Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 27/11/06 for Jaffray Nursing Home

Also see our care home review for Jaffray Nursing Home for more information

This inspection was carried out on 27th November 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 27 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What the care home does well

Jaffray nursing home is a very friendly and welcoming place. Feedback from relatives indicated that they were made welcome by staff and could visit at a time that suited them. During the inspection it was observed that all residents were supported to undertake personal care to a high standard. All were individual in presentation with make up and jewellery where appropriate to reflect their gender, culture and preferences. Residents stated they were happy in the home or appeared relaxed and comfortable. They found the staff friendly and helpful The bungalows that people live in are very well presented and maintained to a goods standard providing a pleasant and safe place for residents to live. All bedrooms are single enhancing residents privacy and are well equipped to meet individual needs. There is a range of equipment for moving and handling residents to ensure their safety. There is also a range of equipment for use to prevent the risk of pressure sores and all areas of the home are accessible to residents whose mobility is restricted. . In all the bungalows there was a good stock of food with a range of fresh vegetables and menus were varied providing residents with a nutritious diet. The majority of requirements made at the last inspection had been addressed. The inspection team could see better how people`s healthcare needs were being met.

What has improved since the last inspection?

The organisation had undertaken a review of the number of staff provided, and has decided to increase the number of staff provided. This is very positive to ensure resident`s needs are better met. Further re-decoration and re-furbishment has been undertaken ensuring the environment is maintained to a good standard and providing a pleasant pace to live.

What the care home could do better:

The admission process needs to be reviewed and staff must ensure a comprehensive assessment is undertaken before all residents are admitted to the home to ensure they are able to meet the residents needs and a comprehensive care plan is drawn up The staff work a long day from 8am until 8pm. There are limited opportunities for residents to go out in the evening and this will need to be kept under review to enhance opportunity to go out in the evenings and develop friendship and confidence, in accordance with ordinary life opportunities for others of a similar age gender and culture. The staff team have undertaken some work towards person centred planning. Some staff were not clear about this process and it will need to be further developed to ensure residents involvement in their planning of care. The care and care records need to be reviewed when there is an incident or someone`s needs change to need are met affectively and a consistent approach to care. Staff retention and staff skill mix need to be reviewed and systems implemented to ensure there is a regular staff team to meet resident`s needs in a consistent manner.

CARE HOME ADULTS 18-65 Jaffray Nursing Home 19 - 31 Jaffray Crescent Erdington Birmingham West Midlands B24 8EG Lead Inspector Ann Farrell Key Unannounced Inspection 27th November 2006 08:30 Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 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 Jaffray Nursing Home DS0000024859.V317924.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 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. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jaffray Nursing Home Address 19 - 31 Jaffray Crescent Erdington Birmingham West Midlands B24 8EG 0121 382 1383 0121 382 9278 jaffraynursinghome@jaffraycare.freeserve.co.uk 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) Jaffray Care Society Post Vacant Care Home 18 Category(ies) of Learning disability (18), Physical disability (18) registration, with number of places Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 18 persons with a learning disability and physical disability. That the home can continue to accommodate four named services who are over 65. That Jaffray Nursing Home apply for variation on behalf of future service users who reach the age of 65. That details regarding how the specific care and social needs of people over the age of 65 will be met must be included in the service users plan. 5th December 2005 Date of last inspection Brief Description of the Service: Jaffray Nursing Home comprises of four bungalows and each bungalow accommodates 4 – 5 people up to a total of 18 people who have a learning disability, physical disability and additional nursing needs. All bungalows are well maintained internally and externally. There is parking to the side of the property plus a pleasant garden with seating to the rear, which can be used by residents when the weather permits. All the bungalows have level access throughout and are fully accessible to people without full mobility. Each bungalow has a dining room and lounge area and one has a conservatory. All bedrooms are single with a wash hand basin and call bell system. There is a separate toilet and bathroom, which are fully adapted and suitable for residents with mobility problems where assistance is required. They also have a range of hoists for residents with mobility problems and pressure relieving equipment for residents who are at risk of developing pressure sores. A copy of the service user guide is available in each bungalow, which provides information about the facilities. The information provided by the home indicates that fees vary depending on residents needs and can range from £318 - £2203 per week. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork inspection was conducted over two days commencing at 8.30 on 27th November 2006. This was the first statutory inspection for 2005/2006 and the manager was available for the duration of the inspection. Prior to the inspection a pre inspection questionnaire was forwarded to the home with comment cards to aid with the inspection process and provide feedback bout the home from a range of individuals. Twelve comment cards were received from relatives, residents and health professionals. The feedback was positive from all groups. Residents stated the staff were friendly and helpful, there was a range of activities to partake in and they always got help and assistance when required. Relatives were satisfied with the care and felt welcomed to the home. The health professionals stated it was a pleasure working with the home. During the inspection process the inspector toured the home, sampled residents files and other documentation. Case tracking was used to determine care for residents from the time of admission to the home plus direct and indirect observation. During the fieldwork the manager, five members of staff, a small group of residents and two visiting professionals were spoken to. The feedback obtained from the visiting professionals was positive and residents stated they were happy with the home. Some residents were unable to communicate verbally and their views could not be obtained. What the service does well: Jaffray nursing home is a very friendly and welcoming place. Feedback from relatives indicated that they were made welcome by staff and could visit at a time that suited them. During the inspection it was observed that all residents were supported to undertake personal care to a high standard. All were individual in presentation with make up and jewellery where appropriate to reflect their gender, culture and preferences. Residents stated they were happy in the home or appeared relaxed and comfortable. They found the staff friendly and helpful The bungalows that people live in are very well presented and maintained to a goods standard providing a pleasant and safe place for residents to live. All bedrooms are single enhancing residents privacy and are well equipped to meet individual needs. There is a range of equipment for moving and handling residents to ensure their safety. There is also a range of equipment for use to prevent the risk of Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 6 pressure sores and all areas of the home are accessible to residents whose mobility is restricted. . In all the bungalows there was a good stock of food with a range of fresh vegetables and menus were varied providing residents with a nutritious diet. The majority of requirements made at the last inspection had been addressed. The inspection team could see better how people’s healthcare needs were being met. What has improved since the last inspection? What they could do better: The admission process needs to be reviewed and staff must ensure a comprehensive assessment is undertaken before all residents are admitted to the home to ensure they are able to meet the residents needs and a comprehensive care plan is drawn up The staff work a long day from 8am until 8pm. There are limited opportunities for residents to go out in the evening and this will need to be kept under review to enhance opportunity to go out in the evenings and develop friendship and confidence, in accordance with ordinary life opportunities for others of a similar age gender and culture. The staff team have undertaken some work towards person centred planning. Some staff were not clear about this process and it will need to be further developed to ensure residents involvement in their planning of care. The care and care records need to be reviewed when there is an incident or someone’s needs change to need are met affectively and a consistent approach to care. Staff retention and staff skill mix need to be reviewed and systems implemented to ensure there is a regular staff team to meet resident’s needs in a consistent manner. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 8 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 Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The information for prospective residents and their representatives is not up to date to provide information about the services and facilities enabling them to make an informed decision before moving into the home. The assessment process prior to moving into the home as not adequate and it cannot be guaranteed that all residents’ needs are identified and met when moving in. EVIDENCE: The home has information available for prospective residents and their representatives to enable them to make an informed decision about moving into the home. A service user guide and statement of purpose was available in each bungalow. On inspection it was noted that they were a combined document and the statement of purpose was in draft format. The service user guide was produced in an alternative format to enable residents to understand it. These documents should be stand-alone documents. The statement of purpose will need developing and any procedures referred to must be included in the document. The service user guide will need to be reviewed in light of the new regulations that came into force in September to ensure residents or their representatives have sufficient information to make an informed choice about moving into the home. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 10 The contract of residents will need to be reviewed and updated and given to all residents or representatives to inform them of the terms and conditions of residency. Also a copy will need to be included in the service user guide and a copy retained on residents files in the home. The home has a stable resident group and one resident has been admitted since the time of the last inspection. On inspection of this residents file it was noted that they had undertaken some short visits to the home and staff had visited them in their previous residence. However, a full assessment had not been undertaken to identify needs and no initial care plan or guidelines had been developed for staff to use following admission to ensure needs are met appropriately. Where there is no assessment it cannot be guaranteed that residents needs will be identified or are met following admission to the home. The home do not currently confirm in writing that they can meet prospective residents needs in order to provide confidence to those moving into the home that there needs can be met. Following admission to the home the National Minimum Standards state there should be a minimum of a three-month settling in period for long-term placements. However, in the above case staff experienced some difficulties with managing the resident and notice was given prior to the three month settling in period. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users needs, wishes and risks are generally well assessed and documented, to ensure their needs are met in the way they prefer. Systems to ensure care documents are reviewed and developed when changes occur must improve to ensure resident’s needs are met in a consistent manner. A more pro-active approach must be taken to unexplained injuries to ensure residents are safeguarded and any actions are taken to minimize the risk of similar incidents occurring. EVIDENCE: Staff develop care plans for all residents in the home, which outlines resident’s needs and the action required by staff to meet their identified needs. On inspection of a small sample of records it was noted that a full assessment, risk assessments and care plan are drawn up. However, it was some three to four months after the admission of a new resident to the home, which means that staff do not have the information required to ensure a consistent approach to Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 12 care and ensure all needs are met during this period when staff know individuals the least. The care plans are kept in resident’s rooms and are weighty documents, but they are not always in a format suitable for residents to understand. Residents need to be central to all plans written about them and to have them in a way they understand and demonstrate their involvement in the process to ensure it is their choice Staff at Jaffray have had some training in Person Centred planning (PCP), which would involve residents in the process of planning their care, but some staff were not sure about the process or what this was so that residents were fully involved in the process and it accords with residents wishes. On inspection of care plans it was stated they use core care plans and they are personalised for individual residents. It was noted that some had not been personalised with specific information e.g. where a resident was at risk of choking it did not indicate the signs that staff needed to observe for. Other areas lacked detail e.g. the size of sling to use when using a hoist to move residents, the size on incontinent pad to use and there were vague instructions such as check regularly, review skin integrity assessments according to risk. In one case a resident had been prescribed three different creams and there was no indication on the care plan where the creams should be used. Also there were no short-term care plans e.g. where a resident had developed a wound there was no care plan to address it. Therefore, it could not be guaranteed that resident’s needs were met in a consistent manner. The care plans were reviewed regularly and there were comments such as reviewed no change. However in one case it was noted that a resident’s mobility had deteriorated and one resident required more assistance with bathing, but care plans had not been updated to reflect changes. In one case it was observed that a residents care plans stated they should have a blended diet and food boosters, but these were not in use and the member of care staff did not have knowledge about this when asked. Therefore, it could not be guaranteed that all needs are met appropriately. All residents have risk assessments to underpin risks they face and are exposed to. These were generally comprehensive, and control measures in place were reflective of the risk assessed. Many had been reviewed regularly, but some had not been reviewed for some time. When the tissue viability risk assessment was reviewed for one resident it was noted to be a low score, but some aspects of their condition had not been included and the result of this may influence the care provided. If staff are not fully conversant with these risk assessments training should be provided to ensure accuracy and appropriate interventions in the future. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 13 The inspector tracked the response of staff to critical incidents such as falls and injuries. In some instances there had been recordings of injuries of unknown origin and records did not indicate that they had not been followed up or investigated. The manager must ensure that all accidents are reviewed and investigations are undertaken where there is any unknown injury or bruising to determine the cause and implement any actions required to prevent re-occurrences where possible. It is recommended that auditing of accidents be undertaken on a monthly basis to determine if there are any similarities and make any changes where required. Feedback indicated that relatives were satisfied with the standards of care provided. Residents appeared content, relaxed and stated they were happy in the home. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 good This judgement has been made using available evidence including a visit to this service. A range of interesting and varied activities is offered with opportunities for personal development to stimulate residents and enhance their lifestyle. Visiting is flexible enabling people to visit at a time that suits them and residents are supported in going out to visit friends/family in order to maintain contact. Residents are offered a nutritious diet that is varied including a range of fresh produce that meets their needs. EVIDENCE: Visiting is flexible enabling people to visit at a time that suits them. Feedback indicated that visitors are made welcome to the home and can meet in private with the residents if they wish. Aspects in respect of activities and stimulation of residents were assessed. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 15 The home has transport available, but currently they do not have adequate drivers to meet all requests from residents for going out. It was stated that currently the ring and ride service or taxis were being used to address the shortfall in part. This being said there is a range of activities both in-house and externally. There is a meeting every week on each of the bungalows for residents to discuss their wishes for the forthcoming week and a member of staff is present. At the last inspection it was suggested that an advocate be present rather than a member of staff to ensure objectivity. The manager stated they had not been able to acquire the services of an advocate. There is a varied range of activities to meet individual preferences and provide stimulation. It was pleasing to see this included opportunity for personal development, such as college courses or day placements, as well as leisure e.g. horse riding, pub meals, shopping, theatre trips, crafts, visits to families etc. Some residents had also been on holiday, week ends away or day trips out. Residents confirmed they were supported to do the things they enjoyed and go out and this was witnessed at the time of inspection. Therapeutic activities including aromatherapy and exercise to music is provided on a regular basis to aid relaxation and enhance well being. The staff work from 8am until 8pm each day. Records did evidence that opportunities to go out in the evening are provided, but they have to be planned well in advance to ensure there are adequate staff available to provide support. This area needs to be kept under review, as there is a lack of flexibility and the shift pattern does not accord with ordinary life opportunities. During the inspection it was noted that some staff were unable to communicate effectively with residents who did not communicate verbally. Other forms of communication were in use and staff training had been arranged in order to provide them with the appropriate knowledge and skills. Staff from each bungalow draw up a three weekly menu based on the residents choices and records of food eaten is recorded demonstrating residents receive a nutritious diet. The food available in all the bungalows was plentiful and varied with a range of fresh fruit and vegetables as recommended for a health diet. It was pleasing to hear of the success of one resident who had been on a healthy eating plan and had lost weight. The home provide blended diets and food boosters where required. The inspector had lunch in one bungalow and observed practices in others. In some cases residents were given a choice prior to serving of the meal, but in another instance staff served the meal on the menu and was told by the resident that they did not want it. Another meal was provided, but it was concerning as another resident may not be able to verbalise their wishes or feel unable to comment at this stage. It should not be assumed that all residents will want what is on the menu and they should be consulted before meals as to what they would like to eat. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 16 Some residents are fed via feeding tubes and this was managed satisfactorily with care plans in place to underpin practice. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Resident’s personal care needs are met to a high standard. Some specific needs tracked need further development to ensure residents health care needs are fully addressed. Medication management needs further development to ensure residents receive the medication as prescribed by the G.P. EVIDENCE: During the inspection it was observed that all residents were supported to undertake personal care to a high standard. All were individual in presentation with make up and jewellery where appropriate to reflect their gender, culture and preferences. All residents are registered with a local G.P. and there is input from other health professionals such as district nurses, dietician, speech and language therapist, specialised community nurses, psychologist, and psychiatrist etc. to ensure health care need are addressed Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 18 The healthcare needs of residents who were case tracked was followed up. All of the files assessed generally contained detailed plans that provided staff with clear guidance on how to meet the detailed needs. Some specific issues were noted and include, • Staff record health care appointments on a matrix. These show most health care appointments are undertaken as required with the exception of chiropody and dentist appointments. These areas need to be addressed to ensure