Inspection on 08/12/05 for Jackson House Nursing Home

This inspection was carried out on 8th December 2005.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Jackson House Nursing Home 09/02/09

Jackson House Nursing Home 08/08/08

Jackson House Nursing Home 09/08/07

Jackson House Nursing Home 26/01/07

Jackson House Nursing Home 25/10/04

Jackson House Nursing Home 19/04/04

Jackson House Nursing Home 16/12/03

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Jackson House Nursing Home 2 Lode Hill Cottages Styal Cheshire SK9 4LH Lead Inspector Denis Coffey Unannounced Inspection 8th December 2005 09:30 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 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 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 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 Adults 18-65. 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. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Jackson House Nursing Home Address 2 Lode Hill Cottages Styal Cheshire SK9 4LH 01625 525443 01625 525443 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) Mr Clifford Slack Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. This home is registered for a maximum of 4 service users in the category of LD (learning disability) The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidance which may be issued through the Commission for Social Care Inspection 8th June 2005 3. Date of last inspection Brief Description of the Service: Jackson House provides accommodation and nursing care for up to four adults with a learning disability. Each resident has a package of care arranged through care managers, and there are no privately funded placements in the home. Residents who live at Jackson House are generally physically independent, and the home does not have any aids or adaptations such as a passenger lift or mechanical hoists. The home is located close to Styal National Trust village, and a small convenience store/post office and pub are within east walking distance. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 6 hours; during which time a tour of the premises took place, and staff, care and general records were inspected during the course of the inspection A total of five requirements to be met were identified at the inspection that are in relation to care records, medicines, staff training, recruitment procedures and cross infection. What the service does well: What has improved since the last inspection? What they could do better: Care records need to include plans of care for all of the identified health care needs of the residents. The storage and administration records of medicines needs improving to ensure that residents are given their medicines as prescribed. The home needs to develop a policy and procedure dealing with physical restraint, and also needs to ensure that all staff employed at the home are given guidance and training in relation to the protection of vulnerable adults. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 6 Staff recruitment procedures would be improved by ensuring that all the necessary information on new staff is obtained prior to them taking up employment at the home.; 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. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&4 Assessments are carried out on prospective residents to ascertain that their needs can be met by the home. EVIDENCE: Since the last inspection one person has taken up accommodation at the home for a six-month trial period. Evidence was seen of an assessment being carried out by a trained nurse employed at the home prior to the person moving into the home. The assessment identified the needs/problems of the person in relation to their activities of daily living. Prior to taking up residency the person visited the home accompanied by his parents, during which time he looked around the home met and had a meal with the other residents. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Care plans were well documented, but did not address in full all of the identified needs of the residents. Residents are involved in and are consulted on decisions that affect their lives, and are encouraged to lead an independent life as possible. EVIDENCE: The care records of the person recently taking up residency at the home were examined at this inspection. An assessment of needs/strengths was in place along with an assessment in relation to problematic behaviour. As this person does not talk, his family had identified his preferred daily routine. Risk assessments for inappropriate behaviour, absconding, and travelling by car were documented. Plans of care were in place and were appropriate, but required adding to, to include one for personal hygiene, and one for communication. Daily entries in the care records were detailed and informative. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 10 Residents spoken with confirmed that they are encouraged and assisted in making decisions about how they lead their lives. All of the residents have individual bank accounts and are encouraged to manage their own finances where possible. Risk assessments were in place and residents confirmed that they were aware of these. See Requirement 1 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 16 & 17 Residents engage in a variety of social and educational activities that provide variety and interest for them. EVIDENCE: Two of the residents were currently attending a local college of further education. One was doing a catering course and the other was on a literary skills course. Another resident works three days a week and is involved in a local choir that held a recital recently. One of the residents had a week’s holiday in North Wales earlier in the year, and two other residents attended a three-day music festival. Residents’ are involved in the local community by going out shopping, and going for pub lunches. One resident is a member of a local gymnasium. One of the residents is spending the Christmas holiday at his parents home and another resident is going to his parents on Christmas Day. The remaining two residents do not have families who live close by and it is proposed that they will go out for lunch on Christmas Day accompanied by the staff. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 12 Residents are provided with keys for their bedroom doors. Access to and from the home has become slightly limited as the front door is now locked because one of the residents has been assessed as at risk of absconding. However, the backdoor is left open during daylight hours when there are people present in the home. Mealtimes are flexible to meet the needs of the residents and choice of food is available. Tea on the day of inspection was braised steak, onions and potatoes. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 20 The health care needs of the residents are well met, ensuring that they keep healthy. The records of medicines needs improving to ensure that residents are administered their medicines as prescribed. EVIDENCE: Personal care is provided in private and staff were heard to address the residents appropriately. The routines at the home are flexible, and the residents are supported in maintaining their individuality. Medicines are stored in a secure wall mounted cabinet. A selection of medicines that can be bought without a prescription were found in this cabinet. These belonged to one of the residents. The nurse in charge was advised to check with the resident’s general practitioner to make sure that none of these products would adversely react with the prescribed medicines the resident was taking. The name of the resident owning these products was not identified on the containers they were in. All medicines stored at the home must be able to be identified for which resident their use is intended. One resident was receiving eye drops twice a day. This medicine has a limited life efficiency of twenty-eight days when opened, but the container for these was not dated, identifying when their use had commenced. There was no Medicine Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 14 Administration Record (MAR) sheet for this resident. The nurse in charge said that the home had not been able to obtain a MAR sheet from the supplying pharmacy, as