Inspection on 27/06/07 for Francis House

This inspection was carried out on 27th June 2007.

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

The inspector 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 22/03/07

Francis House 27/06/06

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 Unannounced Inspection 27th June 2007 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 Francis House DS0000058691.V346329.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.V346329.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) 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 DS0000058691.V346329.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia, over 65 years of age - Code DE(E) (maximum number of places: 23) Mental disorder, excluding learning disability or dementia, over 65 years of age - Code MD(E) (maximum number of places:9) The maximum number of service users who can be accommodated is: 32 22nd March 2007 2. 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.V346329.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, which took place towards the end of June 2007. The manager was on leave so the senior care staff, administrator and service manager assisted in the inspection process. The inspector spoke with service users and staff, read records relating to the care of service users and management of the home. The inspector undertook a tour of the home and observed the interaction between staff and service users. The inspector would like to thank everyone involved for their co-operation and assistance throughout the day. What the service does well: What has improved since the last inspection? What they could do better: The service needs to make better provision for the ensuring staff who deliver the care are fully aware of the strategies in place to prevent accidents. Francis House DS0000058691.V346329.R01.S.doc Version 5.2 Page 6 Activities for service users no longer able or willing to undertake participate in group activities needs to be better developed. 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. Francis House DS0000058691.V346329.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.V346329.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): Quality in this outcome area is good. Service users and relatives can be assured that the home will take appropriate steps to assure itself that it has the ability to meet prospective service users needs before admitting them to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector checked the records of the most recently admitted service user. There was a social workers assessment of need in place which detailed the service users presenting needs and recent history. The service had undertaken an assessment prior to admission and identified risks and considered these before admitting the service user. Francis House DS0000058691.V346329.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. However service users cannot be assured that the home will consistently kept staff advised as to the arrangements they need to put in place to prevent accidents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two care plans were reviewed as part of the inspection process. Both care plans reflected the assessment of need undertaken by the social worker and were detailed in the level of support required. The inspector was pleased to note that on one care plan there was good detail on what the service user could do for himself thereby enabling him to maintain his independence. It was noted that the daily progress reports contained insufficient information in relation to monitoring the wellbeing of the service user particularly on the day of admission. For example on the file of a recently admitted service user there was minimal recorded on how he was adjusting to the home or Francis House DS0000058691.V346329.R01.S.doc Version 5.2 Page 10 information gleaned in regards to likes and dislike, routines etc from the service user or his next of kin who spent the afternoon in the home. This is a crucial time when it would be expected assessment of the service user would be continuing. On tracking an accident one service had which resulted in a hospital admission the inspector noted that the management review of the accident detailed revised moving and handling techniques in that 2 staff were to assist in all transfers and when necessary a standing hoist was to be used to support the service user. However these strategies were not reflected in the care plan or risk assessment. Despite this serious failure to alert staff to revised strategies there was good evidence that the staff in the home respond promptly and appropriate to accidents ensuring service users get prompt medical attention. The homes management of service users medication was reviewed. The inspector audited a random selection of service users medication. The audit evidenced that service users had their medication administered as prescribed. There were clear records that the inspector could track medication being received into the home administered and/or disposed off. The medication is held securely in metal trolleys fit for purpose. All staff have received training on the administration of medication which is administered by two staff who have demonstrated competence. The inspector acknowledges the efforts of staff in improving the management of medication with the home. Francis House have to be commended for having a well organised system where service user are administered prescribed medication by competent staff. During the course of the inspection staff were observed to be appropriate and respectful to service users. Two service users confirmed to the inspector that staff always assist with care task in private and knock before entering their bedroom. Francis House DS0000058691.V346329.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. However service users who are unable to join group activities are not consistently supported in meaningful activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service provides activities for groups of service users who wish to join in. These activities range for bingo, sing-a-longs quizzes and board games. The inspector asked a service user if she was enjoying playing snakes and ladders the service user responded “well I enjoyed it when I was a child”. There is much less on offer for service users for whom group activities are no longer appropriate. One relative told the inspector the service user “hates being locked up in here with nothing to do”. The service users care plan was reviewed and whilst there was no specific social or meaningful activity planned for him it was noted “he will join in house activities and individual ones on the unit”. The inspector tracked the activities recorded for a one week period in early June and it confirmed the relatives comment. Francis House DS0000058691.V346329.R01.S.doc Version 5.2 Page 12 Earlier in the week of the inspection the staff had supported service users on a trip to the seaside. Service users reported they thoroughly enjoyed the outing. The service has a visitors policy advertised at the entrance to the home. None of the service users manage their financial affairs independently. One service user complained to the inspector and service manager that she lacked access and information about her financial arrangements. It became evident that this matter was already being addressed by the organisation. However there needs to be a system in place which gives the service user clear written information about who will be managing her financial affairs and how she can access personal monies. This information needs to be provided to service users in an accessible format which meets their communication needs. The lunch served to service users appeared nutritionally balanced and appetizing. The inspector noted a marked improvement in how staff supported service users at mealtimes. It was evident that staff were attempting to make lunchtime a more social occasion. Three service users the inspector spoke with reported they enjoyed their lunch. The menu was reviewed it provided a choice of meals which appeared nutritionally balanced. It was positively noted that service user are provided with a supper of sandwiches and hot drinks before retiring at night. Francis House DS0000058691.V346329.