Inspection on 01/02/06 for Francis House

This inspection was carried out on 1st February 2006.

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

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

Other inspections for this house

Francis House 27/06/07

Francis House 22/03/07

Francis House 27/06/06

Francis House 24/05/05

Francis House 06/12/04

Francis House 29/07/04

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

CARE HOMES FOR OLDER PEOPLE Francis House 102 Beaconsfield Road Walthamstow London E17 8LU Lead Inspector Zita McCarry Unannounced Inspection 10:00 1 February 2006 st 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 Francis House DS0000058691.V259238.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. Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Francis House Address 102 Beaconsfield Road Walthamstow London E17 8LU 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) 0208 520 5100/2438 0208 509 0482 London Borough of Waltham Forest Linda Cocks Care Home 32 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (9) Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 named people, One of whom has a learning disability and associated mental health problems, one of whom has a learning disability and one who is under the age of 65 years. 24th May 2005 Date of last inspection Brief Description of the Service: Francis House is a residential care home offering 24-hour care for up to older service users. The home is located in a residential area of Walthamstow a short distance from local amenities. The home is managed London Borough of Waltham Forest Social Services Department. Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is the result of an unannounced inspection in early February. The inspector spoke with service users and staff and undertook a tour of the building. The inspector read care records relating to the care delivered to service users and other documents pertaining to the running of the home. Clarification over some records was sought form the administrator the day after the inspection. The inspector would like to thank everyone who participated in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The service must obtain more detailed information about service users needs and particularly their life histories before they are admitted to the home. The management of service users medications is inadequate. The Commission has made requirements at three previous inspections about how the home Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 6 manages services users medication. The Commission is taking enforcement action to ensure that residents receive their medication safely and as they are prescribed by the doctor. 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. Francis House DS0000058691.V259238.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 Francis House DS0000058691.V259238.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): 2, 3, 4, 5 The home takes measures to ensue staff can meet a prospective service users needs before admission but assessments do not adequately reflect the life history of service users which is crucial for people with dementia. EVIDENCE: The inspector read the file of a recently admitted service user. The service user was admitted directly from hospital and there was a social workers assessment of need in place. The home had also undertaken their own assessment of the prospective service users needs. Areas of needs around personal care mobility, mental health and personal safety were addressed. The home had identified the service users risks. There was a discrepancy between the information on the assessment the aid supplied on admission. The staff in the home clarified this on the day of the inspection. It was noted that the staff in the home had made good observations at the time of admission however there was an incident that staff should have provided more detailed information around possible triggers and behaviour. Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 9 As mentioned earlier a social workers assessment was provided it was noted this contained minimal information on the service users basic needs. There was no life history or any real picture of the person. It is essential for a service that provides care for people with dementia to have good quality assessments with a service users history where possible as these are the basis of good quality care for people with dementia. The manager must look at ways of ensuring such information is in place prior to admission. The inspector noted that there was a signed copy of Terms and Condition of residency on the service users file. Francis House DS0000058691.V259238.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, 9, 10 The homes management of service users medication is unsafe. EVIDENCE: The inspector read the care plan of a service user. The care plan contained insufficient detail on the actions staff needed to take to meet service users needs. The inspector read the service users risk assessment, it was undated and not signed by staff, service user or advocate. There was evidence that the home reviews the care delivered to the service users. This is recorded on a tick chart monthly however when a change has been noted the nature of the change has not been recorded so the inspector was unable to track whether the care plan had been updated to reflect the change. At the time of the inspection there were no service users presenting health concerns or pressure sores. From reading service users files it was evident that medical attention was sought promptly and appropriately. However the inspector noted a dressing on the arm of one service user. The staff on duty Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 11 was able to explain the reason for the dressing but these details were not recorded on the service users records. The management of the home’s medication has been a concern to the Commission for some time. The inspector checked a bottle of Temazepam 10mgs and noted on the label that the chemist had dispensed 7 tablets. However the inspector counted 8 tablets in the bottle. The tablets were evidently not the same as three were smaller. On investigation by the manager it was confirmed that staff on receiving the medication had mixed the previous tablets left over with the tablets in with the newly received bottle. This is an extremely dangerous practice as it is apparent staff are effectively dispensing medication which is the role of the pharmacist. On checking another medication Risperadol Quicklet 0.5mg the inspector also found irregularities. Initially it appeared that the 2 tablets were missing and no-one could account for the shortfall. However later the inspector noted from the home’s communication book that the service users Risperadol Quicklet was actually finished before the end of the medication month and staff therefore started using the new months medication earlier. This fully accounted for the 2 tablets thought to be missing. However it was also evident that the service user was not given the Risperadol Quicklet as prescribed as there was none in the home for a day and the dose was omitted. It is regrettable that staff did not make contact with the GP or pharmacist before the medication was depleted to ensure medication is administered as prescribed. Another service user medication Theophylline Liquid 60mgs in 5mls was prescribed three times a day. However on the day of the inspection this medication had run out five days earlier so the service user had missed 15 doses of the medication. The chemist was due to deliver it the day after the inspection. Because there have been significant identified errors and poor practice in the administration of medication identified at three previous inspections the Commission is taking enforcement action to ensure that residents receive the medication they are prescribed, safely. Francis House DS0000058691.V259238.