CARE HOMES FOR OLDER PEOPLE
The Franklyn 25 Easby Drive Ilkley Leeds LS29 9AZ Lead Inspector
Nadia Jejna Unannounced From 10:30 on 2 September 2005.
nd 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. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Franklyn Address 25 Easby Drive, Ilkley, LS29 9AZ 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) 01943 816161 01943 816165 Fezdene Ltd Mrs K Fenech-Soler Care home with nursing 24 Category(ies) of Old age (24) registration, with number Physical disability (1) of places The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Physical disability under the age of 65 is for a named service user. Date of last inspection 1st March 2005 Brief Description of the Service: The Franklyn is a converted, extended property situated in the residential area of Ilkley. The home is within walking distance of the town centre and shops. It is close to local bus routes and is within easy reach of a railway station and the main roads to Leeds, Bradford and Skipton. The home provides personal care with nursing for up to twenty-four elderly service users of both sexes. Accommodation is provided in a combination of twenty single and two double bedrooms, none of these rooms having en-suite facilities. The registered provider has said that one of the double rooms will be used as a single room. Service users have a choice of three lounges. There is a dining room on the lower ground floor. There is an attractive and easily accessible garden area. This has been equipped with garden furniture. Views of the surrounding areas can be enjoyed from the gardens as well as some of the lounges and bedrooms. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was announced and took place on the 1st March 2005. This inspection was unannounced. The people who live in the home prefer the term residents, and this is the term that will be used throughout this report. The purpose of this inspection was to monitor the home’s progress and to assess whether the care given to residents meets minimum standards. During the inspection records were examined and care staff were seen carrying out their work. Discussions were held with members of staff, the manager, residents and visitors. Comment cards/questionnaires were left for residents and visitors so that they can share their views of the home with the CSCI. None had been returned when this report was written. This inspection started at 10:30am and ended at 4:30pm. What the service does well: What has improved since the last inspection?
Residents and visitors said that standards of care provided in the home continued to good. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 6 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. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 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 The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 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) 3 and 5. Prospective residents and their relatives can visit the home to see if it will be suitable for them. Residents’ needs are assessed and staff make sure that they can be met before they move into the home. EVIDENCE: The pre admission assessment for a resident who had been at the home for four weeks was seen. It provided clear information about them and identified their needs. The relatives had been to look around the home on the resident’s behalf. A record of this visit was seen in the enquiry book. Another resident had come to the home from South Yorkshire. Their relatives had visited the home and made the decision on their behalf. The manager had not been able to visit the resident but had made sure that she got copies of the social services and nursing assessments before agreeing to admit them. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10. Residents health care needs are identified and monitored. Residents said that their needs were being met. But this is not fully evidenced in the care plans and there is a risk that some needs will not be met. EVIDENCE: The manager said that the care plan formats have not been changed and that she has not yet been able to send staff on training around care planning. We talked about care plans; that these should be in a format suitable for the home and be both resident and staff friendly. The manager said that she would meet with the nurses to discuss any ideas and suggestions that they might have for improving the care plans. She would also talk to them about sending nominated staff on a training course to lead the way in making changes and improvements. Four care plans were seen. These showed that: • Appropriate assessments were in place to monitor risks such as falls, developing pressure sores and nutrition. • Moving and handling assessments were carried out and appropriate care plans put in place as needed.
The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 10 • • • • • • • Care plans for pressure area care need more information about the type of pressure relieving equipment used. Wound dressings had been used that had not been prescribed by the GP (General Practioner) or the tissue viability nurse in two cases. For the most recent admission not all identified needs had appropriate care plans in place. Some of the care plans could relate to any resident in the home and others were more individual, showing that they were moving towards being person centred. The care plans were evaluated monthly. The resident and their relatives (if appropriate) were involved with care planning and annual reviews. Records of GP visits were kept and requests made to review medication at least annually. Residents said that they were satisfied with the care provided. They said that staff were kind, caring, polite and friendly, and that their privacy was respected. Visitors and relatives said that they were happy with the home and felt that their relatives were safe and well looked after. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13 and 14. Service users are offered choices in all aspects of daily living, and their visitors are made to feel welcome. EVIDENCE: Residents said that they could receive visitors at any time, and that they could go out with their friends if they wanted to. One resident said they went out most weekends with their relatives. Another said that they went out most days, either for a walk locally, or by taxi to a friend’s house. Visitors said that they were made to feel welcome whenever they came to the home. They said that the staff greeted them nicely and kept them up to date with any changes. They felt that the home was friendly and had a lovely atmosphere. Residents said that they were able to choose how and where to spend their time, either in their own room or one of the communal lounges. They said that they choose when to get up, go to bed, if they join in with any activities and where to eat their meals. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 12 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) None of these standards were assessed during this inspection. EVIDENCE: The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 13 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, 24, 25 and 26. Residents are living in a clean, tidy, safe and well-maintained home, which is suitable for their needs. EVIDENCE: The manager said that plans are in place to renovate parts of the building and hopes that work will start in the near future. The manager is looking to employ a handy person in the near future. Until then, she is dealing with minor repairs such as replacing light bulbs. She is also doing the monthly hot water outlet temperature checks. If any larger repairs or works were needed appropriate trades people would be called in to deal with them. The home was clean and tidy. Accommodation is provided in mainly single rooms, none of which are en suite. There are enough communal toilets and assisted bathrooms. Residents said that their rooms were clean. Some of the residents had brought their own furnishings and pictures in order to make the
The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 14 room ‘theirs’. There are three communal lounge areas, which were decorated and furnished to a good standard. Two of these rooms have lovely views of the gardens and areas beyond. The grounds are attractively planted, equipped with garden furniture and are easily accessible to service users. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 15 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, 29 and 30. Residents could be placed at risk because the recruitment procedures are not thorough or robust. There is a risk that residents needs would not be met appropriately because the training programme has not been fully developed or implemented with all staff. EVIDENCE: There were twenty-two residents living at the home. The manager was on duty with one nurse and three care assistants. The manager said that the staffing levels were appropriate to the needs and numbers of residents. There have been some staffing problems but she was in the process of recruiting new staff. She said that staff in the home had worked extra hours to make sure that all shifts were covered. The manager said that enhanced CRB (Criminal Records Bureau) disclosures are in place for all staff employed before April 2002. Two staff files were seen for people who had been at the home for five and seven months. These showed that: • The application forms did not request a full employment history. • Gaps in employment had not been explored. • References were requested but not always from the current or most recent employers.
