Inspection on 07/06/05 for Franklin House

This inspection was carried out on 7th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Franklin House 07/01/08

Franklin House 20/11/06

Franklin House 19/10/05

Franklin House 11/01/05

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

CARE HOMES FOR OLDER PEOPLE Franklin House The Green Swan Road West Drayton, Middlesex UB7 7PW Lead Inspector Rekha Bhardwa Unannounced 7th and 22nd June 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 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. Franklin House Version 1.10 Page 3 SERVICE INFORMATION Name of service Franklin House Address The Green, Swan Road, West Drayton, Middlesex UB7 7PW 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) 01895 452 480 01895 448 132 fiona@lawrence.freeserve.co.uk Care UK Ms Fiona Lawrence Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places Franklin House Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Old age, not falling within any other category (66) Date of last inspection Brief Description of the Service: Franklin House is a purpose built 66-bedded nursing home situated in West Drayton. There are 66 single en-suite bedrooms. The home has three units: the intermediate care unit, frail elderly nursing unit and a continuing care unit. Each unit is located on a separate floor and have their own team of staff. On the intermediate care unit there is also a physiotherapist, nurse consultant and occupational therapist. A kitchenette is available in each unit and there is a main kitchen and laundry on the ground floor. There is a rear garden, which can be accessed by service users. Each unit has a dining room and two lounges.There are two lifts in the home, one is a passenger lift and the other is a service list.The home is close to local shops and West Drayton High Street. All referrals to the home are made through the Care Management Team. Franklin House Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out as part of the regulatory process. A total of 14 hours were spent on the inspection process. The Inspector undertook a partial tour of the premises and inspected staff records, service user plans/records and servicing records. Service users, visitors and 8 staff were spoken to as part of the inspection process. At the time of the inspection there were sixty service users accommodated at the home. The Registered Manager was not available during the inspection and was not expected to be at the home for a month. Interim management arrangements were in place and the Registered Manager from a sister home was providing management support to the deputy manager at Franklin House. The first day of the inspection was also her first day at the home. What the service does well: What has improved since the last inspection? What they could do better: Pre-admission assessments must be completed in full in order that staff obtain a full picture of the needs of the service user. All assessments in relation to the service users moving and handling, Waterlow, risk of falling, nutrition and pain must be regularly updated in order that the current needs of the service user are met. The Registered Manager must undertake work to ensure that the staff team are working together. There must be in place a system for service users Franklin House Version 1.10 Page 6 to give feedback and be consulted about the services provided in the home. Autonomy and choice must be available to service users within their capabilities. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Franklin House Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Franklin House Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4,5,and 6 Service users are provided with information about the home and all service users have a written agreement. Service users are assessed prior to admission to ensure the home can meet their needs; shortfalls in not completing preadmission assessments in full can potentially place service users at risk. Staff have received training to meet service users specialist needs. Prospective service users and their representatives are encouraged to visit the home in order to allow them to make an informed choice. EVIDENCE: Service users and their representatives are provided with information regarding the home in the form of a Service Users Guide and Statement of Purpose. These were freely available, and copies were also available in the foyer of the home. All service users have terms of residence or a resident’s agreement in place. The Registered Provider has a contract with Hillingdon Primary Care Trust and London Borough of Hillingdon Social Services. Franklin House Version 1.10 Page 9 The records viewed contained information that pre-admission assessments are undertaken by nursing staff, the Inspector noted that on one pre-admission assessment there was no date, no signature and was incomplete. Needs Led Assessments completed by the Social Worker were also available. NHS registered nurse carries out the assessments for NHS funded nursing care. The service users have access to specialised services and professionals. The home works closely with the Consultant Physician at Hillingdon Hospital. There are trained nurses on each shift. On the intermediate care unit the service users have access to a physiotherapist, nurse