Latest Inspection
This is the latest available inspection report for this service, carried out on 7th July 2008. CSCI found this care home to be providing an Good service.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
For extracts, read the latest CQC inspection for Franklin House.
What the care home does well Residents on are assessed fully prior to admission to ensure their needs can be met by the home. The home has identified the need to provide information about the home for those admitted for intermediate care and is addressing this. The activities provision at the home is excellent and is based on residents` interests and abilities. The activities co-ordinator is to be commended for her hard work and dedication in this area. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome and offered refreshments. Information regarding advocacy services is available and also is being proactively included in meetings for the intermediate care unit, for help once people return to their homes. The meal provision is good and offers choice, and overall the residents expressed their satisfaction with the meal provision. The complaints procedure is on display throughout the home and complaints are dealt with appropriately. Safeguarding Adults procedures are in place and are followed, and any issues are reported promptly. NVQ training in care and other training in topics relevant to the care of the residents is ongoing to provide staff with the skills and knowledge to care for residents effectively. There are robust systems in place for the recruitment and vetting of new staff. The Manager has the qualifications and experience to run the home, and does so in an effective, open manner, encouraging feedback from residents, relatives and staff. There is a quality assurance system in place and this is effective, as has been evidenced in the improvements made since the last inspection. Monies held on behalf of residents are being managed and are securely stored. Overall health and safety is being well managed at the home. Comments received included: `a very good staff team, friendly, polite and helpful.` `staff are always on hand and answer the call bell.` `It`s simply homely.` `my relative enjoyed a sing along last week and plans to attend a barbeque in July.` `I find everyone polite and efficient and they look after me well.` What has improved since the last inspection? The formulation and review of the service user plans has improved, with evidence of input from residents and their representatives, so that the information is personalised and up to date. On the intermediate care unit, service user plan documentation now includes treatment and recovery programmes. Assessment documentation was complete, up to date and had been reviewed in conjunction with any relevant changes in the residents` condition. Wound care documentation was up to date and gave a clear picture of the dressing regimes and progress of each wound. There has been an improvement in staff attitudes and further work is progressing in this area, particularly on one unit where issues have been identified. The wishes of residents and their families in respect of end of life care is now being discussed and recorded, and this is being progressed on the general nursing care units. A full environmental audit has been carried out and a 5 year improvement plan has been drawn up. There was some evidence of new furnishings and some redecoration having taken place. The home has taken what action they can to limit the storage issues in conjunction with the space available to them. Crockery and cutlery was being dealt with promptly following mealtimes. The staffing has been reviewed and care hours reallocated to provide more effective use of hours. This is subject to constant review and the Manager has discussed the changes with all the staff involved and welcomes feedback from staff regarding how this is progressing. CARE HOMES FOR OLDER PEOPLE
Franklin House The Green Swan Road West Drayton Middlesex UB7 7PW Lead Inspector
Mrs Clare Henderson Roe Key Unannounced Inspection 12:35 7 , 8th & 9th July 2008
th 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 Franklin House DS0000056134.V364617.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. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Franklin House Address The Green Swan Road West Drayton Middlesex UB7 7PW 01895 452 480 01895 448 132 manager.franklinhouse@careuk.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of Manager (if applicable) Type of registration No. of places registered (if applicable) Care UK Manager post vacant Care Home 66 Category(ies) of Old age, not falling within any other category registration, with number (66) of places Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 66 7th January 2008 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, a general nursing unit and a continuing care nursing unit. Each unit is located on a separate floor and has a team of nursing and care staff. On the intermediate care unit there is also physiotherapy and occupational therapy provision. 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 residents. 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 lift. The home is close to local shops and West Drayton High Street. All referrals to the home are made through the Care Management Team. The fees range from £565 to £775 per week. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes.
