CARE HOMES FOR OLDER PEOPLE
Jalna Care Home 285b Manchester Road Burnley Lancashire BB11 4HL Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 10:00 3 & 11th July 2007
rd 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 Jalna Care Home DS0000054471.V338605.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 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. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Jalna Care Home Address 285b Manchester Road Burnley Lancashire BB11 4HL 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) 01282 431182 01282 416119 www.jalna.co.uk Botany House Limited Mrs Margaret Simpson Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home is registered to provide personal care for to up to 22 people in the category Old age, not falling within any other - OP. 18th October 2006 Date of last inspection Brief Description of the Service: Jalna is registered to accommodate 22 older people over the age of 65 who require help with personal care. The home is a semi-detached Victorian property, with surrounding gardens and paved areas. There are 18 single bedrooms, 10 with en-suite toilets and 2 shared bedrooms, 1 with en-suite toilet. Various adaptations to assist with self-help and mobility are provided. The upper floors are accessed by a chair lift. There is a large lounge/dining room with adjoining conservatory, a separate dining area and a small quiet/visitors lounge area. The residents have access to the paved area to the front of the home, with garden furniture being provided. There is car parking space available at the front of the building. Jalna is approximately 1 mile from Burnley town centre and is on a bus route. There are some shops, public houses, churches and a post office quite close to the home. A local park is within reasonable walking distance. Various activities are available including mini bus trips. Jalna is a non-smoking residence. At the time of this inspection visit the range of fees was £332 to £386. Additional charges are payable for hairdressing and personal newspapers. A statement of purpose and service user guide was available to prospective residents and their relatives on request. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Jalna on the 3rd and 11th July 2007. No additional visits have been made since the last inspection. Five completed surveys were received from residents, two from the relatives of residents and two from GP’s of residents. At the time of this inspection 20 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and one visitor were spoken to. Discussions also took place with the manager and proprietor regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
Residents or their relatives were involved in care planning. One resident said, “I sign my care plan every month.” A visitor said she had been involved in reviewing her mother’s care every six months. Care workers responsible for giving out medication have received appropriate training.
Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 6 The registered manager has achieved the NVQ level 4 ‘Registered manager’s Award’. What they could do better:
Failure to address the requirement about care planning made at the last inspection is of serious concern. Action must be taken to ensure all care plans clearly identify and address the care needs of each resident. In order to ensure care workers have up to date information about the needs of each resident care plans should be reviewed monthly. It is also good practice to date and sign all care plans. To promote the safety of residents risk assessments must be carried out for the use of bed rails. It is important that medication is managed safely. This includes keeping a record of all medication received into the home. Urgent action must be taken to ensure residents are protected from abuse. The procedure for safeguarding vulnerable adults must be amended to clearly state the action to take if allegations of abuse are made. A requirement about this issue remains outstanding from the last inspection. All members of staff must be given training in safeguarding vulnerable adults. It is of serious concern that recruitment practices are not thorough in order to protect residents from abuse. Two written references and a POVA/CRB check must be obtained before any new employees start working at the home. Induction training should be further developed in order to meet the ‘Skills for Care’ standard. An annual development plan to help monitor the quality of the service and further improve outcomes for residents should be developed. It is essential that all members of staff understand how to promote the health and safety of residents in the event of a fire. Training in fire safety must be provided. There must be at least one first aid trained person in the home at all times, to make sure that appropriate treatment is given if there is an accident or medical emergency. Jalna Care Home DS0000054471.V338605.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. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 8 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 Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough admissions procedure ensured sufficient information was obtained in order to identify the needs of each resident. EVIDENCE: The individual records of two residents were inspected. Each contained a detailed pre-admission assessment. A senior member of staff and a key worker visited prospective residents in hospital or their own home prior to admission. These assessments provided important information for the care plans. Prospective residents or their relatives received confirmation in writing that their needs could be met at the home. Standard 6 is not applicable to this service.
Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Deficiencies in care planning means the needs of all residents are not identified and met. Medication was managed safely. EVIDENCE: The individual care plans of two residents were inspected. These plans did not identify and address all the care needs of each resident. One of these residents suffered from dementia but the care plan did not give her psychological needs were to be met. Acute care needs had been identified for one resident following a visit from the GP. However, a care plan explaining how these acute needs were to be met and monitored was not in place. Risk assessments about nutrition, falls and the development of pressure sores were not in place on the first day of the inspection. However, these had been completed by the second day of the inspection.
Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 11 A risk assessment for the safe use of bed rails for one resident had not been carried out. A written report about the care given to individual residents was completed during each shift. Care plans were not signed or dated on the day they were written. Not all care plans were reviewed monthly. Residents or their relatives were involved in care planning. One resident said she signed her care plan every month. Residents were registered with a GP and had access to other healthcare professionals. Medication was stored correctly and administered by appropriately trained care workers. Records for the management of medication were seen. However, a record of the medication received for one resident had not been kept. Handwritten instructions on the medication administration record for one resident were not signed or witnessed. Controlled drugs were stored securely and a stock check was satisfactory. Personal care was carried out in the privacy of the resident’s own room or the bathroom. Two members of staff explained in detail how she promoted privacy and dignity for all residents. One resident said, “The staff are excellent.” Another resident said, “I’m very happy here.” Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s decisions were respected and they were supported by care workers to have a fulfilling lifestyle. EVIDENCE: Residents were encouraged and supported to pursue their own interests and hobbies. Members of staff were responsible for organising a range of leisure activities. These included bingo, ball games, dominoes, skittles, praise and worship, art and craft and manicures. An outside entertainer visited the home every two weeks. Trips out were also arranged. A selection of large print books was delivered regularly from the library. Special occasions including birthdays were celebrated. Fund raising events for the local hospice were also held. Visitors were welcomed into the home at anytime and offered refreshments or a meal. One relative regularly stayed for lunch. One resident said, “Visitors are made welcome. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 13 Residents were encouraged to make decisions about their lifestyle and daily routine. One resident said, “I go to bed and get up when I want.” Residents were encouraged to personalise their rooms with photographs, ornaments etc. The meal served at lunchtime on the first day of the inspection was wholesome and appetising. The menus were varied and offered choice. Lunchtime was unhurried allowing residents time to chat and enjoy their meal. All the residents asked said the meals were good. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents felt able to express their concerns. Some care workers had not been given the training necessary to ensure they understood the principles of safeguarding of vulnerable adults. EVIDENCE: A copy of the complaints procedure was displayed in the home and included in the service user guide. One complaint has been made to the manager since the last inspection. Detailed records of the complaint and the investigation were seen. One resident said she would tell the manager if she was unhappy about something. Policies and procedures relating to the safeguarding of vulnerable adults were in place. However, the procedure needed amending to clearly state the action to be taken if allegations of abuse are made. This issue was discussed with four care workers they all said they would report any concerns. However, three of these care workers had not received any training in safeguarding vulnerable adults. A recently appointed care worker said safeguarding was not included in the induction programme. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises were well maintained and provided a comfortable and ‘homely’ environment for the residents. EVIDENCE: At the time of the inspection the home was clean, tidy, free from offensive odour and well maintained. At the time of the inspection a new stair lift was being installed. This will provide easier access from the ground floor to the second floor. All domestic staff have completed NVQ level 1 in housekeeping. The gardens were attractive and well kept. Two residents said they liked to sit outside when the weather was nice.
Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 16 A plan of routine maintenance and improvements to the home was seen. Laundry facilities were appropriate for the size of the home. An infection control policy was in place. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Members of staff were encouraged to acquire the skills and knowledge needed to provide effective care for the residents. Lack of thorough recruitment practices put residents at risk. EVIDENCE: Examination of the duty rota confirmed that staffing levels were appropriate to meet the assessed needs of the residents. The files of four members of staff appointed since the last inspection were examined. Three of these files indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. However, the other file indicated that the care worker had started working at the home before a CRB or POVA check and two written references had been obtained. It was evident from discussion with members of staff and the manager that NVQ training for care workers was actively encouraged. Nine care workers had an NVQ level 2 and one had NVQ level 3 (62 ). In addition to this a further three members of staff were working towards NVQ level 2 and two to level 3. Although induction training was in place the manager was advised this required further development in order to meet the ‘Skills for Care’ standard.
Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a competent manager. The views of residents are considered when decisions about the care and facilities provided at the home are made. EVIDENCE: The registered manager has recently completed the NVQ level 4 ‘Registered Manager’s award’. The registered manager intends to enrol on a ‘key trainers’ course for moving and handling. This will enable her to train care workers at the home in moving and handling. The home has achieved the nationally accredited Investors in People award. This award was successfully reassessed in February 2007. Satisfaction questionnaires are given out to residents annually. The relatives of residents are informed so they can assist in completing these questionnaires if
Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 19 necessary. These are then evaluated by management and areas for improvement identified. Relatives were encouraged to give feedback about the care and services provided at any time. The manager and proprietor said they had an ‘open door’ policy. An annual development plan to help monitor the quality of the service and further improve outcomes for residents was not available. Records of transactions involving resident’s money were seen to up to date. Policies and procedures for safe working practices were in place. Fire alarms and emergency lighting were tested regularly. Fire drills took place monthly and a staff attendance record was kept. Two care workers who had worked at the home for sometime said they had not received training in fire safety. Records of the routine servicing of equipment were seen. These included an up to date gas safety certificate and evidence that the testing of small electrical appliances had taken place in February 2007. Although an up to date electrical installation certificate was not available arrangements were made during the inspection for the necessary checks to be carried out. Only two of the care workers were qualified to administer first aid. One care worker involved in food preparation said she did not have the basic food hygiene certificate. The manager explained that arrangements had been made for all care workers to attend training in first aid, health and safety, basic food hygiene and infection control before the end of November. Records maintained in the kitchen included fridge, freezer and food temperatures. A record of the food served to individual residents was available. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 20 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 2 Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15(1) Requirement To ensure the care needs of all residents are met. Care plans must accurately identify and address the care needs of each resident. Timescale of 31/03/06 and 31/12/06 not met. To promote the safety of residents risk assessments must be carried out for the use of bed rails. To ensure medication is managed safely a record of all medication received into the home must be kept. The procedure for safeguarding vulnerable adults must be amended to clearly state the action to take if allegations of abuse are made. Timescale of 08/12/06 not met. To ensure all residents are protected from abuse and all members of staff know what to do if allegations of abuse are made All members of staff must have training in safeguarding vulnerable adults. Timescale for action 31/08/07 2 OP8 13(4)(c) 31/08/07 3 OP9 13(2) 27/07/07 4 OP18 13(6) 31/08/07 5 OP18 13(6) 28/09/07 Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 22 6 OP29 19(1)(b) Schedule 2 7 OP38 23(4)(d) 8 OP38 13(4) In order to safeguard residents from abuse two written references and a POVA/CRB check must be obtained before new employees start working at the home. To ensure all members of staff understand how to promote the health and safety of residents training in fire safety must be provided. There must be at least one first aid trained person in the home at all times, to make sure that appropriate treatment is given if there is an accident or medical emergency. 27/07/07 28/09/07 28/09/07 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 3 4 5 Refer to Standard OP7 OP7 OP9 OP30 OP33 Good Practice Recommendations All care plans should be signed and dated. To ensure staff have the information necessary in order to meet the needs of all residents care plans should be reviewed monthly. All hand written instructions on the medication administration records should be signed and witnessed. Induction training should meet the ‘Skills for Care’ standard. An annual development plan to help monitor the quality of the service and further improve outcomes for residents should be developed. Jalna Care Home DS0000054471.V338605.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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