Inspection on 12/12/05 for Florence House (Ramsey)

This inspection was carried out on 12th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Florence House (Ramsey) 04/07/08

Florence House (Ramsey) 17/07/07

Florence House (Ramsey) 14/06/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Florence House (Ramsey) Westfield Road Ramsey Cambridgeshire PE17 1JR Lead Inspector Shirley Christopher Unannounced Inspection 12 December 2005 10:10 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 (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Florence House (Ramsey) Address Westfield Road Ramsey Cambridgeshire PE17 1JR 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) 01487 812295 Alfonsa Jenita David Alfonsa Jenita David Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2005 Brief Description of the Service: Florence House was until recently owned jointly by Mr and Mrs McDonagh, who had built up the buisness over many years. The property and ongoing buisness was sold in November of this year to Mr and Mrs David. Mrs David is the registered manager and is supported by her husband, who is a buisness man and manages the financial accounts and the maintainance of the home. They are currently living in private accomodation situated within Florence House, so are available to provide on going support to staff and service users. 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. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Mr and Mrs David were both present during this unannounced inspection, which was undertaken on the 12 December 2005 at 10:10 am. Both were spoken to at length. Nine service users were spoken to and the staff on duty were spoken to and included a domestic, a cook and two care staff. A tour of the home was undertaken and a number of records were inspected which included, the complaints procedure, two service user and two staff files, staff meeting minutes and some maintenance records. Discussions were held with Mr And Mrs David about the progress they had made in the short time they had been managing the home. Mrs David stated that her first priority was to the service users, many of whom understandably had been anxious about the sale of the home. This transition was well managed and Mr and Mrs David got to know the residents before taking over the home. The previous owners have also supported them. A number of maintenance issues have been identified and Mr David has contacted the relevant corgi approved engineers to replace the central heating system and they have identified the boiler needs replacing. The electrical wiring has also been checked. Feedback from service users and staff was positive and Mrs David had begun to establish formal systems of support for care staff, which will include annual appraisals and regular supervision. This will help her determine what tasks care staff are doing and the organisation of the workload. Staff and service users stated that there was at times insufficient staff on duty to meet the needs of service users. Staffing levels have not decreased since the new owners have taken over and the senior care staff have the flexibility to call in additional staff when the need arises. Staffing levels must be kept under review according to service user dependency levels. Two service user files were inspected and one file indicated that the service user had Alzheimer’s disease. This was not identified clearly at the point of assessment prior to admission, but as a result of a hospital stay. The home are not registered to provide dementia care and have agreed to reassess the service user’s needs and if he is placed out of category, apply for a variation to their main category of registration. A full audit of standards will be undertaken at the next inspection, when Mr and Mrs David have had time to get established. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 6 What the service does well: What has improved since the last inspection? 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) DS0000065311.V266371.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Adequate assessments are carried out at the point of admission and needs are kept under review. The home must be able to continue to demonstrate that it has the capacity to meet the needs of the service users accommodated. EVIDENCE: At the point of registration, Mrs David was asked to produce a revised statement of purpose, service user guide and residential contract. These were forwarded to the CSCI and were satisfactory. Two service user care plans were inspected and were satisfactory. Both included a pre admission assessment, completed by other statutory agencies and the homes manager. One persons needs must be reassessed, and if assessed as having dementia the home must apply for a variation to its main registration category. The home must be able to demonstrate that they are able to meet the needs of the existing service users. This must be kept under review giving Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 9 consideration to service users dependency levels and the supervision they require. Staff training and supervision must demonstrate that staff are sufficiently competent to meet the needs of service users. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 The care plan addresses service user’s health, social and physical needs and are of an extremely high standard. EVIDENCE: Two service user care plans were inspected and provide comprehensive information. They describe in detail what support service users require and how this should be provided. One care plan provided clear evidence that all aspects of the care plan had been reviewed monthly and annual reviews had taken place. Service user consent was sought for the care plan to be in place. The other care plan did not show sufficient evidence of monthly review, although extremely comprehensive daily notes had been kept, which showed this person had recently been hospitalised on several occasions which could explain the gaps. The manager commented that she received excellent support from the GP practice and District nurses. Good relationships have also been established with the community psychiatric services. The optician was visiting the following day. Clear medical records are kept. A number of omissions were noted including, no risk assessment for the use of bed sides and poor recording of Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 11 service user weights. Weights of admission were not recorded and the home does not have scales appropriate to the needs of some service users. Nutritional assessments were not seen, even when a service user was described as having a poor appetite and had weight loss. The manager stated that she was reviewing the menus, which go in two weekly cycles. Her main concern was service users gaining weight. She was asked to contact the dietician for advice, staff training. Medication records, and supplies were not checked, but the staff on duty confirmed that they had received training in the administration of medication and evidence was provided of medication reviews. Service users were spoken to respectfully and care staff worked in a professional way. Care staff have recently undertaken a bereavement course in November 2005. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The home would benefit from a person specifically employed to provide activities. EVIDENCE: Nine service users were spoken to about life in the home. A number of service users have long established friendships, lots of visitors and still go out independently but are asked to sign out. Activities are provided for those able to join in. The manager has organised some outside entertainers, including a musical extravaganza. Care staff stated that there was insufficient time to provide any social activities in the morning, such as quizzes, but the afternoon staff provide this. The manager is looking to employ an activities coordinator two days a week and already has some one in mind. The home has weekly communion. The home has a regular hairdresser. Service user hobbies and social histories are documented as part of their care plan. It was good to see that a sensible approach to risk is encouraged and service users are free to go into the kitchen for a chat. The manager has made some contact with relatives, but has not held a relatives meeting. This could be provided, or a newsletter implemented to inform service users, staff and residents of forth coming events. The home operates an open door policy. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 13 Both service user’s care plans inspected demonstrated that choice is promoted and care staff and service users stated that choices are offered although both felt that care staff can be rushed which has the potential of diminishing service user independence and choice. The home employs several cooks, who prepare home made meals, mostly cooked from fresh. On the days menu was chicken, potatoes and three fresh vegetables. The home has a two -week menu, and service users were complimentary about the food. Fluid charts where required were appropriately filled in. The inspection was undertaken over a mealtime and care staff served the meal in a presentable way and supervision was deemed appropriate. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 The home has adequate policies and procedures in place for the protection of vulnerable adults. EVIDENCE: The home has a complaint procedure and no complaints have been received since the last inspection. The adult protection polices/procedures were not requested, but staff spoken to have received training in the protection of vulnerable adults. Further confirmation is necessary that this is up to date for all staff. The staff files provided evidence that staff have appropriate pre employment checks in place including POVA 1st and CRB checks. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,23,25 The home provides spacious, well-proportioned and homely accommodation, which is fit for purpose. EVIDENCE: Most of the standards were not inspected. The home was maintained to a high standard of cleanliness with no unpleasant odours. No maintenance issues were identified although Mr Davis stated that major works had been undertaken on the central heating system and electrical wiring. The boiler also needs replacing. Mr David would like to refurbish and redecorate parts of the home. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The home must ensure that care staffs’ training is up to date and the skills mix of staff on duty is appropriate. EVIDENCE: The inspection took in the views of all the staff working in the home and some comments raised were fed back to the manager. All staff expressed concerns over the staffing numbers at the home, which have not changed under new management. Care staff felt rushed particularly in the morning. The night staff do not get people out of bed. This is the task for the morning staff. They also have medication to administer and breakfast to serve to service users in their bedrooms. The manager is in the process of asking staff for a copy of their contracts and is reviewing care hours, job descriptions and the skill mix of the staff. In reality the manager has made provision for extra staff to be called when necessary, and is reviewing staffing levels through observation and staff supervision. Both Mr and Mrs David work full time in the home and are there to assist care staff where necessary. Two staff files were inspected and provided evidence of pre employment checks. The manager has devised a form to be used at interview and has recently interviewed for one care staff vacancy and for the position of activities coordinator. The manager spoke of increasing the number of relief staff should the need arise. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 17 Evidence of staff supervision was not requested because it was made clear to the inspector that previous supervision records were poor and the manager had just started afresh recently. She had also held a staff meeting. Care staff spoken to confirmed that they had undertaken all the relevant training including NVQ training. The home has achieved 70 . The home employs an external trainer to provide courses, but clear evidence that all the care staffs training is up to date was not available. Staff files have been started from fresh and the manager was asked to provide a training matrix, indicating what training has been completed and what training is planned. Certain training is applicable to all staff. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,36,38 The home is managed to a high standard and the priority is meeting service users needs in a way that is acceptable to them. EVIDENCE: The manager, Mrs David demonstrated her competence at her fit persons interview undertaken by CSCI staff in July 2005. As a qualified physiotherapist she has significant experience in the assessment, and rehabilitation of clients, specifically over 65. She has also managed teams of staff. If she stays as registered manager she would be expected to undertake the Registered Managers award. She did say that once the business it established she may employ a full time manager. She is in the process of recruiting a deputy manager. Both Mr and Mrs David have put a lot of hours in before and since buying the business to enable them to become familiar with the service users Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 19 and care staff and to begin to identify what their priorities for the home will be. Feedback from service users and staff was positive. As part of the recent registration process the new owners were asked to demonstrate that they were financially viable and financial accounts for the business were seen and included the predicted expenditure and cask flow. Some records were inspected and were satisfactory and included some maintenance records. (No record of staff fire drills were seen) and the home were asked to contact the local fire officer with the view of them visiting in an advisory capacity. Works on the central heating and electrical wiring had been carried out. A record of water temperatures was seen. Staff files and service user files were of as high standard, but evidence of supervision and training must be provided. Some health care records must be updated and the home must ensure that it operates within its current certificate of registration. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 4 8 2 9 X 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 4 3 x X 3 X 3 X STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x X X 3 X 3 Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP4 Regulation CSA9 Requirement Timescale for action 31/01/06 2 OP8 3 OP27 4 OP30 5 OP36 A retrospective application must be made to the CSCI for a variation if the recently admitted service users has a diagnosis of dementia. 12(1)(a) The registered person must ensure that evidence is available which demonstrates how service users’ health care needs are fully met. 18(1)(a) The staffing levels must be kept under review according to the dependency levels of service users, as identified through care reviews. 18 1)(c)(i) Evidence must be provided that all statutory training is up to date. Training certificates must be kept as further evidence. (This was a previous requirement, which has been carried over twice when the home was under different management) The time scale of 31/08/05 has not been achieved. The registered person must forward a staff-training matrix to the CSCI. 18(2) Arrangements must be made for DS0000065311.V266371.R01.S.doc 31/01/06 31/01/06 31/01/06 31/01/06 Page 22 Florence House (Ramsey) Version 5.0 care staff to receive formal supervision at least six times a year. (This was a previous requirement, which has been carried over twice when the home was under different management. The time scale of 31/08.05 has not been achieved. 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 OP12 Good Practice Recommendations The home would greatly benefit from a specific person employed to provide social activities. Florence House (Ramsey) DS0000065311.V266371.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office 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) DS0000065311.V266371.R01.S.doc Version 5.0 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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