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Service users living in Francis House have a staff team that understands their role in protecting them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints record was reviewed and there were 4 complaints recorded. These were all responded promptly and well within timescale. It was noted that 3 of the complaints recorded were in relation to staff relations and did not directly relate to service users concerns. There have been no adult protection issues in the service since the last inspection. Staff including agency staff have received training on recognising abuse and their responsibilities in relation to protecting service users from suspicion or actual harm. The service has taken measures to keep service users updated about adult protection issues and what constitutes abuse in the Waltham Forests “no to abuse” leaflet that is accessible to service users. Francis House DS0000058691.V346329.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. However service users cannot be consistently assured that they have the most suitable bedroom furniture. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the home was clean and free from any malodours. The stained carpeting has been replace and the home is bright and welcoming. The service has also upgraded the lighting in service users bedrooms. During a tour of the home it was noted that the following issues need to be remedied. In shower room 3 the floor covering was raised around the shower and tamp had permeated to the other side of the wall. In the large lounge it was noted 2 curtain rails were hanging off the wall. Francis House DS0000058691.V346329.R01.S.doc Version 5.2 Page 15 One service user showed the inspector and service manager her bed, which she found uncomfortable. The mattress was lumpy and the old iron framed bed frame was inappropriate and hazardous. The service manager made immediate arrangements to have the bed replaced. However other beds in the home will need to be checked that they are fit for purpose. Francis House DS0000058691.V346329.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. However because the service has not recruited into vacant posts this results in an unstable staff team that cannot consistently offer continuity of care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the last inspection the service was issued with an immediate requirement notice that related to the skills and competence of the agency staff the service had recruited. As required the service responded promptly. New agency staff were recruited and the service provided training on adult protection, moving and handling and dementia care. The consequences of this was evident to the inspector on the day of the inspection the home was calm service users appeared relax and at ease. One service user told the inspector that the staff were “very nice people its perfect here. Whilst there was sufficient numbers of competent staff on duty the service has still failed to recruit into the vacant permanent posts and for this reason the standard remains unmet. There has been no recruitment since the last inspection permanent staff files were not checked however the service was able to demonstrate that all agency workers coming into the service have been appropriately recruited by their agency. Francis House DS0000058691.V346329.R01.S.doc Version 5.2 Page 17 Since the last inspection the service has provided training for staff on promoting incontinence, moving and handling, managing medication and the core values that underpin good residential care. The service exceeds the national minimum standards ratio of 50 NVQ trained staff. Francis House DS0000058691.V346329.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Service users live in a well managed home although their own experiences and feedback of the care provided needs to be reflected in how the service is developing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the service has been in post several years and is familiar with the presenting conditions of the service users. As detailed within the body of this report there is evidence that the registered manager is skilled and competent to manage this service. The service hold personal monies of most service users. The inspector undertook an audit of 3 randomly selected service users personal monies. The Francis House DS0000058691.V346329.R01.S.doc Version 5.2 Page 19 audit evidenced that the cash held was correct and balanced with the written financial records held. There were receipts for expenditures made. The inspector considered the system well organised. The service has undertaken a survey of the provision of care. It was produced as a quantitative report giving no qualitative feedback or experiences of service users upon which the service could be developed. The service needs to involve other stakeholders such as visitors, relatives or service users friends in undertaking their quality assurance of the service. The service provided records for the inspector that evidenced a it complies with its health and safety responsibilities to service users and staff. The inspector noted the following documents: a gas safety record, a service record for mechanical hoists, records evidencing safe cold and hot storage of food, weekly fire panel tests and regular servicing of the fire panel and fire fighting equipment. Francis House DS0000058691.V346329.R01.S.doc Version 5.2 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 4 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 2 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 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.V346329.R01.S.doc Version 5.2 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 OP7 Regulation 15 Requirement The registered manager must ensure there is evidence that service users and or relatives are part of the care planning process. The registered manager must undertake an audit of all bedroom furniture and replace those items that are unsafe or unfit for purpose. The registered manager must ensure the maintenance issues highlighted in this report are remedied. The registered provider must implement an system of quality assurance. (That facilitates service user feedback.) Unmet requirement from previous inspection. The registered manager must ensure that service users who have identified interests and preferences are supported to undertake these. The registered provider must recruit into the home’s vacant posts. Unmet from previous DS0000058691.V346329.R01.S.doc Timescale for action 01/09/07 2 OP24 23 01/10/07 3 OP19 23 01/09/07 4 OP33 24 01/09/07 5 OP12 12 15 01/09/07 6. OP27 27 01/09/07 Francis House Version 5.2 Page 22 7 OP7 13 8. OP7 14 inspections. The registered manager must ensure that strategies for reducing risk are clearly noted on care plans and that staff are aware of these. The registered manager must ensure that service users and/or their advocates are involved in their risk assessments. 01/09/07 01/09/07 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.V346329.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Francis House DS0000058691.V346329.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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