Inspection on 27/06/06 for Francis House

This inspection was carried out on 27th June 2006.

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

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

Other inspections for this house

Francis House 27/06/07

Francis House 22/03/07

Francis House 01/02/06

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 Key Unannounced Inspection 27th June 2006 10:30 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.V300199.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. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 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.V300199.R01.S.doc Version 5.2 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. 1st February 2006 Date of last inspection 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 DS0000058691.V300199.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a report of an unannounced inspection undertaken at the end of June 2006. The inspector spoke with service users and staff and assisted throughout the inspection by the registered manager. The inspector read documents pertaining to the care of service users and running of the home. A tour of the home was undertaken. The inspector would like to thank everyone who took part in the in process for their assistance and co-operation during the inspection. What the service does well: What has improved since the last inspection? What they could do better: The service has appointed staff without evidence of a satisfactory CRB disclosure. This greatly compromises the welfare of service users, is contrary to Regulations. The service will have to improve its recording of accidents. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 6 The management of service users medication is of concern; errors were identified at this inspection. Statutory Requirements have been made in previous reports for the service to ensure that medication is managed safely and service users receive their medication as prescribed. The service has not complied and this is evidence of a serious failure in the service’s statutory responsibilities. Therefore the Commission will take enforcement action to ensure compliance and that service users receive their medication as prescribed. 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.V300199.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 Francis House DS0000058691.V300199.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. However an accurate detail on diagnosis is crucial and this should be clarified formally with the placing social worker prior to admission. EVIDENCE: The inspector reviewed the file of a recently admitted service user. It was noted that the referral assessment did not advise the service user had dementia, however this was recorded on the homes pre-admission assessment. The manager later confirmed that the service user had a diagnosis of dementia and that staff had been given this information verbally from the social worker. The inspector read limited information on the service users life history; this is something that staff should be eliciting form the service user or relatives. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. However service users medications are not managed safely. EVIDENCE: The inspector read two service users care plans and was impressed with the level of detailed directing staff to meet the service users needs. Each care plan contained a good summary of risk such as physical aggression or falls. The inspector was satisfied that both care plans identified how service users needs were to be met. The manager told the inspector that no service user had pressure sores. The district nurse visits regularly to undertake a leg ulcer dressing. Service users care plans provide details of when they were last seen by their doctor. The home maintains records of accidents and incidents in the service. The inspector tracked two accidents. The first related to a service user who absconded from the home. The report does not provide of where or when or who found the service user. However the inspector was pleased to note that staff had recorded the circumstances of the service user being found in the daily records. The second accident related to the service user sustaining an Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 10 injury after a fall in her room. The service user went to hospital as a result of her injuries there were no details of the follow-up injuries sustained in either the accident form or daily records. The inspector reviewed the homes management of service users medication. There was evidence that one service user’s supply of medication had run out early and was three tablets short. To compensate for this the home had commenced the new weeks medication earlier and were therefore short three doses of medication. The manager tracked back through preceding medication administration records and was unable to identify how the shortage could have occurred. There was also evidence on two service users medication records where staff had failed to record whether the medication was administered or not. The Commission has had concerns about the management of service users medications and made previous requirements to ensure service users were administered their medication as prescribed. However the service has failed to comply. Therefore the Commission will take enforcement action to ensure compliance and ensure service users are administered their medications as prescribed. Service users wear their own clothes, and the inspector observed the interaction between staff and service users to be respectful. Staff were observed also to be knocking before entering service users rooms. One service user told the inspector “They (staff) treat us like royalty”. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 11 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the service must support service users to undertake their preferred activities as agreed in the care plan. EVIDENCE: The inspector saw a variety of activities taking place with service users, such as a quiz, reading to a service user and playing cards. There is a schedule of activities planned for each unit and staff record the service users that take part. One care plan detailed the service user enjoyed gardening and attending her church as a means of meeting her religious and leisure needs. The inspector tracked the recorded activities the service user took part in for 8 weeks prior to the inspection. It was noted that there was no record of the service user attending her church or being supported to undertake some gardening or of her being offered the activity. The home has no set visiting times and visitors are welcome to call at any reasonable time. The inspector did not meet any visitors during the inspection but one service user told the inspector that her regular visitor enjoys coming to the home as staff always make him feel welcome. She confirmed she receives her visitor in private. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 12 The inspector met with a service user who has needs identified as being more appropriately met in a smaller bedded home for people with similar needs. The service user is unhappy at Francis House and wishes to leave. The service user showed the inspector the brochure of a home that he had been assessed for, he was very excited about the prospect of moving to live there, telling the inspector “I can’t wait”. However the manager advised the inspector that he would not be transferred and the placing social worker was reported to be looking at other options. The inspector accepts that the manager and her team have made considerable effort to ensure this service users rights, however now an advocate should be sought and a review held so the service user has appropriate independent support. The inspector viewed the menu for the home and compared it to what was being offered the service users, all appeared in order. The menu offers service users a choice of dishes at mealtimes, care staff advise the catering staff what choices have been made. Two service users that the inspector asked were satisfied with the food and confirmed that they have a choice in food provided. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has ensured that staff have been advised of their responsibilities in relation to adult protection. EVIDENCE: There have been no complaints recorded in the service since the last inspection. The home has in place a complaints procedure and notices to advise service users and visitors how to complaint. As a local authority service all the departments procedures are in place for the protection of vulnerable adults. There have been no adult protection investigations since the last inspection. Staff have received training on the protection of vulnerable adults and what action to take in the event of or a suspicion of abuse. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 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, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. However the service will have to improve the lighting in service users bedrooms. EVIDENCE: The home has been decorated throughout and appears clean, bright and comfortable. There has been new furniture purchased which the service users welcomed, one invited the inspector “come and see our lovely pink chairs”. The signage removed for the redecoration needs to be replaced. A large curtain has been hung which if drawn divides of an exceptionally large room and offers service users a more homely lounge. It was noted that the lighting in service users bedrooms has not been addressed. All areas of the home seen by the inspector appeared to be clean and well maintained. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 15 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The service fails to protect service users by not undertaking adequate checks before staff work in the home. EVIDENCE: There are three units in the home that are staffed by two care workers per unit, with a duty manager running the shift. With the presenting needs at the time of the inspection there was evidence that this staffing level is currently sufficient. However the use of agency staff is extremely high as the service has not recruited for an extensive period. Whilst the agency staff are mostly under long term bookings these staff are not subject to the same accountability as the services permanent staff. 100 of the staff team including agency staff have achieved NVQ level 2 and many are working toward their level 3 award. Examination of staff files was undertaken at the centralised Human Resources Department for the Borough. It was identified that one staff either had no files, or there was no evidence that a CRB disclosure had been obtained. This position greatly compromises the welfare of service users, is contrary to Regulations, and immediate remedial action is now required. Enforcement action will be taken for failure to comply with the stated requirement. The inspector saw evidence that a recently transferred member of staff had an induction into the service, however this was not TOPSS related. The service does not provide foundation training and will need to introduce this to assure Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 16 itself that all staff are adequately equipped to achieve the aims of the service. Despite this service has a good training record and the inspector saw staff had attended training on supervision and appraisal and specialist training on capacity in terms of mental health, some staff also attended training on customer care in health and social care. The service has planned further staff training on cross infection and food hygiene, refresher on moving and handling, adult protection awareness and careworker development. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 17 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, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although more work is required in eliciting the views of service users and families and reflecting these in the development plans for the service. EVIDENCE: The manager holds the NVQ 4 and Registered Manager’s award. She has been managing the service for several years now. The manager undertakes regular training updates. She is familiar with the issues relating to older people with dementia and is ensuring her team are suitably trained. The responsible individual undertakes unannounced monthly monitoring visits and these are forwarded to the Commission. However apart from this there is no more formal system of quality assurance in place as was required at the last inspection. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 18 The inspector undertook a random check of four service users monies that are held by the home. All four wallets of cash were found to balance with the cash held record. Any expenditure had a receipt attached to the back of the cash record. Only the manager and administrator have access to service user funds with a small float that staff can access in their absence. The inspector was satisfied that the home had taken steps to ensure service users monies were protected. The inspector checked the fridge temperatures in the service and noted that chilled food is stored at a safe temperature and monitored twice a day. The home undertakes weekly fire panel checks and ensures all fire doors are closing securely. There had been three fire drill this year and the service has updated its fire risk assessment. There was evidence that fire equipment and had been serviced and maintained. Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 19 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 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 x 3 STAFFING Standard No Score 27 2 28 3 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 3 Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 20 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 OP33 Regulation 24 Requirement The registered provider must implement an system of quality assurance. (That facilitates service user feedback.) Unmet requirement from previous inspection. The registered person must ensure the lighting in service users bedroom is adequate enough to enable service users undertake reading and fine detail activities. Unmet requirement from previous inspection. The registered manager must ensure that service users accidents are adequately recorded. The registered manager must ensure that the Commission is notified without delay of any occurrence that affects the wellbeing of a service user. The registered manager must ensure that service users who have identified interests and preferences are supported to undertake these. Timescale for action 01/10/06 2. OP25 23 01/11/06 3 OP8 17 12 10/09/06 4 OP8 37 10/09/06 5 OP12 12 15 10/09/06 Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 21 6 OP14 12 7 8 OP27 OP29 27 19 9 OP30 18 The registered manager must ensure an advocate is sought for the identified service user and review of care/placement is arranged. The registered provider must recruit into the home’s vacant posts. The registered person to ensure that no person works in the home unless a satisfactory CRB disclosure has been obtained by the Local Authority. Unmet requirement from previous inspection(s). The registered manager must ensure that staff receive induction and foundation training that meets the criteria of the NTO. 10/09/06 10/11/06 28/07/06 10/10/06 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.V300199.R01.S.doc Version 5.2 Page 22 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. Extracts may not be used or reproduced without the express permission of CSCI Francis House DS0000058691.V300199.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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