Inspection on 29/06/06 for Hyman Fine House

This inspection was carried out on 29th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 18/07/07

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 Jennie Williams Unannounced Inspection 29th June 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 Hyman Fine House DS0000014003.V291712.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. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 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 Mrs Margaret Stanbridge Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. The maximum number of service users to be accommodated is fiftyone (51). The service users accommodated must be aged sixty-five (65) years and over on admission. Twenty-two (22) service users in receipt of personal care only are to be accommodated. Seventeen (17) service users in receipt of nursing care only are to be accommodated. Twelve (12) service users in receipt of personal care, with a dementiatype illness are to be accommodated. One named service user aged under sixty-five (65) years on admission only to be accommodated. 23rd January 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 are as follows; £652 for residential placements, £742 for nursing care placement and £694 for a placement on the dementia unit. There are additional fees for hairdressing (£8 to £11), Chiropody (£10), newspapers and Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 5 personal toiletries. This information was provided to the CSCI on the 28 April 2006. 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 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.V291712.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Hyman Fine House will be referred to as ‘residents’. This unannounced inspection took place over approximately eight hours on the 29 June 2006 by two Inspectors. (2nd Inspector, Jan Aston) The Lead Inspector returned to the home for two hours on the 14 July 2006 to provide feedback to the Registered Manager and the Care Manager. The Registered Manager facilitated the full day of the inspection. Eleven residents, of both genders and over the age of 65 years, were spoken with throughout the inspection process. Twenty-five resident surveys were provided to a volunteer within the home who was happy to assist residents to complete these. None of these have been returned to the Inspector. Three resident care plans were looked at in detail and specific areas of care were viewed in three other care plans. The Registered Manager and twelve staff were spoken with throughout the inspection process. Six staff were spoken with in a group and six other staff members were interviewed individually. Staff spoken with included; carers, a registered nurse and the activities co-ordinator. Eleven staff files were inspected. A manager from the catering company supplying the home was spoken with as well as a visiting professional. Fifteen staff surveys were sent out to individuals prior to inspection of which six were returned. Five social worker surveys were sent. Two were returned. One GP comment card was sent, which was returned. A comment card was sent to the Older Peoples Nurse Specialist Team, which was not returned. Fifteen relatives/visitors comment cards were sent to the home to display. One of these was returned. A pre-inspection questionnaire was received prior to the inspection. A tour of the environment was provided to one of the Inspectors, who viewed communal areas and inspected individual rooms. Activity records, fire records and accident records were inspected. The quality assurance system was checked and complaint records were viewed. Previous requirements at the home were assessed to ensure compliance. The staff rota and menus were viewed. The Inspectors ate lunch with the residents. Apart from fire records, no other health and safety records were viewed as this information has been provided in the pre inspection questionnaire. Medication administration and storage practices were inspected. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 7 There were 43 residents residing at the home on the day of the inspection. Eight residents with a dementia type illness, 15 in receipt of nursing care and 20 residents receiving personal care. What the service does well: What has improved since the last inspection? What they could do better: There are six requirements that remain outstanding. Action is required to ensure that the pre-admission assessment is expanded to cover all areas of care needs so that comprehensive care plans can be drawn up using this information, ensuring that all needs of an individual can be met at the home. Care plans need to reflect actual current practice and the reviewing process should include the resident/representative to ensure choice and preferences are reflected. These are both outstanding requirements. Some risk assessments are in place but additional ones need to be implemented to ensure any activity that poses a risk is identified and eliminated so far as is practicably reasonable. Care notes provide limited information on the health status of individuals and information written does not assist staff in monitoring the well being of residents. It remains an outstanding requirement that the storage of equipment be reviewed to ensure communal areas for residents remain free of clutter. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 8 Requirements have been made in regards to the recruitment and training of staff in the following areas; staffing levels in some areas of the home could be improved (outstanding requirement), to ensure residents are moved safely with manual handling equipment. Improvements are required to ensure that all staff receive training in the health and safety topics to ensure staff have the necessary skills to meet the needs of the residents. Recruitment procedures need to be improved so written evidence of a Criminal Record Bureau (CRB) check is in place for all staff, to ensure residents are safeguarded. This remains an outstanding requirement. It remains an outstanding requirement that documenting of accidents be improved, to provide clear information to the reader of what accident/incident occurred. Action is required to ensure the health and safety of residents, visitors and staff. It has been required that the home consults with the local fire authority regarding the suitability of a stair gate being used across a fire exit. Urgent action is required to ensure that shortfalls noted within the recent fire risk assessment are addressed, to ensure residents, staff and visitors are safeguarded in the event of fire. 