oral and foot care are appropriately addressed. • One residents care plan stated they should be having a blended diet and food boosters, but this was not occurring and puts them at risk of choking. Also the advice given by a psychologist had not been included in the care plan and implemented to ensure appropriate management of residents care. • There was no evidence of regular health checks for chronic diseases in order to maintain stability and prevent complications. • One care plans stated glycerine swabs should be used for mouth care, but these are not advocated now as they can cause drying of the mouth. This should be reviewed. • Records of bowels movements indicated that some residents could go considerable times without having their bowels open. This are will need to be reviewed an appropriate action taken as it may cause ill health. • The speech and language therapist visited one resident to assess swallowing at lunchtime. However, staff had already given the residents their lunch. This appointment had been pre arranged and recorded in the diary. This suggests a lack of communication and impacts on residents receiving the correct professional advise in a timely manner. • The cover of the pressure reduction mattress was damaged on one bed and will need to be replaced and it increases the risk of cross infection. • A hoist is available in each bungalow, but the majority of the slings are of the same size and some were damaged, putting residents at risk of falling if used. There was only evidence of one slide sheet. The manager will need to undertake an audit of manual handling equipment and ensure there is adequate equipment in place to meet the needs of all residents. The home uses a monitored dose medication system and on inspection it was found that the monitored dose system was adequately managed. However, there were some discrepancies in respect of boxed and bottle medication as the audits were not accurate. It therefore could not be guaranteed that all residents received the medication prescribed by the G.P. Other areas that need to be addressed: • Creams had not been dated when opened. They should be dated when opened and discarded after a designated period due to the risk of bacterial infection. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 19 • • • • • • The home did not have some medications available for a number of days and residents did not receive medication that was prescribed by the G.P. Destroyed medication was not stored in a locked cupboard as required for safety reasons. The G.P. had not agreed homely remedies and there was no evidence that the G.P. had been consulted about the use of aromatherapy to ensure there are no contraindications to its use. Some of the protocols for the use of PRN medication need reviewing and updating to ensure all staff have guidelines for the use of the medication. The oxygen was not secured as required for safety reasons and there was no protocol to ensure staff are aware of the use of oxygen. There was no suction equipment available for use in the case of an emergency. The feedback from relatives indicated they were kept informed of resident’s conditions; they are consulted about aspects of care. They were satisfied with the overall care provided. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The home has policies and procedures in respect of complaints and protection from abuse. Some staff are not fully aware of the procedures. Further training will be required to ensure staff are aware of the action to take in the event of an allegation of abuse being made so residents are protected from harm. EVIDENCE: The manager stated she had not received any complaints since the last inspection. The Commission have not received any complaints about the service. Policies and procedures are in place to tell people how to make a complaint, which are displayed on the wall on entering the bungalows. However it was not in a format suitable for all residents to understand. The area of complaints, both formal and informal, was raised with the manager as to how residents with limited verbal communication could let any concerns be known and how they would be recorded. This are will need to be further reviewed. There are policies and procedures in place for the protection of residents in the event of an allegation of abuse. On discussion with staff they were not fully aware of the action to take in the event of an allegation of abuse. Staff training will be required in this area to ensure all residents are adequately protected in the event that an allegation of abuse is made. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,288,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained ensuring a safe place for residents to live. The small bungalows are decorated and furnished to a good standard providing a homely and relaxing environment for residents to live. EVIDENCE: Jaffray Nursing Home bungalows were all very well presented, warm and well maintained. Systems are in place for regular redecoration and refurbishment, which ensures the home remains presented to a high standard. It was stated that this year new flooring, decorating of bedrooms and lounges had been completed. Some new furnishings have been provided and solar tubes have been fitted in corridors to provide some natural light. Plans for next year include replacement of gutters, sofits and facia boards plus replacement of paving slabs to the rear with tarmac to reduce any risk of falls. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 22 Each of the bungalows has a lounge and dining areas, separate kitchen plus toilet and bathing facilities, which are accessible to residents with mobility problems. One of the bungalows also has a conservatory. All bedrooms have a call bell system, lockable facilities, locks to doors, carpet/appropriate flooring, curtains furniture and adequate lighting to meet resident’s needs. They were noted to have been well personalised by residents with sensory equipment in some rooms providing a homely and relaxing environment. Call bells are also available in lounges and kitchens to enable staff or residents to summon assistance in the event of an emergency. There is no call bell in the dining rooms or conservatory, but they are in close proximity of the dinging room and kitchen. The manager will need to undertake a risk assessment to determine if these arrangements are satisfactory. Bedrooms are individually and naturally ventilated and windows are provided with restrainers for safety and security reasons. Radiators are covered and the temperature of water from hot water taps was controlled to reduce the risk of scalding. Kitchens in each bungalow were clean and tidy, all foods were stored correctly. Fridge and freezer temperatures were recorded most days ensuring good food hygiene standards. There is a separate laundry facility on the grounds and this was equipped adequately. It was noted that filter of one tumble dryer required attention, the extractor fans in toilets required cleaning plus some cleaning materials were not locked away after use and the laundry was not locked when unattended putting residents are risk. These areas need to be addressed to ensure adequate safety standards in the home. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff rotas demonstrated adequate numbers of staff on duty but the skill mix of staff was not always appropriate to ensure resident’s needs were met. A range of training is required by staff to ensure the have the appropriate skills and knowledge to care for residents. There is a robust recruitment system in place, which protects residents from harm. . EVIDENCE: The duty rota indicated there was adequate staff on duty with two nurses during the day plus two to three carers on each bungalow. Over night there is one nurse and three care staff ensuring there is one member of staff in each bungalow. During the visit some very positive interactions between staff and residents were noted and residents appeared relaxed and comfortable with staff. The number of staff were adequate, but on the first day of inspection there was a newly employed carer with an agency carer on duty in one bungalow. Although there was a nurse covering that bungalow, it was found that the Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 24 carer lacked knowledge about some of the residents needs and was not able to communicate effectively with some residents as they used makaton or an activities communication board. It is recommended that the skill mix of staff in each bungalow is reviewed and action taken to ensure there is a more senior member of staff on duty who has the appropriate skills and knowledge to care for residents in each bungalow The manager stated they were reviewing the staffing arrangements and were going to have an extra nurse on duty during the day. A small sample of staff files were inspected in respect of the recruitment process, which were found to be generally satisfactory so protecting residents. However, it was noted that the Criminal Records Bureau check for a longstanding member of staff was not available and there was no evidence of nurses PIN number checks available in the home to evidence that their registration was up to date. The manager stated they would be at head office. This information should be available in the home. There has been a large staff turnover recently, which can impact on consistency of care. It is recommended that exit interviews be implemented in order to obtain feedback from staff as to the reason for leaving and determine if any improvements can be made in the working environment. Newly appointed staff stated they undertake induction training and are supernumery for one to two weeks in order that they get to know the home, residents, policies and procedures and have the relevant basic knowledge to care for residents. However, the induction programme knowledge base does not appear to meet the standards of the Social Skills Council. The manager stated she was in the process of reviewing this area to ensure staff have the appropriate knowledge and skills to care for residents. NVQ training is undertaken and the tutor was visiting at the time of inspection. She stated the manager and nurses were supportive and they provided what ever was required. On inspection of records it was noted that less that 50 of staff had completed NVQ training. This will need to be addressed in order to provide staff with the appropriate knowledge and skills to care for residents. There is an ongoing training programme for other aspects such as manual handling, fire prevention, first aid, infection control disability awareness etc. Although some staff had completed or updated areas of their training. There were many who had not received the training and it cannot therefore be guaranteed that staff have the appropriate skills and knowledge to care for residents and their needs are fully met in a consistent manner. Some staff had received specific training and guidelines for managing aspects of the resident’s care following admission to the home as they had been experiencing some problems managing it. Staff stated the training was very good, interesting and it had influenced practice. They were now managing much better and things Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 25 had settled down considerably, so they were more able to meet the resident’s needs in an effective manner. The manager and nurse undertake formal supervision of staff in order to monitor staff progress and