Inspection on 30/05/08 for Francis House

This inspection was carried out on 30th May 2008.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Francis House 17/01/07

Francis House 28/02/06

Francis House 05/12/05

Francis House 03/02/05

Francis House 01/11/04

Francis House 03/02/04

Francis House 11/12/03

Similar services:

Flint House

The Ley Community

Yeldall Manor

Cherwood House Care Centre

The Manor Clinic

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Francis House 2 Hulse Road Southampton Hampshire SO15 2JX Lead Inspector Annie Kentfield Unannounced Inspection 30th May 2008 12:00 Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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 DS0000011915.V363605.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 Adults 18-65. 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 DS0000011915.V363605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Francis House Address 2 Hulse Road Southampton Hampshire SO15 2JX 023 8022 4481 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) peter.s@streetscener.org.uk Streetscene Mr Peter Vincent Swift Care Home 18 Category(ies) of Past or present alcohol dependence (18), Past or registration, with number present drug dependence (18) of places Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2007 Brief Description of the Service: Francis House is situated in a residential area of Southampton near to the city centre and Southampton common. The home is registered with the Commission for Social Care Inspection as a treatment centre to accommodate eighteen people with drug and alcohol related problems. Francis House is part of the Street Scene organisation with two other treatment centres in Bournemouth. The treatment programmes consist of cognitive behavioural therapy, motivational enhancement and twelve-step therapy. The home offers both primary and secondary treatment courses. All adults over 18 years of age can be accommodated at the home and Francis House offers both shared and single bedrooms and a range of communal areas in a large period property with a garden. The ground floor is accessible but the upper floors are only accessible via stairs, the building does not have a lift. Fees are £530.00 per week. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report is a summary of information that we have received or asked for since the last review of the service and includes the outcome of an unannounced visit to Francis House on 30th May 2008. This was with one inspector (Annie Kentfield) and over a period of 5 hours we spoke to 3 of residents individually and 3 of the staff, looked around the home, and looked at a sample of the home’s records, including assessment and care plans and some of the health and safety records. Before the visit we sent surveys to 18 residents and 15 staff and we received feedback from 10 residents and 2 members of staff. When we visited the registered manager was on holiday but staff were very helpful and one of the Senior Managers for Streetscene came over from Bournemouth to assist with the inspection and provide relevant information. We received positive feedback from people using the service and one person told us “I feel the atmosphere here is very therapeutic” and another person told us “Everyone here is very approachable if I have any problems”. What the service does well: What has improved since the last inspection? What they could do better: Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 6 The registered manager must ensure that staff are following the home’s policy and procedures for the safe administration of medication. This will ensure that residents receive their medication as prescribed, at all times. We recommend that the registered manager obtain a copy of new guidance on medication that is freely available to download from the Commission website: ‘The Handling of Medicines in Social Care’ produced by the Royal Pharmaceutical Society of Great Britain. 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 DS0000011915.V363605.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are given detailed information about the programme of treatment offered so they can make an informed choice about using the service. Francis House has a comprehensive assessment process to ensure that they can meet all of the needs of people using the service. EVIDENCE: We spoke to 3 of the residents and looked at 3 care assessment/care plans. The service offers a structured treatment programme that aims to provide specific support in order to work towards recovery and rehabilitation. Prospective users of the service can find information about Francis House on the Streetscene website or in a written format (service user guide). Some people using the service may choose a treatment programme that is some distance from their home and it is not always possible for people to have an opportunity to visit beforehand. However, one resident told us that they rang Francis House and were given good information on the telephone by a member of staff and on the basis of that decided to move in for the period of treatment. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 9 The initial assessment is an important part of the process to ensure that the service can meet the care and support needs of the residents and this is carried out by one of the counsellors or a trained support worker. The assessment is also an opportunity for staff to ensure that prospective residents are aware of any restrictions on choice or freedom, services or facilities, which are required by the treatment programme and that these are agreed and recorded. We found evidence in the care files to confirm this. We also spoke to one resident who was clear that the structured programme was necessary for them to positively participate in treatment and recovery while at Francis House. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service are supported to make informed decisions about their daily lives and know that their personal goals and aspirations are reflected in their individual plan. Individual risks are clearly identified and managed with a clear support plan. EVIDENCE: All of the residents have an individual care plan and we looked at three of them and spoke to some of the residents. All residents have a key worker who works with the resident to review the care and support plan. Reviews often include peer feedback, as openness and honesty are values to which residents are encouraged to share. The care plan includes a risk assessment that also identifies potential risks of relapse and possible triggers that may cause relapse or discharge from the treatment. These may change during the period of treatment and will be Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 11 reviewed on a regular basis. Personal goals and aspirations are an important part of the care plan and will be reviewed according to the progress through the different parts of the treatment programme with the resident and their key worker. Inclusion and participation in all aspects of the group work and daily activity in the home are seen as valuable and an important and essential part of the treatment and recovery. This means that residents have a very structured daily routine of group and individual sessions with allocated periods in the day for the routines of daily living and leisure activities. We spoke to two of the residents who felt that the structure was good, and beneficial to them. They explained that some of the risks of relapse are discussed and shared with their peers and this had been positive for them. However, another resident told us in written feedback that they would like more choice about what they do during the day. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a strong commitment to supporting residents to develop their social, emotional, communication and independent living skills. EVIDENCE: We spoke to some of the residents and staff and looked at some of the care plans. Residents have a daily programme of therapeutic activities including leisure and social activities. There is an emphasis on group activity and group support so that residents do not become isolated. Residents are encouraged to share and support each other and acknowledge the agreed set of values to promote respect and openness. The service has a commitment to supporting residents to access resources locally that meet their chosen religious or spiritual needs. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 13 There is a programme of monthly outings and the venues are chosen by the residents and the service hires a mini-bus. Residents told us that last month there had been an outing to the Otter and Owl Centre and Moors Valley Orienteering and this was a joint outing with other projects run by Streetscene. Residents are supported to take part in sport and leisure activities, and there are opportunities for potentially new activities relevant to the interests and aspirations of the residents. One resident told us that they enjoyed doing work in the garden of Francis House and recent work on refurbishing the garden furniture and installing new garden fencing had all been done by the residents. Francis House is very close to Southampton Common for daily walks with some of the staff. Two residents told us that all activities are negotiated on an individual basis in line with their own risk assessment and risk of relapse. Most of the comments we received in the surveys were positive about this although one resident told us “ we can’t do anything with staff permission”. Preparation of meals and shopping are part of the therapeutic process and residents take it in turns to shop, cook and wash-up. One resident told us they enjoyed the shopping and liked the group atmosphere when everyone takes their meal together. We observed the lunchtime meal and there were alternatives to meet different needs and choices and an emphasis on providing healthy and nutritious meals. Residents can use the kitchen to make snacks or drinks whenever they want to, within reasonable and agreed times. Residents are also expected to keep their rooms clean and tidy and there are regular room checks by staff. Residents are supported to do this as part of the therapeutic process and the development of daily living skills. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The healthcare needs of the residents are assessed and monitored and residents have prompt access to community healthcare services when needed. The service has a policy and procedures for the safe administration of residents’ medication. The registered manager must ensure that staff follow this at all times to ensure that residents receive their medication as prescribed. EVIDENCE: We looked at 3 care plans and spoke to three of the residents and some of the staff. We found evidence to confirm that the specific health care needs of the residents are identified in the initial assessment and are part of the individual care plan. Healthcare needs are monitored and residents have access to GP and other specialist services during the period of the treatment programme (this can be up to 6 months). When we spoke to some of the residents and staff we confirmed that residents are encouraged and supported to access other health screening services and Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 15 also to access health promotion resources such as smoke stop therapy, if they choose. We looked at how the service administers medication for the residents, with a member of staff. Since the last inspection there have been some concerns about poor practice that meant that residents have not always received their medication as prescribed. The registered manager has demonstrated that appropriate action was taken when medication errors were identified. However, we found some gaps in the recording sheets, which meant that the home could not demonstrate whether some medication had been given to the residents, or not. This means that staff are not following the home’s policy and procedures to check the daily medication records and ensure that all medicine is signed for. We also found that staff are using different recording methods when PRN or ‘as required’ medicine is dispensed. The registered manager must ensure that there are systems in place to check that there is a clear audit trail for medication that is received, dispensed and returned. The storage of medication is safe and meets current requirements. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure in place and residents are protected from the risk of abuse or harm by the service policies and procedures. EVIDENCE: Residents who returned surveys said they are aware of the home’s complaints procedure. Some people said they speak to staff or their key worker if they have any concerns about anything. Some people told us that staff are always very approachable and available. Residents we spoke to individually said that staff listen to them and they appreciated that respect and ‘good listening’ is promoted within all aspects of the therapeutic process. We have not received any complaints about the service and there are no complaints recorded by the service in the complaints log. The service has a process of risk assessment and risk management and staff demonstrated an awareness of procedures to follow to ensure that residents are protected from the risk of harm or abuse. Staff receive training in ‘safeguarding awareness’ as part of their training programme. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and homely environment. The home is clean and hygienic. EVIDENCE: We looked at all areas of the home with a member of staff. Since the last inspection there have been significant improvement to the building. The kitchen has been upgraded and there is a new cooker. Some of the bedrooms have been decorated and new beds and storage provided. Some flooring has been replaced and there will be new sofas for the sitting room. The home offers a range of single and shared rooms located over several floors. All of the bedrooms have a wash hand basin and residents have access to bathrooms and toilets on each floor. Residents are expected to share a room when they initially move in; this is to ensure that new residents are not isolated. Residents have the option to move into other single rooms as their treatment progresses. Bedroom doors are now lockable to give residents Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 18 privacy but staff are able to access rooms in an emergency. The structured treatment programme does not allow residents to enter other peoples’ rooms and residents are not allowed to spend time in their rooms during the day, except during allocated time to clean and tidy rooms. This is something that residents agree to as part of their therapeutic process and is clearly stated in the ‘statement of purpose’. Shared rooms have screens to provide residents with some privacy. Residents are able to personalise their rooms with their own possessions. During our unannounced visit we found all areas of the home in a clean and tidy state. Residents told us that the home is always clean. Shared bathroom and toilet facilities have liquid soap and paper towels. This is good hygiene practice. Residents are aware of the home’s policy on smoking and smoking is allowed outside of the building and not inside. Residents have a covered area outside that they can use if they want to. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by an effective team of competent and qualified staff. However, staff say that their roles are sometimes compromised by staffing shortages. EVIDENCE: The home employs counsellors and project support staff and also offers placements to social work students and voluntary workers. We were not able to look at the staff recruitment records or training records because the registered manager had these records in his office and was on holiday when we visited. However, we were able to confirm with those staff that we spoke to, and with feedback in the written staff surveys, that the service operates a thorough recruitment procedure to ensure that staff are suitable to work with people using the service. The chief administrative officer who assisted with the inspection told us that they had recently reviewed recruitment procedures and recruitment files to ensure that they were meeting equality and diversity criteria and the Care Homes Regulations. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 20 Staff told us that they receive sufficient training for the job they do, and to meet the needs of people using the service. One person told us “ We are offered regular and ongoing training and are able to ask for any further training relevant to my role”. Some of the staff said that they are sometimes “rushed” if occasionally there are staff shortages due to illness or holiday. However, staff also told us “we do our utmost to cover all of the residents’ needs”. The service has a system for staff supervision and support and generally this is followed, however, one person said, “Because we are so busy, supervision can be deferred. I do get frustrated about this sometimes, everything does get done, but it always seems pushed”. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 - Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is well managed in the best interests of people using the service. The health, safety and welfare of the residents and staff are promoted and protected. EVIDENCE: Feedback and comments from residents and staff confirm that the management approach of the home is open and positive. The registered manager is skilled and experienced and both staff and residents said that the manager is approachable and available. The service has systems in place to review the quality of the service and audit how well the service is providing good outcomes for people using the service. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 22 We looked at evidence in the home that demonstrate that health and safety is promoted and records are kept of health and safety checks and maintenance of equipment, including fire safety systems. We also looked at systems for recording and managing residents’ finances. The cost of care and residents’ personal allowances are paid to the service and residents are then given their weekly personal allowance. The service has developed a new system to support residents to save small amounts of their weekly personal allowance if they choose to. The aim of this is to give people leaving the service a small amount of money to help and support them when living independently. The organisation is looking at the best way of administrating this saving facility to ensure that residents are easily able to access their money when needed. Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Francis House DS0000011915.V363605.R01.S.doc Version 5.2 Page 24 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. Standard YA20 Regulation 13(2) Requirement The registered manager must ensure that staff comply with the policy and procedures for the safe administration of medication. This will ensure that residents receive their medication as prescribed, at all times. Timescale for action 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 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