Care Home: Francis House

What the care home does well Staff are working hard to provide sensitive care and support to people living at the home. The home is purpose built and provides a satisfactory environment for people to live in. The home has good quality information available for prospective residents and a range of effective procedures and practices, including regarding the safe administration of medication, to assist staff meet people`s needs after they have been admitted. The home has started to use volunteers to assist people undertake preferred activities on an individualised basis, and has also started to use a volunteer to act as an advocate for some residents. Relatives and social care professionals spoken to gave positive feedback about the care provided in the home, including positive feedback about the registered manager. What has improved since the last inspection? At the last key inspection eight requirements were made and seven of those were seen to have been complied with at this inspection. Work had been undertaken to address the eighth requirement regarding quality assurance, although further work is still needed regarding this and the requirement is amended and restated at this inspection. The seven requirements that had been complied with were in the following areas: three requirements regarding care planning; two requirements regarding identified maintenance items; residents` activities and staff recruitment. What the care home could do better: A requirement regarding quality assurance is amended and restated from the last inspection. At this inspection four new requirements are made to further promote the quality of care the home provides. These requirements are in the following areas: an identified area of maintenance to assist maximise infection control; staff recruitment; staff deployment and evidencing that the home`s electrical installation has been checked to ensure it is safe. Four good practice recommendations are also made at this inspection in the following areas: information made available to the public; making the complaints procedure more accessible; improved signage to make the building more accessible to residents and training regarding the Mental Capacity Act 2005. The registered provider, the manager and the staff team may wish to refer to the Commission`s Key Lines of Regulatory Assessment (KLORA), to consider how they may further enhance the overall quality of care in the home. CARE HOMES FOR OLDER PEOPLE Francis House 102 Beaconsfield Road Walthamstow London E17 8LU Lead Inspector Peter Illes Unannounced Inspection 21st January 2008 09:30 X10015.doc Version 1.40 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 DS0000058691.V358403.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 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. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Francis House Address 102 Beaconsfield Road Walthamstow London E17 8LU 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) 020 8520 5100/2438 020 8509 0482 London Borough of Waltham Forest Linda Jane Cocks Care Home 32 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (9) Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registerd 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: Dementia, over 65 years of age - Code DE(E) (maximum number of places: 23) Mental disorder, excluding learning disability or dementia, over 65 years of age - Code MD(E) (maximum number of places:9) The maximum number of service users who can be accommodated is: 32 27th June 2007 2. Date of last inspection Brief Description of the Service: Francis House is registered to provide care to 32 older people who may also have a diagnosis of dementia or mental disorder. The L.B. of Waltham Forest manages the home as part of the borough’s in-house residential care resources for older people. The home is a single storey building that is divided into three units: Unit 1 has nine single bedrooms, a lounge/ dining area and a kitchenette and accommodates older people with a mental health diagnosis; Unit 2 has thirteen single bedrooms, a lounge/ dining area and a kitchenette and accommodates older people with a diagnosis of dementia; and Unit 3 has ten single bedrooms, a lounge/ dining area and a kitchenette and also accommodates older people with a diagnosis of dementia. All three units have appropriate bath/ shower and toilet facilities. The three units are reached through the home’s entrance hall that has up to date notice boards for both staff and relatives/ visitors. The registered manager’s office and the administrator’s office are accessed from the entrance hall. The home also has a main kitchen, staff accommodation, laundry facilities, smoking room and has a large pleasant enclosed garden. The home is close to good public transport links and to the shops and other Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 5 community resources in Walthamstow. A stated aim of the home is: to meet the needs of individuals by offering them a choice as to how they lead their lives and how they can maintain their independence and dignity in a safe homely environment. The provider organisation makes information about the service, including CSCI inspection reports, available to people living at the home and other stakeholders. The current charge for the service is £621 per week. