Inspection on 03/05/05 for Francis House

This inspection was carried out on 3rd 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 19/10/06

Francis House 24/01/06

Francis House 01/11/04

Francis House 04/06/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Chandos House

Cherry Orchards Camphill Community Ltd

Broadreach

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

CARE HOME ADULTS 18-65 Francis House Dennington Swimbridge Barnstaple EX32 0DG Lead Inspector Dee McEvoy Announced 3 May 2005 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Francis House Address Dennington Swimbridge Barnstaple EX32 0QG 01271 830030 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) Assisi Community Care Ltd Mr Michael Crumpton Care Home 40 Category(ies) of A Alcohol dependency past/present [40] registration, with number of places Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 3: Age range 25 years plus Date of last inspection 1st November 2004 Brief Description of the Service: Francis House is an inter-denomination Christian home providing care for up to 40 men who have problems relating to the use of alcohol. The home’s philosophy of rehabilitation is based on an abstinence model where service users are offered an opportunity to explore an alcohol free future. All service users are expected to contribute to community living with personal skills and commitment. Accommodation is offered in two buildings, Francis House and Clare House and is mainly single occupancy. The grounds comprise of nearly seven acres, and include trout ponds, vegetable gardens, greenhouse and lawned areas. Frances House are unable to offer places via court orders. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was the first of the year and was undertaken by two inspectors over the course of one day. A senior CSCI manager also attended the inspection for part of the day to establish where this facility fitted in to the overall picture of substance misuse provision in the country. It was concluded that Frances House provides support to people who have had previous episodes of treatment for alcohol addiction, or who have complex needs e.g. homelessness, or secondary mental health problems. There were 16 residents living at the home on the day of the inspection. The inspectors met with 10 residents, three members of staff, the manager and provider. Telephone interviews were conducted with one G.P, a psychiatrist and two care managers. Positive comments were received from health and social care professionals, one said, “We work as a team.” All spoken with were happy with the overall care provided. The inspectors looked around the home and a number of records were inspected, which included pre inspection questionnaire, assessments and care plans and comment cards from six of the residents. Residents spoken with and those responding with comment cards confirmed that they liked living at the home and that they were well cared for; one commented, “The staff are very nice, they are easy to talk to.” Another resident said, “This was the last chance for me, I am feeling well again.” What the service does well: The home has developed good relationships with health and social care professionals ensuring that residents’ needs are addressed. Health and social care professionals felt that the home communicated clearly and worked in partnership with them for the best interests of the residents. Comments included, “I value their experience” and “This is a valuable facility.” The home’s recruitment procedure and staff induction ensure that residents are safeguarded and cared for by informed and supported staff. The home provides attractive, well-maintained grounds; several residents commented that the garden and lakes provide an enjoyable environment, particularly in spring and summer. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 & 3 The admission procedure ensures that there is a proper assessment prior to people moving into the home. Francis House meets the needs of people with past alcohol use and secondary mental health problems. EVIDENCE: Comprehensive assessments are undertaken by referring professionals. The home’s application for residence is used as part of the initial assessment and generally contains all the information needed to contribute to individual care plans. Following admission residents remain on the premises for a two-week assessment period; one recently admitted resident confirmed that they were aware of this condition at the time of admission. The resident also told the inspector that they had been made very welcome by the staff and had settled easily in the home. Care managers and health professionals recognised Francis House as a ‘useful resource’ for chronic alcoholics with associated problems, but said that the home did not provide a treatment programme as such. One to one counselling is available and as recommended at the last visit records are kept enabling staff and residents to reflect on progress. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 9 The home operates a key worker system, which provides continuity of care; staff spoken with were aware of the individual needs and preferences of the residents’. One G.P felt that residents were “treated sympathetically” by the staff. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 Attention needs to be given to the development and review of care plans and risk assessments to ensure that emerging needs are identified and planned for. The home consults residents and relevant professionals appropriately, over decisions or restrictions relating to residents’ lives. EVIDENCE: Individual plans of care are available for each resident; five were inspected. One care plan did not reflect the significant changes experienced by one resident however discussion with staff and the managers suggested that needs were being addressed. Other plans were basic however the daily care record provides a profile of the residents’ day-to-day care. One resident spoken with was aware of their care plan and had attended reviews with their care manager; staff spoken with were aware of residents care plans. The care managers interviewed were satisfied with the care plans produced for their clients. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 11 Any restrictions or limitations are discussed and agreed prior to admission for example restrictions on the use of alcohol and non-prescribed drugs are clearly stated within the Statement of Purpose and contract. Residents are required to hand over control of their finances on moving into the home, to the manager who has non-enduring Power of Attorney. One care manager felt that this was “unusual and could be a controversial issue” but there was no evidence of misappropriation of monies. The providers have said in the past that this was to ensure that the fees were paid. The majority of residents manage their own personal allowance. Since the last inspection the home has developed sessions where support and tuition are available to assist residents to manage their own finances and use budgets. Six residents attended a session on the day of the inspection; two interviewed said they had found the session “very useful” and “helpful”. A weekly house meeting open to all is held to offer residents an opportunity to raise issues and discuss the day-to-day running of the home. The inspectors were told that these meetings are rarely well attended; one resident said, “I don’t go as it doesn’t make a great deal of difference to me.” Some activities have been organised as a result of these meetings and new menus were planned taking residents preferences into account. Risk assessments are documented in a pre printed format but there is limited space for more individual problems to be described and action determined. One risk assessment did not accurately identify the risk of self-harm, although staff were aware and action appeared to be taken to monitor the risk. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) & 17 12, 13, 14, 16 Residents benefit from access to local resources, which provides an opportunity for personal development, acceptance and integration with the wider community. Social activities are organised and residents are free to participate as they choose. Meals in the home are generally good offering residents a choice and catering for special dietary needs. EVIDENCE: Residents are supported to continue their education; four residents attend a local college studying a variety of subjects from art and archaeology to literacy and numeracy. None of the current residents undertake paid work outside the home. Residents are encouraged to undertake duties within the home, such as laundry, gardening and other domestic duties. One resident spoke about their work developing the gardens saying they are provided with the equipment and support they need to do this. Another said that they regularly play pool with a friend and that other activities are available though they do not chose to take part. A newly admitted resident was looking forward to fishing in the lake. The Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 13 manager has attempted to organise activities within the home as well as arranging trips to places of local interest; up take is generally low for group activities. Four residents met indicated that they are treated with respect by staff and do as they wish within the bounds of the agreed and accepted rules of the community. The manager has work hard since the last inspection to produce new menus, which reflect residents’ preferences. Four residents were asked about the food, three indicated that it is satisfactory with one saying it is good and another said, “You can have an alternative from what is on the menu as long as you give reasonable notice”. One resident felt that sausages were too frequently on the menu but said that alternatives were available. Some vegetables are supplied by the home’s own garden such as leeks, potatoes and carrots. The designated cook on the day of the inspection was fully aware of resident’s special dietary needs. Menus reviewed confirmed that residents generally received a varied and healthy diet. Residents were seen helping themselves to drinks as and when they wish. Residents have limited opportunity to actively plan or prepare meals for themselves but the inspector was told that anyone with an interest could volunteer to help in the kitchen. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 The health and personal needs of residents are met with good multidisciplinary working taking place on a regular basis. The system for storing medication has improved since the last inspection; medication at the home is managed safely. EVIDENCE: Health professionals confirmed that they were happy with the overall standard of care provided by the home however one health professional felt that staff skills in mental health issues could be developed but stated that experts such as Community Psychiatric Nurses and social workers supported the staff when necessary. One long serving member of staff had considerable experience of caring for people with mental health problems but could not identify any specific training undertaken at the home. The pre inspection questionnaire did not show that there had been any specific mental health training. (Please refer to NMS 35) Another staff member explained that the home had been in contact for advice and support for one resident twice within the previous week. Health professionals confirmed that the home communicated clearly and worked in partnership with them to ensure that residents’ health needs were met appropriately. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 15 Medications are properly stored in secure cupboards. Storage and record of controlled drugs were checked and were satisfactory. Recording of administration of medication was checked on two charts and both were satisfactory. A recent dispensing pharmacist audit (22/03/05) made one recommendation, which had been acted upon. A Homely remedies policy is available to guide staff. Staff receive the appropriate training before administering any medicines. Two health professionals were satisfied that medication was managed properly. Two of the residents spoken with manage their own medicines; they had signed forms to confirm that they take responsibility for their medication. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Residents know whom to speak with if they are unhappy or have concerns and they are protected by informed staff. EVIDENCE: No complaints have been received by the home in the past 12 months. A copy of the complaints procedure is displayed in reception and is reproduced in the Statement of Purpose. Residents interviewed and those responding with comments cards knew who to talk to if they had any concerns. Two members of staff said they had done some training regarding the recognition and reporting of abuse while undertaking NVQ courses and demonstrated an understanding of their responsibilities. Staff also have access to the home’s policy and procedures for adult protection as well as the local authority Alerter’s Guide. Residents spoken with and those responding with comment cards confirmed that they felt safe within the home and that staff treated them with respect. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The shared space at Francis House is considerable providing residents with choice and freedom around the home. The standard of the décor within the home is satisfactory although some areas are damaged and need attention. The lack of appropriate heating does not provide a homely and comfortable environment for all residents. EVIDENCE: At the time of the inspection all residents had their own room; these had been personalised by many of the residents. In accordance with this standard, on the basis of clinical need double rooms may be offered. None of the bedrooms are lockable. The ‘declaration of intent’ makes clear reference to this, stating that locks were not in keeping with the ethos of the home. Lockable rooms could be considered as a step to semi-independence or independence development. There are sufficient numbers of bathrooms and toilets but some routine maintenance is required to replace broken and missing tiles in the toilet and bathroom on the first floor of Francis House. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 18 The home has lots of shared space including 10 day rooms or quiet spaces and extensive and attractive grounds accessible to residents including a lake, lawned areas, a vegetable garden and greenhouse. The home has smoking and none smoking lounges. Residents spoken with were generally happy with their rooms and the facilities provided; one resident had gone back to bed mid-morning as he found the home cold; another said, “This is quite a miserable environment at times.” The issue of restricted heating was discussed again with the provider and manager; the inspectors were told that new boilers and radiators, to be fitted during the spring the summer, would address the heating issue. All areas seen were clean. It was noted that two bathrooms/toilets within Francis House did not have the appropriate liquid soap or hand towels to ensure that basic hygiene and infection control were maintained. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36 Residents benefit from a committed group of care staff that are supported and supervised in their roles, but staff would benefit from access to the appropriate NVQ modules to consolidate their knowledge The home operates a robust recruitment procedure ensuring that residents are safeguarded. EVIDENCE: Staff have a number of tasks to undertake such as domestic and cooking duties as well as providing care and support to residents. Staff members spoken with said that they think there are generally enough staff on duty. Residents spoken with indicated that there are enough staff on duty one person said “staff are around all the time” another described them as “ good people and easy to talk to”. Two staff files were inspected; both contained all the necessary recruitment checks to ensure the protection of residents. Staff files contained evidence of a detailed induction. A member of staff spoken with said they felt they had been well supported during their induction and since and that colleagues and managers are approachable. Training records showed that regular updates in mandatory training are provided; staff are also encouraged and supported to achieve NVQ 2 and Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 20 above. Currently staff do not have formal NVQ training which reflects the Drug and Alcohol National Occupational Standards {DANOS}. Discussion with staff, the training records and pre inspection questionnaire did not indicate that there is mental health training at the home although one member of staff spoken to did have previous experience in this area. Staff said they have regular formal supervision and that staff meetings are held about every two or three months. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Standards not inspected on this occasion EVIDENCE: Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 3 x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 3 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Francis House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x x x D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 23 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. Standard 6 9 Regulation 15 13 (4) (c) Requirement Timescale for action 14/6/05 3. 24 23 (2) (p) The registered person shall keep the service users plan under review. The registered person shall 14/6/05 ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. (This relates to the need to ensure that risk assessments are reviewed and up-dated to reflect changing needs.) The registered person shall 26/7/05 having regard to the number and needs of service users ensure that ventilation, heating and lighting suitable for service users is provided in all parts of the care home which are used by service users. (This relates to the policy of restricting the heating around the home.) (This is an outstanding requirement from 30/3/05) Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 24 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. 2. 3. Refer to Standard 24 30 35 Good Practice Recommendations It is recommended that broken and missing tiles in the bathroom and toilet of Francis House are replaced as part of routine maintenance. It is recommended that liquid soap and towels are availbale in communal bathrooms and toilets to maintain good hygiene and prevent infection. Staff training is recommended on the issues of mental health and consideration should be given to access toNVQ training which reflects the Drug and Alcohol National Occupational Standards {DANOS}. Francis House D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Suite 1, Renslade House Bonhay Road Exeter EX4 3AY 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 D54-D06 S22184 Francis House V217876 030505 Stage 4.doc Version 1.30 Page 26 - 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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