Inspection on 03/05/07 for Emily Jackson Care Home

This inspection was carried out on 3rd May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

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

CARE HOMES FOR OLDER PEOPLE Emily Jackson Care Home Emily Jackson House 34 Eardley Road Sevenoaks Kent TN13 1XT Lead Inspector Marion Weller Key Unannounced Inspection 09:30 3rd May 2007 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 Emily Jackson Care Home DS0000069287.V333175.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. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Emily Jackson Care Home Address Emily Jackson House 34 Eardley Road Sevenoaks Kent TN13 1XT 01732 465703 01732 465703 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) Barchester Healthcare Home’s Ltd Vacant Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2005 Brief Description of the Service: Emily Jackson House is registered as a care home providing nursing care for sixty residents. Barchester Healthcare Home’s Limited is the registered provider. The home is situated in a quiet residential area, but in close proximity to the main town centre of Sevenoaks. Bedroom occupation comprises 53 single and 3 double rooms. With the exception of two singles and one double bedroom all have ensuite WC facilities. All bedrooms have TV and telephone points. All rooms accessed by resdients are connected to the nurse call system. Day rooms consist of two lounges, a garden/conservatory room and a large separate dining room. The home has two passenger lifts accessing all areas used by residents. Parking is available at the front and rear of the property. The home has well maintained small-secluded gardens. Sevenoaks is served by public transport, including train connections to London and the Kent and Sussex Coast. The home is approximately one mile from the A25. Current fees range from £945 to £1000 per week according to assessed personal need. Additional information on fees can be obtained from the manager of the home. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Marion Weller, Regulatory Inspector between 09:30 am and 5:00 pm. During that time the inspector spoke with some residents, some of the staff on duty, the Clinical Manager and other senior staff members. Some judgements about the quality of care, daily life and choices were taken from conversations with residents, as well as direct and indirect observations. Some records were seen as part of case tracking and to assess work on the requirements and recommendations made at the last inspection. In addition a tour of the building was undertaken. Conversations held with residents indicated they were very satisfied with the standard of care the home provided. Statements made during the site visit included: “On reflection I definitely made the right decision to come to this home and I am very happy with my choice.” “Staff are kind and considerate, quite simply the best there is.” And “I feel very lucky to have found such a nice place to live, all the staff are so kind and the food is very good.” What the service does well: Despite the number of staff and the level of activity generated by a large care home, a calm and very pleasant atmosphere prevails throughout. The home is well organised and management committed to ensuring staff are appropriately trained to carry out their various duties in a safe manner. In addition to the registered nurses in the home over 80 of care staff have achieved an NVQ award in Care at either levels 2 or 3. Residents enjoy a wholesome and varied menu of meals and the home is able to cater for special dietary needs. Relatives and friends are always made welcome when they visit and are encouraged to play an active part in the home. The home enjoys good relationships with other health care professionals, which is to the benefit of the people who live there. Each resident has a detailed care plan in place to ensure that staff understand exactly what support they would Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 6 like and need. Residents care plans cover interests and hobbies and any preferences they have about their care. There is a full and meaningful activity programme available based on the things that residents have said they like to do. People that want to go out into the local community are supported to do so. The home has its own transport, which is fully utilised by the home’s two dedicated activities organisers. What has improved since the last inspection? What they could do better: The home’s information documents could be further improved by including brief details of a recent care initiative arranged with the local Health Authority. Emily Jackson will provide short-term respite accommodation for up to eight people at a time who are recuperating from a stay in hospital or may be waiting for other services to be arranged for them before they return home. The inclusion of such details will ensure that everyone has the most up to date information. Permanent residents would further benefit from having arrangements discussed with them so that they know what to expect and are given the opportunity to air their views on the matter. This will assure them that the home is being run in their best interests. All prospective residents should be given the opportunity to visit the home assess the quality, facilities and have time to ask questions before making a decision to stay to ensure they are confident and comfortable in their new surroundings. Residents would benefit from the home making better provision for the storage of large items of equipment, which does not encroach on communal facilities. Improvements to the finish in some bathrooms and sluice areas would ensure infection control measures in the home are fully met and residents are not placed at risk. The home must comply with blue fire safety notices to ensure people’s protection or take further advice from the Fire Officer to ensure they remain compliant with the requirements of the local fire service. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1 2 3 5 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using this service largely have all the information they need to make an informed decision about whether the home is right for them. Information documents could be further improved by the home including brief details of a recent care initiative arranged with the local Health Authority. This will ensure everyone involved with the home has the most up to date information to guide them. All prospective residents should be given the opportunity to visit the home assess the quality, facilities and have time to ask questions before making a decision to stay to ensure they are confident and comfortable in their new surroundings. The personalised pre admission assessment means that residents’ diverse needs are identified and planned before they move into the home and they are given a contract that clearly tells them about the service they will receive. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 10 EVIDENCE: The home has a Service User Guide and Statement of Purpose, which are made available to residents and their representatives. The documents seen in reception had a review date of March 2007. Evidence suggested that both documents are used to inform residents or their representatives prior to choosing a home and as a source of reference for all parties after moving into the home. Although both documents are comprehensive, informative and detailed they had not been revised to reflect brief details of the recent agreement entered into by the home to provide accommodation for a maximum of eight clients at any one time from the Kent & Sussex Hospital in need of short-term step down/ respite services. A written operational plan made available during the inspection illustrated that people admitted to the eight beds may be recuperating from an illness before returning to their own home or requiring further rehabilitation. They may be awaiting placement in another home or for a complex package of care to be arranged before they go home. Their stay at Emily Jackson House could be anything from two to twelve weeks. Although such initiatives entered into with Health Authorities are consistent with local and national objectives for health and social care and their purpose valuable, they do have the potential to limit patient choice. Two residents had already been admitted to the home. Both were happy with the arrangement but in conversation could not recall making a positive choice to come to the home. They or their representatives had been made aware of the agreement for this to happen when they had reached a certain level of medical stability in the hospital environment and they had then been assessed for suitability to be involved in the project. Neither had been given the opportunity to visit and assess the quality, facilities and suitability of the home before moving in. One resident stated that they had got up very early on the first morning because “ I didn’t know how things worked here” The individual was clear that they were not personally given adequate information about the organisation of the home to make them comfortable and secure in their new surroundings. Staff spoken with were aware that long-term residents at Emily Jackson had not been made aware of the new care initiative prior to its commencement. Residents would benefit from the manager evidencing strategies to both consult with and enable people who live in the home on a long-term basis to affect the way that the care is delivered, should it prove to have any negative impact upon them. People transferred as part of the new initiative should be fully informed about the home prior to transfer, continue on each occasion to be assessed by the home’s staff to ensure only suitable people are admitted and have their ability to make choices about proposals put to them Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 11 safeguarded. It is the responsibility of the provider to show how the services they provide fit together. The pre-admission and admission details of residents case tracked during the inspection identified that all relevant information had been obtained prior to admissions being arranged. It is normal practice for the Manager or a Registered Nurse to assesses prospective residents in their current environment as part of the home’s admission process. This ensures out of category residents are not admitted into the home. Trial visits by prospective residents or their representatives are normally arranged by the home. One prospective long-term resident and a relative were observed being given a guided tour of the home and having their questions answered about the service during the inspectors visit. This arrangement however could not be evidenced for people living in the home and in receipt of short-term step down/ respite services. Residents are provided with a statement of terms and conditions or contract when moving into the home. Evidence was seen of the home’s contracts, which were detailed and signed by the resident or their representative. The home is not registered for intermediate care. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health and personal care needs are being met with evidence of good multi-disciplinary working taking place on a regular basis. EVIDENCE: Three residents’ records were inspected as part of the case tracking process. The residents had been provided with clear and comprehensive care plans and associated clinical risk assessments, including tissue viability, moving and handling, falls risk assessments and nutritional assessments. Residents weight and diets were seen to be recorded and regularly monitored. Care Plans inspected were accurate of the care and support provided to resdients. Elements missing on the last inspection have now been addressed. Care plans are dated as being reviewed monthly and signed by the resident or their representatives. Changes to the main plan are made where indicated. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 13 Care plans contained information on residents‘ likes and dislikes in respect of food and drinks, as well as portion sizes. Nursing and Care staff evidenced a thorough understanding of residents needs. Daily records were seen. Staff record sufficient detail in residents’ daily reports. There are various systems in place to ensure good communication is maintained in the home. The Clinical manager spoke of daily hand over meetings, clinical meetings, Team Leader meetings, staff meetings and staff supervision. The Clinical Manager stated that the home makes great efforts to ensure good communication between staff to ensure continuity of care for residents. The home employs some overseas staff. Residents spoken with on this visit raised no difficulties with language and communication in the home. The home promotes and maintains residents’ health through supporting and facilitating medical appointments as required. The home is able to manage residents with pressure areas, wounds, catheters and those who need syringe drivers for pain relief. Treatment plans were in place. The home welcomes the support and direction of medical staff from the Hospice in the Weald and The South West Kent PCT who provide some clinical training sessions in the home for trained nurses. The home can offer residents a choice of GP from surgeries situated locally but also have their own Visiting Medical Officer. Residents are consulted regarding their wishes concerning terminal care / major illness and arrangements after death. This is well recorded on individual care plans. The staff on duty were observed indirectly throughout the inspection, they were seen to interact in a positive and respectful manner with residents and their visitors. Only trained nurses administer medication to residents. There were no obvious gaps in medication administration records seen. Hand written transcriptions on medication records had been amended by the signature of the person authorising changes and a countersignature to this was evidenced to check for accuracy of their transcription. The requirement issued at the last inspection to ensure this happens in the absence of a new prescription label being provided has been met. The home has a process for establishing people’s capacity to self medicate if they wish to do so and can provide them with suitable resources to lock medication away. The Clinical Manager stated that there are currently no residents in the home who self medicate. The home had up to date medication guidance documents for staff reference. Each resident had an agreed individual homely remedy list approved by their GP. There are procedures and an appropriate contract with a licensed waste disposal contractor for waste medication to be disposed of safely. This ensures the home complies with relevant legislation for the disposal of medication waste. Two Controlled Drug balances were audited. These were found to be correct and records were seen to be well maintained. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 14 In relation to a recommendation made at the last inspection, there is now a permanent record of lost or damaged items of laundry maintained which facilitates an audit of lost or damaged clothing being carried out in the event of a complaint being received. The Recommendation made is now met and will be removed from this report. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities in the community and opportunities for mental stimulation and diversion in the home are well managed and as much as possible provide daily variation and interest for people who live there. Wherever possible residents are given opportunities to make choices in daily life, allowing for an important level of control over their lives. EVIDENCE: The home offers a full and varied activities programme and employ two part time dedicated activities organisers. In conversation it was clear the organisers are focussed on providing meaningful and high quality diversionary activities and try to offer a varied approach. Trips out to community-based events regularly take place and there are sufficient helpers to support residents who wish to go. The home has its own mini bus to facilitate this. On the morning of the site visit residents had been on a trip to the local pub for coffee. In the afternoon a trip to a garden centre was planned. The home Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 16 also arranges for paid entertainers to visit. Some people choose not to join in activity sessions, which is accepted. Residents’ religious and cultural needs are catered for. People from a local Church visit often and a minister offers Holy Communion. People are enabled to visit local places of worship if they request this. The home regularly attends a local church for music recitals, which were reported as being much enjoyed. Information about residents’ interests and hobbies are clearly noted on care plans. Chosen daily routines and preferences are also noted where known. Residents spoke of the home being as flexible as possible with daily routines and people largely decided for themselves when they wished to go to bed and get up. Residents can meet with relatives in there own rooms or there are small areas in which they can sit within communal settings. Relatives and friends are always made welcome when they visit and are encouraged to play an active part in the home. The Clinical manager spoke of residents meetings taking place regularly. Dining tables were nicely laid up with fresh flowers at lunchtime. Staff was observed to offer appropriate and sensitive assistance and encouragement to those who required help. Residents are verbally asked about food choices daily and this is recorded for catering staff. Relatives are also asked about preferences in relation to a residents diet and theses are recorded in care plans, particularly if the resident lacks capacity to