the prescription had not been written in such a manner that would prompt this. A record of all medicines administered to residents must be maintained, and the nurse was advised to devise a suitable MAR sheet for the resident until the problem was resolved. Records were seen of the medicines being audited every two months by the home manager. See Requirement 2 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Information is available for residents and visitors on how to make a complaint and who to make it to. Procedures need to be implemented to ensure that residents are protected from abuse, harm and poor practice. EVIDENCE: One of the residents has made a complaint recently and has asked the Commission to have this investigated on his behalf. The details of the residents concerns have been sent to the registered provider for investigating. The resident has been told that the results of the investigation will be discussed with him. One of the care staff present at the time of inspection said that they had not received training with regard to the protection of vulnerable adults. This member of staff was not aware of the Department of Health’s document ‘No Secrets’ (this identifies the forms that abuse may take, and informs staff what steps to take if they witness or suspect abuse is taking place), or of the homes whistle blowing policy. This member of staff has been employed at the home for two months. A recommendation was made at the last inspection that all staff receive training in the prevention of abuse, and in light of the observations below, this will now be required. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 16 The home has a policy on the prevention and management of challenging behaviour that makes reference to physical restraint. The care records of one resident showed that physical restraint had recently been used on a number of occasions. It is therefore necessary that a separate restraint policy and procedure be devised that identifies under what circumstances restraint may be used, how this is to be used, and for how long. A separate record should be kept whenever restraint is used to enable staff and other relevant parties to see if this procedure is being used correctly, and whether there is a pattern to this. See Requirement 3 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 27 & 30 The standards of décor and furnishings have been well maintained, providing residents with safe, comfortable and homely surroundings. Whilst the home was clean, attention is needed to aspects of hygiene to reduce the risk of cross infection occurring. EVIDENCE: The communal areas of the home are comfortably furnished, and the residents’ bedrooms have been personalised to reflect their interests and tastes. There is a bathroom and toilet on the first floor and a shower room and toilet on the ground floor. The home was clean and tidy and free from unpleasant smells. The staff at the home prepare the meals for the residents and it was noted whilst the evening meal was being prepared that there was only one chopping board available. To reduce the risk of cross infection occurring there needs to be separate identifiable chopping boards for various food items, e.g. meat, dairy products and vegetables. See Requirement 4 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 There are enough staff on duty to meet the needs of the residents at all times. Recruitment procedures are not thorough enough to ensure that residents are protected. EVIDENCE: Two weeks duty rotas were seen that showed that the agreed staffing levels were being complied with. One of the carers employed at the home has attained an NVQ level 2 in care. A further three care staff had commenced training in this award but the training company providing the training have withdrawn from this. The manager said that he was attempting to find another company that would provide this training, as he was aware of the need for 50 of the care staff to have acquired such a qualification. The personnel files of two staff were examined at this inspection. One of these was of a member of staff who had been in employment for two months, and contained a completed application form, a signed confidentiality statement, and a record of induction. However, there was no evidence of references being obtained for this person or of a Criminal Records Bureau (CRB) or protection of vulnerable adults (pova) check being received at the home. However, the member of staff was able to produce verification that they had received a satisfactory CRB disclosure. The second file was that of a person currently undertaking induction. The file contained one reference only. There was no evidence of a CRB or pova check being received for this person. This was discussed with the Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 19 manager who gave an assurance that this person would not work at the home until all the necessary information had been obtained for them. All of the staff had recently received training in managing challenging behaviour, and first aid in the workplace and safe moving and handling training was arranged for the staff to take place in January 2006. Not all staff have received training regarding the protection of vulnerable adults. See Requirement 3 See Requirement 5 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, & 42 The home is well managed and residents views are taken into account so they have an influence in how the home is run. The practices in the home ensure that that residents are safe and their welfare is promoted. EVIDENCE: The home manager has recently taken up this post, prior to which he had been employed at the home for some time. He is an appropriately trained nurse, and had applied to the commission to become the registered manager of the home. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 21 Records were seen of the fire alarm and emergency lighting systems being tested on a regular basis, and of visual inspections being carried out on the fire extinguishers. Fire safety training was provided for all of the staff in May this year. A fire safety officer from the local brigade visited the home in October 2005 and identified a number of requirements to be actioned in relation to fire safety. A follow up visit was due to take place on 16th December 2005 to see if these requirements had been complied with. The portable electrical appliances at the home had bee tested for safety earlier in the year, and those appliances that failed have been replaced. The accident records showed that there had been one accident sustained by a resident since the last inspection, and that there had been five staff accidents within the same period, four of which were attributed to the behaviour of one of the residents. Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X 3 x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X 3 X X 2 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 2 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Jackson House Nursing Home Score 3 X 2 X Standard No 37 38 39 40 41 42 43 Score 3 X X X X 3 X DS0000018802.V263946.R01.S.doc Version 5.0 Page 23 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 YA6 Regulation 15 Timescale for action Care plans must be developed 23/01/06 for every identified care need to ensure that all residents’ care needs will be met. This requirement remains outstanding. Arrangement s must be made to 23/01/06 ensure that accurate recording and storage of medicines is maintained. All staff employed at the home 23/01/06 must receive appropriate training in the protection of vulnerable adults. Additionally, a policy and procedure on physical restraint needs to be implemented. Appropriate equipment must be 23/01/06 provided for food preparation. An enhanced Criminal Records 23/01/06 Bureau disclosure must be obtained for all staff employed at the home. Additionally, two references must be obtained for all staff employed at the home prior to them taking up such employment. Requirement 2 YA20 13 3 YA23 13 4 5 YA30 YA34 13 19 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 24 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 Jackson House Nursing Home DS0000018802.V263946.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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