Inspection on 18/07/07 for Hyman Fine House

This inspection was carried out on 18th July 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

Hyman Fine House 29/06/06

Hyman Fine House 23/01/06

Hyman Fine House 12/04/05

Hyman Fine House 03/02/05

Hyman Fine House 11/10/04

Similar services:

Springfield House

Sutton Lodge Nursing Home

The Shelley

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hyman Fine House 20 Burlington Street Brighton East Sussex BN2 1AU Lead Inspector Elizabeth Dudley Key Unannounced Inspection 18th July 2007 09:30 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 Hyman Fine House DS0000014003.V339018.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. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hyman Fine House Address 20 Burlington Street Brighton East Sussex BN2 1AU 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) 01273-688226 01273 695233 Jewish Care Vacant Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. That service users accommodated must be aged sixty five (65) years or over on admission. That a maximum of thirteen (13) places can accommodate service users with a dementia type illness at any given time. That the maximum number of service users to be accommodated is fifty one (51) That one named service user under the age of sixty five (65) years on admission can be accommodated 8th December 2006 Date of last inspection Brief Description of the Service: Hyman Fine House is owned by Jewish Care and is a care home that provides accommodation for up to fifty-one (51) residents. It is registered with the above written conditions of registration. The home is divided into three working units. One being for residents requiring nursing care, one unit accommodating up to 12 residents with a dementia type illness and one to accommodate residential residents. The home is located in a residential area of Kemptown, Brighton. There is limited parking at the home, but paid parking is available in adjacent streets. The home is located within easy walking distance of the seafront, local amenities and public bus routes. It is a large home and residents’ rooms are spread out over three floors. There is a passenger shaft lift available to all floors within the home. All rooms are for single occupancy and provided with en suite facilities. The home provides a variety of communal areas. The home has its own synagogue on site. There are nine communal toilets located throughout the home and six bathrooms. Specialist equipment is provided at the home as needs arise. Weekly fees range from £625 to £825 There are additional fees for other services, which include Hairdressing, and Chiropody and information regarding these are available from the home. This information was provided to the CSCI on the 18th July 2007. Prospective residents/representatives are provided with a Statement of Purpose and Service User Guide that offer information on the services and facilities provided at the home. A copy of this information is kept within each Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 5 individual’s room. Residents/relatives know about the service through social service referrals, word of mouth, from living in the area and by researching for homes that can provide services to meet specific religious needs. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on the 18th July 2007. Due to the resignation of the previous manager, the company has now appointed a manager who was previously working as development manager within the home. The inspection was facilitated by the appointed manager and the care manager of the home and was undertaken over a period of nine hours. During the inspection a tour of the home took place, documentation which included care plans, medication records, catering and training records and personnel files were examined, and ten residents, three visitors and six members of staff were spoken with. The home provides both nursing and personal care solely for people of the Jewish faith, and all staff receives intensive training, prior to their commencing duty in the home, on the Jewish way of life. Prior to the inspection the CSCI sent out ten comment cards to residents, two to health care professionals and ten to visitors and relatives. Of these seven were returned from residents and five from relatives and representatives, These helped to inform the inspection of the quality of life within the home, and thanks are extended to those who responded. Comments received by the CSCI from residents included: “Very good choice of home, good choice of food. very clean. Help of the staff is wonderful”. “Very happy here. The staff always try to make you satisfied”. “They have changed the Saturday lunch to Friday night and I am not happy about this as I like the sandwiches”. “Very good choice of catering. Home is always very clean and always very good.” Comments from visitors and relatives of people in the home stated: “the nursing care is always very good”. “ The home maintains excellent communication and all my mothers’ needs are addressed. I am impressed by the professionalism of the staff”. “I feel my relative is kept comfortable. The staff are kind and able. The home consults residents regularly and keeps a careful watch on medical concerns. Provides good activities which many of the residents take part in”. Conversations with residents living at the home took place over the day during which the following information was received: ‘ Its quite nice here, you can Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 7 choose how to live your life, and recently there have been a lot of improvements in the food and the things to do’. ‘ Staff are kind and the food is good, they have residents meetings and you can say what you think, generally they act on these, although some might be ignored’. A visitor said ‘ I put in a complaint and this was acted upon immediately in a professional manner and resolved. There have been a lot better’. What the service does well: What has improved since the last inspection? The manager is in the process of generating improvements within the home. The nursing station has been moved to between the two lounges allowing staff to be near to the residents at all times. New furniture is planned for the lounge and dining room areas, with redecoration commenced in the dining room, which includes new curtains. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 8 Residents now have access to hot and cold drinks throughout the day and are able to make themselves drinks within the auspices of a risk assessment. Menus are provided on dining room tables and residents order their meals at the point of service from the choices on the menu, whilst still being able to order something off menu if they wish. All staff are undertaking training in ‘Dining with Dignity’. There is a rolling training programme in place which has concentrated recently on ensuring that all staff are receiving the mandatory health and safety training and training to care for residents with dementia. Most staff have attended the recently implemented introductory course in dementia care, and will now progress to further training in this field. Staff are being encouraged to undertake studies for National Vocational Qualification level 2 in care. The manager has demonstrated awareness of the issues in the home which needed to be addressed, and is in the process of undertaking this. The Annual Quality Assurance Assessment which is required by the CSCI, showed that a thorough quality monitoring had been undertaken and the assessment stated that action plans and annual improvement plans had to be put in place. Records of complaints made about the home are now easily accessible and contain the actions taken to address these. A support manager is to commence in the home to continue with the staff training in the formation of care planning. Care plans generally show improvement although there is still some work to be done. What they could do better: Risk assessments for individual residents and general risk assessments throughout the home need to be expanded and improved. Staff should be encouraged to identify areas which could prove a danger to residents in order for risk assessments to be put in place. This had been a requirement at the last key inspection in 2006 and at a random inspection which took place in December 2006 to ascertain whether requirements had been complied with. A current fire risk assessment should be put in place. Social needs of residents must be thoroughly assessed and the volunteers that undertake one-to-one conversations with residents be guided towards those residents most in need of this. The provider and manager should ensure that requirements made at inspections are complied with within the date shown or contact the CSCI if further time to complete them is required. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 9 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. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 10 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 Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 11 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): 1,2,3,4,5,6. People who use the service experience good quality outcomes in this area Prospective residents receive sufficient information to enable them to be confident that the home can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose and Service User Guide are in the process of review and copies of these documents will be made available to the residents when complete. The reviewed documents comply with the regulations and show current practice and changes made within the home. All residents have a copy of the terms and conditions, which meet the standard. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 12 All prospective residents are assessed by the care manager or manager prior to their being admitted to the home. The pro forma used for recording details of the prospective resident has recently been reviewed and includes references to physical and psychological health care needs and social and leisure interests. Completed copies of this form were used at the assessment of residents recently admitted to the home, with this assessment forming the basis of the care planning. Residents entering the home for respite care receive the same preadmission assessment. The manager is setting up an information pack, which will include the statement of purpose and service user guide, to give to existing and prospective residents. Prospective residents and their representatives are encouraged to visit the home prior to admission Discussions were held with the manager relating to written confirmation of the home being able to meet the prospective residents needs, being given to prospective residents or their representatives. The manager confirmed that this would be commenced. The home admits people for respite care but not for intermediate care. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 13 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. People who use the service experience good quality outcomes in this area. Whilst the standard of care planning does not at present completely identify the current needs of the residents, management are taking actions to address this and residents are receiving the benefits of staff training and their continuing awareness of residents’ needs. The standard of the administration of medication safeguards the resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the course of the inspection six care plans (17 ) were examined in depth, these included three care plans from the dementia care residential unit and three which included both nursing and residents receiving personal care. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 14 A new care planning system is in place and staff are still being trained in the use of this. Consequently the standard of care planning was variable, 50 of those examined did not contain sufficient information to inform the care to be given to the resident, whilst others did not contain all information required in specific areas. Care plans in one of the non-nursing (residential) units of the home identified problems, but did not show that these had been addressed, and this was discussed with the manager. Risk assessments require to be expanded and to address all risks to the residents including use of bedrails and pressure damage and should be reviewed in conjunction with the rest of the care plan. Wound care plans should give information on whether the treatment to the wound has been concluded. In general care plans were improved since the last inspection and the care manager stated that she was aware of the work still required on these and will be progressing with this. Some care plans did not show evidence of the residents or representatives involvement. Daily records were informative and included details of the care that had been given. The