Inspection on 04/07/08 for Florence House (Ramsey)

This inspection was carried out on 4th July 2008.

CSCI found this care home to be providing an Excellent service.

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) 17/07/07

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 27/09/2008.

CARE HOMES FOR OLDER PEOPLE Florence House (Ramsey) Westfield Road Ramsey Cambridgeshire PE26 1JR Lead Inspector Joanne Pawson Unannounced Inspection 4th July 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Florence House (Ramsey) DS0000065311.V368049.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.V368049.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.V368049.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 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 £358.00 to £450 a week. The difference in fees is because some rooms have en-suite facilities. 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.V368049.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. We, the Commission for Social Care Inspection (CSCI) carried out a key unannounced inspection of Florence House on 4th July 2008 from 10:00 am until 16:00 pm using the Commission’s methodology described below. This report makes judgements about the service based on the evidence we have gathered. We spent time talking to the residents and the manager and looking at care plans, health and safety documents, staff recruitment, supervision and training documents, and talking to the members of staff on shift. The manager also completed a pre inspection information (Annual Quality Assurance Assessment) some of which will be included in this report. Twelve surveys were returned to the commission from the residents and two from the staff. What the service does well: Florence House has a homely atmosphere and staff stated that the residents are treated like family. Residents confirmed that they are treated with dignity and respect. Although when some residents moved into the home they needed to use incontinence aids now due to the staff working with the residents on continence programs none on the residents need the continence aids. One resident said ‘ the staff are really wonderful they couldn’t be nicer. They are always polite and we could never be looked after better’. Another resident said ‘ all of the carers are very good’ All twelve of the surveys returned indicated that they had received enough information about the home before moving in, that they always received the medical support they needed and that they knew how to make a complaint if they needed to. Eleven of the twelve surveys returned indicated that that always received the care and support they needed. Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Florence House (Ramsey) DS0000065311.V368049.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.V368049.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): 1,2,3,4,5 Quality in this outcome area is good. Detailed information is obtained prior to anyone moving to the home to ensure that identified needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Before anyone new moves into the home, a detailed admissions procedure is followed. A brochure would initially be sent to any prospective new admission, detailing the facilities of the home, fee levels and general information, together with an initial application form. The brochure was last updated in March 2008. A copy of the inspection report is also shown to the prospective resident and/or their family. Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 Page 9 If the initial enquiry proceeds, the manager and/or a senior carer would then complete a home visit, or visit to the prospective new resident in hospital to complete a pre admission assessment. Where a local authority funds the care, copies of their assessments are also obtained. The information gathered would be used to identify the needs of the person looking to move into the home, and ensure that they were able to meet those needs, and the documentation used was seen on three files examined for people living in the home. All privately funded residents have a copy of their contract with the terms and conditions. Florence House (Ramsey) DS0000065311.V368049.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 excellent. Residents are supported to access any health care they require. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were looked at. The care plans were individual and written to encourage independence and to promote privacy and dignity. For example one care plan stated what the resident could normally do for themselves but also said that on days when her back pain was bad she may need more help with personal care. A resident handling assessment is completed for each resident and is clear to see from the colour on the front of the assessment what level of risk the resident is when being assisted to move. Nutrional assessments are completed for all residents to assess if they need any special diets. Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 Page 11 There was evidence to show the care plans had been reviewed with the resident and their family where appropriate. One resident had suffered with leg ulcers since 2004. Since recently moving into the home the ulcers had started to heal, the manager felt that this was due to regular support from the district nurses, a better diet and the staff encouraging the residents mobility. Care staff have received training on continence programmes. This has resulted in all of the residents regularly being assisted to the toilet and none of them needing incontinence aids. Residents are supported with healthcare requirements where needed. For example one resident broke their glasses and the manager took the glasses to the opticians and had them fixed and picked them up the same day. On the day of the inspection the manager took a resident to a hospital appointment. One resident stated that she had recently broken a bone in her arm and the manager and staff had been fantastic supporting her and helping her with anything she needed and that the manager came and spoke to her everyday to see how she was. There was evidence in the care plans that residents were seen by healthcare professionals when needed. All of the residents spoken to stated that the staff treat them with dignity and respect. The medication administration sheets were inspected and found to be satisfactory. Although the storage of medication has improved the controlled drug cabinet is not secured to the wall using the specific screws as required by the Royal Pharmaceutical Society. Florence House (Ramsey) DS0000065311.V368049.