CARE HOMES FOR OLDER PEOPLE
ELLA & RIDLEY JACOBS HOUSE 19-25 Church Road Hendon London NW4 4EB
Lead Inspector Rebecca Bauers Announced 17 May 2005 @ 9:40 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 3 SERVICE INFORMATION
Name of service Ella & Ridley Jacobs House Address 19-25 Church Road, Hendon, London NW4 4EB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8203 5368 020 8201 5254 Simon Morris of Jewish Care Natasha Carson (Acting Manager) PC Care Home Only 48 Category(ies) of DE(E) Dementia over 65 registration, with number OP Old Age of places ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1 ) Limited to 48 adults of either gender over the age of 65 some of whom may have dementia. Date of last inspection 16 February 2005 Brief Description of the Service: Ella and Ridley Jacobs House, which is operated by Jewish Care, is registered to provide personal care for up to 48 older people some of whom have problems associated with dementia or confusion. The home is purpose built and is located in a busy suburban area know as ”The Burroughs” near Hendon Town Hall. It is very convenient for local shops and transport services. The stated aims of the home are to meet the needs of 44 elderly frail Jewish service users and provide respite care to up to three service users. Service users, relatives and friends are invited to parties at Jewish festival times. There are two friends committees who regularly hold events and raise money to ensure that service users have the best possible care. There is also a small group of volunteers who undertake training to help staff with aspects of social care and manage an in-house shop for the service users. The home aims to encourage service users to live life to the full, ever mindful that they have rights. Dignity and care of service users, support and development of staff, the views of relatives, volunteers, and religious leaders are all monitored by Jewish Care’s Quality Assurance team. The environment and lifestyle arrangements reflect the Jewish culture and way of life. The home is a large building that has been extended and modified over the years to meet the changing needs of service users. It is organised over five floors.
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place on the 17th of May 2005 as part of the annual inspection programme to identify progress with previous requirements and to check standards of care against the core standards. The inspection took eight hours to complete. A full tour of the home took place, six service users were spoken to on an individual basis. No relatives requested to speak to the inspector. Care records, staff records, quality assurance audits and health and safety records were examined. Six staff were spoken to and the inspector was able to have discussions with the newly appointed manager and the service managers. Further information was obtained from the pre-inspection questionnaire and comment cards. Nine comment cards were received from service users, two from health care professionals including GPs and thirteen from relatives. Positive comments were given with regard to the care received and the caring attitude of the staff team. Four complaints had been made. What the service does well:
Service users benefit from good assessments of need prior to admission and informative guidance about he home to enable decisions to be made about the home. Service users social and emotional needs are understood. Service users say the staff are ‘great’, ‘very caring and kind.’ Service users benefit from having an activities co-ordinator and a wide range of activities that meet cultural and spiritual needs. Service users benefit from healthy, wholesome food that meets their cultural and dietary needs. Service users benefit from a stable, competent, well-trained staff team that understand their needs fully. Staff morale is good which promotes good positive team working. Service users benefit from having open forums to discuss the issues that affect them and to influence change in the running of the home to their own advantage. Service users know how to complain and have been given the relevant contact information to enable them to complain both internally and externally.