adequately inform the home. Residents are encouraged to maintain adequate diet and fluid intake throughout the day. The kitchen staff were said to be flexible in their approach to providing food and were happy to cook for visitors if their requests were known in advance. No residents complained that food offered to them was cold or that portion sizes were not to their liking. The Clinical Manager stated that the system for serving meals to residents who chose to stay in their rooms had been revised. A resident spoken with who had been to the pub in the morning was full of praise for the outing, staff and the attention they received in the home. Lunch was served in the individuals bedroom at their request and they said the food was very tasty and there was always plenty of it. A comment was made that the meat pudding enjoyed on a previous day was just like “mum used to make” Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from potential abuse and have access to a clear complaints procedure which they or their representatives understand and know how to use. EVIDENCE: Information provided by the home prior to the inspection showed they had received seven complaints since the last site visit. All complaints had been responded to within the timeframe stated in the home’s complaints procedure of 28 days. Complaints documentation inspected was well maintained. Investigations undertaken in response to complaints received were well documented and outcomes clearly established. Response letters to complainants were seen to be informative, respectful and gave clear explanations. Responses clearly showed the actions the home had taken to satisfy the complainant or where this was not possible, clear reasons had been provided. The Clinical Manager said as a team they are effective in resolving dissatisfaction at an early stage and concerns are dealt with quickly. Residents spoken with were aware of how to complain and who to. All said they felt safe and secure in the home. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 18 The formal complaints procedure is included in the home’s information documents and provides appropriate timescales for resolution. The published procedure includes the Commissions contact details and states that the complainant can contact the Commission at any stage of a complaint. Staff spoken with were aware of how important it is to listen closely to residents and pass concerns on at an early stage. Staff training records for attendance at adult protection courses were in evidence. The manager stated that Adult Protection training had been provided by staff from the South West Kent PCT. The home’s induction procedures for new staff provide a comprehensive overview of adult protection issues and information on ‘whistle blowing’. There are procedures in place for responding to suspicion or evidence of abuse and neglect to ensure the safety of residents. The senior staff evidenced a sound knowledge of adult protection procedures. Staff spoken with were aware of the home’s procedures and who to take issues to in the first instance. The Manager expects staff to report any concerns immediately. The home has a copy of Kent & Medway’s revised adult protection policy document and bases its own safeguarding policy on this together with guidance and information provided from Barchester Homecare. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 19 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 22 23 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The general environment is good providing people who live in the home with an attractive and homely place to live. Residents would benefit from the home making better provision for the storage of large items of equipment, which do not encroach on communal facilities. Improvements to the finish in some bathrooms and sluice areas would ensure infection control measures in the home are fully met and there is no potential to place any residents at risk. The home must comply with blue fire safety notices to ensure peoples protection or take further advice from the Fire Officer to ensure they are compliant with the requirements of the local fire service. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home has a generally well-maintained environment, which provides aids and equipment to meet the care needs of the people who live there. It is a very pleasant and homely place to live and was found to be completely odour free. All but three residents bedrooms had ensuite WC facilities. Residents spoken with were happy with their bedrooms. All bedrooms were comfortable and had been personalised by the occupants to reflect their individual taste and interests. Residents said the home was warm, well lit and there was always sufficient hot water available. Radiators in bedrooms were guarded to ensure safety. Shared areas of the home provided a choice of communal space with opportunities for residents to meet relatives and friends in some privacy or to take them to their own rooms. On the last inspection it was noted that the limited size of some bedrooms meant that residents’ wheelchairs were not always being stored within their own rooms. In addition when staff needed to use lifting equipment some bedroom furniture had to be put into the corridor whilst the moving procedure took place. Although bedrooms meet the minimum sizes of the original regulatory authority, and as such comply with the National Minimum Standards for a pre-existing care home, such situations do present potential hazards to staff as well as mobile residents when items are placed in corridors. The Clinical Manager stated that the home ensures the situation is well managed however and people who need the use of their wheelchairs for moving around the home are assured of having them available. Some do have to be removed at night and during the day on occasions, as they can also present a trip hazard when not in use. The staff are aware of the dangers of placing items of furniture in corridors