consultant and occupational therapist. Where possible service users are encouraged to visit the home prior to admission, where this is not possible the service users representative is encouraged to visit. Franklin House has an intermediate care unit on the ground floor. There is a therapy room and all service users have single en-suite bedrooms. Rehabilitation facilities are provided and include equipment for therapy and treatment. Hillingdon PCT and Social Services provide the Nurse Consultant, Occupational Therapist and Physiotherapist. Staff on the unit expressed concern about the inappropriate referrals that they had been receiving from Hillingdon Hospital, which on several occasions meant that service users were on the intermediate care unit for more than 6 weeks. Franklin House Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10 Service users individual needs were not always identified, reviewed and information held was not always up to date, and this can place service users at risk of not having their needs fully met. Shortfalls in the management of medications potentially place service users at risk. Staff are courteous to service users and personal support is provided in such a way as to promote and protect the service users privacy, dignity and independence. EVIDENCE: Individual service users plans were available and samples were viewed on all three units. One service user’s Waterlow Pressure Sore and nutritional assessment had not been reviewed since admission in March 2005. Pain assessments were not complete. Care plans for this service user had not been reviewed. There had been some improvements in service users and their representatives being involved in the formulation of care plans, these improvements needed to be further developed, maintained and monitored. Risk of falling and moving and handling assessments for two service users were incomplete on Charlie Chaplin Unit. One service user required bedrails to Franklin House Version 1.10 Page 11 be in place, there was no evidence that the use of bedrails had been discussed and agreed with the service user or their representative. The records also indicated input from the GP, optician, audiologist, tissue viability nurse, chiropodist and other health care professionals. Wound care documentation was available, contained information on the type of dressing to be used and details of the progress of the wound. Daily records were available, signed, dated and detailed the care provided. The CSCI pharmacist Inspector undertook a full pharmacy inspection on the 16/6/05 and a separate report is available. The requirements and recommendations from that inspection have been incorporated into this report. Staff were seen to address service users in a courteous manner. Service users and visitors spoken with were generally satisfied with the care given and the attitude of the staff. Service users can have a private telephone and payphone facilities are also available. Healthcare professionals see service users in the privacy of their own rooms. Franklin House Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Social activities are in place and a varied activities programme is offered to service users. Lack of teamwork and leadership on each unit does not allow for the service users to have good social and recreational aspects to their daily lives. Visiting is encouraged for service users to maintain contact with family and friends. Service users do not have choices in all aspects of their daily living therefore this does not suit service users expectations, preferences and capacities. Generally the meal provision in the home is good offering choices, variety and catering for special dietary needs. EVIDENCE: The home employs two part-time activities coordinators. An activities programme was available and displayed throughout the home. It appeared that activities were not seen as an integral part of the care provided to service users and that many of the care staff saw this time as a time where they did not have to be involved with the service users. At the last inspection the Inspector was informed that there was no budget for activities, the two activities coordinators had been fundraising for equipment and days out. The budget for the home viewed by the Inspector indicated that £125 was available Franklin House Version 1.10 Page 13 each month for activities. It was agreed by the support Manager that this money would be made available. Relatives and friends were seen visiting service users throughout the day. Service users can choose to see whom they wish to see and their wishes are respected. Service users were observed to be sitting in the dining area on Audrey Hepburn Unit for over three hours on the second day of the inspection. Service users that spoke with the Inspector confirmed that this was a regular occurrence and that they found the dining chairs uncomfortable to sit on for long periods of time. Several service users had not been moved for over two hours, this had implications for skin care and pressure sore prevention. The home was not able to demonstrate that service users had choices in relation to where they wished to spend their time on Audrey Hepburn Unit. The home operates a cook chill system of meal provision. On each unit there is a kitchen and there is also a main kitchen on