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 6 The home is comfortable and homely. Service users felt that their bedrooms were comfortable and personalised. Communal areas are conducive to promote conversation. What has improved since the last inspection? What they could do better:
Fourteen requirements have been made at this inspection one has been restated for the second time. The restated requirement concerned the need for all service users to be assessed for the risk of pressure sores and for actions to minimise risk to be documented. Further requirements were made for service users to have annual reviews, for risk assessments to include detailed clear actions for staff to minimise risk and for health records to be consistently and fully documented. These are required to ensure that service users are receiving the care they receive and that it is being monitored appropriately to identify if service users needs change. Requirements were made for PRN guidelines to be in place for service users who have prescribed PRN and for service users to be enabled to access the local community. A requirement was made for the outcome and actions of the investigation into a complaint received by the Commission from a relative to be sent to the Commission. Environmental requirements were made to promote the personal care and safety of service users. These included ensuring that an adapted bath is
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 7 replaced and operational on the top floor so that there are adequate washing facilities for service users who are currently using their own wash-hand basins. One service user has her own en-suite. Service users who wish to have their bedroom doors open must have them fitted with approved fire door release mechanisms. The condemned tumble dryer must be removed and replaced to prevent a fire risk to service users and staff. A requirement is made for a maintenance plan to be sent to the Commission to identify all works identified and the timescale for completion. Requirements are made for additional staff to be on duty in the mornings to ensure the needs of service users are met and their safety promoted. For staff files to be completed to safeguard service users and for staff to receive regular supervision to promote continuity in care and the overall service provided to service users. A requirement was made for the homes fire risk assessment to be reviewed. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. ELLA & RIDLEY JACOBS HOUSE Version 1.10 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 Standards Statutory Requirements Identified During the Inspection ELLA & RIDLEY JACOBS HOUSE Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,6 Service users are provided with good information about the home prior to choosing to live in the home. Service users move into the home in the safe knowledge that their needs have been fully assessed and can be met by the home. EVIDENCE: Prospective service users are given a copy of the homes service user guide and statement of purpose prior to admission so that they and their families can make an informed choice about where to live. Two files were seen for two service users who had moved in to the home during April and May, these contained detailed assessments of need carried out by the home and a consultant or GP. Service users can be assured that the home is able to meet their needs based on the initial assessment carried out. The home does not provide intermediate care. ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 The service users health and personal needs are not set out clearly in their individual plans of care. Social care needs are. Service users health needs seem to be fully met however they are not fully documented. Service users are protected by the homes medication policy and procedures. Service users state that they are treated with respect and their right to privacy is upheld. EVIDENCE: A requirement made at the last inspection for the registered provider to ensure that all medication that is carried over to another month is clearly recorded on the new MAR sheet, to provide an accurate audit of service users medication had been completed. Staff follow the homes medication policy and procedure to protect service users. Staff spoken to were knowledgeable with regard to when to give prescribed PRN medication however PRN guidelines were not documented; to safe guard service users these must be in place. A requirement made for all ointments and creams to be locked away in service users rooms had been complied with. Service users health and personal care needs are set out using the ‘standex system’, which is more geared to a nursing environment. The home is not a
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 11 nursing home and so the care plans are not currently reflecting a holistic picture of service users, nor are their support needs clearly identified. The newly appointed manager showed the inspector a new care plan format that is due to be introduced across all ‘Jewish Care homes’ this was an improvement but still needs to reflect individual support needs and clear actions to minimise risk. The nursing element is still prevalent and is not relevant to this particular home. The current service users files were examined, six in total, they were incomplete in some crucial areas. For example, there were large gaps in the health records, when and how personal care was given and monitoring of weight. Actions to minimise risk of falls and pressure sores had not been documented or assessments had been partially completed. These must be fully documented to demonstrate appropriate care is being given to service users and that staff are working in ways to minimise risk to service users. Service users did make very positive comments with regard to the care they receive saying that ‘the staff are very kind, that they agree their personal care needs with staff and that staff always respect their wishes, privacy and dignity’. Six of the service users spoken to knew who their key worker was and had been involved in their monthly reviews. One service user explained that he had been living in the home for eighteen months, when asked ‘have you had an annual review?’ He responded, ‘ no I don’t think that I have had a big review yet, I have been hear for one and a half years.’ All service users must have annual reviews to ensure the home is able to continue to meet their needs. ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Service users benefit from living in a home that meets their social and cultural expectations and preferences. Family and friend contact is promoted although access to the community is limited. Service users exercise choice and control over their lives and enjoy a wholesome, varied diet in small dining rooms or in their own rooms when requested. EVIDENCE: Service users find the lifestyle experienced in the home matches their preferences and satisfies their social, cultural, religious and most recreational interest needs. These had been documented in service users individual plans. Service users were observed talking to each other and some were having a group discussion with a visiting Rabbi. Other service users were involved in playing cards, arm chair exercise and art work. The home has an activities co-ordinator who was seen interacting positively with service users who had varied dementia care needs. Service users expressed their delight with the planned day trips provided by the home, others felt that they would like to be given more opportunity to access the local community, but were understanding that there was not always enough staff on duty to take them out. Some service users said that they had their
