Inspection on 30/03/10 for Francis Lodge

This inspection was carried out on 30th March 2010.

CQC found this care home to be providing an Poor service.

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 Lodge 02/12/08

Francis Lodge 06/12/07

Francis Lodge 19/02/07

Francis Lodge 03/05/06

Francis Lodge 27/09/05

Francis Lodge 12/05/05

Francis Lodge 21/10/04

Francis Lodge 18/05/04

Extracts from inspection reports are licensed from CQC, this page was updated on 03/06/2010.

Random inspection report Care homes for older people Name: Address: Francis Lodge 4 Belsize Road Harrow Weald Middlesex HA3 6JJ zero star poor service 23/11/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Jane Collisson Date: 3 0 0 3 2 0 1 0 Information about the care home Name of care home: Address: Francis Lodge 4 Belsize Road Harrow Weald Middlesex HA3 6JJ 02089312108 02089312108 francisservicesltd@yahoo.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ms Monica Maxwell Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 4 Number of places (if applicable): Under 65 Over 65 0 4 dementia old age, not falling within any other category Conditions of registration: 4 0 The maximum number of service users who can be accommodated is: 4 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: Old age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Francis Lodge is a semi-detached house located in a quiet residential street in Harrow Weald. It is registered as a care home to provide personal care to four adults aged 65 Care Homes for Older People Page 2 of 17 2 3 1 1 2 0 0 9 Brief description of the care home years and over and is registered to care for people with dementia. The home has a garden that can be accessed by steps, through the conservatory. Two bedrooms, with ensuite facilities, are located on the ground floor and the other two bedrooms are on the first floor. There is a bathroom and toilet on the first floor of the building. The home has a stair lift. The Proprietor has an office on the first floor. The care home is fairly close to community and leisure facilities within Harrow Weald and Stanmore. There is off-street parking on its driveway in addition to unrestricted street parking. Mrs Maxwell is the Registered Provider. The fees start from £650.00 per week. Care Homes for Older People Page 3 of 17 What we found: We carried out an unannounced inspection at Francis Lodge on 30th March 2010 from 11.30am to 3.05pm. Two Inspectors, including one from the CQCs Enforcement Team, were present. The Registered Provider was in the home, together with two members of the care staff and an administrative officer. All four residents were present. We carried out the inspection to look specifically at the three Statutory Requirement Notices (SRN) which were issued as a result of the inspection which commenced on the 19th November 2009 and whether there had been progress in meeting them. The first Statutory Requirement Notice required the following action to be taken by the Registered Provider, regarding the medication administration in the home and pursuant to Regulation 13 (2) of the Care Homes Regulations 2001. The Registered Provider was required by 14th February 2010, to: 1 Make sure that the system in place at the Home which ensures the safekeeping and safe administration of medicines received into the care home. This system should clearly identify which service users have been prescribed medication and that the medication is only administered to the service users to whom it is prescribed. 2 Ensure that service users are only administered medication which has been prescribed for them personally. On checking the records and the medication, we found that the residents no longer had the medication that was the subject of the notice. We did find information about one of the tablets in the medication file but the Registered Provider explained that this information was out-of-date and she removed it. She also told us that she had some of the medication in stock but it was due to be returned to the pharmacy. On checking the medication stock, we found that one medication had not been administered on the day it was due but the Registered Provider explained the reasons for this. It was recommended to her that the instructions for the medication, which is not administered daily is clarified in the persons medication care plan. Otherwise, we found the medication records to be satisfactory. The second Statutory Requirement Notice required the following action to be taken by the Registered Provider, in relation to staff records, and in breach of Regulation 19 (1) (a)(b) & (c) of the Care Homes Regulations 2001. By the 19th of February 2010, the Registered Provider was required: 1. To ensure that you do not employ any person to work at the care home until you have ensured that the person is fit to work at the care home and you have obtained in respect of that person the information and documents specified in paragraphs 1 to 9 of Schedule 2 of the Care Homes Regulations 2001. 2. To obtain any outstanding information and documents as specified in paragraphs 1 to 9 of Schedule 2 for all existing staff where these are not already in place and ensure these are available for inspection in the home. Care Homes for Older People Page 4 of 17 We checked the information on the file of one member of staff who had only one reference at the time of the inspection in November 2009. The Registered Provider had obtained a second reference from a previous employer. We also examined the information for a member of staff recruited following the date of compliance within the Statutory Requirement Notice. We found that the information required had been obtained and was satisfactory. The third Statutory Requirement Notice was in respect of staff rosters in breach of Regulation 17 (2), 17 (3) (a)(b). 17 (4). The Registered Provider was required by 19th February 2010 to: 1. Ensure that records required by Regulation 17 and Schedule 4 of the Care Homes Regulations 2001 are maintained in the home, kept up-to-date and are available for inspection at all times. 