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. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 9 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.V291712.R01.S.doc Version 5.1 Page 10 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, 3, 4, 5 & 6 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” The home has information available for prospective residents/representatives on the facilities and services provided to make an informed decision if their needs can be met at the home, however inadequate pre-admission assessments place some residents at risk of their needs not being met. EVIDENCE: The home has a Statement of Purpose and Service User Guide available for all prospective residents/representatives. Copies of these documents were observed to be left in individual rooms. These documents provide the reader with information about the care and facilities provided at the home. Pre-admission assessments viewed did not provide clear information on the assessed needs of individuals and only demonstrated the dependency levels of the individual. Social services care plans are obtained wherever possible. The home should not be just using this information to base the admission process on. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 11 There was evident that a resident admitted for respite care did not have a preadmission assessment undertaken. It was confirmed by the Registered Manager that this individual had received respite at the home on previous occasions and was known to the staff at the home. A pre-admission assessment was also not available for inspection for another resident. There was a copy of the social service care plan available. It was reiterated that all residents must have a pre-admission assessment completed before being admitted to demonstrate that the home can meet their assessed needs. A newly admitted resident was spoken with regarding the admission process. This individual felt that the process could be improved. This individual confirmed that they received no proper orientation to the home, staff didn’t assist to unpack clothes and there was no discussion about the care needs of this individual. They did confirm that they had visited the home prior to moving in. Prospective residents/relatives are encouraged to visit the home prior to being admitted. All residents residing at the home follow the Jewish faith. There is a synagogue at the home for residents to use. Food is also cooked accordingly to religious beliefs. Staff individually and collectively have the skills and experience to deliver the services and care which the home offers to provide. The home does not have dedicated accommodation to provide intermediate care, however respite is available if there is a vacancy. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” There is a risk of some residents needs not being met due to care plans not being updated to reflect actual current practice. Risk assessments must be improved to promote the safety and well being of residents. EVIDENCE: Care plans have improved since the last inspection, however additional work is still required to ensure that all needs of an individual are reflected and that clear guidance is provided to staff on how to meet the assessed needs. There was no pre-admission assessment, care plan or risk assessments in place for a resident who had been residing at the home for a few days. Residents receiving respite must also have a plan of care implemented. There was a resident who required insulin. The Inspector could find no written information in the care plan regarding this or if a specialist diet was required. Another care plan did not clearly state that the individual should not receive personal care from male carers. Another care plan provided guidance that an individual required to checked hourly at night time. There was no evidence to show that this was being done. The Registered Manager did confirm that Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 13 hourly checks were no longer required for this individual. There was evidence that some care plans are being reviewed on a monthly basis, however some care plans were not reflecting actual current practice. A staff member confirmed that care plans are reviewed with the residents/relatives, however there was not evidence that this was being done with all resident. One staff member confirmed there is sometimes insufficient time provided to review care plans with an individual. A relative had signed one care plan following the monthly review. There was evidence that specialist advice is sought from the tissue viability nurse when required. There is pressure-relieving equipment available at the home for those who are at risk of developing pressure areas. A chiropodist is employed monthly at the home, whilst some residents have private chiropodists that visit. The GP comment card received shows that staff demonstrate a clear understanding of the care needs of residents and is satisfied with the overall care provided to residents within the home. The two social worker comment cards also demonstrate that they are satisfied with the overall care provided to residents. It was noted that records were being maintained for a resident who required being cared for in bed. The records demonstrated that regular pressure care, mouth care, pain control and the monitoring of fluid intake and output is undertaken. Two visiting health professionals comment cards demonstrated that there is