the ground floor. Two service users commented that they would like to eat a cooked breakfast; the Registered Manager had informed them that this was not possible. The support Manager from a sister home informed the Inspector that cooked breakfasts could be made in the main kitchen. She informed the Inspector that she would meet with the catering manager to address this the following week. This will be reviewed at the next inspection. The kitchen was not inspected at this inspection. Menus were available and these reflected choices. Franklin House Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 The home has a satisfactory complaints system with evidence that service users and representatives concerns are listened to and acted upon. Service users rights are protected and service users are able to exercise their legal rights directly. Staff have knowledge and understanding of adult protection issues which protect service users from abuse. EVIDENCE: The home has a detailed complaints procedure, which is freely available and also detailed in the Service User Guide. The complaints records viewed clearly recorded the action taken by the home to investigate the complaint, address any shortfalls, the outcomes and copies of all correspondence. The CSCI had received a complaint since the last inspection. This was referred to the Registered Provider to investigate. This had been investigated and completed. One relative confirmed that she knew the procedure for making complaints, as did some of the service users that were spoken with. Information on the Age Concern advocate allocated to the home was displayed on notice boards throughout the home. Age Concern in Hillingdon also holds regular advocacy surgeries within the home. The home has a clear procedure for the protection of vulnerable adults (POVA), and this dovetails with the Local Authority documentation. Staff had received training in POVA. Franklin House Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24 and 25 The standard of the décor, environment and furniture and fittings within the home is good and presents as a homely, safe and comfortable environment for service users. EVIDENCE: Franklin House is a purpose built nursing home. A full time handy person is employed. Records of routine maintenance were being kept. Work was underway to address snagging defects in the building. The grounds were tidy, safe and accessible to all service users via the ground floor. Garden furniture was available. CCTV cameras are in place at the front and rear entrance areas. Each service user has the required communal and private space. A dining room and lounges are available on each unit. Visitors can meet service users in private in the lounges, dining room or individual bedrooms. The assisted bathrooms, shower rooms and communal toilets viewed were satisfactory. All the bedrooms are single and have en suite facilities to include a toilet and wash hand basin. Franklin House Version 1.10 Page 16 All furnishings and fittings were in good condition. Several of the rooms viewed contained pictures, photographs and individual ornaments. The lighting in the communal areas appeared to be satisfactory. The intermediate care unit has a dedicated space for this service group. The laundry was not inspected at this inspection. Franklin House Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29 and 30 The home was adequately staffed to meet the needs of the service users. Staff training is ongoing to ensure that staff have the skills to meet the needs of the service users. The vetting and recruitment practices need reviewing to ensure they are complete so as to safeguard service users. EVIDENCE: The staffing levels were adequate to meet the needs of the service users on the first day of the inspection, on the second day of the inspection Audrey Hepburn unit was short of one care staff for the afternoon shift. The deputy manager was attempting to cover this shift. The Registered Provider has proposed to the CSCI that a sliding scale of staffing be implemented on the intermediate care unit as the numbers of service users varies from day to day. The Inspector discussed the need to keep staffing levels under review in order to ensure that the changing needs of service users are met. Ancillary, domestic and catering staff are employed in sufficient numbers. 13 care staff are currently undertaking the NVQ level 2,3 and 4 training. The staff employment files viewed contained details of the applicants completed application forms, medical declaration, 2 references, copies of passports, plus terms and conditions of contract. Criminal Records Bureau checks had been carried out. One file did not contain a recent photograph. Franklin House Version 1.10 Page 18 Training attendance records are kept, as are certificates in individual staff files. Training that had been undertaken Franklin House Version 1.10 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,34,35,37 and 38 Staff were not working together to meet the needs of the service users. This does not enhance the quality of life for service users. There is a lack of leadership on each unit and the staff did not have clear direction, openness or feel valued. There is a lack of forward planning in relation to staff duty rotas and this could potentially place service users at