but this if for a very limited time only and staff ensure people are made aware of any hazard. The home generally appeared badly off for storage areas. Several items of equipment were stored in a communal bathroom. The Clinical Manager agreed that they are under pressure to find adequate storage for some large items. Equipment seen was of a very good standard and regularly serviced. The home had a good supply of transfer slings for hoists but many were hanging together in sluices. Best practice demands that slings are maintained for individual residents to evidence the home’s adherence to good infection control measures. The sluice rooms in the home are generally clean and well organised but again space is very limited. Some are now in need of refurbishment. Some wall tiles were seen to be cracked or missing where fixtures had been removed. The areas had not been made good and the situation is making it difficult to keep the room clean to the required standard. Some sink seals were seen to be old and worn and generally had the potential to compromise good infection control Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 21 measures. The same situation with cracked and missing tiles was found in residents’ communal bathrooms. A toilet had recently been removed from one bathroom. Redundant pipe work had not been completely removed at floor level or the tiled areas around made good. A new bath had been fitted and was in general use for residents. Tiles were missing around the new installation area. The clinical manager stated that she was aware that the Provider had plans to refurbish some rooms on a rolling programme but had no specific details to hand. The home has a sufficient level of housekeeping staff and a good infection control policy. They encourage staff to work to the policy to reduce the risk of infection. The inspector is confident that the provider will recognise areas in need of improvement that have emerged from this site visit and will take advice to reduce any risk and seek to resolve them. Staff was not complying with a blue fire safety notice on a fire door leading into a communal area from a kitchenette. Another fire door leading in and out a communal area had two contradictory notices in position. These were discussed with the Clinical Manager and another senior member of staff who is one of the home’s fire marshals and trains staff in the home’s emergency procedures. The home are currently updating their fire risk assessments, as such it was agreed that they would seek further advice and clarification from the Fire Officer about the blue fire safety notices to ensure peoples protection. The home generally has sound fire safety systems in place. Although the home’s gardens are small, they are maintained to a high standard. The home does not have a dedicated gardener, but work is lead by the home’s maintenance man with input and support from residents and staff. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by a dedicated staff team who are well supported and supervised. The home continues to effectively train and develop its staff to their full potential to ensure residents’ needs are met at all times. Residents are protected from any potential abuse by the home’s robust recruitment procedures. EVIDENCE: Residents spoke highly of the staff, saying they were friendly, skilled and professional. One resident stated, “ From the manager through to the housekeepers, everyone is very helpful and happy” Adequate levels of staff are available to care for residents and staff are appropriately supervised. Vacant duties on staffing rosters are covered with substantive staff taking on additional hours or by the use of the home’s bank staff. According to information provided prior to the site visit there had only been a very limited use of agency staff used in the previous eight weeks. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 23 There is an excellent atmosphere in the home. Staff spoken with said they would be reluctant to work elsewhere. Training takes a high priority in the home. Apart from qualified registered nurses, care staff are encouraged to attain National Vocational Qualifications. The Clinical Manager provided information that 80 of care staff are now qualified at NVQ Levels 2 or 3 in the home. All staff spoken with was enthusiastic in regard to developing their skills. Sixteen staff holds a First Aid certificate. The home has comprehensive and well-maintained training records. There is an electronic staff training matrix/ database, which provides a clear overview of staff, training completed, staff training planned and when training updates are due. The home has a comprehensive induction programme for new staff. All mandatory training for staff is up to date. CRB & POVA checks for staff were clearly in evidence and the home follows a robust recruitment process, which protects residents from any potential for harm. There are currently six volunteers who work in the home and provide befriending services to residents, a beverage service, a trolley shop service, a weekly coffee morning is also arranged by them and a hostess service is offered. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Temporary management arrangements are meeting the needs of the service and residents benefit from living in a well run home. Residents would benefit from receiving brief details about the homes recent arrangement to provide step down/ respite services in partnership with the Health Authority and being given the opportunity to air their views on the subject. This will assure them that the home is being run in their best interests. EVIDENCE: The previous registered manager accepted a transfer to another home in the Barchester organisation. A temporary General Manager had been appointed to Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 25 Emily Jackson who was unfortunately not on duty during the site visit. The home’s Clinical Manager, whose role supports that of the General Manager ably assisted the inspector throughout. Barchester Healthcare continues with a recruitment process to secure a permanent manager for the home. The current temporary arrangements are satisfactorily meeting the needs of the people who live in the home. The home initially pays for any expenditure incurred by residents and then invoices relatives or their representatives for the cost. The home has one person who manages their own finances. The home does not assist with managing residents’ personal money and they do not hold any cash for people who live in the home. Resident’s relatives and representatives are encouraged to be fully involved and assist them with this aspect of their care. No one in the home raised any concerns about the management of personal finances. The home has an appropriate fire safety system installed and staff receive regular training in emergency procedures. Fire marshals are appointed to ensure compliance with good practice. A very competent ‘in house’ trainer for fire safety was spoken with. The content of training programmes were discussed and emergency evacuation procedures seen. It was clearly evident that this member of staff is committed to ensuring safe practice. However, during the visit it was noted that staff were not complying with one blue fire safety notice on a fire door leading into a communal area from a kitchenette. Another fire door leading in and out of a communal area had two contradictory notices in position. To maximise safety, staff must ensure fire safety signs are complied with or advice must be sought from the Local Fire Officer to possibly vary current requirements. The home is fully committed to ensuring staff receive appropriate training and support for their role. Training records were sound and staff understood what is required of them. Ensuring staff are appropriately trained maximises safety to both residents and staff. Records were seen to be kept in a manner that preserved confidentiality and safeguarded residents’ rights and best interests. The home’s record keeping is normally very effective and efficient with reviews of policies, procedures, information documents and systems of work being undertaken regularly. It was therefore disappointing to find they had not updated information documents to give brief details of a recent care initiative arranged in partnership with the local Health Authority. Regular review of such documents will ensure everyone involved with the home has the most up to date information to guide them. As mentioned elsewhere in the report, two residents had already been admitted to the home under the step down/ respite care initiative. Both were basically happy with the arrangement but were unable to recall making a Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 26 positive choice to come to the home, had not visited prior to admission or been in receipt of adequate information to make one of them at least, feel comfortable and secure in their new surroundings. Staff spoken with were aware that long-term residents at Emily Jackson had not been made aware of the new care initiative prior to its commencement. Residents would benefit from the manager evidencing strategies to both consult with and enable people who live in the home on a long-term basis to affect the way that short-term care is delivered should it prove to have any negative impact upon them. The Commission is aware through their own research that people receiving long-term care do not like the disturbance of residents in a home continually changing. The Clinical Manager stated that some people might find new faces in the home stimulating. This is possible. It is however the responsibility of the provider to show how the services they provide fit together and how they seek the views of service users to help them measure success in meeting the aims, objectives and purpose of the home. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 27 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 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 3 X X 2 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 X 2 X 3 X X 2 Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 28 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 Home’s Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4, 5 Schedule 1 Requirement The Statement of Purpose and the Service users guide must be reviewed and revised and must contain the information required by regulation. A copy must be supplied to the Commission. The registered person must ensure that prospective service users are invited to visit the home before they and /or their representatives make a decision to stay. Blue fire safety notices must be complied with. Suitable storage facilities must be provided for items of the home’s equipment that does not encroach on residents’ communal space. This requirement remains unmet from the report dated 29/09/05 Improvements must be made to sluices and bathrooms to ensure suitable arrangements are in place to prevent infection, toxic conditions and the spread of DS0000069287.V333175.R01.S.doc Timescale for action 01/07/07 2. OP5 14 01/07/07 3. 4. OP19 OP38 OP22 23 23 01/06/07 01/07/07 5. OP26 OP38 13 01/07/07 Emily Jackson Care Home Version 5.2 Page 29 infection at the home. A plan as to how the home will address this should be provided to the Commission within the timescale given. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Refer to Standard OP33 Good Practice Recommendations It is recommended that the manager inform long term residents about the recent care initiative arrangement made for some short-term clients in partnership with the local Health Authority. This will ensure that they know what to expect and are given the opportunity to air their views on the matter. 1. Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Emily Jackson Care Home DS0000069287.V333175.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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