always a senior member of staff to confer with and that staff demonstrate a clear understanding of the care needs of residents. Risk assessments need to be expanded. Areas where the risk was identified as high had no clear guidance for staff on steps to take to reduce the risk. Risk assessments must be implemented for those residents who independently go out into the community. Daily care notes written on individuals do not provide sufficient information to monitor their health. Some staff have written ‘all care given’ or ‘no problems’. This is not suitable, particularly when some residents do not have a comprehensive care plan in place. Medication Administration Records (MAR) charts were inspected for all three units. It was confirmed that there are policies and procedures in place for all aspects of dealing with medication. The content of these were not read. It was observed that medication was generally being signed for at the time of administration, however it was noted on two of the MAR charts observed that medication had been signed for but not given. This was addressed on the day of the inspection. Cream being prescribed for individuals did not give any indication as to where the cream was required to be applied. The order was ‘Apply as directed by the Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 14 GP’. There were no records available to trace the original order for this prescription. It was brought to the attention of an Inspector that a resident was hiding medication in their handbag, following administration by the staff. This raised concerns regarding the procedures for correct administration. It was confirmed that this resident will hide the medication in their mouth and later place the tablets in the their handbag. Staff have become aware of these practices and are now more observant and ensure the medication has been swallowed. This must be reiterated to the staff to ensure residents take the tablets administered. Some prescriptions on MAR charts had hand written amendments on them, that had not been signed to show who had made the changes. Any handwritten prescriptions on MAR charts should be checked and double signed by two staff who have undertaken medication training, to ensure staff and residents are safeguarded from errors being made. Signature samples are kept of staff administering medication. Medication is stored appropriately and there are accurate records of controlled drugs kept. Staff were observed to have a good professional rapport with residents and were heard to be calling them by their preferred term of address. Of the residents that were asked, all felt that their privacy and dignity are respected. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 “Quality of this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents’ lifestyles within the home are their own choice and are provided with opportunities to participate in activities that fulfil their interests and needs. EVIDENCE: There is an activities person employed at the home. On discussion with the activities co-ordinator, it was confirmed that there is not always a structured activity programme in place and that residents decide on the day what they wish to do. One of the residents spoken to state that the provision of activities at the home are poor, but could not state what they would like to be offered. Some spoke positively of recent trips out of the home. Two gentlemen, exservicemen, informed an Inspector that they were being assisted to attend a ceremony in London to be awarded medals. There were sections in an individuals care plans specific for activities. These were not being completed. There was no documentation being kept to evidence who participated in activities. Activities were observed on the day of the inspection. There was a notice board near the dining room that advises the residents of some of the activities that are available. Some of the activities listed were; manicures, chess, flower arranging, keep fit, and monthly Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 16 reminiscence groups. It was discussed with the activities person to ascertain what the gentlemen residing at the home would like to participate in, as a lot of the activities appeared female orientated. Residents meetings are held every two months and minutes are kept of these meetings. Activities and issues within the home are discussed at these meetings. Visitors are welcomed at the home and there is a visitors’ book that must be signed when entering and leaving the home. Residents are able to receive visitors in private. Of the residents that were asked, all confirmed that their lifestyle within the home is there own choice in respect of times to go to bed and get up, bathing preferences etc. Residents were observed to move freely around the home. Residents on the dementia unit had designated communal areas and are safeguarded by having their movements restricted to these areas. The menus provided demonstrated that residents are provided with a choice and variety of nutritional meals. The Inspectors enjoyed a tasty meal with the residents. Lunchtime was observed to be relaxed and unhurried. Staff were present to offer discreet assistance to those residents who required assistance. There were mixed feelings from the residents about the food provided and the home is continuing to work to improve these standards. The food is prepared and cooked in a way that is compliant with the religious needs of the residents. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 “Quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Complaints are dealt with appropriately, reassuring those involved that they are being listened to and that action will be taken, if necessary. Staff and residents will be safeguarded better if written policies and procedures for the Protection of Vulnerable Adults (POVA) are followed at all times. EVIDENCE: The home now maintains a clear record of complaints received. No complaint has been made directly to the CSCI since the last inspection. There were some complaints made to the home in March 2006 regarding the quality of the food provided and about lost clothing. There were three complaints made to the home in June 2006. These were to do with foot care provided to an individual, furniture being moved within a residents room and one about some breakfast food not being available. One complaint was partially substantiated, on remains unresolved and the last was substantiated and resolved immediately. The home keeps copies of any correspondence relating to complaints. Staff receive training in Protection of Vulnerable Adults (POVA) and there are policies and procedures in place providing guidance to staff on action to take in the event of an allegation of abuse being made. There have been two POVA investigations since the last inspection. The home did not follow the correct procedure initially for one of these. A letter was sent Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 18 to the Registered Manager following this incident reminding her of the homes responsibility in POVA issues. The home co-operates with the multi-agencies involved in POVA investigations. One incident is unresolved, but the home was advised by the multi-agency POVA team of additional measures to take to safeguard the individual involved. It was advised that an individual does not receive personal care from male carers. This was not reflected in the individuals care plan. The second POVA investigation was inconclusive and was dealt with through the homes disciplinary procedures. This resulted in the staff member being suspended from work and left the employment of the home. Both these POVA investigations were lead by social services. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 “Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service.” Residents live in a safe and well-maintained environment that is clean and hygienic. EVIDENCE: There are fifty-one single rooms for residents with en-suite facilities, either toilet facilities with a shower or just a toilet facility. Currently forty-three of the rooms are occupied. Where there were empty rooms it was noted that they had been redecorated and new carpets laid and were ready for use. Rooms are lockable but only a few residents wish to hold a key, none of the rooms were locked. Where a resident was in hospital the room was not kept locked. This should be addressed. All rooms were furnished appropriately and had been personalised with residents’ belongings. Of the residents that were asked, all confirmed that they were happy with their individual room. Equipment such as adjustable Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 20 beds, hoists, special mattresses were seen to be in place where required. It was noted that the mattresses and hoists had been serviced and checked for safety. There was no evidence of equipment being left in corridors. However two armchairs were being stored under a stairwell in between floors and an area on the ground floor was being used as a storage area for wheelchairs and hoists. All rooms were fitted with a call alarm system. A check was undertaken by the Inspector to ensure that the call alarm system was in good working order. It was noted that all windows had restricted opening. The Inspector was informed that the hot water outlets in resident rooms and bathrooms were regulated to a set temperature by safety valves and radiators were of a low surface temperature but could be controlled individually. Hot water temperatures were not checked by the Inspectors. Bathrooms and toilets in the home were seen to be clean, lockable and had a call alarm system. Generally the home was found to be clean and well maintained. However the following were raised with the Registered Manager that required attention. A stair gate is fitted across a fire exit on a staircase on the dementia unit. If this is continuing to be used the Fire Officer must be consulted and evidence of their agreement to this submitted to the Commission. The basement door, which is usually locked using a code, was broken and this must be addressed. Some other fairly minor points were raised during the feedback with the Manager and have not been put into the report. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 21 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 & 30 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Staffing levels in some areas of the home could be improved to ensure all needs of residents are met. Staff and residents will be better safeguarded with improved health and safety training. Recruitment procedures need to be followed, ensuring residents are safeguarded. EVIDENCE: During the visit to the home six members of staff were spoken within a group and four were interviewed individually. Surveys had been adapted by the Commission to send to all members of staff working in the home as per staffing list provided in the pre-inspection questionnaire. Members of staff returned six surveys. Surveys indicated that the home undertook the necessary recruitment checks, provided each member of staff with a contract of employment, job description and induction training when starting to work in the home. All who responded said they felt they had enough support from their Manager. All said that they had received training in adult protection, they had sufficient time to work with each resident, they have regular supervision, their work is observed and they have regular staff meetings. Members of staff spoken with during the inspection felt that generally staffing levels were appropriate for the needs of the residents and they had sufficient time with each resident. They also felt that the use of agency staff within the Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 22 home had reduced recently. Some residents spoken with stated that the staff were wonderful and very kind. The rota provided to the Inspectors was not clear in what position or what hours staff work. There was no guide for the codes used or clear distinction on who works days or nights and on what unit. The Registered Manager provided additional information at the inspection. However it was brought to the Inspectors attention by staff, that at times on the nursing unit there are not always sufficient numbers of staff to ensure that two members of staff are present when moving a resident in a hoist. To ensure the safety of residents and safe working practices for members of staff the Registered Manager must ensure there are sufficient numbers of staff to ensure that safe moving and handling guidelines and procedures are adhered to. Staff confirmed that other areas within the home had suitable numbers of staff on duty. Those members of staff spoken with confirmed that they received regular supervision; staff meetings were held on a regular basis and described a range of training that had been undertaken and updated as required. 