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 6 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 unannounced key inspection took approximately eight hours with the registered manager being present or available throughout. There were thirtyone people accommodated at the time and one vacancy. The inspection activity included: meeting and speaking with the majority of people living in the home, five of them independently, although conversation with people was limited to varying degrees because of the individual’s assessed needs; independent discussion with four relatives that visited the home during the inspection; discussion with the home’s dispensing pharmacist who visited the home during the inspection; detailed discussion with the registered manager; discussion with a number of staff members, five of them independently; independent discussion by telephone with a reviewing social worker from L.B. of Waltham Forest; independent discussion by telephone with a Social Service officer from Essex Social Service, a local authority that currently place two residents at the home; independent discussion by telephone with a L.B. of Waltham Forest Volunteer Coordinator and discussion by telephone with the responsible individual. Further information was obtained from: an Annual Quality Assurance Assessment (AQAA), submitted by the home to the Commission prior to the inspection; a tour of the premises and documentation kept at the home. What the service does well: Staff are working hard to provide sensitive care and support to people living at the home. The home is purpose built and provides a satisfactory environment for people to live in. The home has good quality information available for prospective residents and a range of effective procedures and practices, including regarding the safe administration of medication, to assist staff meet people’s needs after they have been admitted. The home has started to use volunteers to assist people undertake preferred activities on an individualised basis, and has also started to use a volunteer to act as an advocate for some residents. Relatives and social care professionals spoken to gave positive feedback about the care provided in the home, including positive feedback about the registered manager. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 9 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 Outcomes Statutory Requirements Identified During the Inspection Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home keeps up to date information available for prospective residents and other stakeholders to give them relevant details about the home, although managers of the service may benefit from personal information about them being made more concise. People benefit from having their needs properly assessed before being offered a trial period at the home so that staff have up to date information to effectively address these. Once admitted people’s needs continue to be reviewed to help staff in meeting their changing needs. EVIDENCE: A copy of the home’s Statement of Purpose was given to me for information and was seen have been updated in November 2007. The document contained the required information about the home, the services it provides and the services it does not provide (such as nursing care). It is commendable that the Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 11 information is clear and very detailed and is a very helpful document for people considering using the service and other stakeholders. However, in the copy I was given there were appendices containing Curriculum Vitae’s (CV’s) of managers involved with the service. These CV’s contained a range of personal information about the managers involved with the service that, in my judgement, is not appropriate to share in such a document. A good practice recommendation is made that these appendices are reviewed and amended for the protection of the managers involved. The files of five residents were inspected and I was pleased to see that each of these contained a current statement of terms and conditions for living in the home that had been signed by the person or a relevant stakeholder. The five files inspected related to four people that had been admitted to the home since the last inspection and one person that had lived at the home for a longer period. All the files contained details of a community care assessment that had been received by the home before the person was admitted and an in-house assessment undertaken to ascertain that the person’s needs could be met by the home. Several of the files contained other specialist health professional assessments including a consultant psychiatrist assessment on one and a physiotherapist’s assessment on another. Evidence was also seen that the service provides a trial period of six weeks at the home followed by a review. A relative of one of the people that had been admitted since the last inspection confirmed that they had been involved in such a review. The relative also indicated that they were happy with the placement and felt that the staff were doing “a good job” in meeting the person’s needs. Evidence was also seen that the home keeps people’s needs under review following the trial period to assist staff meet these changing needs. The L.B. of Waltham Forest had placed twenty-nine of the residents who were living at the home at the time. I spoke to a reviewing officer from the Borough who stated that he found the care at the home to be good and especially praised the registered manager on her wide knowledge regarding the residents’ needs and her sensitive interaction with relatives at reviews. Essex Social Services had placed the other two residents. I spoke to an officer from that authority about one of these residents who stated that a paper review had been carried out on the person within the past year. She went on to say that their records indicated that this had been satisfactory and that the review had included input from a relative that had contact with the home. The home does not provide intermediate care. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People’s needs, and guidance to staff on meeting these, are recorded on their care plans and staff are working hard to make these records meaningful to people. People also benefit from their health care needs being properly addressed, are safeguarded by the home’s current medication policies and procedures and are treated with respect while living at the home. EVIDENCE: At the last inspection three requirements were made regarding residents’ care plans. These were: to ensure that residents and/ or relatives were involved in the care planning process; to ensure that risk management strategies were clearly recorded on care plans; and, that residents and/ or their advocates were involved in their risk assessments. The files of five people were inspected and these showed evidence that these three requirements were being complied with. The care plans of the five people all showed evidence that they were based on current assessment information and showed what staff input was Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 13 needed to meet the needs identified. All of the care plans showed information that was known about the person’s previous life experiences and all had evidence that the person or their representative had been involved in reviewing the plan. I was informed that since the last inspection the home had initiated a system whereby a volunteer advocate assisted those residents that had no contact with relatives and needed support to review their care plan. I spoke independently by telephone to a L.B. of Waltham Forest Volunteer Coordinator. She confirmed that a volunteer, appropriately trained and vetted by her service, sat with identified residents to check and review their care plans. The home is commended for developing this initiative. I was informed that care plans are monitored by key workers during the month and a monthly tick box check list was seen on each file that had been filled in by the key worker. This showed a tick where the key worker judged the person’s needs had not changed during the month in a specific area and a cross where they felt the person’s needs had changed. Evidence was also seen of a monthly evaluation of the care plan undertaken jointly by a senior care worker and the key worker where any changes were agreed and noted in detail on the care plan. A good practice recommendation is made in the Staffing section of this report regarding staff training on the practical implications of the Mental Capacity Act 2005, which is relevant to this process. The care plans were seen to be informed by risk assessments including an overall risk assessment, a moving and handling risk assessment and a nutritional risk screening tool with evidence seen that the person and/ or their representative had been involved in this process. Evidence was also seen where a new substantial risk to a resident had been identified since the last inspection. Robust action had been initiated by the registered manager regarding this risk including: the completion of a detailed new risk assessment; updating the person’s care plan to reflect this risk and the issuing of detailed guidance/ instructions to all staff on how to minimise the possibility of the person being subject to the same risk again in the future. Evidence was seen that the home had involved and consulted with relevant stakeholders at the time regarding the action taken, including the Commission. A referral had also been made at the time under the L.B. of Waltham Forest’s Safeguarding Adults procedures regarding this risk. There was clear evidence on the files inspected of five residents to indicate that the home was working hard to meet people’s health care needs. Each file had a summary sheet that showed what health care appointments a person had undertaken and a more detailed sheet for each appointment that included details and the outcome of the appointment. This provided staff with a clear overview of people’s healthcare needs including preventative treatment appointments such as for a flu jab. Each person is registered with a GP and evidence seen of appointments with these. The files inspected showed that people were supported to attend appointments with a range of mental health specialists, appointments at general hospitals, optician and a chiropodist. I was Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 14 informed that, until recently, the residents also benefited from the services of a visiting dentist but that the Primary Health Care Trust (PCT) had allegedly withdrawn funding for this dental practice. Evidence was seen that the home was actively seeking alternative dental services for residents. Nutritional risk assessments are now in place and there was evidence of monthly weights being recorded. A number of noticeable variations in the monthly weight were noted in the files inspected, these indicated both increase and decrease for different people. The registered manager stated that the weight charts were reviewed as part of the monthly care plan review process although there was no detailed recording of this on the evaluations inspected. The registered manager stated that she would discuss this further with senior staff. Nearly all the residents living at the home at the time of the inspection were mobile and I was informed that only three people needed two staff to assist with moving and handling tasks. I was also informed that none of the current residents had pressure ulcers although skin vulnerability was monitored. The home has a clear medication policy and procedures that were seen to have been reviewed and updated by the provider organisation in May 2007. Medication and medication administration record (MAR) charts were inspected for three people, one from each unit. The medication corresponded to that recorded on the MAR charts and the charts were up to date. Medication was properly stored, the record of the medication fridge was seen to be satisfactory and up to date and the medication room contained a controlled