This was an unannounced inspection carried out as part of the regulatory process. A total of 30 hours was spent on the inspection process, and was carried out by 2 Inspectors. We carried out a tour of the home, and service user plans, medication management & records, staff rosters, staff records, financial & administration records and maintenance & servicing records were viewed. We spoke with 11 residents, 18 staff and 3 visitors. The pre-inspection Annual Quality Assurance Assessment (AQAA) document completed by the home, plus completed CSCI surveys from residents, staff, representatives/visitors and healthcare professionals have also been used to inform this report. Any issues raised on our surveys were fed back to the Manager in general terms. What the service does well:
Residents on are assessed fully prior to admission to ensure their needs can be met by the home. The home has identified the need to provide information about the home for those admitted for intermediate care and is addressing this. The activities provision at the home is excellent and is based on residents’ interests and abilities. The activities co-ordinator is to be commended for her hard work and dedication in this area. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome and offered refreshments. Information regarding advocacy services is available and also is being proactively included in meetings for the intermediate care unit, for help once people return to their homes. The meal provision is good and offers choice, and overall the residents expressed their satisfaction with the meal provision. The complaints procedure is on display throughout the home and complaints are dealt with appropriately. Safeguarding Adults procedures are in place and are followed, and any issues are reported promptly. NVQ training in care and other training in topics relevant to the care of the residents is ongoing to provide staff with the skills and knowledge to care for residents effectively. There are robust systems in place for the recruitment and vetting of new staff. The Manager has the qualifications and experience to run the home, and does so in an effective, open manner, encouraging feedback from residents, relatives and staff. There is a quality assurance system in place and this is effective, as has been evidenced in the improvements made since the last inspection. Monies held on behalf of residents are being managed and are securely stored. Overall health and safety is being well managed at the home. Comments received included:
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 6 ‘a very good staff team, friendly, polite and helpful.’ ‘staff are always on hand and answer the call bell.’ ‘It’s simply homely.’ ‘my relative enjoyed a sing along last week and plans to attend a barbeque in July.’ ‘I find everyone polite and efficient and they look after me well.’ What has improved since the last inspection? What they could do better:
Whilst there has been an improvement with the medication management, issues were identified with the storage and disposal of medications. Action was taken promptly at the time of inspection to address this. Monies and valuables were again found being stored in the medications cupboard, and alternative safe storage was purchased at the time of inspection. Whilst we acknowledge prompt action was taken, the fact that these issues should have been identified and dealt with when they occurred and not as a result of our inspection was discussed. Despite the environmental audit taking place, the first floor corridors and some bedrooms are in need of redecoration and the area is quite shabby in appearance. A shortage in domestic hours is to be addressed to ensure the home is clean throughout at all times. The frequency of fire drills for day and night staff is to be reviewed to ensure they take place at the required intervals. Comments received included: ‘some staff are more caring than others even if they have had the right training.’
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 7 Some anonymous comments were fed back to the Manager in general terms and she said she would look into these and where possible address them. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 8 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 Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 9 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): 3 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are fully assessed prior to admission to the home, to ascertain that the home is able to meet their needs. The home has an effective intermediate care unit, where residents are helped to maximise their independence and return home. EVIDENCE: The home has a clear pre-admission assessment and those viewed had been fully completed, to ascertain that the home is able to meet the needs of the resident. The home also obtains copies of the Social Services assessment documentation. Several comments had been received on our surveys indicating that residents admitted to the intermediate care unit do not receive information about the home prior to admission, and the Manager had also identified this shortfall. As a result the home is producing a pre-admission booklet specifically for prospective intermediate care residents, which will have input from the home and the Primary Care Trust and which will provide clear
