Inspection on 17/07/07 for Florence House (Ramsey)

This inspection was carried out on 17th July 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Florence House (Ramsey) 04/07/08

Florence House (Ramsey) 14/06/06

Florence House (Ramsey) 12/12/05

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 PE26 1JR Lead Inspector Joanne Pawson Unannounced Inspection 17th July 2007 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 Florence House (Ramsey) DS0000065311.V346354.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 (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Florence House (Ramsey) Address Westfield Road Ramsey Cambridgeshire PE26 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 jenitadavid@aol.com Alfonsa Jenita David Alfonsa Jenita David Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (12), Physical disability (2) of places Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two named service users with physical disabilities under the age of 65 years(PD) to be accommodated for the duration of their residency 14th June 2006 Date of last inspection Brief Description of the Service: The property and ongoing business was sold in November of 2005 to Mr and Mrs David. Mrs David is the registered manager and is supported by her husband, who is a businessman and manages the financial accounts and the maintenance of the home. They are currently living in private accommodation situated within Florence House, so are available to provide on going support to staff and residents. Accommodation is provided for up to fourteen service users over the age of 65. All the bedrooms are single and three have en-suite facilities. The majority of bedrooms have external doors opening on to a terraced patio. There is a dining room and separate 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. The manager stated that the current fees were £354.00 to £420 a week. The difference in fees is because some rooms have en-suite facilitites. Extras are charged for items of a personal nature, such as toiletries and chiropody. A small amount of personal allowance is kept on behalf of residents. Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 17th July 2007 for seven hours. Methods used for the inspection included speaking to the manager, reading documentation, talking to the residents and staff and sending out surveys to the residents. Mr and Mrs David live on the premises and were both present during the inspection. The home was maintained to a high standard of decoration and cleanliness. Residents comments included ‘I’m very happy, it’s lovely here. Everybody is nice’ and ‘ it does not matter what you do they encourage you’. What the service does well: What has improved since the last inspection? Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 6 A new cook has started working at the home and as a result the menus have become more varied. Residents can choose what they would like for their tea such as a hot snack, sandwiches or a salad. A fire risk assessment has been completed and sent to the fire service for approval. The local fire service has visited the home to familiarise themselves with the fire panel and the layout of the home. 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. The summary of this inspection report can be made available in other formats on request. Florence House (Ramsey) DS0000065311.V346354.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 (Ramsey) DS0000065311.V346354.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): 1,3,5,6 Quality in this outcome area is good. The manager assesses prospective residents needs to ensure the home can meet them before they move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three of the resident’s files that were inspected included an initial resident assessment which had been completed before they moved into the home to ensure that the home could meet their needs. The manager completes the pre admission assessment with prospective new residents. Several of the residents spoken to stated that they had chosen to move into the home as they were from the local area and knew people living in the home and the staff. Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 9 Some of the residents stated that they or a member of their family had been to look round the home before choosing to move in. One resident said she had been lonely living on her own and wanted to move to somewhere she knew so had chosen Florence House. She also stated that she liked living in the home. The home does not provide intermediate care. Florence House (Ramsey) DS0000065311.V346354.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. The staff obviously know the residents well and this helps to ensure that the residents are encouraged to be as independent as possible where appropriate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents care plans were inspected. Each file contained handling assessments, falls assessments, mobility assessment and health and safety risk assessment. However when changes are identified the care plan is not always updated to reflect this. The care plans were written to encourage the residents to be as independent as possible for example ‘allow her to do as much for herself as she can, giving her plenty of time to achieve the task’. Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 11 Some of the statements in the care plans were not detailed enough for example ‘ ensure good oral hygiene’ does not explain what the residents can do for themselves or how much support the staff need to give. The care plans are reviewed monthly. The reviews were personal and showed that the staff knew the residents living in the home well. There was evidence that staff following the care plans had helped a resident to become more independent and this had been reflected in the monthly reviews. Evidence of involvement from the relevant healthcare professionals was seen. It is not always possible to weigh the resident accurately as some find it hard to stand on the scales. The home would benefit from sit in scales. The manager stated that she is aware of this and had included it in the budget for the next financial year. The residents spoken to confirmed that they feel they are always treated with dignity and respect and staff always knock on their bedroom door before entering. The medication administration sheets were inspected. There were several omissions of signing for the administration of medication. The manager had already become aware of the issue and had written to the staff responsible. Staff have completed a distance learning course on the safe handling of medication. However there is no observed competency test for staff administering medication. The controlled drugs cabinet does not meet the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973. The controlled drugs record is not suitable and does not give a running total of what medication should be in stock. The drugs trolley is stored in an unlocked cupboard (which is also used for other storage) and is not chained to the wall when not in use. Florence House (Ramsey) DS0000065311.V346354.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. Resident’s likes and dislikes are taken into consideration when the activities are organised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a large board in the lounge with the day and date and a large clock next to it. One of the carers offered round hot drinks and biscuits on a plate that the residents could choose what they would like. They were also offered another drink after they had finished there first. Nearly all of the residents had gone on a trip organised by the manager to a garden centre. When asked about activities and hobbies one resident stated ‘does not matter what you do they encourage you’. The same resident was making a doll and decorating it with things she had bought during a recent trip out to a garden Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 13 centre. She also stated that the manager had allowed her to bring her sowing machine so also enjoyed using that. One resident has their own area of garden where she grows plants and flowers and Mr David helps her to water it. On the day of the inspection there was an entertainer singing songs that the residents recognised. They all seemed to enjoy this. The home has an activities coordinator who also organises other sessions such as exercise sessions, quizzes and bingo. The senior carer on shift during the inspection came through to the lounge and asked a resident if they wanted to help change their bed linen. One of the residents goes into the kitchen and helps with washing and drying up. Another resident stated that if the cook is not in the kitchen she could go and make herself a hot drink. The lunch on the day of the inspection was cottage pie and vegetables followed by spiced apple pudding and vanilla sauce. All of the residents seemed to enjoy their food and there was a really nice atmosphere in the dining room with the residents and staff talking to each other. The staff obviously know the individuals likes and dislikes for example one resident had bread and butter with her lunch and another resident had a Guinness with hers. Adapted eating utensils were provided where needed. If a resident would like something different other that what is on the menu they can request it in the morning. Florence House (Ramsey) DS0000065311.V346354.