Inspection on 14/11/07 for Beis Pinchos Nursing Home

This inspection was carried out on 14th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Beis Pinchos Nursing Home 12/04/07

Beis Pinchos Nursing Home 14/12/06

Beis Pinchos Nursing Home 23/01/06

Beis Pinchos Nursing Home 07/06/05

Beis Pinchos Nursing Home 30/11/04

Beis Pinchos Nursing Home 08/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Beis Pinchos Nursing Home 2 Schonfeld Square London N16 0QQ Lead Inspector Jon Fry Unannounced Inspection 14th November 2007 10:35 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 Beis Pinchos Nursing Home DS0000007351.V354245.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. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beis Pinchos Nursing Home Address 2 Schonfeld Square London N16 0QQ 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 8802 7477 020 8809 7000 info@aihaltd.co.uk Agudas Israel Housing Association ****Post Vacant**** Care Home 43 Category(ies) of Dementia (4), Dementia - over 65 years of age registration, with number (20), Old age, not falling within any other of places category (35) Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Minimum Staffing Notice Four (4) service users under the age of 65 years to be accommodated in the home with dementia or in need of nursing care Up to 35 Beds for Nursing Care Date of last inspection 12th April 2007 Brief Description of the Service: Beis Pinchos Nursing Home provides residential and nursing care for up to 43 older people from the Orthodox Jewish Community. 20 of these places can accommodate people who have dementia. The home is based in the London Borough of Hackney on the border of Stoke Newington and Stamford Hill. It is situated in the midst of the largest Orthodox Jewish Community in Europe. Schonfeld Square is easily accessible by public transport and is close to local parks and shops. The service offers a wide range of religious and culturally appropriate services and activities to the people who live there and to the Orthodox Jewish Community in the immediate area. A copy of the service’s Statement of Purpose and Service User Guide can be obtained on request. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out by one inspector who spent ten hours in the home over two separate visits. The inspector talked individually with eleven people living at the home. Four relatives or friends of individuals were also spoken with during the inspection. A number of records were examined and discussions took place with the manager and six staff members. Completed surveys were received from six people living at the service and ten relatives or friends of individuals. What the service does well: What has improved since the last inspection? All of the 25 Requirements made following the April 2007 inspection visits have been met. We saw that staff recruitment files were kept very well and contained all the necessary checks to help protect the people who live there. The training provision for care staff is good and records are being updated to make sure this is well evidenced. Staffing levels meet the needs of people who live there. Medication is properly administered with full records kept. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory information is currently available to prospective users of the service about the home although this could be improved. Assessments are completed before people move in to make sure that their individual needs can be met. EVIDENCE: We spoke to one person who had just moved into the home who said that they came there because it was for Orthodox Jewish men and women. They said that they had been welcomed and treated “wonderfully”. One person said “ my family found it” and another individual commented “it’s the best place for me”. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 9 A glossy brochure is available to tell people about the service provided. We saw that the home is working to update this document as some of the information is now out of date. We recommend that other formats are looked at for the guide such as large print, pictures or audiotape to make sure that it can be used by as many people as possible. We saw that there is an admissions procedure and that assessments are completed prior to anybody moving in. Individuals and their relatives are given an opportunity to visit and see if the home is suitable for them. A relative or friend commented “there is a long waiting list”. Once an individual comes to live there, a care plan is written based on these assessments. We looked at the information kept on file for three people during our visit and each had a full pre-admission assessment completed. We have recommended that the service look at the assessment format in use to make sure that it captures good quality information about the person. A questionnaire could also be used to ask relatives or friends about the person if they are unable to provide the information themselves. All this information is important for the care plan and personalising the service to the individual. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans need to be improved to be more individual and person centred. Individual health needs are met. Arrangements for the handling, storage and administration of medication are good. EVIDENCE: Comments from people who live there included “very good”, “amicable”, “I like it very much”, “they look after me” and “I’m well looked after – very much so”. 88 of relatives or friends who sent in surveys said that the home ‘always’ met the needs of the individual. 12 said ‘usually’. Comments included “always dignified and respectful care”, “my relative is well cared for, clean and happy” and “they always stay focused on the welfare / wellbeing of the residents”. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 11 We looked at the care plans for three people. Each care plan sets out how their needs are to be met, this document is reviewed regularly. The plans are currently based on a tick box approach, are too generic and the person was ‘missing’ from the ones we looked at. The care staff need to improve each one to contain more individual information and to better address social and emotional needs. Life story work may also help staff and other people living at the home ‘see’ the person better. Care plans seen for areas such as personal hygiene included phrases such ‘assist with oral hygiene’ and ‘give all assistance necessary with washing and dressing’. Staff need to make sure that specific person centred information is recorded. For example, when and how does the person like help with washing and dressing, what specific assistance is needed with oral hygiene and where does this all happen? Monthly evaluations of care plans are taking place but again staff need to look at being more specific in what they are recording and make sure that useful information is being captured. We saw one example where someone had written ‘requires help with showering and bathing’ when reviewing an individual care plan for someone’s personal hygiene. This is too general and leaves unanswered questions for other staff members. Staff on duty were seen to be polite and well meaning in what they did. We saw a small number of occasions where staff did not properly communicate with people about what was happening. This needs to be discussed to make sure that staff are ‘walking alongside’ people rather than ‘doing to’ them. We saw that health needs of individuals are being met. “I saw the optician recently”, “I had my flu jab last week” and “they arrange appointments quickly” were comments from people living at the home. A GP was visiting people on one of the days we visited. Records of appointments with healthcare professionals are kept well. Appropriate medication policies, procedures and practices are in place and medicines are labelled and stored correctly. We saw that Medication Administration Record Sheets are kept up to date and signed by staff. Two instances were seen where individual creams were being kept in communal toilets. This is poor practice and needs to stop immediately. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home offers a good range of activities. There is scope to improve this by making sure there is a detailed social care plan for each person and involving all care staff in delivering this important aspect of care. People living there enjoy the food provided to them. EVIDENCE: People we spoke to were positive about the activities on offer to them. “A good social programme”, “lots of events – time goes very quickly”, “wonderful” and “there’s enough to do” were some comments from individuals. Feedback from relatives or friends of individuals included “Religious services, studies, lectures and entertainment all provided for” and “they have always tried to interest my relative in different activities”. The activities programme displayed included arts and crafts, quizzes, a clothing sale, sewing, bingo and a film afternoon. Activities start in the morning and go on into the evening. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 13 One of the real strengths of the home is the involvement of the community in the life of the home. The home is situated in Schonfeld Square and is surrounded by family homes and sheltered flats. During our visits, we saw people of all ages visiting and participating in what was going on. Families and volunteers are encouraged to visit at any time and the individuals who live there are able to take part in community events. Some people who live there had been supported to go to a wedding at the time we visited. As stated previously, care plans need to be developed to contain more information about the person and their interests and hobbies. This information needs to be seen and used by everyone. It is recommended that all care staff be encouraged to see wellbeing, engagement and occupation as an important part of their job. Any opportunity to spend time with people should be used positively and person centred care promoted rather than task based care. Two of the staff we spoke to said that they would welcome more time to spend quality time with the people who live there. It is recommended that life story books be developed with people living there and these could then be shared with others in the home. This may also help staff to relate to people as individuals and encourage more interaction. Staff may wish to develop their own life story books as part of this process also. People spoken with said that they enjoyed the food offered with comments including “good”, “very good”, “very nice”, “plenty”, “a good cook” and “if you don’t like one thing, you can always have another”. The mealtimes we observed were very lively social occasions with volunteers, visitors and people from the sheltered flats participating in this. On the first day we visited we saw a number of staff helping two people at once to eat. This was discussed and improvements had been made when we went back to the home. There may be opportunities to improve the mealtime experience further. Ideas such as protected mealtimes and displaying menus in picture format should be considered. The use of plastic aprons also needs to be looked at as this undermines the homely feel of the mealtime. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are protected from abuse. Concerns about the care provided are listened to and acted on. EVIDENCE: The complaints procedure is part of the guide for the people living there. Records are kept of any concerns or complaints received and we saw that action had been taken by the home to address these. People we spoke to said that they knew how to voice any issues they had. Comments included “I speak to the nurses”, “no complaints” and “I speak to my relative”. 100 of relatives or friends who sent in surveys said that they knew how to make a complaint if they needed to. Comments included “any concerns are discussed fully and changes implemented” and “they investigated the matter thoroughly and took appropriate action in a timely manner”. Staff are trained in Safeguarding Adults during their induction and procedures for them to follow are available. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home enjoy a clean, comfortable and safe living environment. The bathrooms could be further improved for the benefit of people living there. EVIDENCE: People spoken to were generally happy with the environment. Comments from individuals included “comfortable”, “I like my room” and it suits me pretty well”. A new day centre, Synagogue and reception area is currently being built. Two people spoke of how they thought this would improve the home and provide more communal space. We saw that the home generally provides a pleasant and well maintained place for people to live. We thought that the communal bathrooms and toilets Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 16 needed work to make them more homely and less clinical for the people living there. Supplies of incontinence pads need to be stored in cupboards and individual creams / toiletries kept in people’s bedrooms. The home was clean and hygienic when we visited. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are enough staff on duty to meet the needs of people using the service. People living at the home are protected well by the recruitment procedures. There is a staff training and development programme in place. EVIDENCE: Feedback about the way the staff carried out their duties was positive. Comments included “very nice”, “they look after me”, “good” and “there are enough around”. Relatives or friends of individuals said “Mrs Symons chooses staff who demonstrate respect for the residents, try to encourage them and have endless patience”, “they are professional, kind and caring” and “staff are always proactive in dealing medical or social issues”. Staff have access to training and recent courses attended include moving and handling, prevention of abuse and falls awareness. New staff receive induction training and can then go on to study for the NVQ Level 2 and 3 awards. We saw that the home is reviewing and updating its training records and putting a system in place where mandatory training is flagged up for individuals where needed. This includes refresher training for existing staff. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 18 The service is accessing specialist external training around person centred care and is participating in the national ‘my home life’ programme. We have recommended that the service continues to access training for staff in dementia care and person centred planning. This may help encourage staff in continuing to move away from task based care to more person centred approaches. We saw that the necessary recruitment checks are carried out for new staff and good records are kept of these. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. There are good arrangements to make sure that the health and welfare of people using the service is protected. EVIDENCE: Comments from relatives or friends of people using the service included “it is run according to the needs of the residents”, “we are amazed how well it is run” and “the service provider is really sensitive to the needs of my relative”. A new manager has been in post since August 2007. She is very experienced and demonstrated her commitment to achieving high standards in all areas of the care provided. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 20 A system for regular individual staff supervision is in place but needs development to make sure that all full time staff receive this at least six times per year. The new manager is already addressing this and a new staff policy has already been put in place. Staff we spoke to felt well supported. Comments included “the manager is very good”, “it’s better now” and “a nice staff team”. There are quarterly meetings for people who use the service and their relatives / representatives. The home also sends out surveys annually to seek the opinions of people about the home. We were told that visiting relatives will usually not wait for the meetings if they have something to say and the feedback process tends to be informal and ongoing. Health and Safety checks take place to make sure people are kept safe and generally good records are kept of these. We have required the home to make sure that weekly checks are kept of hot water temperatures for all bath and shower outlets. Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 3 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 2 X 2 Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 22 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 OP1 Regulation 5 (1) (2) Requirement In order to ensure individuals and their representatives have good up to date information about the home, the user guide must be updated as necessary. To make sure that people’s needs are being met, care plans must fully address all areas of need and clearly state the support required by staff. Care plans must be specific to the individual. In order to ensure the welfare and dignity of people living at the service, prescribed creams and individual toiletries need to be stored in people’s bedrooms and not in communal toilets / bathrooms. Incontinence supplies need to be stored in cupboards. Hot water temperatures of baths and showers must be checked weekly with full records kept. This will help to ensure the safety of people living at the Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 23 Timescale for action 01/04/08 2. OP7 15 (1) 01/04/08 3. OP9 OP21 12 (4) 13 (2) 01/01/08 4. OP38 13 (4) 01/01/08 home. 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. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The user guide should be made available in different formats such as large print, pictures or audiotape. The service should review the assessment format to make sure that it captures good quality person centred information. A questionnaire could be developed for relatives or friends of individuals to be used where appropriate. The home should look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person orientated and less task based. Better background information about the person and their life should be recorded. Care staff need to make sure that they are person centred in their approach and not task based. The home needs to make sure that there is a senior leading each shift who is role modelling good practice for other staff to follow. Life story books should be developed with the individual and their family or friends. These books should be used to help communication and engagement. Staff may wish to develop their own life story books to share. The service should continue to look at the mealtime experience for the people living there and ideas to enrich this further. This could be through protected mealtimes and staff eating alongside the people who live there. Menus should be displayed in picture format or in other ways to help people to make real choices. The use of white plastic aprons should be reviewed. The service should look at ways of making communal bathrooms / toilets less clinical and more homely. All staff who work at the home should receive training in dementia care and person centred care. 3. OP7 4. OP10 5. OP12 6. OP15 7. OP15 8. 9. OP21 OP30 Beis Pinchos Nursing Home DS0000007351.V354245.R01.S.doc Version 5.2 Page 24 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. 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