The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 16 • • • • CRB disclosure and POVA (Protection of Vulnerable Adults) checks had not been done. There was no record that the NMC (Nursing and Midwifery Council) personal identification number had been verified. There were no records of these staff receiving induction training. There were no records of any training provided to them. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 17 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) 31 and 36. The well being of residents and staff would be monitored more effectively by the introduction of regular formal supervision. EVIDENCE: The manager said that she hoped to enrol on the registered managers award at a local college. She hoped to start the course in September 2005. The manager has had difficulty with implementing changes in the home due to staffing problems. Because of this she has had to spend more time doing other duties in the home and less time on managerial responsibilities. The staffing situation has now improved and the manager intends to concentrate on making sure that requirement’s from this and previous inspections are met in a timely fashion. The provider should make sure that she is able to have enough supernumerary time and the support needed to carry out her managerial responsibilities. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 18 The manager said that she aims to provide all staff with formal supervision every eight weeks. But this has not been done because of recent staff shortages. These led to the manager working as the nurse in charge and as the cook on some days. The manager said that overall staffing levels have been maintained but she has not been able to keep up to some of the managerial duties. She is looking at involving other staff to help her with supervision and was reminded that these staff should receive appropriate training. The two staff files seen did not show that these employees had received any sort of supervision or appraisal. They had been at the home for five and seven months each. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 3 x x 3 3 3 STAFFING Standard No Score 27 3 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 2 x 2 x x 2 x 2 The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 20 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. Standard 7 Regulation 15 Requirement The registered person must make sure that a plan of care is in place for each service user, which details clearly how all assessed health, personal and social care needs will be met. These must evidence all actions taken and provide an accurate picture of the service users medical, physical and social wellbeing. (The first timescale of 30.9.05 will not be met and it has been agreed to extend it.) Steps must be taken to ensure that wound dressings are prescribed for individual residents by people qualified to do so. Steps must be taken to make sure that the recruitment procedures are robust and include: a)a full employment history and confirmation that gaps in employment have been explored b)confirmation that POVA and enhanced CRB disclosures are in place c)confirmation that the NMC register has been checked when nurses are recruited.
J52 S64293 The Franklyn V236114 190705 Stage 4.doc Timescale for action 28.2.06 2. 9 13 3. 29 19 Immediate as discussed with the manager. Immediate as discussed with the manager. The Franklyn Version 1.40 Page 21 4. 30 18 5. 6. 31 33 9 24 7. 36 18 8. 38 12, 13 and 18 Steps must be taken to make sure that that the training programme is developed and that this includes induction to Sector Skills Council standards, mandatory and specialist training for all levels of staff, in order to meet the needs of service users. The manager must achieve the Registered managers Award. A system of obtaining comment and feedback from the residents, their relatives, representatives and other stakeholders must be developed. The results of these must be published and made available to interested parties including the CSCI. (This standard was not assessed on this ocassion and it has been agreed to extend the original timescale of 31.7.05.) Steps must be taken to make sure that all staff receive formal supervision at least six times per year from people who have been appropriatley trained. Records must be kept. The registered person must ensure that all staff receive mandatory training and updates and that records are maintained. 28.2.06 1.4.07 28.2.06 28.2.06 ongoing 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 7 Good Practice Recommendations Staff should receive training in writing care plans and appropriate systems put in place to ensure this. (This recommendation was first made in the inspection report dated 29.7.04.) Care plans for residents needing pressure area care should contain more information about the type of equipment to
J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 22 2. 8 The Franklyn 3. 28 4. 38 5. 27 and 31 be used and what nursing interventions are to be carried out. The registered person should make sure that the NVQ training programme ensures that a minimum of 50 of care staff have achieved NVQ level 2 by 31st December 2005. The following details should be documented in either the accident record or in individual service user care plans following an accident: a)The time the accident victim was last seen before the accident and by whom. b)Clear and concise details of the circumstances surrounding the accident. c)Details of any treatment given and observations made. If head injury is suspected neurological observations should be carried out. d)Confirmation that the incident has been reported to the next of kin and to the CSCI. e)Details of any outcomes of the accident. (This standard was not assessed and the recommendation first made during the inspection of 1.3.05 has been carried forward.) The provider should make sure that the manager has enough supernumerary time and support to fulfill her role and responsibilities. The Franklyn J52 S64293 The Franklyn V236114 190705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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