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. Residents are confident they could complain to the manager and any concerns would be dealt appropriately with. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents spoken to said if they had any complaints they would talk to the staff or the manager about it. One resident stated she had complained about over cooked vegetables so the cook now took her vegetables out of the pan whilst they where still crunchy. All of the residents stated that they found Mr and Mrs David very approachable and that they always had a chat with them each day. All of the staff have attended training on the protection of vulnerable adults. Staff spoken to on the day of the inspection were aware of the procedure to follow if they suspected a resident had been abused. Florence House (Ramsey) DS0000065311.V346354.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): 19,20,22,23,24,25,26 Quality in this outcome area is excellent. The environment is homely, comfortable and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is purpose built, on one level and all bedrooms are single, some have en-suite facilities. A number of bedrooms were inspected and were pleasantly furnished and personalised with belongings and photographs. There is a menu in the dining room with the lunchtime meal on. There was also an activities poster and a fruit bowl in the dining room. There was a vase of fresh flowers in the living room. Extremely high standards of cleanliness were observed. The external grounds are well maintained. There is ample parking. The home has three toilets and Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 16 two bathrooms which are domestic in style. One bathroom has a bath hoist fitted. One member of staff suggested that a call bell close to the bath would help if there was an emergency in the bathroom. There is no call bell facility in the lounge or the dining room. This could place the residents at risk especially as there is only usually two members of care staff on shift and for at least one hour a day there is only one member of staff on shift. Florence House (Ramsey) DS0000065311.V346354.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 good. The resident’s benefit from staff that know them very well due to a low staff turnover and small staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: When asked by the inspector two residents stated that there are always enough staff available. However for one hour a day there is only one member of care staff on shift. The manager stated that she is also always around at this time and the residents tend to be resting at this time of day. The staffing levels must continue to be monitored to ensure the residents needs can be met and they are not placed at risk from a lack of available staff. Five of the carers have completed the NVQ 2 in care and one has completed the NVQ 3. The care staff have attended various training such as moving and handling, topps induction, safe handling of medication, continence, food hygiene, infection control, first aid and protection of vulnerable adults. Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 18 The recruitment files for three members of staff were inspected and found to be satisfactory and contained all of the necessary information. The manager stated that she has a waiting list for people applying for jobs. All of the residents spoken to made positive comments about the staff and stated that they had no complaints about how they were cared for. Florence House (Ramsey) DS0000065311.V346354.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): 31,32,33,35,36,37,38 Quality in this outcome area is good. The manager is respected by the staff and residents and the home has systems in place to review the quality of its care provision. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One resident stated that whilst she had been unwell the manager had come and seen her in her bedroom every morning to see how she was or if there was anything she needed. There are plans to extend the home and these have been discussed with the residents currently living in the home. Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 20 One member of staff stated that it is a small focused team that work well together and the owners are seen as part of the team. Seven of the care staff had received two supervision since January 2007. The manager stated that she had planned for the supervisions to be more frequent in the future. The head of care has extra responsibilities such as updating care plans and ordering medication. At present she either comes in early on her shift or tries to fit them in as part of her care shift. It would be beneficial if the head of care worked supernumerary for at least one shift a week to give her time to fulfil her other duties. The manager has completed a fire risk assessment which has been sent to the fire service for approval. The local fire officer and crew have been to visit the home so that they are familiar with the layout. Records show that the emergency lighting and fire alarms are being tested weekly. The Portable appliance testing was last completed in July 2006 and has been booked to be done again in July 2007. The manager gives out a quality questionnaire to the residents and any visitors to the home once a year. The results of the survey were seen on the notice board in the dining room. The manager has acted on any issues raised in the questionnaire replies. The results from the GP included comments that they are called at appropriate times and residents are given sufficient privacy when receiving any treatment in the home. There is also a questionnaire given to new resident after their trial period to ensure they are happy with the home. The records and balance was checked for money kept on behalf of two residents and was found to be accurate. The accident records were inspected. It was noticed that there were a lot of accident forms for one resident. The manager stated that she was aware of this and his needs were being assessed by the relevant health care professionals to ensure the home could still meet his needs. Florence House (Ramsey) DS0000065311.V346354.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 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 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 4 3 X 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 X 3 2 3 3 Florence House (Ramsey) DS0000065311.V346354.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 OP9 Regulation 13(2) • Requirement Timescale for action 01/08/07 2. 3. OP22 OP36 23(2)(n) 18(2) There must be accurate recording of the administration of medication. • There must be an appropriate controlled drugs register. • The storage of controlled drugs must comply with the Misuse of Drugs Regulations 1973. There must be a call bell facility 01/10/07 in all rooms used by service users. There must be system in place to 01/08/07 ensure that staff receive regular supervision. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 23 Florence House (Ramsey) DS0000065311.V346354.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cambridgeshire Area Team 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 © 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 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!