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 offers service user some lively group activities EVIDENCE: The inspector positively noted and improved atmosphere in the home, staff were interacting very positively and service users who appeared interested in the going on around them. The inspector noted that in one unit a lively lighthearted quiz taking place and in the other a sing-a-long. The inspector meet with two service users who reported that they preferred to sit and chat to each other but considered there was enough activities to join in if they wanted to. The home keeps a good record of the activities or social event service users attend. The service offers no restrictions on visitors to the home unless a service user preferred not to see someone. At the time of the inspection no service user required assistance with feeding. The inspector saw the homes menu plan and noted it appeared nutritious. Feedback from service users asked varied from “its ok” to “very tasty”. Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Staff have demonstrated a marked improvement in understanding their responsibilities in adult protection. EVIDENCE: There had been two complaints received about the service one was responded to promptly the second complaint had a slower response, which did not meet the service’s timescales. There have been 3 referrals to the Adult Protection team concerning separate incidents at Francis House. Whilst the service will have to continue to make improvements in the recording of incidents there has been a marked improvement in the prompt reporting of incidents. Staff including agency staff receive training in the Protection of Vulnerable Adults. Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 25, 26, The service has made physical improvements to the home. EVIDENCE: The service users physical environment had been improved with the purchase of some new furniture and redecoration. The inspection took place on a winter’s day and the home was warm and comfortable throughout. The manager explained that the service has plans to improve and the very large space which one unit currently uses as a lounge and dining area. However the area still lacks definition and functions as a thoroughfare in the home. The two remaining unit lounges and dining areas have been redecorated and whilst small currently appears to meet service users needs. No work has been undertaken to improve the light in some service users bedrooms many of which dark, the removal of uplighting shades may improve the lighting in these rooms. Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 15 During the inspection it was evident that the service had sufficient and adequate equipment around the home to support service users independence. Francis House DS0000058691.V259238.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, 30 The staffing levels in the home have improved however temporary agency staff mostly provides care as the managing organisation is failing to recruit its own staff. EVIDENCE: Files to evidence safe recruitment are held at the service human resource department, so these were not checked at this unannounced inspection. Recruitment to the home is centralised and files to evidence the safety of this recruitment are not held at the home therefore this area was not tested. The service has improved the staffing levels in the home there are now 6 care staff on both early and late shifts with a 30-minute handover in between. There are two waking night staff on duty. From observation the staff appeared less rushed, had more time to spend with service users and the activity program is taking place, these observations lead the inspector to consider that at the time of the inspection there was adequately skilled staff in sufficient numbers to meet the needs of the service users. However the vast majority of staff in the home are agency and the service has not as previously required recruited into the vacant posts. The manager confirmed all permanent staff and 10 out of 12 agency staff hold and NVQ level 2 in care. The home as delivered a range of training to its staff team such as first aid, sensory awareness, PoVA and diabetes. Eight care staff have attended the five Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 17 day care worker development work shop which has topics on mental health, person centred planning, and challenging behaviour. The manager confirmed that long-term agency staff access the organisations training courses. It was the inspector’s view that the training was impacting positively on the standard of care delivered and has been fundamental to securing better outcomes for service users. Francis House DS0000058691.V259238.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, 35, 38 The home ensures service users personal monies are held safely and accounted for. EVIDENCE: The registered manager holds her NVQ 4 in Management and Registered Manager’s Awards. She undertakes periodic training to update her knowledge and skills. The home manages cash for many service users to ensure they have access to personal monies. The inspector randomly selected records and cash held for three service users. A check was undertaken of monies removed and the inspector noted there was a corresponding till receipt to verify expenditure. Following clarification form the homes administrator the day after the Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 19 inspection the inspector was satisfied that service users finances were held and managed safely. Records to evidence that the service ensures the maintenance of fire detectors, and alarm were checked and in order. There was also evidence that staff who come to work in the home are inducted into emergency procedures and informed of their responsibilities in respect of health and safety. Francis House DS0000058691.V259238.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 X 3 2 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 3 3 X X 2 3 STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 X X 3 Francis House DS0000058691.V259238.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 OP3 Regulation 14 Requirement The registered manager must ensure there are improved and comprehensive assessments that reflect service users life history and assessment of need prior to admission. The registered manager must ensure the nature of the changes in need are recorded when care is reviewed. The registered manager must ensure that that all first aid/ treatments are appropriately recorded. The registered person must ensure that the service responds to complaints within it’s 28 days timescales. Outstanding requirements from previous inspections. The registered manager must ensure that all residents are provided with comfortable and relaxing communal space by making this area more defined and homely. Timescale for action 01/05/06 2 OP7 14 01/05/06 3 OP8 15 01/04/06 4 OP16 22 01/05/06 5 OP19 23 01/05/06 Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 22 6 OP14 12 The registered manager home must ensure that service users are enable to take part in 7decisions directly affecting lives. A risk assessment must evidence why a service user is unable to have a role in the decision making process. The registered person must ensure the lighting in service users bedroom is adequate enough to enable service users undertake reading and fine detail activities. The registered person must further develop the care plans to reflect service users strengths and life histories. 01/05/06 7 OP25 23 01/05/06 8 OP7 15 01/05/06 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 Francis House DS0000058691.V259238.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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. 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