CARE HOMES FOR OLDER PEOPLE
Jah Jireh 72-76 Main Street Ellenborough Maryport Cumbria CA15 7DX Lead Inspector
Nancy Saich Unannounced 16 September 2005 10:00 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 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 F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Jah Jireh Address 72-76 Main Street Ellenborough Maryport Cumbria CA15 7DX 01900 816943 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Miss Joanna Hindmoor Care Home 15 Category(ies) of OP - Old Age registration, with number DE(E) - Dementia, over 65 of places PD - Physical Disability Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 1 named service user in the category of (PD) (physical disability) who is under sixty-five years of age may be accommodated within the overall number of registered places. Date of last inspection 14 February 2005 Brief Description of the Service: Jah-Jireh is an older property that has been adapted and extended to take up to fifteen older people, some of whom may be suffering from dementia. One named younger person also lives in the home. The home is owned by the Hindmoor family and Ms Joanna Hindmoor is the registered person. The home is affiliated to the wider network of Jah-Jireh homes and only take residents (and staff) who are Jehovahs Witnesses. Further information is available on Jah-Jireh homes by going to their website www.jah-jireh.org/homes.htm. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted by Nancy Saich that started around 10 a.m and lasted for approximately six hours. The inspector met with all of the residents either in the dining room or lounge or privately in their rooms. She also met visitors to the home including a health care professional. She spoke with the registered person and the staff team. She toured the building, shared a meal with residents and saw relevant documents that backed up what was said and what she observed. What the service does well:
This home is good at ensuring that they only admit new residents who will fit in with the rest of the group and who they can care for properly. The home is good at providing the kind of health and personal care that lets older people live as independently as possible and maintains their dignity and privacy. There was spoken evidence to show that the home give people at the end of their lives the right kind of physical, spiritual, emotional and practical care. Residents said they had plenty of opportunity to join in with the local congregation and maintain their links with the wider church network. Some residents make a major contribution to the work of ministry in the church and most of the residents continue to have friendships within the wider community. The home is very good at providing nutritious, home-grown and home cooked food that helps residents to be as healthy as possible. The home has good procedures in place to allow residents to raise concerns and to be as safe as possible both in the home and within the wider community. The home was warm, safe, well decorated and tastefully furnished and provides a relaxing home for the residents. Everyone was comfortable and happy in both his and her own rooms and in the communal areas. The home is suitably staffed by carers who had received good levels of training in all the core skills that are important for residents’ well-being. Residents were positive about the staff. One person said they “…treat people with tremendous patience…the patience of a saint really…”. The management systems in the home were operating fairly well and staff were aware of their roles within these systems. This meant that the home was being run for the benefit of the residents and the outcomes for them were, in their opinion, very satisfactory. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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 F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 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 standard(s) 3 The home is good at only admitting new people who will fit into the existing residents’ group and who they can care for properly. EVIDENCE: The inspector spoke to residents who had been admitted since the last inspection. They had been given the opportunity to learn about the home and visit before they decided to make Jah Jireh their home. They were happy with the way the provider found out about their needs before they made this decision. The residents’ files confirmed that they had been seen by members of the management team before admission and had also seen social workers or health care professionals as necessary. The home is very specific about only taking people who are Jehovah’s Witnesses and this is declared in their brochure and meets with the wishes of people who live in the home. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 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 standard(s) 7,8,9,10,11 The good levels of health and personal care provided in the home allow residents to be well cared for and support their right to dignity, privacy and independence. EVIDENCE: The residents were aware of their written plans of care and some people had written their own plan detailing how their care was to be carried out. The inspector met with residents and asked them their needs and then saw that the plans did cover all of their expressed needs and hopes. The manager has plans to continue to improve these written documents and this will be looked at during the next inspection. The inspector spoke to residents and to a visiting health care provider about how health care was managed. Their responses were very positive and showed that the nurse or doctor visited on a regular basis and that residents were taken out to appointments. People with dementia have regular visits from a member of the mental health team. Medication kept on behalf of residents was checked and found to be ordered, administered and disposed of appropriately. A number of people managed their own medication and this was being monitored correctly by staff.
Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 10 The residents said that the staff treated them respectfully and allowed them privacy and independence. The inspector saw a number of appropriate and sensitive interactions between staff and residents. People also spoke about the excellent care that had been given to someone who died in the home and felt that this was very important as residents felt they wanted to end their days in the care of the staff group who were supporting them so well in life. This person said the resident “wasn’t left to go through it alone for even five minutes…”. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 11 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 standard(s) 12,13,14,15 Residents in the home were happy with the levels of choice offered to them and felt that they made their own decisions about how they spent their time. EVIDENCE: Residents choose to come to this home because it is part of the wider community of Jehovah’s Witnesses. They said they prefer to live with and be cared for by “our brothers and sisters…” and there was lots of evidence to show that their lifestyle is very much like that of other members of the congregation. Residents enjoy going to the Kingdom Hall and join in with the work of the congregation. Residents study independently and together as a group. Residents said they went out with friends and felt they were part of their wider community. Some people go out to shop independently and all the residents go out to the local hairdresser. The residents said they were content with the religious study and activities that the home afforded them. A number of residents have their own computers and enjoy pursuing their own hobbies. There were no activities organised by staff as residents managed their own interests. The staff agreed that they might try to look at some activities for residents who need support due to their frailty and it was recommended that some activities are offered in the home. Residents were happy with the choices they had in their lives and felt that they were kept well informed and included in everything that went on in the home.
Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 12 The residents all looked very well and they put this down to good care and to the “excellent food we get here…”. The inspector took lunch with the residents and looked at food stored in the home. There was evidence to show that the home uses good quality (sometimes home-grown) produce and that the standard of cooking is high. The residents felt they were given the best of everything and no expense was spared. Everyone ate very well at lunchtime and were used to having several choices at every meal. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 13 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 standard(s) 16,18 There were good arrangements in place to allow residents concerns to be acted upon and to keep them safe from harm. EVIDENCE: Residents said they would discuss any concerns with the management team or would go to someone in the church to discuss any problems. Residents could access outside agencies and said they would do this but preferred to have things dealt with within their own community. Residents said that they felt supported and protected by being in the home and that staff treated them appropriately and that frailer people were protected from harm by the staff team. There were good policies and procedures available to residents and visitors. Staff had received training on these issues and were confident about how to deal with any problems. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 14 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 standard(s) 19,26 Residents live in a pleasant and comfortable environment where they can feel relaxed and safe. EVIDENCE: The home was warm, clean and comfortable on the day of the inspection. The home is currently undergoing the second part of an improvement programme that is now nearly complete. This will provide a new kitchen and laundry and two further bedrooms. The building work was progressing well and the residents said that it had been done with minimum disruption due to the way staff had worked during this time. Residents were happy with all aspects of the environment. They liked the close proximity of the Kingdom Hall, the pleasant garden and the access to local facilities. Everyone was content with their own rooms and were relaxed in the lounge and dining room. They had asked for new furniture for the dining room and this was on order. The home was clean in all areas and the residents said it was always kept to a high standard and that staff did their laundry to their satisfaction. Staff were
Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 15 aware of how to prevent cross infection and said they had plenty of equipment to help with this. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 This home is suitably staffed by people who have the appropriate skills and attributes to care for vulnerable older people. EVIDENCE: The inspector saw the rosters for the four weeks prior to the inspection. There were two or three staff on shift during the day and two people at night. Residents thought these levels were more than adequate and said that the provider and her parents were in the home almost every day and they worked with the staff. Two new staff had been recruited since the last inspection and these recruitments had been done with due attention to checking that they were the right kind of people to care for older people who need sensitive care. The manager had a good training programme that meant that all of the staff were involved in training sessions that would ensure they had training in all the core skills and knowledge they needed to do their job. Residents thought that the staff were well trained and brought their training back to the home. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35,38 The home is well managed in general but there was one omission in the procedures for fire safety that must be dealt with. EVIDENCE: Joanna Hindmoore is the registered person and she is assisted in the management of the home by her parents and a deputy manager. They are very much a ‘hands-on’ management team and this was evident in the easy and informal way that staff looked for leadership from their manager. The home has a simple quality assurance system that runs through out the year. The residents said they were asked their opinion all the time. The manager was preparing to do the annual questionnaires for residents and other people involved in the home. She agreed to send the quality report to the inspector. The residents said that they looked after their own finances or had family members or solicitors to help them with this. The manager said she wasn’t looking after money for any resident.
Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 18 The home was hazard free on the day and there was plenty of things seen around the home that made the inspector feel that good health and safety practices were the norm in the home. There was, however one area where the registered person had not recorded a routine safety measure. The two new staff had not received two sessions on fire safety instruction during their first month of employment. It is important that these two staff feel really confident about how they must react if there were to be a fire in the home. A requirement was made about updating their instruction for the safety of the residents and the rest of the staff team. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4
COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 x 3 x 3 x x 2 Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 20 NA 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 38 Regulation 23 (4) Requirement The registered person must ensure that all new staff have two fire instructions during the first month of their employment. Timescale for action 31st October 2005 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. Refer to Standard 12 Good Practice Recommendations it is recommended that the registered person introduce some creative or leisure activities into the home that are not based on the spiritual needs of the residents. Jah Jireh F58 F10 s22593 jah jireh v234435 160905 ui stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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