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 13 own telephones in their rooms to contact family and friends. Several service users were seen with relatives during the day. Service users were generally positive about the food provided in the home and said that the kitchen staff were flexible when and if they wanted alternative meals. Some special diets and diabetic alternatives are provided and the meals are kosher to reflect the culture of the service users. Service users have regular meetings where issues are discussed; menus and food generally is a regular agenda item. ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Service users and their relatives are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse by well-trained staff and the home adult protection procedures. EVIDENCE: Service users are protected from abuse, all staff have received adult protection training and a clear adult protection policy and procedure is in place. The CSCI received a complaint from a relative with regard to the care provided in the home this had also included an allegation made against a member of staff who had been suspended. The home had started investigating this complaint and had informed Barnet social services of the allegation as appropriate. The Commission has been kept informed. The home must ensure that the outcome and action of the investigation is forwarded to the Commission. An additional three complaints had been received on comment cards from relatives. The home had already been made aware of these by the relatives and had been resolved either fully or partially. The partially resolved complaint was general and will be addressed in an open forum during a relatives meeting to ensure that relatives have an opportunity to air their views. Complaints had been logged appropriately. Service users stated that they knew who to complain to and felt that their views were listened to and acted upon. None of the service users spoken to
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 15 wanted to complain about anything in the home they were generally positive about the care received, the staff and the new manager. ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,21,23,25,26 The home is clean, pleasant and hygienic. Service users live in comfortable surroundings however the safety of the service users has been compromised in some cases. Service users have not got sufficient washing facilities on the top floor. EVIDENCE: Service users benefit from a clean, pleasant and hygienic living environment. All floors of the home were seen and a sample of service users bedrooms were visited. Service users had been given the freedom to choose colour schemes and to bring furniture and personal items with them. Some of the bedrooms viewed needed to be redecorated for example, wallpaper in some of the rooms had been ripped or was coming away from the wall. Service users can be reassured that there are plans to refurbish many parts of the home. A maintenance plan must be forward to the Commission addressing the areas raised during the inspection and from their own audit. Service users spoken to however did say that their bedrooms were very comfortable.
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 17 The service users on the top floor are currently managing without an assisted bath or shower facility. This is not acceptable and must be rectified immediately. In some cases service users prefer to keep their bedroom doors open, they had been propped open using a variety of methods, self- closing door devices as approved by the fire brigade must be fitted to safe guard service users in the event of a fire. One of the tumble dryers in the laundry room had been recently condemned as a fire risk. This must be removed and replaced with a tumble dryer that is in good working order to ensure the safety of service users, relatives and staff. ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Service users needs are not met fully by the numbers of staff on duty; in fact they are currently being put at risk. Staff are trained and competent to do their jobs. The homes recruitment policy and procedures are not demonstrating that service users are protected although service users are involved in the recruitment of staff in some instances. EVIDENCE: Service users needs are not currently being met by the numbers of staff on duty in the morning. Staff have explained the difficulties with having one member of staff on duty in each dining area. Staff feel that given the needs of the service users, particularly those with greater dementia care needs and their propensity to wander off during breakfast becomes too much to manage safely for one staff member. They described the duties that staff member is responsible for; these were trying to support service users to eat, give medication and check on those who wander. This current situation poses a risk to service users and to staff through possible medication errors and falls. Service users said that they had noticed that one staff member seemed to be rushing around in the morning and never really had a chance to sit and talk to them. There must be sufficient staff on duty to ensure the needs and safety of service users is safe guarded. Five staff files were examined. All contained CRB checks and photo I.D. Three out of five did not contain two references, not all contained contracts, start
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 19 dates, inductions or application forms. All these must be included to safe guard service users and to demonstrate that the homes recruitment procedures do protect service users. Staff training records demonstrated that staff had been appropriately trained to meet the needs of service users. Feed back from service users included ‘the staff are great’ ‘they are always kind, helpful and understand my difficulties.’ One service user said he had recently been involved in the recruitment of the ‘new manager’ Feedback from relatives were again full of positive comments with regard to staff conduct and professionalism. ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36,38 Service users are living in a home that is well run and are positive with regard to the newly appointed manager. The home positively promotes service users involvement and is run in the best interests of the service users. Staff are not supervised regularly. Service users health, safety and welfare are promoted and generally protected by the homes safety checks. EVIDENCE: Service users and staff were very positive with regard to their comments about the newly recruited manager, who had been in post two weeks. They said that she listened, is approachable and open. The acting manager has applied to the Commission to become registered. Service users said that there are several forums in which they are able to discuss idea and issues to affect the running of the home and in their best interests.
ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 21 Staff are receiving supervisions, but in some cases they have been sporadic and certainly not every two months, this must be rectified to ensure continuity in service. The health, safety and welfare of service users is protected by the homes regular safety checks, however the fire risk assessment must be reviewed. All relevant safety certificates were in place. ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 2 14 3 15 3
COMPLAINTS AND PROTECTION 1 x 2 x 3 x 1 3 STAFFING Standard No Score 27 1 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 x 3 x x 2 x 2 ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 23 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 13(1)(b) Requirement The registered person must ensure that all service users are assessed for the risk of developing pressure sores and that where a risk has been identified information must be recorded on what the home is doing to reduce that risk. (Timescale of 01/5/05 not met) This requirement is restated for the second time. The registered person must ensure that all service users have annual reviews involving multidisicplinary team input. The registered person must ensure that service users risk assessments identify in detail ways to minimise risk and actions to be taken by staff. For example, pressure care, cot sides, risk of falls and manual handling and lifting. The registered person must ensure that service users health records are fully and consistently documented. The registered person must ensure that specific, agreed PRN guidelines are in place for service users who are prescribed
Version 1.10 Timescale for action 31/7/05 2. 7 15(2) 1/9/05 3. 8 13(4)(b) (c) 17 (1)(a) Schedule 3 (m) 31/7/05 4. 9 13 (2) 31/7/05 ELLA & RIDLEY JACOBS HOUSE Page 24 PRN medication. 5. 13 16(2)(m) The registered person must ensure that service users are enabled to access the local community on a regualar basis. The registered person must provide the Commission with a written outcome and actions to be taken following the investigation into a complaint made by a relative. The registered person must replace the condemed tumble dryer in the laundry room. The registered person must ensure that the adapted bath on the top floor is replaced as a priority. The registered person must ensure that all planned maintenance work is documented in a maintenance plan and a copy sent to the Commission. The registered person must ensure that service users who prefer their bedroom doors open must have self -closing devices fitted to their bedroom doors. The registered person must ensure that the staffing levels reflect the needs of the service users, this is with particular reference to the morning shifts. Two additional staff are required to meet the service users needs. The registered person must ensure that staff files include a contract of employment, two references, application form, training certificates and a completed induction. The registered person must ensure that staff receive documented supervision at least six times a year. The registered person must
Version 1.10 31/8/05 6. 16 22 (3)(4) 31/7/05 7. 8. 19 19 23(2)(c ) 23(2)(j) 30/6/05 30/6/05 9. 21 23(2)(d) 30/6/05 10. 25 23(4)(a) 30/6/05 11. 27 18(1)(a) 30/6/05 12. 29 17(2) Schedule 3 31/8/05 13. 36 18(2) 30/9/05 14. 38 23(4)(c ) 31/8/05
Page 25 ELLA & RIDLEY JACOBS HOUSE (v) ensure that the homes fire risk assessment is reviewed. 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 Good Practice Recommendations ELLA & RIDLEY JACOBS HOUSE Version 1.10 Page 26 Commission for Social Care Inspection North London Area Office Solar House 1st Floor 282 Chase Road, Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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