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Inspection on 08/05/06 for Ella & Ridley Jacobs House

Also see our care home review for Ella & Ridley Jacobs House for more information

This inspection was carried out on 8th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users benefit from a good standard of care in the home. One service user said "all the staff are lovely" and another service user said "the staff are always very polite and respectful". The service users are supported by a stable team of staff who enjoy their work. The staff have developed positive relationships with the service users and communicate with them in a friendly and supportive manner. The service users benefit from having an activities co-ordinator who makes arrangements for them to access to a wide range of activities that meet their cultural and spiritual needs. The atmosphere of the home is enhanced by the visitors and volunteers who come to the service and provide company, support and activities for the service users. The service users all have access to information about the home through a comprehensive information pack available in all their rooms. The service users and relatives all have an opportunity to find out about what is happening in the home and to give their views on the home through regular service user and relative meetings.

What has improved since the last inspection?

Five requirements were made at the last inspection and four had been met and the final requirement had been partly met. The inspector recognised that achieving these requirements had represented a great deal of hard work from the manager and staff team. Since the previous inspection the new care planning system has been implemented for all the permanent service users. This provides a clear system that the staff said they now found much easier to use. This has also meant that the individual care plans are covering all aspects of the service users needs, linked to their assessments and that the care plans are being reviewed and amended as required on a monthly basis. In addition the new care planning system incorporates risk assessments based on the service users needs and including the risk of falls and the use of cot sides. The home is well maintained and where maintenance problems are occurring they are addressed immediately. The adapted bath located on the top floor is now repaired and working and there was no other broken equipment in the home.

What the care home could do better:

Fourteen requirements were made at this inspection of which one was amended and restated. In addition three recommendations were made. Service users need to all have a completed nutritional assessment, have access to being weighed even if they are in a wheelchair, and have their record of appointments updated for dental and optical appointments. It is also recommended that they are offered another key worker if their regular key worker is away for an extended period and that residents meetings include a summary of agreed action that can be updated at the start of each meeting. The staff need updated training records and an audit of training for the whole team so that the training gaps can be identified and training booked including all the health and safety training and training on adult protection issues. The staffing levels need to be reviewed in the evening and for reception duties to ensure staffing levels are adequate. All staff must have a signed contract and staff employed in the last six months need a completed induction record. Staff must also receive regular supervision. Environmental improvements include eradicating bad odours in some of the bedrooms, planning to redecorate the corridor areas upstairs, providing curtains and bedspreads in bedrooms and to smartening up the reception area. The fire safety risk assessment also needs to be updated.

CARE HOMES FOR OLDER PEOPLE Ella & Ridley Jacobs House 19-25 Church Road Hendon London NW4 4EB Lead Inspector Jane Ray Key Unannounced Inspection 8th May 2006 09:00 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 Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 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. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 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 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 8203 5368 020 8201 5254 Jewish Care Miss Natasha Jane Carson Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Old age, registration, with number not falling within any other category (48) of places Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 48 adults of either gender over the age of 65 years some of whom may have dementia. 21st October 2005 Date of last inspection 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 known 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 45 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 are also a small group of volunteers who visit and manage a “trolley” shop for the service users. The home aims to encourage service users to live life to the full, ever mindful that they have rights. The home uses the Jewish Care quality assurance process that helps to monitor the dignity and care of service users and the support and development of staff by arranging visits of lay assessors and undertaking questionnaires that seek the views of everyone involved in the service. 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. The current range of fees in the home is £401 to £679 per week depending on the individual needs of the service users. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 8 May 2006 and was unannounced. The inspection lasted a whole day. The inspection was the main annual inspection and looked at all the key National Minimum Standards for Older People and the associated regulations. The inspection also looked at how the home was progressing in meeting the requirements from the previous inspection that had taken place in October 2005. The inspector spoke in detail to four service users and also spoke briefly to other service users whilst walking round the home. The inspector observed care practice throughout the day. The inspector interviewed two staff and also spoke to a number of other staff throughout the inspection. The manager and administrator assisted the inspector throughout the inspection. The inspector did a tour of the premises and also looked at service user case notes, staff records and other documents relating to health and safety, medication and quality assurance in the home. What the service does well: What has improved since the last inspection? Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 6 Five requirements were made at the last inspection and four had been met and the final requirement had been partly met. The inspector recognised that achieving these requirements had represented a great deal of hard work from the manager and staff team. Since the previous inspection the new care planning system has been implemented for all the permanent service users. This provides a clear system that the staff said they now found much easier to use. This has also meant that the individual care plans are covering all aspects of the service users needs, linked to their assessments and that the care plans are being reviewed and amended as required on a monthly basis. In addition the new care planning system incorporates risk assessments based on the service users needs and including the risk of falls and the use of cot sides. The home is well maintained and where maintenance problems are occurring they are addressed immediately. The adapted bath located on the top floor is now repaired and working and there was no other broken equipment in the home. What they could do better: Fourteen requirements were made at this inspection of which one was amended and restated. In addition three recommendations were made. Service users need to all have a completed nutritional assessment, have access to being weighed even if they are in a wheelchair, and have their record of appointments updated for dental and optical appointments. It is also recommended that they are offered another key worker if their regular key worker is away for an extended period and that residents meetings include a summary of agreed action that can be updated at the start of each meeting. The staff need updated training records and an audit of training for the whole team so that the training gaps can be identified and training booked including all the health and safety training and training on adult protection issues. The staffing levels need to be reviewed in the evening and for reception duties to ensure staffing levels are adequate. All staff must have a signed contract and staff employed in the last six months need a completed induction record. Staff must also receive regular supervision. Environmental improvements include eradicating bad odours in some of the bedrooms, planning to redecorate the corridor areas upstairs, providing curtains and bedspreads in bedrooms and to smartening up the reception area. The fire safety risk assessment also needs to be updated. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 7 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. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 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 Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3 and 5 Quality in this outcome area is good. This judgement has been made based on evidence gathered during the visit. Service users are given good information about the home and a copy of the contract with the home. Service users can visit the home as part of their admissions process. Service users can move to the home knowing they have been properly assessed so the home can meet their needs. EVIDENCE: During the tour of the premises the inspector looked at the information available in all the service user bedrooms. This includes a statement of purpose, service user guide and copy of a contract. This documentation is very comprehensive and is written in a clear style. The inspector looked at four service user case notes including case notes for a service user who has recently moved to the home. These all included an assessment prepared by the Jewish Care social work team and these were comprehensive. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 10 Four service users were interviewed as part of the inspection. They all said they had known the home well prior to their admission. This was because they had been to the home for respite care, visited relatives in the home or been for visits. The service user who had recently moved to the home said he had been made very welcome by the staff and service users and they had all helped him to settle in the home. The home does not provide intermediate care. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made based on evidence gathered during the visit. Service users health, personal and social care needs are addressed in the comprehensive care planning system. Service user health care needs, appear to be met but would benefit from being recorded more fully. Medication is well organised in the home but service users who self-administer would benefit from a risk assessment. Service users said their privacy and dignity is upheld. EVIDENCE: The care plans for four service users were inspected. All the permanent service users have now got care plans using a new system. The respite service users still use the old “standex system”. It was positive to note that the care plans were based on the comprehensive assessment that were updated on a monthly basis. They also incorporated information completed with the service user or their relatives about the service users history so that the staff have a good understanding