CARE HOMES FOR OLDER PEOPLE
Jah-Jireh 7 Beechfield Court Leyland Lancashire PR5 2WA Lead Inspector
Pauline Randles Unannounced Inspection 16th February 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Jah-Jireh DS0000005936.V283303.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. Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Jah-Jireh Address 7 Beechfield Court Leyland Lancashire PR5 2WA 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) 01772 623710 Jah Jireh (Charity) Homes Mr Russell Charles Baker Care Home 36 Category(ies) of Old age, not falling within any other category registration, with number (36) of places Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th December 2005 Brief Description of the Service: Jah-Jireh is situated in a residential area in Leyland, close to local shops and facilities. The home provides 24-hour personal care for up to 36 older people. Jah-Jireh homes have been established and are run wholly and solely to give accommodation and care to members of the community of Jehovah’s Witnesses. The home provides accommodation throughout two floors in both single and shared rooms, and the majority have an en-suite facility. The communal areas are situated on the ground floors. The home has a passenger lift. The grounds to the house are extensive, and private for the residents to enjoy. Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a four-hour period. There were thirty-five residents living at the care home at this time. During the course of the inspection the managers’ assistants, three staff, one visitor and twelve residents were spoken to, of which four were case tracked. In addition policies, procedures and records were examined and three bedrooms viewed. Mr Baker registered manager was unwell at this time and therefore not available at the time of the inspection visit. What the service does well: What has improved since the last inspection?
Although only a brief period had elapsed since the previous inspection the requirements and recommendation made at that time had been addressed. Some work was still in progress and some outcomes had been achieved. In particular, records relating to consultation about activities had been developed and food temperature recording had been reintroduced. Evidence of compliance with the Water Supply (Water Fittings) Regulations 1999 had been located and, as recommended, supervision topics had been extended to meet all elements of the standard. Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 7 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 Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 8 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): 2 The contract issued to new residents clearly stated the terms and conditions of residency and ensured clarity of the agreement being entered into. EVIDENCE: Examination of a contract recently drawn up for a new resident evidenced that the terms and conditions were clearly stated and included identification of the room to be occupied, fees chargeable, a description of services provided and the rights and obligations of both parties. Residents spoken to confirmed that their initial service expectations had been met. One resident said as soon as she put her foot over the threshold she thought, “This is home.” Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 9 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): 8 and 10 Health needs of residents were well met and their dignity and privacy respected. EVIDENCE: As evidenced at the previous inspection the health needs of residents were effectively met with detailed records maintained. Files indicated that in depth assessments were undertaken for each resident. As previously recommended it was suggested that, wherever practicable, risk assessments should be signed by residents to confirm their agreement to any risk control measures that were introduced. Staff members were observed to treat residents with courtesy and respect. In discussion with staff the approach they undertook to promote privacy and respect was discussed. These methods included dignified personal care support and knocking on doors before entry. One resident explained that she needed to rest during an afternoon for health reasons and that arrangements had been made for her to not be disturbed at those times whilst another resident said, “I’m really coddled, happier here than I could be anywhere else in the world.”
Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 10 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, 14 and 15 The procedures relating to activities and outings adequately evidenced that consultation had taken place, that the resulting arrangements were resident led and that residents were enabled to exercise choice and control A wholesome diet was provided that aided appetite and nutrition. EVIDENCE: As required following the previous inspection the record of activities had been extended to demonstrate that consultation was taking place and that residents, who participated, were consulted about their satisfaction with particular events. One resident spoken to said, “We are invited to comment on everything from food to entertainment” and went on to say, “There are exercises and other activities during an afternoon, I tend to rest then, but can join in if I want.” Residents confirmed that they were enabled to exercise choice and control in regard to meal and bed times. It was observed that residents were asked about choice of meal and provided with a range of alternatives. More than one resident referred to the underlying philosophy of the home to “Promote independence” and one of the residents spoken to said,“ This is your home and they want you to enjoy it.”
Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 11 There was written evidence that trustees of the service visited the home and provided support for residents in the form of “an interchange of encouragement.” Also in some cases family members provided advocacy and support. There was however no evidence of the availability of independent advocacy services and it was therefore recommended that this be made available as an alternative for residents to access should they so wish. Once again the quality of meals was highly praised by residents. It was observed at lunchtime that residents were enjoying a hot snack followed by fruit and a range of homemade cakes. A hot meal was provided in the evening and snacks and refreshment at intervals throughout the day. The dining area had a pleasant ambience. Assistance and encouragement was given to residents as required. As previously recommended food items will be pureed separately for any resident, to maintain attractiveness and appeal of the meal, for those who take a softer diet. Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 12 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 The procedures for dealing with complaints ensured that residents were confident that any concerns raised were effectively addressed. EVIDENCE: Complaints were logged individually as a grievance or concern. The record illustrated that concerns raised had been fully and timely investigated with responses and outcomes recorded. Residents were confident that they could raise issues with their key worker or directly with any member of the management team. One resident commented my “ key worker is a treasure, most helpful.” Whilst others said, “No complaints,” and “Not a grumble.” Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 13 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): 24 and 26 The premises were suitably fitted, furnished and hygienically maintained providing a safe and homely environment for residents. EVIDENCE: Three residents were spoken to in their bedrooms. It was observed in each bedroom visited that the room had been personalised with photographs and ornaments from home. Rooms were well maintained with good standards of décor and furnishings. All doors were fitted with suitable locks to enhance privacy and security. A relative of two of the residents visiting at the time of the inspection confirmed that her grandparents were settled at Jah Jireh and that the environment was satisfactory to their individual needs. The premises continued to be hygienically maintained and were welcoming and odour free. Confirmation that the premises complied with the Water Supply (Water Fittings) Regulations 1999 had been located, as recommended following the previous inspection, and was available for examination at this time.
Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 14 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 and 29 The availability of staff and the skills mix ensured that the needs of residents were well met. Records of Criminal Records Bureau clearances were not sufficiently adequate to confirm that all staff members had been satisfactorily cleared and suitable for employment at the care home. EVIDENCE: Staffing rotas indicated that the home continued to comply with the staffing regulations of the previous regulatory authority whilst taking into account changing dependency needs of residents. There were sufficient staff members on duty at the time of inspection. There were no current vacancies with some bank staff availability to cover duties as and when required. Discussion with staff and sight of training records demonstrated that staff members have a range of skills and a commitment to continuing development. As noted at the previous inspection, recruitment practices were detailed and complied with standard requirements. Since the earlier inspection evidence of Criminal Records Bureau clearance had been obtained from the head office of the home. However, according to the written record, there were still two clearances outstanding. Both managers’ assistants had knowledge of these two clearances and confirmed they had been obtained but could not evidence this at the time of inspection. It was required that confirmation be provided to the Commission when obtained.
Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 15 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 and 37 The home was well managed and promoted the interests of the residents ensuring their best interests were served. EVIDENCE: The registered manager has had extensive experience of managing residential care services for older people, holds a National Vocational Qualification Level 4 in Care and recently completed the Registered Managers’ Award. In addition the registered manager had undertaken periodic training that had recently included Fire Safety. From discussion with the managers’ assistants it was apparent that individual management responsibilities and lines of accountability were clearly defined and there was evidence of continuing training and development needs being met. Residents confirmed that managers were approachable and one resident commented in regard to one of the management team that they were “firm but fair,” in their dealings with staff members.
Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 16 Quality assurance was assessed through frequent consultation with residents by the means of meetings and anonymous surveys that were analysed and feedback provided from head office. The home also holds the Investors in People award. A detailed business plan was available for examination that evidenced that findings from consultation had been reflected in service development plans. Financial affairs of residents were dealt with through head office in conjunction with residents and their families. The only personal money of residents handled by the home was the weekly allowance paid out to individuals. This money was distributed weekly for out of pocket expenses with records kept. However the resident themselves had not always signed to receipt the money. On occasions staff members had signed on behalf of the resident. It was recommended, to ensure safe handling of money, that this practice cease and wherever practicable residents to sign. Supervision systems had improved since the previous inspection. Measures had been put in place to ensure that the elements as outlined in the standard were addressed at each supervision meeting so that any matters of relevance arising could be discussed at suitable intervals. Records continued to be maintained in good order and were clearly and concisely completed. Food temperature records had been reintroduced as previously recommended. Some progress had been made in development of kitchen cleaning schedules although these had not yet been implemented. It was recommended that the schedules be implemented as soon as possible to ensure suitable cleaning processes are in place and adhered to. Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 17 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 X 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X 3 X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 2 X Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 18 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 OP29 Timescale for action 19(b)(1) Evidence of completed Criminal 15/03/06 Sch(2) (7) Records Bureau checks for all staff must be available for inspection at the care home. 17 (2) Records relating to kitchen 15/03/06 cleaning must be effectively maintained. Regulation Requirement 3. OP35 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. Refer to Standard OP8 OP14 OP35 Good Practice Recommendations Wherever practicable, risk assessments should be signed by the service user or their representative. Information relating to independent advocacy services should be made available to residents. Residents should sign to receipt acceptance of money paid to them weekly. Jah-Jireh DS0000005936.V283303.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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