drug cupboard although no resident was prescribed controlled drugs at the time. The home’s dispensing pharmacist visited the home during the inspection and was spoken to. He stated that he visited the home on a weekly basis to undertake spot checks of the home’s medication and procedures and also undertook staff training in the safe administration of medication including regular refresher training including undertaking assessments of staff competency in this area. It was noted that the inspector that undertook the last inspection acknowledged and commended the home for the improvement at that time in the home’s system of administering medication. My judgement is that this improvement has been maintained. It was noted at this inspection that medication continued to be administered by a senior care worker who was assisted by a second care worker to minimise the risk of mistakes. The registered manager stated that the provider organisation had previously agreed funding for a second senior carer to be on the early shift to assist meet residents’ needs, including ensuring that medication administration was robust. However, she was not clear whether the funding for this would continue after March 2008. In my judgement this strengthening of the senior staff team on the morning shift has clearly been significant to meeting residents needs, including in maximising protection to them regarding administration of medication. A requirement relating to staff and senior staff cover at the home is made in the Staffing section of this report. One resident asked to speak to me independently and stated that they were not happy at the home. They stated that there was nothing wrong with the Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 15 home but that they wanted to be at their “real” home with their relatives. On further investigation I was satisfied that the home was aware of the request by the resident to return to their previous address and had taken appropriate action, including calling a review with the person’s social worker. Residents were well presented during the inspection and observation of staff interaction with residents and feedback from them and from relatives indicated that residents’ dignity is respected at the home. The registered manager stated that the home paid particular attention to ensuring that personal care is given to residents of the same gender. The home had a calm atmosphere on the day that residents appeared to appreciate. The registered manager did point out to me that some days seemed more hectic than others, which I am sure is the case! Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are working hard to provide people living at the home with a range of social and recreational activities that they enjoy. Relatives and other visitors are made welcome at the home, which they and people living there appreciate. People are encouraged to exercise as much choice and control over their lives as they can to maximise their independence. They are also provided with a range of healthy and nutritious meals that they enjoy. EVIDENCE: At the last inspection a requirement was made that the registered persons must ensure that residents who have identified interests and preferences are supported to undertake these. This requirement was made by the inspector that undertook that inspection who was concerned that people that did not want to take part in group activities may not have meaningful activities that met their interests. Evidence was seen that the home was working hard to comply with this requirement. An example of this is the use of volunteers to work with individuals. On the day of the inspection a volunteer took one resident to a local pub for lunch. Both the volunteer and the resident were Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 17 spoken to separately and independently. The resident clearly enjoyed the outing and the volunteer was knowledgeable about the needs of the person. The registered manager indicated that the home would seek to expand on the use of volunteers over the coming year and a L.B. of Waltham Forest Volunteer Coordinator, spoken to independently by phone, confirmed this. The registered manager also indicated that one staff member had started a gardening club and was planning further work to engage residents in this activity, especially when the weather improved. The home has an activities programme that was seen and included such activities as music and movement, ball games, tea dances and reminiscence work. On the day of the inspection I observed a finger nail painting session and sing-along session, which residents appeared to be enjoying. The home also holds regular joint activities between the units within the home including bingo and a coffee morning and also takes residents on trips out into the community. Trips since the last inspection have included two trips to Southend, Crews Hill Park for lunch and to Battersea Park. Evidence was also seen of entertainers attending the home to celebrate events on a quarterly basis including a pantomime, Valentine Day celebration and a Family Day. The five residents files inspected included a daily record of activities individuals had undertaken including a record of activities offered and refused. The majority of residents were of white European origin with a minority of residents from ethnic minority communities. A relative of one resident from an ethnic minority community was spoken to and was liaising with the registered manager regarding visitors to the home from an Evangelical reform church that the family belonged to. The relative stated that “the home is wonderful” and that they, the relative, were always made welcome at the home and invariably offered a cup of tea. The cultural needs and preferences of people were recorded on their care plans