of the persons background. Each service users had between three and five individual care plans based on their individual needs and these were holistic and looked at physical and Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 12 emotional needs. Where the service user had specific needs linked for example to their dementia, the care plans would incorporate these needs. The care plans were all reviewed and updated on a monthly basis. Each permanent service user had a record an annual care plan review with relevant external care professionals attending as required. Each service user has a key worker and the service users when asked, knew who this person was and what support they could expect from them. One service user said that her key worker had not been at work for a while and it is recommended that in these circumstances the service user is offered another temporary key worker until the permanent member of staff returns to work. The case notes that were inspected for four service users incorporated health care assessments including a nutritional assessment and pressure care assessment. If there was a high risk identified then the necessary care plans and risk assessments were in place such as care plans linked to pressure care. It was noted that one service user had a blank nutritional assessment in her case notes and it is recommended that they are all checked to ensure they are completed. The service users are supported to have their weight checked fortnightly. One service user who uses a hoist for moving and handling did not have a record of having her weight checked. The record of each service users health care appointments was inspected. These included records of visits to the GP and other specialist outpatient appointments. There was however no record of the optician and dental appointments. The manager thought they had been recorded in the old system but the information had not been transferred to the new care plan system. It is required that the appointment dates are recorded in the new care plans so key workers can monitor when follow up appointments need to take place. It was observed that staff in the home, work closely with visiting district nurses as required. The medication was inspected for four service users. This is stored in medication trolleys and uses the Boots blister pack system. The respite service user had her medication stored in a labelled container. Her medication was clearly labelled and a MAR sheet had been set up to record medication administered. Two of the service users self medicate all or part of their medication and would benefit from a risk assessment being in place for this. The medication being administered by the staff was all correctly recorded and medication entering the home was recorded on the MAR sheet to provide an audit trail. Control drugs were stored in a separate cabinet and two staff sign when they are administered. The temperature of the medical room is monitored on a daily basis. There is a list of staff available who have been trained to administer medication. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 13 The four service users who were interviewed were asked if they felt the staff treated them with respect. They all confirmed that they felt staff showed respect and knocked before entering their room and spoke to them politely. It was observed during the inspection that staff helped to support service users to receive personal care in a private manner when for example they were being assisted to use the toilets near to the lounge areas. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 based on evidence gathered during the visit. Service users are supported to access a range of activities if they wish to do so, based on their individual needs. Contact with families and friends is promoted. Service users are supported to make choices as far as possible. The food in the home is healthy and nutritious and meets the service users cultural needs. EVIDENCE: The inspector was able to speak to the activities co-ordinator and service users about the activities. She was also able to observe the activities that took place on the day of the inspection, which included gentle music and movement, bingo and a pianist visiting the home playing a range of music including traditional Jewish songs. The activity co-ordinator talked about the activities available. This incorporates activities in the home, trips out of the home and links with local schools and other community groups to enable community participation. She explained that for the service users who have dementia they focus on providing the activities with 1:1 staff support or in small groups. The people with dementia also come on outings with higher levels of staff support. They have also got funding to turn the small downstairs lounge into a reminiscence room decorated and furnished in an appropriate manner, which will be completed later in the year. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 15 She also said the people with dementia respond very positively to the children who visit the home and a pat a dog scheme. The activity co-ordinator said the programme also includes weekly sessions from an aromatherapist and a drama therapist who work with a number of service users. The service users spoken to said they choose the activities they want to join. One man said he likes to go out for a walk each day and another said he enjoys reading and has just joined the local library. Four service user case notes were inspected and they all included a record of the activities that each service user had participated in. The activities also link with the Jewish festivals and one service user talked about how they had celebrated Passover in the home. It was observed during the inspection that relatives and friends were all made welcome in the home when they visited the service users. Service