CARE HOMES FOR OLDER PEOPLE
Jane Campbell House Waverley Road St. Albans Hertfordshire AL3 5ST Lead Inspector
Alison Jessop Unannounced Inspection 5th October 2005 10:00 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 Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Jane Campbell House Address Waverley Road St. Albans Hertfordshire AL3 5ST 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) 01727 858 130 01727 799 964 Quantum Care Limited Amanda Neville-Patterson Care Home 54 Category(ies) of Dementia - over 65 years of age (54), Old age, registration, with number not falling within any other category (54), of places Physical disability over 65 years of age (54) Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 3rd March 2005 Brief Description of the Service: Jane Campbell House is a care home providing personal care and accommodation for 54 older people. It is one of a number of homes owned by Quantum Care Ltd. The home offers single room accommodation on each of three floors; there is a passenger lift. Just over 50 of the rooms are below 10 square metres and are limited in layout because of built in wardrobe units. The bathrooms and toilets are appropriately situated throughout the home and fitted with appropriate aids. The home has well-maintained and accessible gardens. Jane Campbell House is set in its own grounds on a fairly steep road, in a quiet residential area of St Albans, to the north of the city and close to the City Hospital. A small parade of local shops is close by the foot of the hill. The bus stop for the local bus service to the City Centre is just outside the home Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over one day by two Regulatory Inspectors. Time was spent talking to service users, staff and visitors, feedback gained was positive. The atmosphere in the home on the day of the inspection was relaxed and a range of activities were observed on each floor throughout the day, which service users appear to be enjoying. What the service does well: What has improved since the last inspection?
The manager and staff more have done a lot of work to improve care plans and risk assessments, there is however more work to do in this area. Service users weight is monitored and is now being recorded on individual files. The hairdressing room has been moved and a specialist hair-washing basin has been fitted which is more comfortable for service users. Some pictures of rooms have been put onto doors to assist people who have dementia to identify where they are going. Also a large map has been displayed on the wall with labels to locate where people originated.
Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 6 Two of the kitchenettes have undergone complete refurbishment and the new beech units offer a bright spacious area for staff to prepare light snacks and drinks. 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. Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 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 Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 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): None of these standards were assessed on this occasion. EVIDENCE: Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 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): 7, 8,9 & 10 Care practice observed was sensitive and dignified; carers spoke to service users respectfully, offering encouragement in an appropriate manner. EVIDENCE: A lot of work has been done recently to update and review care plans and risk assessments. Service users weight and any visits from the GP are now being recorded on individual files. More work is required to ensure that vital information is recorded on the care plan, risk assessments and MAR sheets. An example of this was one service users care plan stated ‘allergic to Aspirin’. This had not however been recorded on his risk assessment or on his Medication front sheet. Other examples of this kind were observed on other service users files and information was not consistent with what had been recorded. Medication procedures were generally satisfactory however there were an alarming number of gaps on MAR sheets. Discussions with staff indicated that the medication had in fact been administered but had not been recorded and staff spoken to did not appear to be aware of the consequences of this error. PRN medication administered had also been recorded incorrectly. Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 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): 12,13,14 & 15 A varied programme of activities ensures that service users receive appropriate stimulation. EVIDENCE: On the day of the inspection there were a variety of activities taking place. This included floor games, chair exercises and music. Activities that service users have participated are recorded on each individual service users file. A relaxation room is available which has a massage chair, aromatherapy oils and soothing music. On the day of the inspection several visitors were observed in the home. One visitor said that she visits the home regularly and has no concerns about her friends care. She also felt able to talk to staff if she needed to. A care plan of a service user from an ethnic minority background was observed and did not contain much information about how their cultural needs could be met. The manager stated that they have done some work to improve the service for those from minority groups however more is to be done in the future. Meals are served in a central dining room. The room is large accommodating all 54 service users. Food is served from a hot plate to the tables and a rota is
Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 11 in place which is changed on a daily basis which ensures that the same service users don’t get served last every day. Food looked appetising and feedback about the food was mainly positive. One service user said that there’s not enough flexibility in the menu and stated ‘I’d really like a bacon sandwich with ketchup, we don’t get bacon sandwich’s we can only have what’s on the menu.’ The manager stated that cooked breakfast has been introduced, it was agreed that this needs to be promoted, as some service users were not aware that it was available. One service user said that she did not want to go to the dining room for lunch, as she does not like waiting for long periods of time after to be escorted by staff back to the lounge. Several service users were observed sitting by the lift after lunch waiting to be taken back to their own floor. Staff were at this time observed in a team meeting. Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 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): 16,17 & 18 No complaints have been received since the last inspection. There is a comprehensive complaints procedure in place and is readily available. EVIDENCE: The home has built good relationships with a local advocacy service. The advocate from Age Concern visits the service users regularly and meetings are held. A copy of the Hertfordshire Protection of Vulnerable Adults is available in the manager’s office and staff spoken to confirmed that they are aware of the whistle blowing procedure. Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 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): 19,20, 21, 22, 23, 24, 25 & 26. Service users bedrooms contain personal possessions creating a homely, familiar environment to service users. EVIDENCE: Many areas of the home have been redecorated and offer a pleasant and bright atmosphere. The ground floor lounge and hallway is in need of redecoration and the kitchenette on the main floor needs replacing as the work surface is worn and cupboards in a general state of disrepair. The programme of redecoration continues to progress and the manager was aware of the need for continual improvements. The home looked clean and tidy and no malodours were detected. One clinical waste bin had no lid and used gloves had been disposed of in an open waste paper basket. The hairdressing room has been moved and a new specialist hair-washing basin has been fitted to make this more comfortable for service users.
Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 14 One of the tumble dryers in the laundry is out of order and has been for some time. Staff said that this has caused them to have to work longer hours, as the washing is not getting dried. Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 15 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 & 30 A comprehensive induction period ensures that staff have sufficient knowledge to be able to undertake their role. EVIDENCE: The manager stated that there has been difficulties in recruiting, therefore a recruitment agency has been utilised to recruit new staff. Feedback about this was good and a high calibre of applicants had been recommended. The staff training programme continues and feedback about training was positive. One member of staff said ‘the induction is very good, Quantum Care are very proactive with training.’ Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 16 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, 32, 33, 37 & 38 The manager who has been in post for a year has done a lot of work to improve the environment; this has boosted the morale of the service users and staff within the home. EVIDENCE: Residents meetings are held once a month on each floor and are organised by the Care Team Manager. The manager of the home has an active involvement in gaining feedback and working towards improvement. Water temperatures tested in one bedroom exceeded recommended levels and a risk assessment in relation to this is required. The fire hose unit was being used to store hoist slings, which would obstruct access to the hose. A requirement has been made for this to be cleared and slings to be stored appropriately.
Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 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 X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 3 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X X 2 Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 18 Are there any outstanding requirements from the last inspection? No 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 13(4)(b) & (c) Requirement The manager must ensure that important information is easily identifiable. Risk Assessments must be updated to reflect any changes to the care plan. Correct procedures must be followed for administration and recording of medication. An Immediate requirement was made during the inspection. The broken tumble drier in the laundry must be repaired and/or replaced. The work surface and broken units in the ground floor kitchenette must be replaced. Clinical waste units must have lids to prevent the spread of infection and ensure the environment is free from offensive odours A risk assessment must be submitted to CSCI for hot water temperatures that exceed recommended levels of 43°C. All fire equipment must be accessible and fire equipment storage areas must not be used for other purposes.
DS0000019438.V256047.R01.S.doc Timescale for action 31/10/05 2 OP9 13(2) 05/10/05 3 4 4 OP19 OP19 OP26 23 (2)(c) 23(2)(b) 13(3) 30/11/05 05/04/06 30/11/05 5 OP38 13(4)(a)& (c) 23(4)(c) (i) 31/10/05 6 OP38 31/10/05 Jane Campbell House Version 5.0 Page 19 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 4 12 Good Practice Recommendations The needs and preferences of service users from ethnic minority backgrounds should be understood and as far as possible met. Service users who require assistance should be able to return to their preferential location within reasonable timescales. Jane Campbell House DS0000019438.V256047.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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