and staff spoken to were aware of these. The registered manager indicated that the home was supporting one resident to continue to attend a local day service that catered for the person’s particular cultural needs and preferences. The staff group was fairly representative of the resident group and were able to provide appropriate input regarding meeting people’s individual care needs and preferences. A representative from the Church of England visits the home and holds services for people that wish to attend and evidence of this was seen on the activity records of some people. The registered manager also indicated that faith leaders from different denominations also visit the home. The home has a clear visitor’s policy that was seen included in the Statement of Purpose. I spoke to a number of relatives independently throughout the inspection. All indicated that they were made welcome at the home and that staff were friendly and helpful. Several relatives confirmed that the home always phones them if there are any issues involving their resident. Relatives also confirmed that they are invited to reviews. The home organises regular relatives meetings throughout the year although, despite the best efforts to hold meetings at times that suit relatives, attendance at these is variable. I Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 18 saw minutes of several meetings including the last one in September 2007 that confirmed this. The registered manager stated that the home does not act as the financial appointee for any of the residents and that State Benefits and other monies are dealt with either by relatives or the L.B. of Waltham Forest. People living at the home are able to bring their personal possessions into the home and rooms seen during a tour of the building showed bedrooms personalised to varying degrees. The home has a menu that is adjusted seasonally. This was seen and showed a range of nutritious meals with choices including cultural choices. The menu included: breakfast; lunch, as the main meal; evening tea, at approximately 5pm and supper before residents retire. Lunch on the day of the inspection consisted of a choice of macaroni cheese or sausage casserole or egg salad. This looked appetising and residents appeared to enjoy their meal. Both residents and relatives spoken to were generally complimentary about the food at the home. The cook was spoken to independently and confirmed that residents were consulted about the menu. The cook also confirmed that diets to meet different needs and preferences could be supplied if needed. The kitchen was clean and tidy, food appropriately stored and an up to date record of health and safety checks was seen that included cooked food temperatures and fridge and freezer temperatures Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home has satisfactory procedures for dealing with concerns and complaints although people may benefit from a more accessible summary. However, people living at the home and other stakeholders felt confident that any concerns raised would be properly dealt with by the home. People living at the home are protected by an up to date safeguarding adults policy and procedures that the registered manager and her staff are familiar with. EVIDENCE: The home uses the L.B. of Waltham Forest Social Services complaints procedure that was seen in the home and had been updated since the last inspection. The complaints procedure has three stages and a 28-day timescale for dealing with complaints. Request for copies of the complaints procedure is written in 6 languages. However, although the complaints leaflet is available in the home’s entrance hall it was not, in my judgement, particularly prominent or accessible to people that use the service. A good practice recommendation is made that an easy to read summary of the complaints procedure is produced and displayed in the communal areas of the three units of the home so that it is more easily accessible to residents and other stakeholders that visit the home. Both people living at the home and relatives spoken to at the time indicated that they felt confident that the home does and would continue Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 20 to act promptly to deal any concerns that they may raise. Three complaints had been recorded in the home’s complaints log since the last inspection. Evidence was seen that all three of these had been robustly investigated and dealt with in the required time scales. All three were judged by the registered manager to have been substantiated and appropriate action taken, including action to minimise a recurrence of the complaint. Evidence was also seen of two compliments received by the home since the last inspection. The Commission had received no complaints about the home since the last inspection. The home had a copy of the latest (2007) L.B. of Waltham Forest’s Safeguarding Adults policy and related procedures, with evidence also seen that staff receive training in safeguarding issues. Staff spoken to were aware of how to respond should an allegation or disclosure of abuse be made to them. The home had made two safeguarding adult referrals under the L.B. of Waltham Forest procedures since the last inspection. Evidence was seen that the home had taken robust and appropriate action regarding both of these, the actions taken by the home regarding one of these being referred to in the Health and Personal Care section of this report. The Commission had been notified of both of these allegations at the times they were made and no other safeguarding issue relating to the home has been made to the Commission since the last inspection. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 & 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People live in a home that is well decorated, well furnished, well maintained and that meets their needs. However, an improvement is needed in the laundry room to maximise infection control and people living in the home may also benefit from more robust signage to assist them locate where they wish to go. The home was clean and tidy throughout creating a pleasant environment for people accommodated, staff and visitors. EVIDENCE: The home is a single storey building that is divided into three units: Unit 1 has nine single bedrooms, a lounge/ dining area and a kitchenette and accommodates older people with a mental health diagnosis; Unit 2 has thirteen single bedrooms, a lounge/ dining area and a kitchenette and accommodates older people with a diagnosis of dementia; and, Unit 3 has ten single Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 22 bedrooms, a lounge/ dining area and a kitchenette and also accommodates older people with a diagnosis of dementia. All three units have appropriate bath/ shower and toilet facilities. The three units are reached through the home’s entrance hall that has notice boards for both staff and relatives/ visitors. The registered manager’s office and the administrator’s office are accessed from the entrance hall. The home also has a main kitchen, staff accommodation, laundry facilities, smoking room and has a large pleasant enclosed garden. At the last inspection a requirement was made that the registered persons must ensure that two items of maintenance were undertaken regarding damp in a shower room and curtains in a lounge, evidence was seen at this inspection that this requirement had been complied with. At the last inspection a requirement was also made that the registered persons must ensure that an audit was undertaken of all bedroom furniture and that those items that were unsafe or unfit for purpose were replaced. This requirement was also seen to have been complied with and bedrooms seen were well equipped, well decorated and had been personalised with photographs and the resident’s personal possessions. A tour of the premises was undertaken. Although the layout of the building can seem confusing to the first time visitor the three units were well decorated, colour coordinated to assist people with a diagnosis of dementia and were generally comfortable and well equipped. Various rooms in the units had appropriate signage to assist residents locate their bedrooms and communal areas although these signs appeared quite flimsy and a few individual signs had been removed by residents, on the day I was informed. This was discussed with the registered manager and a good practice recommendation is made that the home should improve and make more substantial the signage within the building to further assist residents orientate themselves within the home. The home’s handy person was spoken to briefly and he indicated that he felt well supported by the home’s management in keeping the home well maintained. During the tour of the building it was noted that the home was generally clean, tidy and free from offensive odours. The home had appropriate laundry equipment although it was noted that a plinth that one of the machines stood on was deteriorating to a significant degree and was judged to be a potential health and safety hazard. A requirement is made that the registered persons must ensure that this identified plinth is repaired or replaced and its surface made non-porous to maximise infection control in this area. Evidence was seen that staff had received training in infection control. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 23 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are currently supported by a sufficient number of staff to address their needs and by staff who have a range of competencies. However further work is still needed to strengthen the continuity of staff input to residents and on the future deployment of staff, including senior staff, so that residents’ needs can continue to be effectively addressed. Staff have access to a wide range of training opportunities although people living in the home may also benefit from further staff training relating to a new piece of legislation related to giving informed consent. The home’s staff recruitment procedures contribute to protecting people living at the home. EVIDENCE: At the last inspection a requirement was restated that the registered persons must recruit into the home’s vacant posts. This requirement was made by the inspector undertaking that inspection as there were a significant number of care posts being covered by agency staff at the time and it was judged that continuity of care for residents needed to be more robust. Evidence was seen that the home had advertised to fill vacant posts but that this had only resulted in one care post being filled. At this inspection it was noted that the Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 24 home was still using a significant amount of agency staff although a number of these staff had worked at the home at least since the last inspection. Agency staff spoken to were generally able to adequately describe residents’ needs, how these should be addressed and were reasonably conversant with the service. It was also noted that at the time of this inspection the L.B. of Waltham Forest was undertaking a consultation exercise with all relevant stakeholders on the closure of another of its registered care homes for older people. I was informed that if the proposed closure goes ahead the authority might consider redeploying some staff from the other home to Francis House. However, on the day of the inspection more that half of the care staff deployed were agency staff and some of these presented as being more conversant with the needs of residents that others. As a result of this a new requirement is made regarding filling posts