2. To put in place a system whereby the duty roster of people working in Francis Lodge records the full details of agency staff used by the Home, and comprehensively records whether the rostered shifts were actually worked and by whom. This rota must be kept up-to-date and made available for inspection at all times. At this inspection, the Registered Provider was asked to provide us with the rosters for the weeks since the 20th February 2010. The four weeks until week beginning 22nd March 2010 were provided. The roster for the last week of February 2010 was not available at this point. The Registered Provider consequently produced a roster which had initially had been for January 2010, but we were informed that this was an error. We examined a sample of a service users Daily Observation Notes dating 10th to 22nd March 2010, along with the Medication Administration Record sheet (MAR) and daily nutrition charts for the same service user from around that period. A number of discrepancies between these and the rosters were found. These are as follows: From the information available for the 9th March 2010 we found information on a Nutrition/Fluid Chart and on the MAR sheet, signed by one member of staff, but the roster for the 9th March 2010 did not record the member of staff as working at any point across that day. The Daily Observation Notes for the service user during the night starting 10th and finishing 11th March 2010 were signed within the initials of a staff member. However, the roster recorded a different member of staff as working across that night. The staff member was present at this inspection and confirmed the initials as being theirs. The same discrepancy in records, involving different staff members, occurred for the night starting 11th and finishing 12th March 2010. The roster for the 12th March 2010 recorded only To be confirm for the middle (commonly 3-8pm) slot. The Nutrition/Fluid Chart was initialled by a member of staff for that period, suggesting which member worked that shift. The Daily Observation Notes for the 14th March 2010, without a stated time but with the comment that the service user was ...now looking forward to bed, and for the 15th Care Homes for Older People Page 5 of 17 March 2010 without a stated time but with the comments...slept well all through the night, and 9.45 breakfast has been given... were both initialled by a member of staff who was not on the roster at all. The person recorded as being on duty was a different member of staff. The Daily Observation Notes for the service user on 20th March 2010 were signed with the initials of the member of staff at 9am, who made observations about the persons care through the previous night. The MAR sheets for that period also had the persons initials. However, the roster recorded that the Registered Provider was the only person on duty across that period. Finally, for the days of 23rd and 24th February 2010, the roster recorded Agency as working from 8pm across the night. No-ones name had been recorded here. We discussed with the Registered Provider these discrepancies, which were explained in detail, and she stated the rosters had not been changed and had not been updated. The Inspectors asked if there were other explanations for these discrepancies and the Registered Provider said that there was not and she had been planning to check them the following day. It was therefore found that there had been a failure to ensure that up-to-date records were being maintained as to whether people worked the roster as planned and there was a failure to ensure that somebody was recorded as rostered for each shift. The Commission is taking enforcement action in respect of these findings, to secure compliance and achieve better outcomes for the service users. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 6 of 17 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 The Registered Provider must 28/02/2010 ensure that the information required under the Care Home Regulations 2001 in respect of the Service Users Guide and Statement of Purpose is included the documentation to ensure that people have the full information about the home and its services. To ensure that there is information available to people. 2 2 5 The Registered Providers must ensure that the terms and conditions supplied to the people using the service are in accordance with the Care Home Regulations 2001. To ensure that people have full details regarding potential payments. 28/02/2010 3 4 4 The Registered Provider must 28/02/2010 demonstrate that the home is able to meet peoples specialist needs in relation to their dementia or other disabilities and illnesses. This must include reference to the staffing, environment, Page 7 of 17 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action training and activities to demonstrate the homes capacity to meet these needs. To ensure that any specialist needs are met by appropriately trained and sufficient staff, and the environment. 4 7 15 The Registered Provider must 28/02/2010 ensure that the care plans are reviewed and changed as required to reflect the care and support being provided. To ensure that people have their care needs met. 5 8 13 The Registered Provider must 28/02/2010 ensure all of the potential areas of risk are assessed and action is recorded to show how the risks to the people using the service and to staff are minimised. To minimise the risks to people living in the home, to the staff and to visitors. 6 8 12 The Registered Provider must 28/02/2010 ensure that there is a record of all health and medical checks, which show the outcomes of the procedure or checks. To provide evidence of peoples medical and health needs being met. 7 9 13 The responsible person must 28/02/2010 Page 8 of 17 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action provide medication training to all staff involved with the administration of medicines. Ensuring people using the service are safely supported around the administration of medication. (Previous timescale of 01/02/09 not met.) To ensure that staff are trained to administer medication. 