28 of care staff currently have National Vocational Qualification (NVQ) qualifications. The home employs 28 care staff. Two staff have completed NVQ level 3 and six have achieved NVQ level 2 qualifications, with an additional two carers due to complete these studies in August 2006. The Registered Manager confirmed that an additional seven carers are enrolled to commence NVQ level 2 studies in September 2006. A sample of staff records were examined; eleven in total. From these records it was demonstrated that the home follow the organisations recruitment procedures. However out of the eleven records that were examined there was no written evidence of a CRB check or POVA check being obtained in respect of three members of staff. This was discussed with the Registered Manager who confirmed that a telephone call had been received from the organisations Head Office stating that satisfactory Criminal Record Checks had been received. The Registered Manager was advised that a written record should be kept of confirmation of a satisfactory CRB for all staff. The Manager from the catering company responsible for the running of the kitchen was spoken with during the visit to the home. This company is also responsible for the employment of domestic staff within the home. The Inspector examined the records for two domestic staff that were seen in the home on the day of the visit. The records demonstrated that they had been included in some training events in the home such as fire and the protection of vulnerable adults. However there was no written record of Criminal Record Checks for either member of staff. This was discussed with the Catering Manager who agreed that a complete review would be undertaken of records Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 23 and that he would ensure that the Registered Manager is kept informed of any domestic agency staff being used in the home and that the necessary employment checks had been undertaken. Training records were examined for the sample of eleven staff. The Inspector was informed that the Deputy Manager is in the process of compiling new training records by using an index card system. The index cards for the sample of staff were examined. The records demonstrated that members of staff have received a range of training relevant to the work they perform. Topics covered this year ranged from induction, wound care, Dementia, Risk assessments, Jewish Way of Life, resuscitation and the protection of vulnerable adults. Members of staff confirmed that training in NVQ study is supported. The Inspector could not find sufficient evidence that all staff had received an update in moving and handling techniques within the last year. This is discussed in more detail in the next section. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 “Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service.” Residents are not protected by the health and safety procedures within the home. EVIDENCE: The Registered Manager is a registered nurse with current registration with the Nursing and Midwifery Council (NMC) and with the CSCI. It was confirmed that there are clear lines of accountability within the home and with any external management. The Registered Manager completed NVQ level 4 in management in 1997 and updated this qualification in 2004. She is not responsible for any other establishment. The home has a quality assurance and quality monitoring system in place. Surveys are undertaken with all staff, residents and relatives every three months. An external company provides an analysis of these surveys, from Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 25 which the home develops an action plan to address any shortfalls highlighted. It was confirmed that surveys have just been undertaken and the home is awaiting the analysis. The Registered Manager and Care Manager undertake regular checks of the environment and randomly select care plans to review. Someone from within the organisation undertakes monthly-unannounced visit to the home to speak with residents, staff and undertake their own audits within the home. A copy of this report is provided to the Registered Manager and the CSCI. The home does not act as an appointee for any residents. Some residents manage their own finances and others have relatives assisting with their finances. The home does hold personal allowances for residents. All monies are kept in one tin, however all residents have their own financial records maintained. Receipts are kept of any financial transactions. Money is accessible to the residents during administration office hours. This money is checked within the home every week and head office undertake an audit of personal allowances held at the home every three months. It was confirmed that if the personal allowance for an individual becomes too high and unsafe to keep on the premise, the money is placed in a separate account for the individual. The cash counted and financial records inspected correspond with each other. Staff confirmed that they receive supervision on a regular basis. The pre-inspection questionnaire demonstrates that there are suitable policies and procedures in place. The Registered Manager confirmed that some of these are old and all policies