on a permanent basis, within a negotiated timescale. The registered persons must agree a clear plan, with specified time scales, for recruiting permanent staff to the home’s vacant posts and send a copy of this plan to the Commission. This is to maximise continuity of care for residents. An up to date staffing rota was seen that correctly recorded the staff on duty during the inspection. The rota showed six care staff and two senior staff on duty during the early shift and six care staff and one senior staff on duty on the late shift. At night there are three care staff on duty with a designated on call manager and senior manager available for advice and support. The registered manager’s hours are in addition to the above. The home also employs administrative staff, a laundry staff, domestics and cooks/ kitchen assistants. I was informed that the home’s current budget for 2007/ 2008 allowed for the deployment of two senior care staff on the early shift and that this had been agreed because of the volume of work on that shift, including a significant amount of medication administration. I was also informed that the provider organisation had not formally agreed funding for the second senior staff member on the early shift for the financial year commencing in April 2008. As indicated elsewhere in this report, the home has made improvements in its care of residents over the past twelve months including ensuring a more robust system for safely administering medication. I was informed by a number of key staff that the deployment of a second senior member of staff on the early shift had significantly contributed to this improvement. A requirement is made that the registered persons must ensure that there are sufficient staff, including senior staff, deployed at all times in the home to effectively meet the needs of residents and can demonstrate how the staff to resident ratio has been determined for all shifts. Evidence was seen that 10, approx. 66 , of the home’s permanent care staff have achieved the national vocational qualification (NVQ) level two in care or above. The home had recruited one permanent care worker since the last inspection and this person’s file was inspected. This contained: evidence of an enhanced Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 25 criminal records bureau (CRB) clearance and protection of vulnerable adults (POVA) check, a completed application form, two references, proof of identity with a photograph. Evidence was also seen that the registered manager checked the qualifications, CRB and POVA checks for the agency staff recruited. An agency member of staff’s file was checked at random and included evidence of a CRB, POVA clearance, proof of identity and references provided by the agency. Evidence was seen that the provider organisation also uses a vetting system for all staff employed, including agency staff, which includes verifying a person’s employment status and entitlement to work in the UK. Staff spoken to were clear about their roles and responsibilities. Evidence was gathered from the staff training matrix and from discussion with staff that training has been provided since the last inspection in: moving and handling; first aid; continence and fire safety. The registered manager stated that all staff received in-house refresher training in moving and handling and safeguarding adults on a six monthly basis and refresher training in continence and safe administration of medication annually. Evidence was seen that staff were currently working on a distance learning workbook regarding safeguarding adults and that this was part of a joint training project with the local primary care trust (PCT) and the local mental health trust (NELMET). It was noted during the inspection that staff in the home have not yet received formal training on the practical implications of the Mental Capacity Act 2005, which came fully into effect on 1st October 2007. This legislation is particularly relevant for assessing whether people accommodated, including those with a diagnosis of dementia or mental health needs, have the capacity to give consent or make decisions about a range of areas that affect their lives. A good practice recommendation is made in this section of the report that managers and staff at the home receive training on the practical implications of the Mental Capacity Act 2005. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 26 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living at the home benefit from the service being managed by a competent and experienced registered manager. People accommodated are consulted to promote and monitor the quality of the service they receive although further work is still needed to obtain the views of wider stakeholders. People’s financial interests are safeguarded while living in the home. The home provides staff with formal supervision to support them meet the needs of people accommodated and to assist in their own development. A range of effective health and safety procedures protect people living in the home. However, further work is needed to evidence that the home’s electrical installation system is safe. EVIDENCE: The registered manager of the home has held that position since 2002 and presents as being knowledgeable about the needs of older people and of Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 27 managing a residential care home. Feedback from residents, staff, relatives and other stakeholders was generally positive about the home, the registered manager and her style of management. At the last inspection a requirement was restated that the registered persons must implement a system of quality assurance (that facilitates residents’ feedback). I was informed that the provider organisation was working on a wider quality assurance system for all