Inspection on 02/11/07 for Florence House

This inspection was carried out on 2nd November 2007.

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 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

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOME ADULTS 18-65 Florence House 29-32 St Georges Road Great Yarmouth Norfolk NR30 2JX Lead Inspector Maggie Prettyman Unannounced Inspection 2nd November 2007 09:30 Florence House DS0000069732.V354093.R01.S.doc Version 5.2 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 DS0000069732.V354093.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 Adults 18-65. 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 DS0000069732.V354093.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Florence House Address 29-32 St Georges Road Great Yarmouth Norfolk NR30 2JX 01493 332079 01493 850914 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) Miss Antonia Christophi Mrs Lorraine Michelle Nicola Leggett Care Home 24 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (24), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (3) Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A total number of twenty four (24) service users with mental disorder may be accommodated which may include up to 3 named Service Users with mental disorder, who are over 65 years of age. Date of last inspection Brief Description of the Service: Florence House is situated near the centre of Great Yarmouth with easy access to a range of local recreational, social and health care facilities. The home provides care and accommodation for up to 24 adults with mental health support needs. There are 20 single rooms and two shared rooms, most having en-suite facilities. The home informed CSCI of its charges in November 2007 and charges £315 per week for care provision. Residents are expected to pay extra for newspapers, magazines, toiletries, transport, hairdressing and chiropody. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. This inspection took place over 7 hours and included a tour of the building, discussions with residents and staff, inspection of records and observation of care practice. Prior to the inspection the manager submitted an Annual Quality Assurance Assessment. This was read in conjunction with previous reports and contact records held by the Commission, to plan the inspection. What the service does well: Florence House is a friendly and comfortable home that has a strong feeling of “ownership” by its residents. Staff are warm, courteous and professional. The manager of the home is experienced, kind and concerned that people living there have the best outcomes that she can provide. Nobody comes to live at the home without having their needs assessed and an individual plan of care sets out how each person is helped in their daily lives. People living at the home are involved in their local community, and their families and friends are welcomed at the home. The manager is being innovative by including school volunteers at the home to break down barriers and stereotyping. Everyone who lives at the home has a different routine, and people choose their activities and meals daily. People’s healthcare needs are met, and the home works hard to ensure they get the best service possible from the health care profession. Complaints and grumbles are listened to, and action is taken to improve things as necessary. The owners of the home commit considerable resources to maintain the home and residents are consulted about the style and décor of the home and their own personal rooms. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: This is a good home with some excellent areas of practice. Some further areas of improvement were identified during the inspection as follows; Requirements • • Flammable materials stored under the stairs must be removed Output water temperatures should be recorded and a legionella risk assessment undertaken. Recommendations • • • • • The needs assessment form could be expanded to cover all areas stated in the standards The contract could be expanded to include service levels and accommodation agreed The home should continue to build on its recent good recruitment practice An up to date record of staff training should be available Frozen foods should be stored appropriately, with uncooked meat being stored separately from cooked products. 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 DS0000069732.V354093.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 2 and 5 People who use the service experience good quality standards in this area. This judgement has been made using available evidence including a visit to this service. People have the information they need to decide if the home is right for them. A needs assessment is conducted before people move in and a contract sets out their rights of tenancy. EVIDENCE: Since the change of registered provider this year the home has upgraded its Statement of Purpose and produced a small brochure about its services. It is in the process of fully updating its Service User Guide. Evidence from residents’ files demonstrated that a needs assessment is undertaken before people come to live at the home. The placing authority undertakes this assessment. The home has a short form, which is completed when the manager goes to visit people before they come to the home. This form lacks some detail and could be improved by covering a wider range of needs as stated in the care standards. A recommendation has been made in this respect Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 9 An example of the contract drawn up between the home and resident was seen. This covers most of the detail contained in the standards. It could be improved by further expansion noting the room that the person has and their rights to staff cover and types of service. A recommendation has been made in this respect. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Individuals are involved in decisions about their lives and play an active role in planning the care and support they receive. EVIDENCE: A selection of files was examined with the permission of people living at the home. A new Computer format is being used. The plans were found to be clear and concise. They were easily read and accessible and evidence of individual involvement was seen. These plans covered all aspects of people’s daily lives. The home has started work implementing the MUST nutritional assessment for each person living at the home. People living at the home confirmed that they are consulted about their lives and how the home is run. They described making individual decisions and are Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 11 happy with the support offered to them by staff. Examples of consultation included decoration of communal areas, the acquisition of a rabbit and fish tank and daily choices for meals. A full consultation about the ongoing menu has been undertaken. People are able to choose their key worker and make decisions about their daily lives and activities. Risk assessments covering peoples daily lives and activities of choice were seen in people’s individual files. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service make choices in their daily lives and are supported to develop their life skills. The home is working to encourage people to make more individual decisions about educational and recreational activities. EVIDENCE: The home is working to encourage people to make more individual life choices by reducing the organised “Group” activities and supporting people to arrange their activities themselves. This approach is not necessarily approved by all people living at the home. This is a time of transition and the new approach will undoubtedly result in more self-determination and confidence for some people. In the meantime some people are engaged in individual activities such Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 13 as keep fit, pool and swimming, and some have done independent living courses. People confirmed that they go out and about in the local community, accessing pubs, churches and shops according to their individual choice. During the inspection people were seen coming and going from the home pursuing their individual personal activities. People are registered to vote and either vote in person or by post. The home has encouraged links with a local school to promote positive perception. A young person was observed helping at the home under supervision during the inspection. People living at the home confirmed that they have individual friendships and relationships. Families and friends are made welcome and people stay for meals and snacks if they wish. People were observed living their lives according to individual choice and control. Staff were seen to be respectful of individual decision-making. Each person has a key to his or her individual room. Staff are not allowed to spend time in the office other than to do specific administrative tasks. Communal areas are freely accessed. The home is working with the new smoking regulations and a designated area has been identified. Alcohol is not allowed in the home, but this is specified in the contract and residents accept this as a condition of living at the home. They do, of course, go out to the pub as they choose. Evidence of a recent consultation about menu choices was seen. Records demonstrated that people are asked daily about their wishes, and great flexibility of choice is available to people. Healthy eating options are encouraged. People eat at times of their choice and have access to drinks and snacks at all times. Some people said the food is not very exciting, but agreed that the menu choices reflected their individual choices. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Peoples care plans demonstrated that they receive differing levels of personal care support according to their individual needs. People living at the home were seen to choose their own style of dress and hairstyle. One person described regular visits to a beauty therapist. A member of staff is a qualified hairdresser, but people choose if they wish to have their hair done elsewhere. A system of key workers is in place; people living at the home confirmed that they choose who their key worker is. Records of visits by healthcare professionals are maintained in people’s individual care records. Plans of health care are in place. Several people were Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 15 seen to go to individual appointments relating to aspects of their healthcare during the inspection. A new medicines trolley has been purchased and medication records have been improved. Evidence of regular written audits were seen. All records and medicines checked during the inspection were found to be in order. Those residents that are self-medicating were found to have been risk assessed and secure storage safes were seen to contain their drugs in these people’s rooms. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have an effective complaints procedure. Staff are trained in adult protection. EVIDENCE: The home has not received any formal complaints since the last inspection. Records of resident meetings demonstrated that everyday grumbles `and concerns are dealt with appropriately. The home plans to institute a record of minor complaints, concerns and compliments so that an audit can be undertaken to identify any changes the home could make overall to better meet the needs of residents. Inspection of staff induction records demonstrated that people are trained in recognising the signs and symptoms of abuse when they start to work at the home. A recent situation relating to confrontational outbursts from one resident was found to be carefully recorded and an analysis of trigger points had been undertaken. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in an environment which is regularly maintained and comfortable EVIDENCE: Florence House is comfortable and homely, but the interior décor does not always reflect the good standards of care that the home provides. The owners are constantly refurbishing and improving the environment, but much work still needs to be done. People said they are happy with the way the home is, and rooms seen by the inspector were found to be individual and filled with personal belongings. Records of fire drills and alarm testing were seen. An under stair cupboard was found to contain flammable substances. A requirement has been made in this respect. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 18 The building is on several floors; no bedrooms are on the ground floor. The home is aware that this lack of accessibility may cause difficulties in the future and is examining various options that may resolve this. The home is clean and hygienic throughout. It is free from any odours and was seen to be tidy and well organised. A laundry is on site with domestic machines that people are helped to use to wash their own clothes and linens. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34 and 35 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff at the home are trained and skilled. There are enough staff to meet the needs of people living at the home EVIDENCE: The home is doing well in ensuring that the majority of its staff have completed or are completing NVQ qualification. Staff on duty were observed to be caring, compassionate and knowledgeable about the people who live there. The home has a policy that staff do not use the office unless writing records or distributing medication. This ensures that they interact with people at the home throughout their shifts. A selection of staff files was inspected. The most recent file is of a better standard in terms of meeting the requirements of the regulations. Older files did not meet the standards. The home’s manager understands that this has Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 20 been an area of shortfall in the past. The need for thorough vetting of staff was discussed, and a copy of “Safe and Sound” good practice guidelines, ( a publication produced by the Commission), was left at the home for future reference. A recommendation has been made in this respect Staff induction records were inspected. Some books were unavailable because they are in progress. The manager is committed to training and evidence of training and training update was seen in people’s individual files. However an overall picture of current status and renewal dates was not available. The home would benefit from this information being readily accessible. A recommendation has been made in this respect. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is a competent and professional person who runs the home with the best interests of residents at heart. Some quality assurance systems are in place and more work in this area is planned EVIDENCE: Throughout the inspection the manager demonstrated that she is competent, professional and has the relevant training and experience to fulfil her role. Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 22 Quality assurance questionnaires are given to residents and their representatives and the feedback from these helps to guide the home’s development. A good example is the recent survey on food preferences and suggestions that have helped to inform menu planning. Safety practice and procedure were checked. Most certificates and routine checks were in place. The two exceptions were a legionella risk assessment and output water temperature checks. A requirement has been made in this respect. The homes kitchen has a 4* Environmental Health Office grading. The cook is currently absent and some frozen foods were found to be incorrectly stored. A recommendation has been made in this respect Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 4 14 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 24 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 YA24 Regulation 13.4a Requirement All flammable substances must be removed from the cupboard under the stairs and stored safely elsewhere. Output water temperatures must be regularly checked and a legionella risk assessment undertaken. Timescale for action 15/12/07 2 YA42 13.4a 31/12/07 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 5 Refer to Standard YA2 YA5 YA34 YA35 YA42 Good Practice Recommendations The needs assessment form should be expanded to include all aspects stated in the care standards The contract should be expanded to include peoples rights to levels of cover provided and room occupancy The home should continue to implement and build on good recruitment practice An easily read up to date list of training should be kept Care should be taken that frozen foods are stored correctly, with uncooked meat being kept separately from cooked items Florence House DS0000069732.V354093.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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