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 10 information regarding the purpose of the unit and the services provided at the home. The intermediate care unit is purpose built and there is dedicated space containing physiotherapy equipment plus equipment to aid with activities of daily living. In addition to the nursing and care staff there is one full time physiotherapist, two part time physiotherapy assistants, one full time occupational therapist and two part time occupational therapy assistants. There is a multi-disciplinary team meeting every week to discuss the progress and goal setting for each individual. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 11 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 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service user plan documentation is well completed to provide staff with the information to meet each resident’s needs. Overall medications are being well managed at the home, thus safeguarding residents. Shortfalls in storage and disposal must be addressed in a robust manner. Staff care for residents in a gentle and professional manner, respecting their privacy and dignity. The home provides good end of life care, thus ensuring that residents and their families have their wishes and needs discussed, recorded and met. EVIDENCE: Service user plans were sampled on each unit. The home holds computerised records and it is acknowledged that there had been problems with the printers and the home was in the process of addressing this. On the intermediate care unit those viewed were up to date and clearly recorded the needs of each individual and how these needs are to be met. There was evidence of involvement and input from each resident and the multi-disciplinary healthcare team, and include treatment and recovery
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 12 programmes with goals to re-establish community living. The service user plans had been reviewed whenever a significant change had occurred. On the general nursing units there had been an improvement in the formulation of the care plans, with information being better personalised to each resident. In some instances where residents had clear preferences for their daily routine these had been well documented. Speaking with residents it was clear that staff had discussed their care needs and the contents of the care plans with them. The service user plans had been reviewed monthly and whenever there had been a significant change. Risk assessments for falls were viewed and had been updated following falls. Some information was updated at the time of inspection, and evidence of this was viewed. With one exception assessments for the use of bedrails had been completed and written consent obtained for their use. The Manager said this would be promptly addressed. There was also evidence that where bedrails were no longer assessed as being needed, their use had been stopped and this had been recorded in the relevant care plan. Wound care documentation was viewed on all units. On the second floor one care plan had been completed for 3 wounds, and this was reviewed at the time of inspection to provide 3 separate care plans – one for each wound. Pressure sore risk assessments were in place, and there were records of wound care dressing regimes and wound progress information. In most instances care plans for pain had also been formulated, with some being completed at the time of inspection. Pressure relieving equipment was in use and had been identified in the documentation. Assessments were in place to include continence, nutrition, moving & handling, dependency, communication and night care. There was evidence of input from the GP, tissue viability nurse, physiotherapist, dentist, chiropodist, speech & language therapist, dietician and optician. There was evidence that residents’ healthcare needs are being well met. Medication management was viewed on each unit. Lists of staff signatures and initials had been completed. Fridge minimum/maximum/actual temperatures had been recorded daily and were within safe range, as were the clinical room temperatures. Receipts, administration and disposal of medications had been recorded. Two exceptions were noted for medication administration on the ground floor. Single use lancets are used for blood glucose monitoring. For residents being fed via a percutaneous endoscopic gastrostomy tube (PEG) the daily feeds had been signed for on the medication administration record (MAR) and also recorded on the daily fluid balance chart. We recommended that the batch number and expiry date also be recorded. For residents on warfarin therapy the result of the blood tests and the resulting warfarin dosage is kept with the MAR. Medication reviews take place with the GP. On the Intermediate Care unit all residents have a self-medication risk assessment in place and systems are in place to supervise residents who wish to self-medicate. Some issues with delays in medication disposal were identified on all 3 units, to
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 13 include in some instances controlled drugs. On the ground floor some medication labels had been removed and the medication not yet disposed of. The importance of disposing of medications in line with current legislation and relevant guidance was discussed with the Manager. Action was taken to obtain the appropriate disposal containers and to arrange to have the medication collected by the approved clinical waste contractor. Appropriate secure storage arrangements are in place for all medications. On the second floor general nursing unit due to the backlog of medications for disposal some of the controlled drugs were not being held in the inner secure cabinet, and this was addressed at the time of inspection. The importance of staff being aware of the differing storage requirements of medications was discussed. On the intermediate care unit and the first floor nursing unit monies and valuables were found in the medication storage cupboard. This was a repeat finding. The Manager obtained a small safe at the time of inspection so that any monies, valuables or appropriate items that are handed in outside office hours can be stored securely until they are handed over to the Administrator. At the time of inspection staff were seen caring for residents