Inspection on 24/05/05 for Francis House

This inspection was carried out on 24th May 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 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

Francis House 27/06/07

Francis House 22/03/07

Francis House 27/06/06

Francis House 01/02/06

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 Announced Inspection 24th and 25th May 2005 at 10:00am 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Francis House Address 102 Beaconsfield Road, Walthamstow, London, E17 8LU Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8520 5100/2438 020 8509 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 Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th December 2004 Brief Description of the Service: Francis House is a residential care home offering 24-hour care for up to 32 service users (elders). The home is located in a residential area of Walthamstow a short distance from local amenities. Currently the London Borough of Waltham Forest Social Services Department manages the home. Francis House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a report from an announced inspection undertaken in at the end of May 2005. The inspector spoke with the manager, met with staff and service users both in groups and individually. Service user and staff files were inspected, as were various records and documents relevant to the running of the home. The inspector received a high volume of service user and staff feedback comment cards all of which were positive. Although there was several comments that they did not always think the home was well enough staffed. Going into the inspection the Commission was gravely concerned about the service’s non-compliance, it had 50 unmet statutory requirements, and 31 had been outstanding for some time. The hard work of the entire staff team has been noted as thirty-nine of these requirements have been met and definite progress has been made to improve the standards of care provided. Seven new requirements have been made at this at this inspection. Whilst more work needs to be done, it is the inspector’s view that the management and staff team have created a base on which to further develop good practice. The inspector would like to thank all the service users and staff for their cooperation in the inspection process. What the service does well: What has improved since the last inspection? The service has made improvements in all areas of its service. Service users now have care plans, which describe the actions of staff to meet identified needs. The care plans also identify service users risks. Although further development is required this is a considerable improvement. Staff, both permanent and agency are now being trained in the skills needed to care for older people with dementia. Staff are receiving regular supervision. Francis House Version 1.10 Page 6 The home is progressing with its redecoration program. New radiators have been installed in the large corridor areas. Progress has been made in respect of employment checks although more work is required in this area. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Francis House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Francis House Version 1.10 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 standard(s) 1, 3, 4 The service takes steps to ensure they can meet potential service users needs before admission. The service does not give prospective service users sufficient information about the service. EVIDENCE: The service has revised the Statement of Purpose it now provides the information required under regulations 4 of the Care Home Regulations 2001. The Service Users Guide has also been improved however the guide needs to include the Terms and Conditions and a service users complaints procedure that is accessible to service users who have varying communication needs. It was noted that the assessments lack sufficient information in respect of social history; knowledge of the life history of service users with dementia is crucial for staff in the provision of a holistic package of care. Inspection of the file of recently admitted service user provided evidence that the home had received care approach program as an assessment of need before commencing the admission process to the home. Additionally, the home Francis House Version 1.10 Page 9 had undertaken a pre-admission assessment before arranging for the service user to be admitted for a trial stay. Francis House Version 1.10 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 standard(s) 7, 8, 9, 10, The home has made great progress in the implementation of care plans and risk assessment. However, the handling and management of service users medication was a cause for grave concern. EVIDENCE: The inspector reviewed two service users care plans. It was positively noted that the service has worked hard to introduce a care planning system that addressed the needs of service users. Detailed risk assessments were seen on each service users file identifying risks such as falls and aggressive behaviour. On tracking these it was noted that the strategies for managing the risk identified in the assessment were included in the care plan. The service will need to begin developing these further now to ensure that the life histories and strengths of service users are incorporated into the plan as this is the way the service will promote the service users well being. The service users are registered with local health practices. District nurses visit the home to undertake nursing tasks. During the course of the inspection the inspector observed various equipment used in the