge. The home benefits from a large kitchen and generous outside space. The house is situated in a quiet residential area, which is accessed by a private road and is close to the town of Ramsey. On the day of inspection the home was maintained and decorated to a high standard. The house was light and airy. A good standard of cleanliness is promoted throughout the home. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection on the 31st May took place over four hours. At the time of inspection Mr and Mrs McDonagh were present. Two other care staff were on duty. A number of records were inspected including: 2 staff files, staffing rotas, service user finance, (1 record,) medication records, Fire and emergency lighting records, portable appliance testing, maintenance records, and 2 care plans. Eight service users and two visitors were spoken to. A tour of the premises was conducted. The manager confirmed that the home was to change ownership; new buyers have been identified and will take over the business in the autumn. What the service does well: What has improved since the last inspection? Since the last inspection the majority of the requirements and recommendations have been met. Staff training in ongoing and includes statutory and NVQ training. Staff turnover has been low and staff who have left usually return either as bank staff or permanent. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 6 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. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 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 standard(s) 1,2,3,4,5 The manager completes a thorough service user assessment before admission to ensure that service user care needs are clearly identified and can be met by the home. Staff have complimentary skills and experience. EVIDENCE: The majority of service users have lived at the home for a long time. The manager confirmed that service users may be able to come in for a period of respite care and then become permanent residents. A trial period of a month is offered. The home has an up to date service user guide and statement of purpose. A copy of the Service user guide is given to service users. There is a low staff turn over and staff are actively supported by the owners of the home, one who is the registered manager. Care records are excellent and a thorough handover took place on the day of inspection. Staff training is good although a number of gaps were identified. The home is adequately staffed. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 9 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 standard(s) 7,8,9,10,11 Care plans are extremely comprehensive and are regularly reviewed. Evidence should be provided that service users are involved in the development and subsequent review of their care plans. EVIDENCE: A number of care plans were inspected and provided evidence of comprehensive assessments, completed by the manager and other agencies where appropriate. Records inspected included care plans, which are updated monthly. The manager confirmed that statutory reviews from social services were also up to date. Notes are kept, but these are not written every day, but at least every other day. A few gaps were identified, which the manager was aware of. A recent history was recorded as well as past significant events. A current medical history, ongoing health and support needs are recorded. Records of weights are usually recorded, although the home does not have appropriate scales that can be used by all the service users. Nutritional assessments are not in place, but the manager stated that she regularly contacts the GP, and district nurses if she has any concerns. Fluid charts/diet records are kept where required. Moving and handling assessments are kept, as well as a risk assessment for falls and a falls register. This was discussed with the manager, as one record did not appear to inform the other. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 10 Assessments must be updated if the falls register records a number of falls and action taken to minimise falls should be recorded as part of the assessment. The care plans in place are excellent and cover all areas of personal care and behaviour. Records of any professional input are recorded. Evidence was not provided of service user involvement in their care plans. The two seen were not signed and reviews did not indicate how service users were involved. Service users were well groomed and had beautifully kept nails and regular visits from the hairdressers. The medication records and stocks were checked, but a full audit was not carried out. Medication recording sheets have a photograph of the service user. No gaps in record keeping were identified. The local pharmacist regularly audits medication stocks. Drugs are appropriately stored and two staff administer the medication. Some homely remedies are kept as part of the medication stock and the home were asked if they had a homely remedies policy. This was not provided. All medication should be prescribed by the GP, although the manager stated that the pharmacist regularly checks medication and no issues have been identified. The last audit was in March 2005. Care staff are supervised in the administration of medication until they feel comfortable. External medication training should be provided. The home have polices and procedures with regards to service users last wishes. This is covered on the care plan. There are policies and procedures in place. Staff have not had specific training in this area although it is covered as part of their NVQ and induction. Specific training was recommended. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 11 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 standard(s) 12,13,14,15 Service users are able to take part in a range of activities and staff showed a good understanding of service user’s needs. Choice is promoted. EVIDENCE: Some service users were spoken to and confirmed that activities are provided and included: exercise, current affairs, memory recall games and bingo. Some service users are able to go out independently or with family. The atmosphere on the day of inspection was relaxed, with positive interaction between staff and service users alike. A number of service users have known each other for most of their lives. Staff demonstrated a good understanding of service user’s needs and were respectful. Outside the lounge was a timetable of activities, on the notice board and activities were discussed at handover. The menus are also displayed. The home employs a cook who works from 9.30 to 1.30. A main meal is provided at lunch- time. A sample of the weekly menu was on display and showed that there is a varied menu of ‘home cooking.’ A meal was observed and service users were appropriately supported throughout the meal, which was served and enjoyed in a relaxed and unhurried fashion. Drinks and snacks are available throughout the day. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 12 A number of service users were spoken to and stated that were happy at the home and had no complaints, although there was an acknowledgement that it was not a substitute for their own homes. A number of visitors were present during the inspection and spoke positively about the home. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 13 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 standard(s) 16,18 The home has a robust complaints and adult protection policy and procedure. EVIDENCE: The home has a complaints procedure, which is displayed on the notice board. There are also adult protection policies and procedures in place, which staff sign to say that they have read. The home employs an external trainer who has provided training on adult protection. The manager confirmed that no official complaints have been received since the last inspection, but she does keep a record of any concerns. If these are from service users they would be recorded in their daily notes. A number of policies and procedures were inspected. They are kept in a separate file and included the complaints procedure. The complaints policy needs to be updated. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 14 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 standard(s) 19,20,21,22,23,24,25,26 The home provides spacious, clean and well-maintained accommodation. EVIDENCE: A brief tour of the home was undertaken, but did not include all areas. One bedroom was seen, the lounge, dining room, kitchen and communal halls. The home was decorated to a high standard and no maintenance issues were identified. The home smelt fresh and extremely high standards of cleanliness are promoted. The home employs domestic help. The outside space was well maintained and lots of flowers and plants were in bloom. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Care Staff are provided in sufficient numbers and are given appropriate training, support and induction. Staffing records must be improved to ensure the fullest protection for service users. EVIDENCE: The home has a low turn over of care staff. The manager confirmed there were no vacancies and staff that leave often come back to work at the home on a casual basis, to cover permanent staff’s holidays and sickness. Staffing levels are maintained throughout the shift and the manager and husband are included on the rota. There is only one member of staff on at night, but the manager/ joint owners are on call and will stay over if a new member of staff is on night duty. Rotas for the month were inspected. There were four staff in the morning, and four staff in the afternoon, although some staff work slightly shorter shifts so there are not always four staff at the home. There is also a domestic and cook. A handover takes place between shifts and staff are expected to read the care plans and the communication book. Two staff files were inspected and records were incomplete. Evidence was seen of: written references, (2), application form, which was supported by a curriculum vitae in one instance and interview notes taken by the manager on a second file. There were no staff photographs on file or identification. The manager produced training certificates for one member of staff, but generally staff keep their certificates. She was asked to keep these on file. Personal staff details are kept in the staff register and supervision records are kept Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 16 separately. Evidence was not provided that supervision is given every six weeks. The manager confirmed that she is always available to provide staff support, but this is not recorded. It was suggested that she introduce a contact sheet in which she recorded general issues discussed with staff. Evidence of CRB checks was seen. A discussion was held around the requirement to have confirmation that new staff are not on the POVA register. This should be in place before staff are appointed. The majority of staff have or are doing a NVQ qualification. The manager stated that a number of staff who were doing the course had left. Currently 3 staff are doing NVQ3, 1 senior member of staff has NVQ3, 1 has just completed level 2, 1 member of staff has just completed a TOPPS foundation course and 2 members of staff are doing it. They would like to go on to do an NVQ qualification. The home has a training matrix, which provided some evidence of staff training including: adult protection, first aid, manual handling, fire training and food hygiene. Some gaps in training were identified such as first aid for 2 staff, fire training for 3 staff, (booked for June 2005.) The home uses an external training provider for all staff training requirements. They also have fire-training videos and it was suggested that other training videos might be advantageous to supplement rather than replace training. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,35,36,37,38 The home is well managed and policies and procedures inform good working practices. Health and safety practices must be improved in some identified areas. EVIDENCE: The manager and her husband have owned and ran Florence House for many years and are suitably qualified and competent to do so. The manager confirmed that she is actively involved with the service. A number of maintenance issues were identified. Portable appliance testing records were incomplete. Tests must be taken annually. All staff must participate in a fire drill at least twice a year. Evidence of this was not provided. Water temperatures are checked periodically. Thermostatically controlled valves are fitted but water temperatures must be tested more frequently. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 18 Other records inspected were satisfactory and included: Maintenance records for the boiler, central heating system, fire equipment and weekly fire alarm and emergency lighting. Accident records and risk assessments for fire prevention. Fire training is provided for staff, by the external trainer. The home has a portable hoist and an automatic bath hoist. Servicing records were not available as this was a new piece of equipment. Financial records were not inspected for the business. The home holds monies on behalf of one service user. Details records and receipts were seen for this. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x x x 3 2 3 2 Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 20 yes 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 29 Regulation 19 Requirement Staff files must be updated and include a photograph and proof of identification. Confirmation of Pova checks must be in place before the employment of new staff. Evidence must be provided that all statutory training is up to date. A number of training gaps were identified. Training certificates must be kept as further evidence. ( The previous timescale of 30/11/04 had not been met.) Arrangements must be made for care staff to receive formal supervision at least six times a year. ( the previous timescale of 31/12/04 had not been met.) A number of maintainance records must be brought up to date including: Annual portable appliance testing, regular tests on water temperatures and updated staff manatory training. Care staff must particiate in regular fire drills. Timescale for action 31st August 2005. With immediate effect for new staff. 31st August 2005 2. 30 18 3. 36 18 (2) 31st August 2005 4. 38 13 31st August 2005. 5. 6. 38 23 31st August 2005. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 21 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. 2. 3. 4. Refer to Standard 7 8 9 11 Good Practice Recommendations Evidence should be provided how service users are involved in the development and review of their care plan. Intervention taken to minimise falls should be recorded and used to update risk assessments. Nutritional screening should be undertaken External medication training should be provided and the home should have a homely remedy policy in place. Training should be provided on the spiritual needs of service users. Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 Page 22 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE 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 Florence House (Ramsey) I53 I03 S15095 FLORENCE HOUSE (RAMSEY) V229254 020605 STAGE 4.doc Version 1.30 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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