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Inspection on 10/07/05 for Jansondean Nursing Home

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

This inspection was carried out on 10th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

Residents felt that the care provided was good and one commented that the food was excellent. Staff appeared willing and co-operative both with the residents and the inspector.

What has improved since the last inspection?

The home has a permanent manager who has been in post since late 2003. Prior to this the home had had a temporary manager whilst ongoing recruitment took place. The staff felt that the manager had brought leadership and guidance to the home and was beneficial with the devising of care plans.

What the care home could do better:

Staff in the home must continue to maintain all areas as hazard free and homely as possible. Staff must have an increased awareness of health and safety in a home within this difficult lay-out.

CARE HOMES FOR OLDER PEOPLE Jansondean Nursing Home 56 Oakwood Avenue Beckenham Kent BR3 6PJ Lead Inspector Rosemary Blenkinsopp Unannounced 10 July 2005 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. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Jansondean Nursing Home Address 56 Oakwood Avenue, Beckenham, Kent BR3 6PJ 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) 020 8659 7810 020 8325 8008 Sage Care Homes Limited Mr David Walters Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Staffing notice issued 28/4/97 - Imposed 1/4/02. One service user who is known to CSCI may be under the age of 65 years - Imposed 19/5/04 Date of last inspection 18/1/05 Brief Description of the Service: The home is a detached house in a residential area of Beckenham. The house has been extended and adapted to provide accomodation for up to 32 residents in the catagory of frail elderly requiring nursing care. Communal areas with garden access are located on lower ground floor level. The laundry is also sited on the lower ground floor. Bedroom accomodation is located on the other two floors. Single and double bedrooms are provided in this home. Not all bedrooms have en suite facilities although a wash hand basin is provided in every bedroom. There is lift access to all floors, although this is slow and in terms of staff, time consuming. The layout of building is confusing and not ideally suited to providing care to residents, however efforts have been made to provide a home-like environment and personalise individual bedrooms. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted as an unannounced inspection Sunday morning at 09.45 am, over a period of two and three quarter hours. The inspector met with some of the staff on duty .Two residents were spoken to at length whilst others briefly. The premises were inspected including some bedrooms, communal areas, kitchen and laundry. A selection of records were inspected although there were some records which were requested but not available. Some of those records inspected, namely care plans and medication charts, needed to be further developed to provide comprehensive information. There were two qualified staff on duty, one of whom facilitated the inspection as she had been in post for several years. Staff in the home were generally pleasant and co-operative. What the service does well: What has improved since the last inspection? What they could do better: Staff in the home must continue to maintain all areas as hazard free and homely as possible. Staff must have an increased awareness of health and safety in a home within this difficult lay-out. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 6 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. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 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 Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 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) EVIDENCE: No standards were assessed in this section. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 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. Health and personal care needs are adequately addressed although the home should look at an holistic, individual approach to care . EVIDENCE: The care plans of three residents were inspected of those identified during the tour of the home. Care plans contained activities of daily living assessments, which included information relating to the residents’ cognitive state and mental health. Residents’ photographs were on the records. Care plans reflected physical heath needs and little on social, spiritual or leisure needs. In some cases the action to address the problems was limited in content. Daily records were also limited in content and bore limited relevance to identified needs. Supporting risk assessments were in place to address nutrition and skin integrity. Reviews were recorded although these were generally conducted monthly, even when risk or a high risk was identified. One care plan stated that the nutrition assessment had been reviewed February 2005. It was identified in the review that the resident was assessed as at very high risk. This should prompt staff to seek dietetic advice and introduce further monitoring in respect of intake, increased calorie intake and frequent checks Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 10 on weight. There was no evidence that these had been addressed . Please see requirement 1. The medication fridge temperatures were recorded. The medication charts were inspected, which contained photographs of the residents. The medication administration charts are not a standard size and the covers which they were stored in, not an appropriate size. This made the file untidy and charts could be easily mislaid or damaged. The individual charts were not fully completed with relevant information including allergies. In some cases hand transcriptions had been entered onto the chart. The information was incomplete with no quantity recorded. One medication was not being administered even though this is prescribed as a regular medication, and not “As required “. Medication must be administered as prescribed by the GP and if this is not the case then the staff should review this with the resident, GP and relatives. Please see requirement 2. Please see recommendation 1. On the lower ground floor, on the dining room table, there was a list of residents and a “toileting chart” which detailed the use of incontinence pads and other personal information. There was also a bath list located in the office indicating the residents “ bath/ shower day “. These practices and recording methods are reflective of institutional practice and not in line with current practice. Please see requirement 3. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 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. The social activities are limited and built around the routines of the home. The menu is not always adhered to, and the availability of some foods limits residents’ choices. EVIDENCE: The majority of residents were in their own bedrooms. One gentleman said although he was satisfied with food and care provided, his newspaper was often delayed. Some residents were sat in front of their own TVs but were sleepy. On inspecting the communal lounge at 10.30 a.m. this was empty. The inspector was advised that residents stay in their bedrooms until it has been cleaned, then they are brought down. This did happen later that morning when staff brought the residents to the lounge. Fluids were seen in residents’ rooms and communal areas. The kitchen was inspected. There were two staff working, one a weekend cook. The dishwasher was out of order. It was hot day, and the lunch was being prepared. The lunch was roast lamb with vegetables and potatoes. The menu indicated that salads were an alternative, however there were no salad ingredients available. This is unsatisfactory, particularly in summer. In addition, there was no fresh fruit available. There was a pack of yoghurts, brought in for a resident, which had expired 30 June 2005. In the fridges there was a joint of meat, a container of prunes and some cooked meat all were covered but not dated. In a separate Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 12 container were four pieces of cheese, three were only partly covered none had a date. In the lounge a box of Forticreme had expired. Please see requirements 4 and 5. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 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) EVIDENCE: No standards were assessed in this section. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 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) 19,20,21,22,23,24,25,26. The home has ongoing maintenance and refurbishment but the layout of the accommodation is unsuitable for use as a care home and restrictions prevent any improvement to this. EVIDENCE: A tour of the home was undertaken. The front exterior of the building was pleasant with flower tubs. Access to all floors is via the lift, which is slow. On the lower ground floor, there is a lounge area with a dining table at one end. Adjacent to the lounge is the laundry. There is an area in the lounge, which is screened off ,this is used as storage. There is limited storage space in the home and this was evident. The ground floor bathroom was cluttered with items of equipment, two pedal bins etc. This was also the case in Bedroom 1, which was also cluttered, and with this amount of items, could pose a hazard to residents. There was a strong smell on the ground floor; this was present on an intermittent basis, although it permeated throughout the ground floor. This, the inspector was advised, was due to one resident who suffers from colitis. The staff must manage this and eradicate the smell to maintain the home Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 15 odour free for the welfare of all residents in the home. Please see requirement 6. Some bedrooms were personalised with ornaments, photographs and pieces of furniture. Redecoration of some areas, including individual bedrooms had been addressed. Generally it was noted that in bedrooms, call bell leads were not in reach for residents to use. This was rectified on the ground floor once the inspector pointed this out. An oxygen cylinder was located in one bedroom, whilst in another there was a portable fan, which was in use. Risk assessments must be in place for all items, which may pose a risk to residents. Some corridors had badly marked walls particularly on the lower ground floor level. Please see requirement 7. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 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 Staff are employed in sufficient numbers to meet the needs of residents. EVIDENCE: During the inspection two qualified staff and six care assistants were on duty. This is in line with the agreed staffing notice. Ancillary staff comprised of two cooks, one cleaner and one laundry person. Staff were pleasant and helpful throughout the inspection. Staff members confirmed that the staffing levels are maintained and ancillary staff employed as needed. One staff commented that the availability of training had improved with more courses on offer. In the office there were several notices regarding forthcoming study days. Staff confirmed supervision both by direct contact with the manager and through formal sessions. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 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) 38 The inspector was not provided with sufficient records on which to confirm that health and safety issues were addressed. EVIDENCE: The inspector had limited access to records including those for health and safety. The fire records detailed weekly fire alarm testing although gaps of longer than one week were evident i.e. 8/12/04 –19/1/05, 11/5/05-23/5/05. Fire alarm testing must be conducted weekly. Fire drills had been conducted 12/2/04 then 17/3/05. Staff must be proficient in dealing with all health and safety issues, particularly fire, and more fire training needs to be conducted. All day staff must have fire training twice a year whilst night staff receive this four times a year. All staff should sign for receipt of all training. Please see requirement 8. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 18 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION 2 2 2 2 2 2 2 2 STAFFING Standard No Score 27 3 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x 2 Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 7 Regulation 15 Requirement The Registerd Manager must ensure that robust care plans are in place, reflective of needs and appropriate actions taken to address the problem. Previous time frame for action 31/3/05 The Registered Manager must ensure that medication systems are robust both in record keeping and administration. Previous time frame for action 28/2/05 The Registered Manager must ensure that the privacy, dignity and individuality of residents are maintained at all times. Previous time frame for action 28/2/05 The Registered Manager must ensure that the procedures and practices in kitchen are in line with basic food hygiene . All foodstuffs must be covered and dated. Previous time frame for action 28/2/05 The Registered Manager must ensure that all food stuffs are in date and supplied in sufficient amounts to ensure choice for residents. The Registered Manager must ensure that the home is G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Timescale for action 30/9/05 2. 9 13 30/7/05 3. 10 12 30/9/05 4. 15 16 30/7/05 5. 15 16 30/7/05 6. 26 16 30/7/05 Page 20 Jansondean Nursing Home Version 1.40 maintained oudour free 7. 22 16 The Registered Manager must 30/7/05 ensure all items in the home which may impact on residents care are risk assessed including portable fans and oxygen. The Registered Manager must 30/8/05 ensure that all records required for inspection are available.All health and safety measures must be addressed. Previous time frame for action 31/3/05 8. 38 17 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 9 Good Practice Recommendations The Registered Manager should ensure that two staff sign for all medication which is hand transcribed. Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Jansondean Nursing Home G51-G01 S10138 Jansondean V237334 10.07.05 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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