prevention of pressure sores. No service user had pressure sores at the time of the inspection. Francis House Version 1.10 Page 11 The inspector was gravely concerned about the safe keeping and management of service users medications. On the Medication Administration Record (MAR) for one service user who was prescribed Morphine, a controlled drug it was recorded that the service user had been administered the drug on three occasions on one day, on checking the monitoring sheet there was no record of the medication being administered. The manager undertook an investigation and concluded that the medication had not been given and the MAR entries were in error. Other entries on one service user’s MAR sheet recorded receipt of 100 painkillers there were 20 tablets left in the box 2 tablets had been recorded as administered to the service user this left 78 tablets unaccounted for. There was evidence that staff were dispensing medication without training or the home checking their competence. The inspector also found a brown glass bottle in the medication cupboard with unknown liquid contents. The label on the bottle stated “for destruction Poison”. The senior staff responsible for medications was unable to explain its purpose or how long it had been there. The inspector was so concerned about the handling and management of medication in the home that an immediate requirement notice was served to ensure the service took immediate action to ensure medication was handled and managed safely. From observing the interaction with service users and staff it was noted that staff were respectful in their communication. Two service users confirmed that personal care is always delivered in the privacy of their bedroom and another service user told the inspector that even though she does not like her bedroom door closed staff would still knock on the open door and wait to be invited in. Francis House Version 1.10 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 standard(s) 12, 14, 15 The service does not keep accurate records on the activities of service users. More work will need to done for staff to champion service users choice and autonomy. EVIDENCE: The home has activity plans for each unit of service users. However the inspector was unable to accept the records for these activities as factual. For example on one file checked the review of activities stated the service user declined to join any activities however the unit record states she attended music and video sessions. Another service user is recorded as attending knitting and sewing, spending time in the garden and 1:1 chatting. However on tracking this record became evident that the service user did not even live in the home at the time. It was noted on the file of one service user that she had been excluded for her the review held at the end of her trial stay. The explanation given was that “the meeting thought that it might well confuse and irritate Mrs X”. It is the responsibility of a home offering a service to people with dementia to facilitate a discussion that does not confuse and irritate the service user. The service also needs to be acknowledging and validating the service users irritation. When service users are excluded from the decision-making process, the reason why must be documented. Francis House Version 1.10 Page 13 The manager explained that the home was currently undergoing a review of the menu plans to ensure service user choice. The home offers service users seasonal menus these appear nutritious and appetising. The feedback from the service users on the food provided varied “it’s lovely” to “not very nice at all”. Staff confirmed that a service user was receiving pureed meals, however there was no evidence of a nutritional assessment or specialist advice available. The inspector was extremely concerned to see staff chop up food and pour the pureed food over it and proceeded to feed this very unappetising mess to a service user. The member of staff confirmed that this is the usual practice at mealtime for this service user. Additionally, the feeding of the service user could nave been undertaken more discreetly there was a lack of social interaction between staff and service users. Francis House Version 1.10 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 standard(s) 16, 18 The service has taken steps to protect vulnerable service users from abuse. However it has failed to give these service users accessible information on how to make a complaint. EVIDENCE: There were four complaints recorded since the last inspection. Two of these were dealt within the service’s timescale and two were not, they were still incomplete at the time of the inspection. Despite repeated requirements the service has no implemented a complaints procedure that is accessible to the service users. The home has had 3 adult protection inquiries at the time of the inspection. The Commission has had concerns about how promptly staff responded when concerns were raised. It was positively noted that the service has undertaken work with the staff team, including agency staff to ensure everyone can define abuse and have a clear understanding of their responsibility in reporting suspicions or actual abuse. From discussions with staff the inspector was satisfied that this aspect of their role was understood. Francis House Version 1.10 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 standard(s) 19, 21, 22 24, 26 The service is progressing well in redecorating and refurbishing the home although at the time of the inspection this was not complete. EVIDENCE: A major redecoration program was in progress during the