in a caring manner, respecting their privacy and dignity. Some comments were received that a few staff can be abrupt and speak in an off-hand manner. The Manager was already aware of this and has also identified issues with teamwork on one particular unit. As a result action has been taken to provide continuity of nursing staff and introduce senior care workers to the floor and new staff to improve the communication and teamwork. This has been hard work for the senior staff and those spoken with felt that the situation is steadily improving. Staff are also receiving training in customer care and values, to reinforce the importance of person centered care. In some of the service user plans viewed the information in respect of end of life care wishes was very personalised and had clearly been discussed with the resident and their relatives, so that their wishes are recorded and respected. Staff are receiving training in end of life care and the Manager supports the nursing staff in discussing this sensitive issue with resident and relatives. Further training and work to ensure the information is available for all permanent residents is taking place. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activities provision is good and varied, and each residents right to choose to join in is respected, thus meeting their individual needs and wishes. The home has an open visiting policy, thus encouraging residents to maintain contact with family and friends. Information regarding advocacy services is available, thus ensuring the residents’ right to independent representation is respected. The food provision in the home is good, offering variety and choice, with resident’s choices being respected. EVIDENCE: The home has a full time activities co-ordinator and there are a wide variety of in-house and external activities arranged to meet the interests of the residents. There is a reminiscence room and this is accessed by residents and is very well appointed with memorabilia and music for them to enjoy. Weekly sessions such as book reading, art groups, current affairs and other activities that interest the residents take place. Lunch outings, outside entertainers and activities such as barbeques are also arranged. There is an activities programme on each floor and the carers assist in facilitating activity groups. One-to-one sessions with residents who are unable to or do not wish to
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 15 partake in group activities also take place. There is a regular newsletter and residents have a lot of input into this. There were several very positive comments received about the activities provision at the home, and it is clear that the activities co-ordinator takes much pride in her work and her priority is to provide a comprehensive activities programme to meet the needs of the residents, which is commendable. The home operates a cook-chill system of nutrition. Overall the comments about the meal provision were good and residents spoken with said that they enjoy the meals and are offered a choice of meals. The home can provide specialist diets to meet differing nutritional needs, both for medical and cultural reasons. The kitchen was clean and tidy and all the records viewed were up to date. The home has recently had an inspection by Environmental Health and gained a high standard report. Each unit has a small kitchenette where drinks and snacks can be prepared. These again were clean and tidy and items in the fridges were in date. Fresh fruit is available, however the home currently only has one delivery per week. The Manager said that this would be reviewed to provide 2 deliveries per week. We sampled the lunchtime meal on the second day of inspection and this was well presented and tasty. The home has an open visiting policy and visiting is encouraged. Visitors spoken with said that they are made welcome at the home and are offered refreshments. Visitors can have meals at the home and information regarding the cost of these is on display. Residents can receive visitors in one of the communal rooms or in their own bedrooms, according to their wishes. Information regarding advocacy services was displayed in the main entrance of the home. The home has contact with Age Concern and various advocacy services to provide financial advice. An advocate from Age Concern is attending the Focus Group for residents and relatives, which is particularly relevant to the intermediate care unit to provide support when people return home. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has clear complaints procedures in place to address any concerns raised by residents and their visitors. There is a robust system in place for safeguarding adults, thus protecting residents from abuse. EVIDENCE: The complaints procedure is displayed throughout the home and copies are available in the Statement of Purpose and Service User Guide. There had been 2 complaints since the last inspection. These had all been fully investigated and responded to. An anonymous concern raised with us had been discussed with the Manager who had responded promptly to this. A folder of complaints is maintained and the documentation viewed was comprehensive. The Manager has an ‘open door’ policy for residents, visitors and staff, and responds to any concerns raised. The home has adult protection policies and procedures in place that dovetail with the Hillingdon Safeguarding Adults documentation. Staff spoken with said that they had received POVA training and were clear to report any concerns. Safeguarding information and procedure notices were prominently on display throughout the home and staff had clearly read the information provided. The importance of reporting any issues that could have a safeguarding adults element to it was discussed with the Manager who was clear on this matter.