its older people’s services. This would more systematically obtain and evaluate views from a range of stakeholders including relatives, health and social care professionals. However, this system had still not been implemented at the time of this inspection. I spoke with the responsible individual by telephone during this inspection and both she, and the registered manager, agreed that the home would implement it’s own system of obtaining formal feedback from stakeholders while waiting for the provider organisation’s wider system to become operational. As a result of this the requirement is amended and restated with a negotiated timescale. The registered persons must ensure that formal feedback is sought from stakeholders including relatives, health and social care professionals on the quality of care provided by the service and that this information must inform the ongoing development of the service that residents receive. Evidence was seen of regular meetings with relatives although records showed that attendance at these was variable, and evidence of regular residents’ meetings. Evidence was also seen of the home consulting on an ongoing basis with residents regarding such things as their preferences regarding activities and the food in the home. In addition the home has regular quality monitoring visits from managers within the provider services in addition to the regular monitoring visits from the responsible individual. Reports from these visits were sampled and were detailed and clear. I was informed that either the L.B. of Waltham Forest or relatives act as appointee for residents and that the home only holds personal allowances for a number of residents. The systems in relation to this were sampled, including checking the cash held for two residents against the records that are held in the home relating to that money. These were satisfactory. Evidence was available, including from a supervision timetable and from staff spoken to independently, that staff receive supervision at least every two months. Staff spoken to felt that this was useful. A range of satisfactory health and safety documentation was seen. This included: gas safety certificate, portable appliance certificate and water tank maintenance to minimise the risk of legionella. However, an electrical installation certificate could not be located at this inspection. A requirement is made that the registered persons must ensure that the home has a current electrical installation certificate and that this is available for inspection at all times. The home’s fire log was inspected and included an up to date record for the servicing of fire fighting equipment and a record of regular fire drills being Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 28 undertaken. It was also noted that as a result of an earlier fire officer’s inspection of the home that new smoke seals had been fitted to fire doors. The fire officer had undertaken a subsequent visit of the service in October 2007 and that the report of this visit was satisfactory. Although requirements are made in this section of the report my judgment is that overall people using the service experience good outcomes as a result of the home’s management and administration systems. Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Yes 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 OP26 Regulation 13(4) Requirement Timescale for action 29/02/08 2. OP27 18(1) 3. OP27 18(1) 4. OP33 24(3) The registered persons must ensure that an identified plinth, that laundry equipment stands on, is repaired or replaced, including its surface being made non-porous to maximise infection control in this area. The registered persons must 29/02/08 agree a clear plan, with specified time scales, for recruiting permanent staff to the home’s vacant posts and send a copy of this plan to the Commission. This is to maximise continuity of care for residents. The registered persons must 29/02/08 ensure that there are sufficient staff, including senior staff, deployed at all times in the home to effectively meet the needs of residents and can demonstrate how the staff to resident ratio has been determined for all shifts. The registered persons must 31/03/08 ensure that formal feedback is sought from stakeholders including relatives, health and social care professionals on the DS0000058691.V358403.R01.S.doc Version 5.2 Francis House Page 31 5. OP38 13(4) quality of care provided by the service and that this information must inform the ongoing development of the service that residents receive (previous timescale of 01/09/07 not achieved). The registered persons must ensure that the home has a current electrical installation certificate and that this is available for inspection at all times. 29/02/08 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 OP1 Good Practice Recommendations The Statement of Purpose’s appendices that show personal details about managers involved with the service should be reviewed and amended to remove such personal information. This is for the protection of the managers involved. The home should produce and displayed in the communal areas of the three units of the home an easy to read summary of the complaints procedure so that it is more easily accessible to residents and other stakeholders that visit the home. The home should improve and make more substantial the signage within the building to further assist residents to orientate themselves within the home. Managers and staff at the home should receive training on the practical implications of the Mental Capacity Act 2005. 2. OP16 3. 4. OP19 OP30 Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Francis House DS0000058691.V358403.R01.S.doc Version 5.2 Page 33 - 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. 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