risk. EVIDENCE: An external audit is undertaken annually. Little feedback is obtained from the service users with the exception of food provision. The importance of obtaining regular feedback and consultation with service users was discussed at the inspection. Between the first day and second day of the inspection the support Manager had undertaken feedback questionnaires with all service users. She was in the process of collating the results. It was not clear from the Franklin House Version 1.10 Page 20 information provided by the home when and how often service users and relatives meetings were taking place. It was not clear what systems the Registered Manager had in place for service users to voice their concerns and opinions. Regulation 26 visits are carried out and copies of the report are forwarded to the CSCI. Staff meetings were not taking place and the last recorded staff meeting was on the 16/7/04. Systems are not in place to obtain the views of staff, how they are working, team working and future planning. The home deals with small amounts of money for some service users and records are kept of all receipts and expenditures. Where possible the service users or their representatives are encouraged to deal with the money and valuables. The home has a safe facility and receipts are given for any items given in for safekeeping. Shortfalls in record keeping have been identified under the Choice of Home, Health and Personal, Staffing and Management sections of this report, and requirements set accordingly. It was noted that the home did not have planned duty rotas in place for Audrey Hepburn Unit. This is poor and does not allow for future planning, covering sickness, annual leave and training. This had been brought to the attention of the support Manager who was in the process of formulating a 6 week duty rota. Servicing records were viewed at random and were up to date. Generic and specific risk assessments were available. The home has a business and financial plan, which the Registered Manager has formulated. Franklin House Version 1.10 Page 21 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 X STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 x 2 2 3 35 x 2 3 Franklin House Version 1.10 Page 22 yes 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 3 7 Regulation 14 7(1)(a) Requirement Pre-admission assessments undertaken by the home must be completed, signed and dated. Care plans must be up to date and accurately reflect the condition of the service user. It must be updated monthly and when a service users condition changes. The Registered Provider must ensure that consent for the use of bedrails is obtained. This must be recorded. (Timescale of 28/2/05 not met) Assessments for pressure sore risk, nutrition, risk of falling, moving and handling and pain must be completed in full and be reviewed monthly and when a service users condition changes. The stocking of aspirin 300mg and glucagon for emergency use must be reviewed All medicines must be recorded when administered including variable doses. PRN or as required medicines must be included on the MAR e.g. rectal diazepam and full instructions for use must be available. Version 1.10 Timescale for action 8/8/05 8/8/05 3 7 13(7)(8) 8/8/05 4 8 15(1)2 12(1)a,b 8/8/05 5 6 7 9 9 9 13(2) 13(2) 13(2) 1/8/05 1/7/05 1/7/05 Franklin House Page 23 8 9 13(2) 9 10 11 9 9 9 13(2) 13(2) 13(2) 12 14 12(2), (3), 4(a) 13 14 12(2), (3), 4(a) 14 29 19, Schedule 2 15 33 24 16 37 12(1)(a) (b) Balances for CD must read zero when disposed of. The key to the CD cupboard on the ground floor must be kept securely. Continuous supplies of medication must be maintained for service users. Labels must correlate with the MAR and the medication profile. Dates of opening must be written on liquid medicines including calogen and eye drops on the ground floor and they must not be used past their expiry date. The Registered Person must ensure that the planning of care is in keeping with the wishes and choices of service users and that these wishes and choices are respected. Care planned to facilitate the rostering of staff is not acceptable. The Registered Manager must have in place team building sessions, in order that staff work together in meeting the needs of the service users. The Registered Person must ensure that the required information and documents for all persons working at the care home are available as per Schedule 2 of the Care Homes Regulations 2001(Timescale of 28/2/05 not met) The Registered Manager must ensure that service users and their representatives are given opportunities to give feedback about the service provided and voice their opinions. The Registered Manager must have in place planned duty rotas. 1/7/05 1/7/05 1/7/05 1/7/05 8/8/05 8/8/05 8/8/05 8/8/05 8/8/05 Franklin House Version 1.10 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. Refer to Standard 9(4) Good Practice Recommendations To review the use of lancets and finger pricking devices in the home to ensure that there is no infection control risk to service users. Franklin House Version 1.10 Page 25 Commission for Social Care Inspection Ground Floor 58 Uxbridge Road Ealing London W5 2ST 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 Franklin House Version 1.10 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!