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 excellent. Daily life meets residents’ expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents confirmed that if they did not like what was on the menu they could choose something different. Because the staff know the residents so well they are aware of the likes and dislikes and if they are aware that a resident does not like the main meal an alternative is offered. One resident said ‘everyone looks after me well and the meals are nice’. Residents confirmed that they have enough daily activities to keep them occupied. The manager stated that religious needs are met by visiting clergy of individual choice. A monthly communion is organised in the house for those who wish to attend. One resident wanted to see a catholic priest monthly so Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 Page 13 this was arranged. The manager took this resident to the Sunday service, which the resident had not done for a number of years. Community contacts are maintained by some residents going to the day centre, visiting the bank and the post office. There is no restriction on visiting times and residents can choose to see people in the communal areas or their bedroom. Relatives and friends were invited to the homes Christmas party for the first time and it was appreciated by both parties. Florence House (Ramsey) DS0000065311.V368049.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. The Commission has not received any complaints or safeguarding alerts since the last inspection. The manager stated that she speaks to all of the residents daily and any dayto-day matters are resolved constructively through informal discussion. This is documented in the concern/comment page of the care plan. 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.V368049.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): 19,20,21,22,23,24,25,26 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. Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 Page 16 Extremely high standards of cleanliness were observed. The external grounds are well maintained. There is ample parking. The home has three toilets and two bathrooms, which are domestic in style. One bathroom has a bath hoist fitted. Several rooms have been redecorated and new carpets and curtains have been fitted during the last year. Three of the bathroom floors have been replaced. The corridor and the main lounge have been painted and re-carpeted. New curtains have been fitted in the dining area. Florence House (Ramsey) DS0000065311.V368049.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. Staff have the training they require to meet the residents needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff files were inspected and found to have the necessary recruitment checks before employment. Two of the files did not contain clear information dates from their previous work history. This information must be provided so that the manager can investigate any gaps in work history. The training matrix showed that staff had attended training on moving and handling, infection control, food hygiene, health and safety, protection of vulnerable adults and mental capacity act, continence training, skin care, catheter management, medication management, dementia distance learning course and National Vocational Qualifications (NVQ) in Care level 2 and 3. All new staff complete a skills for care induction so that they have the basic training they need to do the job. Out of the 10 care staff 6 have NVQ 2 or above. Two staff are currently doing NVQ 2 and the other staff do not meet the criteria. The head of care has completed NVQ 3 in management. Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 Page 18 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. All of the residents spoken to during the inspection spoke highly of the staff. When asked how the home could be improved none of the residents could think of anyway this would be possible. The home does not use any agency staff. Any extra hours needed are covered by the home staff. Florence House (Ramsey) DS0000065311.V368049.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): 31,32,35,38 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: The manager lives onsite and is able to provide support in the day or night time. Some management responsibilities are shared between the senior staff. All of the staff and residents spoken to were positive about the management style of the home. Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 Page 20 The manager has completed a fire risk assessment, which has been approved by the fire service. Records show that the emergency lighting and fire alarms are being tested weekly. The Cambridgeshire Fire and Rescue service completed a fire audit in September 2007, no issues were identified. The manager gave out a quality questionnaire about the activities provided. 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. 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. Florence House (Ramsey) DS0000065311.V368049.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 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 3 3 4 4 3 4 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 3 3 X X 3 X X 3 Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 Page 22 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 OP9 Regulation 13(2) Requirement The storage of controlled drugs must comply with the Misuse of Drugs Regulations 1973 to ensure medication is as secure as possible. Timescale for action 01/09/08 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.V368049.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact 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 Florence House (Ramsey) DS0000065311.V368049.R01.S.doc Version 5.2 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. 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