inspection. The homes’ large corridors are more comfortable now with heating installed. The kitchenette worktops along with the rotten kitchen window have been replaced. Service users bedrooms are being redecorated gradually and the inspector was satisfied that staff were fully supporting decanted service users and recognised that they would need additional support during this confusing time. The manager explained that the corridors and lounges would be redecorated when the bedrooms were completed and that the service had given some thought as to how to better define the large spaces. In the event that service uses bedrooms become vacant following discharge or death the home redecorated the room before a new service user is admitted. However many of the bedrooms have very poor natural light and the lighting Francis House Version 1.10 Page 16 provided in the bedrooms is inadequate for and writing, reading or fine detail work. Toilets are easily accessible and in close proximity to service users living areas. There is signage on toilet and bathroom doors to support service user’s independence and orientation. The inspector saw the aids and rails the service had put in place to in toilets and bathrooms to support service users independence. Despite the redecoration program in progress the home appeared clean and free from any mal odours. The laundry is well organised into clean and dirty areas and the floors have a permeable surface. Francis House Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The home has an extremely high usage of agency workers, which despite considerable investment in training and support undermines the continuity of care offered to the service users. The service has made excellent progress in the training offered to staff working in the home. EVIDENCE: The home is divided into three group living areas of 13, 10 and 9 service users. The inspector has been concerned that the unit with 9 service users has only one care worker form 11.30 and through lunch and during he afternoon and evening shift. The manager stated that an additional member of staff would be brought on to accommodate hospital appointments. At the time of the inspection the manager stated there were 4 service users who required personal care on this unit. The inspector remains unsatisfied that the service provides adequate supervision, support and stimulation to this group of service users. On a late shift on one of the days of the inspection the inspector met briefly with the team. The late team consisted of six staff including the shift leader, it was a concern that 5 out of the six staff were agency; and including the shift leader four of these had worked in the home for less than four months. There was evidence throughout the inspection that the home had re-inducted agency staff, and was providing both training and supervision to agency workers. Whilst all this is a benefit and evidence that the home is trying to compensate for the high usage of agency staff there is still a very obvious lack in continuity, which ultimately undermines the stability and wellbeing of service Francis House Version 1.10 Page 18 users. The lack of rapport between many staff and service users was evidence during the inspection. However there was evidence that an agency worker had taken responsibility as duty manager of a shift and administered medication without an adequate induction. However when the inspector spoke to staff who had worked at the home for a sometime she was very impressed with the ease of the relationship between the staff member and service users. The service users were very interested and alert in the discussions and the staff member had very good insight into the individual service users realities. The member of staff was skilled at being able to keep three service users engaged in conversation about church and recipes for home cooking. The discussion was evidence of good practice in the promotion of service users wellbeing. The inspector was impressed training the service has recently invested in both permanent and agency staff. Most staff have attended a five day workshop on dementia care which addressed topics on dementia, activities, death and dying, mental health and challenging behaviour. Nine staff have undertaken and passed a four day first aid training, and 13 staff, including the catering staff have undertaken a certificated food hygiene course. The service has undertaken no recruitment recently, however staff files were made available to the inspector. The service was unable to present two staff file, as there reportedly could not be located. It was impossible therefore to evidence their recruitment. Work has been undertaken retrospectively ensure those staff employed in permanent posts have now got sufficient checks and references and the improvement has been noted. However in addition to the missing staff file there were a further 2 CRB disclosures outstanding, although there was evidence that these had been applied for. There was one CRB disclosure returned to the provider where the inspector could find no evidence that the organisation human resource department had taken appropriate action in line with its own employment procedures. The manager explained to the inspector the local measures the home had taken to ensure service users were protected form abuse. She explained that before a new agency worker commences a shift in the home they must present their CRB disclosure. The inspector randomly tested two agency staff files and this supported the manager’s evidence. Francis House Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36, 38 The service has made progress