users can see relatives in their rooms or in the lounges. The manager explained that there is a quarterly relatives meeting and a monthly newsletter is sent to relatives. The service users are supported to make choices. A monthly service users meeting takes place and the records of this were inspected and showed that service users discuss a range of aspects relating to the home. The manager said that they have just decided to divide the service user meeting into two groups based in the two main lounges to allow more service users a chance to participate in the meeting. Meetings also take place with the senior cook to discuss preferences for the menu. One service user said that she felt that not all the action agreed at the residents meeting was followed up and it was recommended that the minutes include an action plan and the progress can be reported to the next meeting. The manager explained that the home has a four-week rolling menu that changes in the summer and winter. The current weeks menu was inspected and was healthy and nutritious. The food is kosher and offers a range of traditional Jewish food. The senior cook explained that the home caters for a number of service users who are diabetic or need a soft diet. If an individual has a specific request this can also be met. The lunch on the day of the inspection was vegetable soup, shepherds pie and a pudding. The service users when spoken to said the food was “well cooked and suitable” and “very edible”. All the service users said that if they wanted an alternative this was available. There was an acknowledgement that when cooking for such large numbers of people it was hard to create food that appeared home cooked. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made based on evidence gathered during the visit. Service users are confident their complaints will be acted upon and appropriate procedures are in place. Staff training records need to be updated to ensure all staff have received training on adult protection to ensure the service users are protected. EVIDENCE: The inspector spoke to four service users. They all said that they would feel happy if they had any concerns to discuss it with the senior staff on duty or the manager. The record of complaints was inspected and all complaints are clearly recorded and it is possible to see the action that has taken place to address the complaint and the timescale of this response. The complaints had been addressed within a few days. Since the last inspection there has been one serious complaint and the home notified CSCI of this complaint and the outcome. The complaint was fully investigated using the Jewish Care complaints procedure and was partly substantiated. Appropriate follow up action was taken by the home. The home has an adult protection policy and procedure. The two staff interviewed both said they had received training on adult protection and both knew how to recognise and respond appropriately to abuse. The staff training records were inspected for five staff and only one had a record of being trained on adult protection. The training records need to be updated and training Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 17 provided to staff who have not yet received this training. The manager explained that she will be providing some training. Since the last inspection there has been one adult protection issue. The home used adult protection procedures appropriately. This procedure was used in response to an allegation that was made by a service user about a male carer. The allegation was unsubstantiated. During the inspection the inspector spoke to the service user concerned and he is continuing to make possible allegations about different male workers but is also very confused. It is recommended that this is discussed at a multi-disciplinary meeting with a view to putting in an appropriate risk assessment to protect the service user and staff. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 18 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 the following standard(s): 19,20,25 and 26 Quality in this outcome area is poor. This judgement has been made based on evidence gathered during the visit. The home appeared clean and tidy but in some bedrooms there were unpleasant odours. The home is comfortable but ongoing decoration and a review of the lighting is needed in the corridors. The reception area would benefit from being reviewed to make the environment more pleasant. Some bedrooms would benefit from new curtains and bedspreads to make them more homely. EVIDENCE: The building is purpose built over five floors. The ground floor has the communal rooms and access to an attractive garden. There are two main lounges and two smaller lounge areas, one that is used as a synagogue and the other that is being developed into a reminiscence room. The dining areas are located as part of the lounge areas. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 19 The upper floors are bedroom and bathroom areas. Each floor has suitable bathing facilities for people with mobility difficulties. The inspector did a tour of the building and looked into random bedrooms on each floor. The building was clean and tidy but in a few bedrooms there were unpleasant odours linked to incontinence. There needs to be a review of the bedding, cleaning and carpet shampooing in these bedrooms. The homeliness of the bedrooms is variable and depends on how far the service users have been supported to bring personal items into the home. In some bedrooms it was noted that the curtains and bedspread were rather old and shabby and if these were replaced this would help to make the rooms more comfortable. It was noted that the corridors on the upper floors were in poor decorative order and very dark. The maintenance programme needs to look at reviewing the lighting and redecorating these areas. On the day of the inspection the reception area did not create a good first impression, with dead flowers, worn net curtains and an untidy appearance. It is required that this area is improved. The home was an appropriate temperature and the manager explained that water temperatures are controlled by thermostatic valves on the mixer taps and the temperature of the water is checked regularly. On the day of the inspection the laundry was working well and three of the service users spoken to during the inspection said they were happy with the laundry service. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is poor. This judgement has been made based on evidence gathered during the visit. The inspector had concerns about low staffing levels in the evening and the effect this could have on service user care. Inadequate levels of staff in the reception area could also have an impact on service user safety. Service users are protected by staff recruitment checks being improved from the last inspection. Training records need to be updated in order to plan an ongoing training programme. EVIDENCE: The manager explained that the staffing structure in the home consists of one deputy, one team leader co-ordinator, eight team leaders and about thirty care staff. At the moment there is an early, late and night shift but the organisation is looking at progressing a twelve-hour shift pattern. The staff turnover is low with four staff leaving in the last year. The manager said she is currently recruiting more bank staff. The current shifts mean that there are ten staff available for the early morning peak period and seven staff for the evening peak period. Two staff however said when interviewed that the evening shift can have less staff if someone is unable to come to work as this shift is not always covered by bank or agency staff. The inspector is very concerned about this as occupancy in the home is generally high and staff need to work across five floors and some service users Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 21 have higher support needs. This puts significant demands on the staff working at the evening peak time. The inspector was also concerned about the staffing of the reception area. There is currently a part time receptionist who works four hours a day, four days of the week. On the afternoon of the inspection the inspector sat in the reception area for one hour looking at records. During this time there were quite a number of visitors to the home including maintenance staff, deliveries to the home, relatives, members of the public wanting application forms etc. All the visitors needed assistance and directions and the administrator was also trying to deal with some other urgent matters. The staffing of the reception needs to be reviewed to ensure there are adequate staff to deal with visitors to the home and to protect the service users from unwanted intruders. The rota is in place and is clear to follow. The staff have regular team meetings including senior staff and carer meetings. The record of these meetings was inspected and a good range of issues are discussed. The manager explained that at the time of the inspection eighteen staff had completed an NVQ in care at levels 2,3 and 4 and three staff were undertaking the qualification. This means that approximately 50 of the staff have completed or are undertaking the qualification in line with the standards. This will need to be monitored top ensure the ratio remains at 50 . The manager explained that the home currently uses internal assessors but is also looking at using external assessors in the future. The inspector looked at the recruitment information for five staff. All the staff had a CRB disclosure and ID. One member of staff did not have two references but had worked for Jewish Care since 1999. All the staff had a contract of employment but two staff had not signed the contract. Two of the staff whose files were inspected had started working at the home in October 2005. One did not have a record of completing her induction training. The staff training records were inspected for five staff. These did not accurately reflect all the training the staff had received as stated by the manager and the staff themselves. There needs to be a complete staff training audit so there is a clear record of what training each member of staff has received and when this training took place so that ongoing training can be booked. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made based on evidence gathered during the visit. Service users are living in a home that is well run with a competent manager. Some quality assurance work needs to be updated to include service user views in this process. Service users monies held on their behalf are appropriately managed. Staff need to all have regular staff supervision and some need their health and safety training updated to ensure they work effectively. EVIDENCE: The manager throughout the inspection demonstrated a good knowledge of the home and the needs of the service users. She was aware of issues that needed to be addressed and was already working towards making the necessary improvements. Jewish Care has a quality assurance system based on an ongoing programme of audits and questionnaires. The inspector noted that there was no completed Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 23 service user and relative audit in the last year and was told that the questionnaire responses had been sent to Head Office for the results to be collated. The inspector saw the blank questionnaires and these were very comprehensive. The current insurance certificate was viewed and is satisfactory. The administrator explained that relatives help support each service user with their personal finances. The home only helps by holding some spending money on behalf of the service users. The spending monies passed to the