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 17 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, 21, 22 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a programme for redecoration and refurbishment, however some areas are in need of prompt attention to bring the décor back to a good standard. Issues with storage are being addressed as best the home can within the limitations of space to minimise the issue. Overall the home is equipped to meet residents moving & handling needs, with action being taken to review delays caused by the need to share equipment. Procedures are in place for infection control and these are practiced, thus minimising the risk of infection. Shortfalls should be easy to address. EVIDENCE: A tour of the premises was carried out. An audit of the home had been completed following the last inspection and there is a 5 year plan in place to include the redecoration and refurbishment of the home. New chairs had been purchased for areas of the home, which look smart and meet the needs of the
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 18 residents. Some redecoration work had been done, however the corridors require attention, especially redecoration of the corridors and some bedrooms on the first floor, which was looking very shabby. Some of the Perspex protectors on the corners had been damaged and could present a risk to residents. There is a garden with furniture for people to sit out in. Work has taken place to ensure the showers are in full working order and the flooring was being replaced in one shower room on the second floor at the time of inspection. The Manager has also identified the need for some of the bathrooms to be reviewed to provide appropriate bath facilities to meet the needs of the residents currently living at the home. The home continues to have an issue with storage, and items to include hoists and one wheelchair were found in one bathroom on the first floor. Hoists were also being stored in bathrooms on the other floors. It is acknowledged that the home does not have designated storage facilities for hoists and that these can be removed easily from the bathrooms when required. Overall wheelchairs are now being stored more appropriately within the home. The corridors are wide and there are handrails throughout the home. On the first floor there are 2 hoists and on discussion with staff it was clear that due to the dependency of the residents a third hoist is needed to ensure residents needs can be better met in a timely fashion. Also discussion was had regarding the need for some additional shower chairs. This was passed back to the Manager who said that she would review the equipment provision in the home. We viewed the laundry facilities. The laundry room was clean and tidy and the laundry is now being completed promptly, with no backlog noted. Comments from residents indicated that the laundry system had improved. Good practice information was on display in the laundry. Protective clothing to include gloves and aprons was available and protective goggles are provided in the laundry. Staff had received training in infection control and, where needed, care plans for infection control issues were in place. With the exception of areas on the first floor the home was clean. Some malodour was noted in 2 localised areas and we discussed the flooring provision for these rooms. Suitable flooring to assist with cleaning and odour control is required and the Manager said that this would be reviewed. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is appropriately staffed to ensure that the needs of the service users are met, however domestic hours need reviewing to maintain all areas in a clean condition. Systems for vetting and recruitment practices are in place and protect residents. There is an ongoing training programme, providing staff with the skills to meet the needs of residents. EVIDENCE: Since the last inspection the staffing provision had been reviewed to provide more effective staffing for the general nursing units. The Manager said that this would be kept under review. At the time of inspection the home was being appropriately staffed in most areas, however the domestic hours available need reviewing to ensure that all areas of the home are kept clean, as the first floor had areas that were dusty and in need of attention. For the kitchen, additional staff had been trained up to work in the kitchen when there are staff shortages. The home has over 50 of care staff who are either trained to NVQ level 2 in care or are currently undertaking this training. Staff spoken with said that they do receive regular training sessions and updates, and this was evidenced on the staff training matrix.