on how it supports and supervises the staff team. How the service seeks the views of the people that use it needs to be developed further. EVIDENCE: The inspector saw a variety of documentation to evidence that the service takes steps to ensure the health, safety and welfare of service users. The home undertakes weekly fire alarm tests, and has begun recording the staff attending the home fire drills. There were certificates to evidence that the fire panel was maintained and serviced. The home has the service user lifting equipment serviced and maintained. In addition to a gas safety check the home also undertakes water analysis to ensure the safe water storage temperature. The Commission has been receiving regular monitoring visit reports from the provider. As part of the homes quality assurance has commenced auditing Francis House Version 1.10 Page 20 service users opinions on the food and activities provided. Whilst this in itself is positive more thought needs to be put into how opinions are sought. Questions such as “Are you happy with the breakfast menu”? Would most probably be very intimidating and threatening for someone who does not recall what he or she ate for breakfast. People with dementia need are very vulnerable to poor self-esteem, asking questions that they are unable to answer reinforced such negative feelings. The service may want to consider keyworker taking on some direct detailed observational work or showing pictures of some foods or meals. After randomly inspecting three staff files the inspector was satisfied that the manager had now put in place regular planned supervision for staff, including agency staff. The managing organisation acts as corporate appointee to a number of service users. The home had policies and procedure in place for safeguarding service users finances. The inspector checked monies held on behalf of 4 service users. On all 4 records the cash held and the balance sheet tallied with corresponding receipts detailing any expenditure. However on two records there was evidence that families had deposited cash for service users. It was of concern that these deposits were not recorded in a receipt book and a copy issued to the relative. Francis House Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 2 COMPLAINTS AND PROTECTION 2 x 3 x x 2 2 x STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x 2 3 x 3 Francis House Version 1.10 Page 22 no 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. 2. 3. OP26 OP23 19 16 Standard Regulation Requirement Below are requirements outstanding for previous inspections. The registered provider must ensure that CRB checks are undertaken for all staff. The registered provider must replacement of furniture (beds, wardrobes and chairs) throughout the home. The registered provider must ensure that the redecoration the entire building inside (walls and woodwork) and woodwork out. The registered manager must ensure that service users, their family and/or advocates have information about the home as defined in regulation 5 of the Care Homes Regulations 2001. The registered provider must ensure the home has adequate staffing levels to meet the needs of the residents. The registered manager must ensure that receipt of all medicines is recorded when received into the home. The registered manager must ensure safe practice in the Francis House Version 1.10 Page 23 Timescale for action 1/12/05 1/12/05 4. OP19 23 1/12/05 5. OP1 5 1/12/05 6. OP12 18 1/12/05 7. OP9 13 immediate 8. OP9 13 9. OP16 22 10. OP33 24 11. OP35 18 handling and administration of medications including assessment of staff competence. The registered manager must put in place an accessible notice to advise residents and relatives how to make a complaint. The registered manager must ensure that all residents are provided with comfortable and relaxing communal space by making this area more defined and homely. The registered provider must implement an system of quality assurance. (That facilitates service user feedback.) The registered manager must ensure staff operate within the organisations financial guidelines. Below are requirements from this inspection. The registered manager home must ensure that service users are enable to take part in decisions 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 that service users receiving a pureed diet do so on specialist advice and staff must follow instrctions as detailed in the care plan. The registered perosn must ensure the lighting in service users bedroom is adeqate enough to enable service users undertake reading and fine detail activities. The registered person must ensure anyone left in charge of the home has appropiate skills and competence confirmed in Version 1.10 immediate 1/12/05 1/01/06 1/12/05 12. OP14 12 1/12/05 13. OP15 13 1/12/05 14. OP25 23 1/01/06 15. OP30 18 1/12/05 Francis House Page 24 induction. 16. OP35 17 The registered person must ensure that the service responds to less than satisfactory CRB disclosures and evidence of this must be provided. The registered person must ensure accurate records are held in the home. The registered person must further develop the care plans to reflect service users strengths and life histories. 1/01/06 17. OP7 15 1/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Francis House Version 1.10 Page 25 Commission for Social Care Inspection Gredley House 1-11 Broadway 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. Extracts may not be used or reproduced without the express permission of CSCI Francis House Version 1.10 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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