training needs etc. and records are retained in the home. On Inspection it was noted that it was undertaken four to six times a year. The manager stated that she was currently reviewing the process to ensure it is more effective Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Team working and communication systems need to be improved to ensure resident’s needs are met in a consistent manner. The health and safety of residents, staff and visitors is well protected by robust systems for servicing and testing of equipment. EVIDENCE: The home has a manager who has completed the Registered Managers Award and is registered with the CSCI. There are regular staff meetings for individual bungalows, nurses meetings plus weekly residents meetings to discuss progress and address any issues. There has been a high turnover of staff recently and give everyone an opportunity to have a say in how the home is run. The home has been utilising agency staff, which has lead to some lack of consistently in some areas. Also issues in relation to a lack of communication were identified during the inspection and minutes of staff meetings confirmed Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 27 issues around problems with communication, low staff moral and teamwork. The manager stated she was aware of some of the issues and the organisation were looking at incentives for staff and were actively recruiting into vacant positions. The manager stated audits are undertaken and policies reviewed in respect of quality assurance. However, there was no evidence in respect of obtaining feedback from all stakeholders or of an annual development plan outlining objectives for residents and service improvement. The area manager undertakes regular visits to the home and writes a report every two months on the conduct of the home following discussion with residents and staff. The regulations require that these reports be written every month and be available to the Commission. The health and safety of residents, staff and visitors is generally very well protected by robust servicing and testing of equipment and fittings. All fire safety tests and routine tests of electrical, gas and lifting equipment had been undertaken. Some issues in respect of the lifting equipment was in the process of being addressed in order to ensure it is safe to use. The maintenance manager stated evidence of testing of mini buses is held at head office. Areas that need to be reviewed are the maintenance of pressure relieving mattresses, wheelchairs and electric beds. In addition, the risk assessments for the environment need developing further and risk assessments in respect of cleaning materials need to be undertaken and staff made aware of them to ensure any risks are identified and minimised. Jaffray Nursing Home DS0000024859.V317924.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 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 Standard No Score 1 2 2 1 3 X 4 1 5 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 1 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 X 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 X 15 3 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 2 X Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 29 YES Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 4 Requirement Timescale for action 30/03/07 2 YA1 5 3 YA2 14 4 YA5 5(1) The registered person must ensure the statement of purpose is a stand-alone document and is fully completed in line with the National Minimum Standards and Regulations. The registered person must 30/03/07 ensure the service user guide is reviewed and updated in line with the new Regulations. The registered person must 30/12/06 ensure: • A comprehensive assessment is undertaken prior to residents moving into the home to determine if they can meet the resident’s needs. • Write to residents or their representatives confirming if they can meet residents needs. Timescale 1/2/06 not met. The registered person must 30/01/07 ensure the contract is reviewed and in line with the new regulations plus: • The fees charged. Rights and responsibilities of both parties. DS0000024859.V317924.R01.S.doc Version 5.2 Jaffray Nursing Home Page 30 5 YA6 15 6 YA6 12(3) 18(1) 7 YA9 12(1) a, b 13 (4) a-c 18(1) 8 YA11 12(1) a-b, (2)(3) Elements of the Care management Care plan to be provided outside of the home Timescale 1/9/05 not met. The registered person must ensure: • A suitable care plans is drawn up when residents are admitted to the home. • All care plans must give specific details as to how resident’s needs are to be met. • The care plan must be updated following any changes in resident’s conditions. • Systems must be in pace to ensure care plans are implemented to meet residents needs in a consistent manner. The registered person must ensure residents are supported to develop and obtain a person centred plan. Staff must receive training and awareness regards this. Timescale 1/6/06 not met. The registered person must ensure all residents risk assessments are reviewed and updated where necessary. Timescale 1/8/05 not met. • Undertake nutritional risk assessments for all residents moving into the home. • Where necessary staff should be provided training in respect of risk assessments. The registered person must ensure communication systems to support residents are in use in the home and staff have the training to provide this. DS0000024859.V317924.R01.S.doc • 30/12/06 28/02/07 30/12/06 30/01/07 Jaffray Nursing Home Version 5.2 Page 31 Timescale 1/2/06 not met. 9 YA19 12(1) The registered person must 30/12/06 ensure nursing care be reviewed to ensure residents health care needs are being fully met. Timescale 1/9/05 not met. To include: • Residents receive the appropriate diet to meet their medical needs. • Advise from health professionals are followed unless there is some reason not to follow it. • Review the use of glycerine swabs for mouth care. • Ensure suitable systems are in place for monitoring residents bowels and appropriate action taken when necessary. • An audit of all mattresses is undertaken and any damaged mattresses are replaced. • An audit of all manual handling equipment is undertaken and ensure there is sufficient equipment in the home to meet residents needs. The registered person must 30/01/07 ensure residents are supported to receive treatment from chiropody and dental services as required. Timescale 1/9/05 not met. • Regular checks are undertaken in respect of chronic diseases. 