8 12 16 The Registered Provider must 31/01/2010 ensure that there is sufficient evidence recorded to show that people have the opportunities to out of the home, including the garden. To ensure that people have opportunities for outings and fresh air. 9 15 16 The Registered Provider must 28/02/2010 ensure that nutritional and varied meals are on offer, which provides a choice. The recording of the meals taken must be recorded accurately to evidence this. To ensure that people have a varied choice of meals, which are well cooked. 10 16 13 The Registered Provider must 28/02/2010 ensure that the staff are provided with the training in safeguarding. To minimise the risks to the people using the service. Care Homes for Older People Page 9 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 11 19 13 The Registered Provider must 28/02/2010 ensure that risk assessments have been carried out to ensure that any equipment used in the home, including the stair lift and bath equipment, is suitable for the residents to use on an individual basis, and it is shown how the risks are minimised. To try and ensure the safety of the people being supported and the staff. 12 19 23 The Registered Provider must 31/01/2010 ensure that the steps to the garden are safe for the residents to use and have the necessary equipment. To ensure safer access to the garden and minimise risk. 13 25 13 The Registered Provider must 28/02/2010 ensure that the hot water temperatures are regulated to ensure that people are protected from the risk of scalding. To minimise the risk of scalding. 14 26 23 The Registered Provider must 31/03/2010 ensure that, to promote infection control, the area used for laundry is kept clean with laundry finishes being impermeable and wall finishes being able to be readily cleaned. Care Homes for Older People Page 10 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To minimise the risk of infection and promote cleanliness. 15 27 18 The Registered Provider must 31/01/2010 demonstrate that there are sufficient staff on duty to meet the needs of the residents. To ensure that the people living in the home are supported appropriately. 16 27 17 Ensure that records required 19/02/2010 by Regulation 17 and Schedule 4 of the Care Homes Regulations 2001 are maintained in the home, kept up to date, and are available for inspection at all times and retained for not less than three years of the date of the last entry. Statutory Requirement Notice To ensure that all of the required records are available for inspection. 17 27 17 To put in place a system 19/02/2010 whereby the duty roster of people working in Francis Lodge records the full details of agency staff used by the Home, and comprehensively records whether the rostered shifts were actually worked and by whom. This rota must be kept up to date and made available for inspection at all times. Statutory Requirement Notice Page 11 of 17 Care Homes for Older People Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To provide evidence of the staff working and who have worked. 18 28 18 The Registered Provider must 28/02/2010 provide evidence that staff have taken or are undertaking their National Vocational Qualifications To provide evidence that staff have the opportunity for training and development. 19 30 18 The Registered Provider must 28/02/2010 ensure that there is staff training plan in place which ensure that all of the staff have the basic training courses and the required refresher training. This must include manual handling, first aid, fire awareness, food hygiene, infection control and any other courses required to carry out the work undertaken. To demonstrate that staff have the training and skills to meet the needs of the people they support. 20 30 18 The responsible person must 31/03/2010 provide a minimum of three paid training days per calendar year ensuring staff can update their knowledge and skills and service users needs can be fully met. Previous timescale of 01/04/09 not met Care Homes for Older People Page 12 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action To demonstrate that staff have the opportunity for traning. 21 30 18 The responsible person must 28/02/2010 provide specialist training in Dementia ensuring people with this condition are cared for appropriately. Previous timescale of 01/02/09 not met To provide the specialist care for people the home is registered to support. 22 31 10 The Registered Provider must 31/01/2010 ensure that the home is managed efficiently, with the information required to meet the Care Home Regulations 2001 which must be available for inspection. To provide evidence that the home is well managed. 23 36 18 The Registered Provider must 28/02/2010 ensure that there is evidence of regular staff supervision to demonstrate that staff are supported. To demonstrate that staff have the support they require. 24 37 17 The Registered Provider must 31/01/2010 ensure that all of the records required for inspection are available at all times and are up-to-date. To provide evidence that the Care Homes for Older People Page 13 of 17 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Home Regulations are being met and to demonstrate the support being provided to residents and staff. 25 38 23 The Registered Provider must 31/01/2010 ensure that the precautions identified in the Fire Risk Assessment are in place. This includes the fire signage. This is to protect the people who live in the home, visitors and staff. To minimise any risk to people living, working and visiting the home. Care Homes for Older People Page 14 of 17 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 29 17 1. Ensure that records 04/05/2010 required by Regulation 17 and Schedule 4 of the Care Homes Regulations 2001 are maintained in the home, kept up-to-date, are available for inspection at all times. 2. Put in place a system whereby the duty roster of people working in the home, records the full details of any agency staff used, and comprehensively and promptly records whether the rostered shifts were actually worked and by whom. This roster must be kept up-to-date and made available for inspection at all times. To ensure that a correct record is maintained of the staff who work in the home. Care Homes for Older People Page 15 of 17 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 16 of 17 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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