and procedures are currently being reviewed by head office of Jewish Care. There were no clinical policies and procedures in place for guidance for the trained nurse. Training records did not demonstrate that members of staff had received training in all health and safety topics and refresher training as required in respect of; moving and handling, first aid, fire, infection control and food hygiene. From the sample of staff records the Inspector could only see written evidence that fifteen members of staff had undertaken training in moving and handling in November 05. There was no evidence of the remaining twenty-five staff having moving and handling training last year or this year. The Registered Manager confirmed that this training had been undertaken by all staff, however there was no written evidence for this. During the inspection the Inspector observed two members of staff moving a resident using a hoist. The way in which this was undertaken gave the Inspector the view that their moving and handling training should be updated. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 26 It was noted from records relating to two members of the domestic team that they had received training in kitchen hygiene, the use and storage of hazardous substances and fire precautions and procedures. Pre-inspection material received prior to the inspection stated that annual safety checks had been undertaken on equipment and utilities. The documenting of accidents still requires to be improved. Some accident records viewed provided the reader with no information of what the incident was, what action was taken or how reoccurrence may be reasonably avoided. Some sections of the accident form were not completed. Fire records inspected that the fire alarm is tested weekly and fire drills are undertaken every few months. These are done at different times; ensuring night staff are also involved. An external company undertook a fire risk assessment in November 2005, from which the home has just received the report. Management must ensure that the shortfalls noted in the report are addressed. The Catering Manager confirmed that Environmental Health had recently visited the home, however a copy of this report was unable to be located on the day. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 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 3 X 2 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 2 X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 1 Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 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 Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement That detailed pre-admission assessments are undertaken on all prospective service users. (Timescale 31.03.06 not met) That care plans cover all aspects of health, personal and social needs. Care plans must reflect actual current practice. (Outstanding from last three inspections) That evidence be provided of service users/representatives input into the reviewing of care plans. That suitable risk assessments are in place to safeguard staff and service users. That daily records about service users are expanded. That clear guidance is provided for the administration of prescribed creams That documentation of activities provided be maintained and that care plans for individuals regarding activities are kept upto-date. That the Protection of Vulnerable Adult procedures are followed at DS0000014003.V291712.R01.S.doc Timescale for action 15/09/06 2. OP7 15 15/09/06 3. OP7 15(2)(c) 30/09/06 4. 5. 6. 7. OP7 OP7 OP9 OP12 13(4) Schedule 3 (k) 13(2) 15 15/09/06 15/09/06 31/08/06 15/09/06 8. OP18 13(6) 31/08/06 Hyman Fine House Version 5.1 Page 29 9. OP22 23 (2) (l) 18(1)(b) 10. OP27 11. OP29 19 (4)(b)(i) 12. OP30 18(c)(i) 13. 14. OP38 OP38 Schedule 3 (j) 23(4) 15. OP38 23 all times. That suitable provision is made for storage for the purposes of the care home. (Timescale 28.02.06 not met) The Registered Person shall ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users. (Timescale 31.03.06 not met) That staff files comply with Schedule 2. Evidence of satisfactory CRB checks must be kept on staff files. (Timescale 31.03.06 not met) That the Registered Person shall ensure that the persons employed to work at the care home receive training appropriate to the work they are to perform. Evidence must be available for inspection. That the documenting of accidents be improved. (Timescale 28.02.06 not met) The Registered Person shall after consultation with the fire authority take adequate precautions against the risk of fire, particularly in respect of the use of a stair gate across a fire exit. That shortfalls identified in the fire risk assessment are actioned. 15/09/06 15/09/06 15/09/06 30/11/06 31/08/06 15/09/06 15/09/06 Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 30 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. 4. 5. 6. 7. 8. Refer to Standard OP3 OP9 OP9 OP12 OP23 OP28 OP33 OP38 Good Practice Recommendations That the admission process is reviewed to ensure all new service users are assisted and orientated to their environment. That handwritten prescriptions on MAR charts be checked and double signed by two staff who have undertaken medication training. That any hand written amendments on MAR charts are signed. That the activities person ascertains that interests of the male service users residing at the home. That individual rooms are locked if the service user is in hospital. That the home continues to work towards the 50 ratio of NVQ level 2 qualified staff. (Ongoing recommendation) That clinical policies and procedures are developed and implemented. That the door to the basement is kept locked. Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 31 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. Extracts may not be used or reproduced without the express permission of CSCI Hyman Fine House DS0000014003.V291712.R01.S.doc Version 5.1 Page 32 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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