30/12/06 The registered person must ensure: • All medication is administered and recorded accurately. • Systems are in place so that there is a supply of medication at all times. DS0000024859.V317924.R01.S.doc Version 5.2 Page 32 10 YA19 13(1)(b) 11 YA20 13(2) Jaffray Nursing Home 12 YA23 13(6) 13 YA24 13(4c) 23(2a-b) 14 YA30 23(2)(d) 15 YA30 13(4) 16 YA32 18(1) 17 YA34 17(2) Creams are dated when opened and discarded at specifies times. • Homely remedies and the use of aromatherapy are agreed by G.P.s and a record of this is retained in the home. • PRN protocols are reviewed and updated where necessary. • Oxygen is secured safely and a protocol is in use for is use. • Destroyed medication is stored in a locked cupboard. The registered person must ensure all staff are provided with training in respect of prevention of abuse and the action to take in the event of an allegation. The registered person must ensure the uneven paving slabs in the garden be levelled to reduce the risk of residents and staff tripping. Timescale 1/10/05not met. The registered person must ensure: • The tumble dryer filter is cleaned regularly. • The extractor fans are cleaned. The registered person must ensure: • The laundry door is kept locked when not attended by a member of staff. • Cleaning materials etc are stored in a locked cupboard when not in use. The registered person must review the skill mix of staff in bungalows and ensure they have adequate skills and knowledge to care for the residents The registered person must DS0000024859.V317924.R01.S.doc • 30/01/07 30/03/07 30/12/06 30/12/06 15/12/06 20/12/06 Page 33 Jaffray Nursing Home Version 5.2 18 YA35 13(3) 17(2) 19 YA35 16(2)(j) 17(2) 20 YA35 23(4) 17(2) ensure there is evidence of CRB and PIN checks for all staff in the home The registered person must 28/02/07 ensure all staff undertake training in respect of infection control and records are retained in the home. The registered person must 30/01/07 ensure all staff undertake training in respect of basic food hygiene and records are retained in the home. The registered person must 30/12/06 ensure all staff undertake training in respect of fire prevention and fire drills at least twice a year and records are retained in the home. The registered person must ensure all staff undertake training in respect of moving and handling and records are retained in the home. The registered person must ensure all staff undertake training in respect of first aid and there is at least one first aider on each shift and records are retained in the home. The registered person must ensure staff supervision is undertaken with all staff, at least six times each year. Timescale 1/2/06 not met. The registered person must review the arrangements for communication and team working addressing any issues The registered person must ensure a quality assurance process is implemented to include feedback from stakeholders and an annual development plan drawn up indicating outcomes for residents. DS0000024859.V317924.R01.S.doc 21 YA35 13(5) 17(2) 30/01/07 22 YA35 13(4) 17(2) 30/03/07 23 YA36 18(2) 28/02/07 24 YA37 10(1) 12(1) 24 30/12/06 25 YA39 30/03/07 Jaffray Nursing Home Version 5.2 Page 34 26 YA39 26 27 YA42 13(4) 17(2) The responsible individual must ensure a report is written each month following visits and forwarded to the Commission. The registered person must ensure: • All wheelchairs are serviced on a regular basis and records retained in the home. • Risk assessments are reviewed and further developed to cover all areas in the home especially in relation water temperatures and take appropriate action. • Risk assessments are undertaken in respect of cleaning fluids. 30/12/06 30/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2. Refer to Standard YA4 YA6 Good Practice Recommendations The home must review the arrangements for the settling in period in line with the National Minimum Standards. It is recommended that residents care documents be presented to them in a way they find accessible. (Carried forward) It is recommended the opportunity for service users to undertake activities in the evenings be kept under review. (Carried forward) It is recommended that the provision of an independent advocate be explored. (Carried forward) It is recommended that ways of supporting service users with limited verbal communication skills to make choices regarding the choice of meals be developed. (Carried forward) DS0000024859.V317924.R01.S.doc Version 5.2 Page 35 3 4 5 YA12 YA16 YA17 Jaffray Nursing Home 6 7 8 YA22 YA34 YA42 It is recommended that areas be explored to support residents is raising concerns if they wish. It is recommended that exit interviews be held with all staff who terminate their employment. It is recommended that the tissue viability nurse be contacted regarding the servicing of pressure relieving mattresses and electric beds. Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Jaffray Nursing Home DS0000024859.V317924.R01.S.doc Version 5.2 Page 37 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!