administrator to manage on behalf of two service users were inspected. These balances are computerized but for each person it was possible to see their balances, a record of expenditure and copies of receipts. The staff supervision records were inspected for five staff. Only one had received regular supervision in the last six months. The home has comprehensive health and safety policies, a health and safety team in the home to address health and safety issues and a health and safety officer employed by the organisation to carry out checks in the home. The current health and safety maintenance certificates were available for the lifts, hoists, electrical installations, portable appliances, water legionnaires check and the gas check was being done the following day. The fire alarm emergency lights and fire extinguishers had been serviced in the last year. The records showed the alarm was being checked weekly and fire drills were taking place every two months. The work identified in the last LFEPA report had been completed including putting strips on fire doors and installing an emergency opening device in small downstairs sitting room where the door is a fire exit. The fire safety risk assessment was inspected and there is one outstanding area of action. The fire safety training records were inspected for five staff and one member of staff had no record of receiving the training. The record of accidents was inspected and reports are being completed appropriately and the CSCI notified as required. The senior cook said he had not done his food hygiene training for “many years” and this may need to be updated. The health and safety training records need to be updated for all staff to ensure they are all up to date with health and safety training including first aid, moving and handling and infection control. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 1 2 x x x x 3 2 STAFFING Standard No Score 27 1 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 2 3 3 2 x 1 Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 13(1) Requirement The registered person must ensure the service users healthcare needs are met by: • Ensuring they all have a completed nutritional assessment • Ensuring all service users including wheelchair users can be weighed regularly • Having a record of the most recent dental and optical check to ensure the checks happen on a regular basis for all the service users The registered person must ensure that where service users self medicate there is an appropriate risk assessment in place. The registered person must ensure that all staff have received training on adult protection. The registered person must incorporate the following work into the homes ongoing maintenance programme: • Decorate and review DS0000010428.V289897.R01.S.doc Timescale for action 15/06/06 2. OP9 13(2) 15/06/06 3. OP18 13(6) 15/07/06 4. OP19 23(2)(b) 15/06/06 Ella & Ridley Jacobs House Version 5.1 Page 26 5. OP26 16(2)(k) 6. OP27 18(1)(a) 7. OP27 18(1)(a) 8. OP29 17(2) Schedule 3 9. OP30 18(1)(c) 10. OP33 24(1)-(3) 11. OP36 18(2) lighting in the upstairs corridor areas • Refurbish the front reception area so it is comfortable and creates a positive impression of the home • Replace old curtains and bedspreads throughout the bedrooms in the home The registered person must take the necessary steps to eradicate unpleasant odours in some of the bedrooms. The registered person must ensure that there are adequate staff available every evening to meet the needs of the service users bearing in mind the layout of the building. The registered person must review the staffing available in the reception area to ensure there are staff available to greet and direct visitors to the home. The registered person must ensure that staff files include a signed contract of employment, and a completed induction. This requirement is amended and restated from the last inspection. Timescale for action was the 31/12/05 The registered person must ensure a full staff training audit has taken place identifying when staff received training and what training they still require or need updating. A training programme must then be arranged to meet the staff training needs. The registered person must collate the service users and relatives responses from the quality assurance audit and prepare an action plan. The registered person must ensure that all the staff have DS0000010428.V289897.R01.S.doc 15/06/06 15/06/06 30/06/06 15/06/06 30/06/06 15/06/06 30/06/06 Page 27 Ella & Ridley Jacobs House Version 5.1 12. OP38 23(4) 13. OP38 13(3) 14. OP38 13(3)(4) (5) 18(1)(c) regular supervision. The registered person must ensure the work identified in the fire safety risk assessment is completed. The registered person must ensure the senior cook and the other catering staff all have current food hygiene certificates. The registered person must ensure that all the staff have received up to date health and safety training including first aid, moving and handling, infection control and fire safety. 15/06/06 30/06/06 31/07/06 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. 3. Refer to Standard OP7 OP14 OP18 Good Practice Recommendations The registered person should arrange an alternative key worker if a member of staff is away from work for an extended period of time. The registered person should prepare an action plan at the end of the service user meeting and then report back on progress at the next meeting. The registered person should arrange a multi-disciplinary review meeting for the service user who makes allegations to discuss the most appropriate way to address this and to prepare a risk assessment to protect the service user and staff. Ella & Ridley Jacobs House DS0000010428.V289897.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Southgate 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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