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 20 Two sets of staff employment records were viewed. These contained all the information required under the Care Homes Regulations 2001. The home has an induction programme that includes the Skills for Care common induction standards. Each new member of staff is given an orientation and induction booklet to complete and a mentor is allocated to ensure all areas are completed. Staff said that they had received induction training, both on the computer, which is called ‘El Box’ training, and also practical training in health & safety topics plus orientation to the home. Staff also said that they do receive training in topics relevant to the needs of the residents, and this was evidenced on the staff training matrix. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 21 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 & 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager has the skills and experience to manage the home effectively and has an open approach to management, encouraging good communication. Systems for quality assurance are in place, thus providing an ongoing process of review and feedback. Resident’s monies are well managed and securely stored. Systems for the management of health and safety throughout the home are good, thus safeguarding residents, staff and visitors. Shortfalls should be easy to address. EVIDENCE: The Manager is a first level registered nurse with several years of management experience. She has a certificate in management and has undertaken post qualification training in palliative care, dementia care and care of the elderly. The Manager is in the process of completing A BSc in health & social care for
Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 22 older people. Staff and residents spoken with said that the Manager is supportive and approachable. The Manager has identified some issues such as staff interaction, and has taken appropriate action to address this whilst supporting her staff in the process. The Manager has applied to us for registration. The Deputy Manager has 12 supernumerary hours per week and the need to ensure the Deputy works supernumerary whenever the Manager is on leave was discussed and is being addressed. The Manager has introduced a shift co-ordinators file for whoever is in charge of the home at any one time, and this provides clear information regarding contacts and how to manage any incidents that may occur. This together with the fact that the Deputy Manager works most Saturdays has provided more effective weekend and out of hours management cover for the home. Care UK has systems in place for quality assurance. There is a monthly audit topic and over the 12 months all aspects of the home are audited. The audit for June was in respect of admission procedures and associated documentation, and as a result of the audit some points had been identified to address. The Manager carries out a three monthly audit to include all areas of resident care. A full audit is currently being carried out of all the service user plans and work already carried out is reflected in the improvement found in the service user plans viewed at this inspection. Regulation 26 visits are carried out on behalf of the Registered Provider and written reports are available. Separate meetings for residents, relatives and staff are held on a regular basis and minutes are taken. An annual survey for residents and relatives is carried out and the results of this had been published and were available in the reception area. The home holds some personal monies on behalf of residents. Written records of income and expenditure are maintained and receipts are obtained for expenditure. On the first day of inspection there was a discrepancy with one of the amounts viewed and the administrator carried out an audit and identified the expenditure and reconciled the account. Other records and expenditure checked were correct. We recommended that a monthly audit be done of all monies held. Servicing and maintenance records were sampled and those viewed were up to date. The maintenance schedules are comprehensive and include weekly and daily checks of various areas of the home, with clear records being kept. Staff undertake health & safety training to include moving & handling, infection control, fire safety and food hygiene. The fire risk assessment for the home had been completed in April 2007 and the Manager said that this is due for updating. There have been no significant changes in the home in this time. Fire drills had been carried out in January & February 2008, with one undated document also available. The Manager said that she does carry out fire drills for day and night staff and we discussed the importance of ensuring these are done at a frequency to include all staff in the drills at the required intervals. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 3 X X 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 3 X 3 X X 2 Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement All medications must be stored and disposed of in accordance with the Royal Pharmaceutical Guidelines and the Nursing and Midwifery Council Standards for Medication Management in order to safeguard residents. All medication administration must be signed for immediately after the medication has been administered. The first floor must be audited and redecoration carried out in the corridors and other areas noted to be in need of decoration. Other floors must be kept under review. Flooring must be reviewed to ensure that in each room the flooring is suited to the needs of the resident. The hours available for domestic care work must be reviewed to ensure sufficient hours are available to keep the home clean throughout at all times. Day and night fire drills must take place for all staff in line with relevant current legislation, to
DS0000056134.V364617.R01.S.doc Timescale for action 09/07/08 2. OP9 13(2) 09/07/08 3. OP19 23(2)(b) & (d) 01/09/08 4. OP26 16(2)© 01/09/08 5. OP27 18 01/08/08 6. OP38 23(4) 01/08/08 Franklin House Version 5.2 Page 25 safeguard residents, staff and visitors. 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 OP9 Good Practice Recommendations It is recommended that a clear record be maintained of medications given to residents on their discharge from the intermediate care unit. Franklin House DS0000056134.V364617.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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
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