home has a retained General Practitioner practice and surgeries are held regularly. The home has a physiotherapist that visits on a private basis as well as residents receiving treatment from the physiotherapist from the Care Home Support Team. Involvement of the wound care specialist nurse, and in the residential part of the home, district nurses, was identified. Residents and visitors spoken with said that the standard of care given was good, that a doctor was always available and that staff acted quickly if something was wrong. This was seen on the day of the inspection when a resident became ill and an ambulance was called promptly. During the inspection it was noted that staff showed respectful interaction with residents, and residents spoken with confirmed that this was the general rule. Medications administration in all units was satisfactory with receipt, recording and disposal of medications following prescribed guidelines. No specific guidelines were in place for the administration of creams is in place as required at the last inspection, however the manager stated that although this had been overlooked it would be put in place. No residents were identified as self-medicating at the present time. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 15 Staff should regularly check cleansing agents to ensure that they are still in date. All medications had been signed for following administration. The introduction of specific training in end of life care has been commenced, but residents reaching the end of their lives can stay at the home if medical reasons permit. All staff have received training in the Jewish way of life and the religious and cultural requirements of the care required at the end of life. On the day of the inspection a visitor to the home was heard to thank staff for the ‘excellent care given during the last days and that (the resident) could not have received better care anywhere’. The home is proposing to send staff for training in end of life care. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 16 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, People who use the service experience good quality outcomes in this area. Residents are encouraged to participate in varied activities in and out of the home and to make their own decisions regarding their daily lives. Issues previously identified around the provision of catering in the home have now been addressed and substantial improvements are in place, which benefit residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: An activities programme is in place and this identified that a variety of activities are offered to residents, these include outings, visits to a local Jewish day centre, quizzes, crafts and visiting entertainers. A previous inspection noted that activities tended to be geared to the female residents with little in place for men. The activities organiser said that pub visits and outings are now in place that appeal to the men in the home. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 17 Residents are involved in preparing for the religious festivals, and several volunteers participate in the life of the home, including spending time with the residents on a one-to-one basis. At present hairdressing is included as a leisure activity rather than as a personal care necessity, this was discussed with the manager On the day of the inspection a barbecue was taking place with music from an accordionist playing to accompany it. People from the Ralli Hall Day Centre (a local day centre which is also attended by residents in the home) had been invited to the barbeque. They said that they were often invited to the home for various occasions and that when they come to the home they are “Made welcome and have a lovely time, the food is good and the home puts on transport to fetch us”. Records of the activities were not up to date in several care plans, but residents spoken with said ‘ There is quite a lot to do here, there is a quiz on this afternoon, and other things going on most days’. Most residents agreed that there was ‘plenty going on’ although one resident said that there was insufficient activities that suited him. All residents receive a copy of the weekly activities programme. However one relative and one resident identified that volunteer staff who come into visit residents do not always spend time with those residents that would benefit most from conversation. Residents spoke of their choices regarding their participation in the activities of daily life and relating to their times of rising and retiring, visitors and freedom to go out as they please, being upheld and of staff facilitating these. Visitors are welcome in the home at any time and there is involvement with the Jewish and local community. Catering within the home is subcontracted out to an external company; the hotel services manager is in charge of this aspect of the home. Concerns had been raised with the manager over some aspects of the catering provided and the manager and the hotel services manager are in the process of addressing these with effects being already seen. Residents are now provided with an area where beverages and cold drinks are available throughout the day. Catering and care staff are to attend a ‘Dining with Dignity’ course which will assist them with understanding the nutritional needs and the difficulties faced by the older person. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 18 A ‘ Catering Forum’ is held monthly which involves residents in the planning of the menu and sharing traditional recipes with the catering staff, addresses any complaints the residents have about the food and invites their comments on the menu and the ongoing service of the food. Residents spoken with said that ‘ The food is better now’. All food is prepared and cooked in a way that is compliant with the religious needs of the residents. Lunch and supper were provided in a relaxed and unhurried manner, a barbecue was taking place at lunchtime and the majority of residents from all the units in the home participated in this. Those residents who chose not to do so were provided with a choice of alternative meals in the dining room and staff were seen providing assistance to residents in an empathetic and discreet manner. There are three or four options at every meal and menus are on tables in the dining room with choices now being made at point of service. There was evidence of fresh vegetables in season and fruit being served to residents and the majority of the cakes and desserts are made at the home. The kitchen is clean and all records as required by the Environmental Health Authority are in place. The home has recently been awarded the ‘Clean Food Award’. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 19 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): 16.17.18. People who use the service experience good outcomes in this area. Residents and visitors to the home are aware of how to make a complaint and are sure that this will be addressed in a professional and transparent manner. Clear records enable the manager to identify issues and to prevent their reoccurrence. Staff have sufficient training to enable them to be aware of their responsibilities towards those in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A new complaints policy is in place and will be displayed in the ground floor corridor and in the service user guide. The manager gave information that there have been 46 complaints to the home over the past year, however the previous system of recording of complaints has not allowed the current manager to identify the outcomes of all complaints received. Records in place since the manager came into post identified that eight complaints have been received over the past four months. These related to care of the residents, lack of hot water, the standard of catering and one relating to the change of manager. All of these were addressed by the manager and either substantiated or partially substantiated. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 20 Clear records are now in place which identify the investigations taking place, actions taken to prevent reoccurence and whether the complaint was proven. A relative of a resident said that she had to make a complaint relating to care, and that this had been: ‘ Addressed immediately in a thorough and professional manner and there has been no reoccurence’. The resident concerned also said that she was satisfied with the way it had been dealt with and that everything was now ‘much improved’. Residents have received information on registering a postal vote for the civic process. Advocacy services are now provided by an outside agency in addition to those provided by Jewish Care. There have been nine adult safeguarding referrals in the past year, records showed that in seven cases the home manager or Jewish Care has been the lead agency in investigating these seven were inconclusive or unsubstantiaed and two are still ongoing. One of these has been the subject of a coroner’s inquest. There have been no referrrals of staff to the Protection of Vulnerable Adults list. Staff have recommenced training on their role in safeguarding adults, and this will include participation by the ancillary and catering staff. Those members of staff spoken with were aware of their responsibilities towards those in their care and of the protocols in the reporting of adult safeguarding issues to ensure that the residents are protected. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 21 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): 19,20,21,22,23,24,25,26 People who use the service experience good quality outcomes in this area A well-maintained and clean environment provides a pleasant home for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All areas of the home were well maintained with redecoration having taken place in some rooms. There is a redecoration plan in progress for the dining room and lounges and this will include new curtains and furniture. The nurses station is in the process of being moved from an office in the corridor to a position between the two lounges which will enable staff to see residents at all times, with a lockable unit for care plans installed. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 22 The Annual Quality Assurance Assessment required by the CSCI had identified that there was a safety risk concerning the lift mechanism, but this has now been addressed. The keypad accessing the stairs to the basement was broken, information has now been received by the CSCI that this has now been mended. Risk assessments should have been in place to address any safety risks to residents during this time. There are fifty-one single rooms for residents with en-suite facilities; these consist of a toilet and washbasin with some rooms including a shower. Currently forty-three of the rooms are occupied. As rooms become vacant they are redecorated and new carpets laid. Residents spoken with liked their rooms and said that they were always clean. All residents have lockable doors, with residents being provided with a key if they wish to have one; risk assessments to cover this were not sufficiently in depth to prevent these being given inappropriately. Records of hot water temperatures of residents’ outlets were seen and these have been checked on a regular basis and were within recommended parameters. The appointed manager stated that previous problems with low water temperatures, a subject of a complaint, have been resolved. Equipment including adjustable beds, hoists and pressure relieving mattresses are in place in the home. Width of doorways of individual rooms leading into the garden and lack of ramps make it difficult for those residents who have mechanised wheelchairs to access the patio area. The standard of cleanliness within the home was good with no odours apparent. However the use of the kitchen as a thoroughfare by members of management and other staff should be discouraged, as this is an infection control and health and safety risk. Care staff entering the kitchen should be provided with disposable aprons or other protective clothing. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 23 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): People who use the service experience good outcomes in this area There are sufficient staff on duty to meet the assessed needs of the residents and staff receive training relevant to the care of those living at the home. Robust recruitment procedures safeguard the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rota and conversations with staff and residents identified that there are sufficient staff on duty to meet the needs of the residents. Registered nurses cover each shift. Staff spoken with stated that there are enough staff on duty to enable them to spend sufficient time with residents and that they could attend to their work in an unhurried manner. The rota was clear and identified what hours staff were working, the home uses agency staff as required but tries to ensure continuity. One resident and a visitor stated that the lack of management at weekends can have a detrimental effect on the standards within the home being Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 24 maintained. The manager said that she is aware of this and is in the process of implementing staff training to address this. Staff receive an induction training at commencement of their work at the home, this includes two weeks learning about the Jewish way of life and also the conventional care skills required. The ‘ Core skills for care’ induction course is used. Staff are receiving ongoing training relevant to the care needs of those in their care also undertaking a programme for training in ‘Dementia care’, which includes training in challenging behaviour. Senior care staff receive medication training. All staff have attended mandatory training but the Annual Quality Assurance Assessment received by the CSCI identified that Control of substances hazardous to health training is needed for all staff. This also identified that volunteer staff do not receive any training relevant to the role they undertake which includes one- to– one time with residents. Nine members (33 ) of care staff now hold the National Vocational Qualification level 2 in care with a further ten staff undertaking study for this qualification. Six staff personnel files were examined and these contained all information required by the regulations. No member of staff commences work at the home prior to the Criminal Records Bureau check being obtained. The manager gave assurances that all volunteers undergo the same recruitment procedures as other staff and that the head office holds those records Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36,37,38 People who use the service experience good quality outcomes in this area Although temporary management systems have produced uncertainty for residents and staff, there are clear indications that issues relating to meeting resident’s expectations and ensuring a safe environment have been identified and are in the process of being addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was employed in the home initially as Development manager in January 2007, took over as acting manager in June 2007 and appointed as Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 26 manager in July 2007. She is not yet registered with the CSCI. The appointed manager is a registered nurse (level 1) has a certificate and diploma in management studies and is currently working towards a masters degree in business administration (MBA) She has previous experience in the care home industry and is supported by a care manager, also a registered nurse (level1). Residents, staff and visitors to the home stated that management changes over the past few months have produced uncertainty and anxiety within the home whilst saying that there have been noticeable improvements to the quality of life for the residents. Staff said that although systems had changed, they were for the better, but it had been a time of some anxiety. The quality monitoring system involves residents by holding monthly residents meetings, a resident food forum and the use of residents’ surveys. At present the results from the surveys have not been collated but the manager states that this is in progress. The Annual Quality Assurance Assessment identified the need for a quality assurance system that ensures consistent self monitoring and that an action plan require to be developed. Staff meetings are taking place and whilst staff supervision is taking place it is not at the intervals recommended by the National Minimum Standards. Policies and procedures have not been reviewed since 2005 and there are no clinical policies in place, which identify the clinical practice local to the home. At present the home uses a procedure manual developed by hospital clinicians. A previous requirement asked for a specific policy to give guidance to staff and this has not yet been addressed. The manager gave assurances regarding compliance. The home does not act as appointee for residents finances but keeps money for safekeeping and personal expenditure. Records relating to these were in order. The last fire risk assessment was dated 2005, conversation with the health and safety representative at Jewish Care stated that they were at present in consultation with a representative from the fire services. The manager stated that some doors have closing devices which respond to the fire alarm and that they could not leave their doors open until these were in place. The acting manager and the laundry staff expressed concern at the fire exit available in the laundry, the manager was recommended to discuss this with the relevant authority. All staff have undertaken fire training. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 27 Disused items stored in the basement area which include wheelchair batteries may be a fire hazard, and a safety hazard, as catering staff have to move around disused items to access freezers. Information received following the inspection is that arrangements have been made to remove these items. Some staff require moving and handling training and this is identified in the training records. The kitchen should not be used as a thoroughfare as this is a safety hazard and also has implications for infection control. Risk assessments throughout the building and those relating to individual residents should be expanded and this was discussed with the manager. Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 28 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 3 3 x 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 3 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 2 3 2 Hyman Fine House DS0000014003.V339018.R01.S.doc Version 5.2 Page 29 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 OP7 Regulation 13(4) Requirement That detailed risk assessments are in place to safeguard staff and service users. (This was a previous requirement over the past two inspections) Timescale for action 30/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hyman Fine House DS0000014003.V339018.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 Hyman Fine House DS0000014003.V339018.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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