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Inspection on 13/09/07 for Jansondean Nursing Home

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

This inspection was carried out on 13th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

The home has retained a stable senior staff team over the last few years and has little in the way of staff retention issues. This is essential in maintaining continuity and consistency of care. The Manager has worked hard to ensure that the staff team are working collaboratively and are competent in their roles. Staff were helpful and friendly throughout the site visits and this was confirmed by relatives and residents.The Manger has engaged external outside bodies for the benefit of residents including voluntary organisations. Staff training has improved with mandatory training occurring at regular intervals.

What has improved since the last inspection?

Since the last inspection there has been a reduction in occupancy to facilitate refurbishment and improvement in individual bedroom areas. Those bedrooms, which have been addressed, have improved both in terms of space and presentation. Ten new beds had been ordered and the handy man was erecting these for use. The new beds were said to be comfortable. New furniture was also in some bedrooms to replace the existing older style items. The foundations for the new conservatory were being dug, once this is fully completed this will provide better communal accommodation for residents. There are plans to re-site the kitchen onto the lower ground floor with better storage provision. The appointment of a new administrator has been beneficial. Those records, which were required, were easily accessible and maintained in an orderly manner.

What the care home could do better:

It was evident that the assessment of residents is not being fully addressed There were gaps evident in those care plans selected for case tracking. Essential information such as manual handling assessments had not been completed. The Manager must ensure that all staff have an understanding of, and a working knowledge in adult protection issues, this may require additional training in the matter. The kitchen area was in parts in need of deep cleaning particularly behind the work surfaces. The morning of the first site visit there was little in the way of activities taking place the TV was continually playing with little else. The Manager stated that organised activities are planned for every afternoon with the morning reliant on staff engaging with residents for individual activities. Recruitment procedures need to be tightened up to ensure staff are suitably and safely recruited.

CARE HOMES FOR OLDER PEOPLE Jansondean Nursing Home 56 Oakwood Avenue Beckenham Kent BR3 6PJ Lead Inspector Miss Rosemary Blenkinsopp Key Unannounced Inspection 10:30 13 and 28 th September 2007 th 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 Jansondean Nursing Home DS0000010138.V343300.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. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jansondean Nursing Home Address 56 Oakwood Avenue Beckenham Kent BR3 6PJ 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) 020 8650 7810 020 8325 8008 jansondean@btinternet.com 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 DS0000010138.V343300.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 28 April 1997 Date of last inspection 27th July 2006 Brief Description of the Service: Jansondean is a large, detached, older building, situated in a pleasant residential area of Beckenham. It is near to local facilities and shops, and is close to a main road, bus routes and train stations. The Providers (Sage Care Homes), have several other homes for the care of older people at different locations around the country. Accommodation is provided on 4 floors (lower ground, ground, first and second), and a passenger lift facilitates access to all floors. A new build extension was completed at the rear of the property about 12 years ago, and this incorporates a lounge/dining room on the lower ground floor, which leads out into a large garden; this is mostly laid to lawn, and has mature trees and shrubs. The home is currently underway extending the lower ground floor to provide more communal space for residents. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The home was inspected unannounced on the first site visit and by appointment on the second site visit by two inspectors. The home is currently operating with only 25 beds as double bedrooms are now used for single occupancy. At the time of the first site visit there were 23 residents on site. Prior to the first site visit the home had completed the AQAA and this provided good information to facilitate the inspection process. During the first site visit the inspection was facilitated by the two qualified staff, the Manager was on annual leave. Both of these staff were helpful during the visit. The inspector spent time during this visit observing practice routines and interactions. The inspector spoke to any relatives who were visiting, residents and interviewed staff. A tour of the building was undertaken, the kitchen inspected and the laundry. Individual bedrooms and communal areas were included in the first site visit. Five residents questionnaires and feedback from two Care Managers was received. Positive information regarding the running of the home and the staff was relayed in these comments. During the second site visit the staff personnel files; the health and safety as well as quality assurance systems were inspected. The Manager was present for this visit and feedback was provided to him. The inspectors felt that on the information provided, that resident’s health care needs were well addressed and engagement with the multi disciplinary team to ensure all care was addressed was good. There needs to be comprehensive records of all aspects of residents care provided. Other areas were identified which need to be actioned particularly in respect of records and documentation. What the service does well: The home has retained a stable senior staff team over the last few years and has little in the way of staff retention issues. This is essential in maintaining continuity and consistency of care. The Manager has worked hard to ensure that the staff team are working collaboratively and are competent in their roles. Staff were helpful and friendly throughout the site visits and this was confirmed by relatives and residents. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 6 The Manger has engaged external outside bodies for the benefit of residents including voluntary organisations. Staff training has improved with mandatory training occurring at regular intervals. What has improved since the last inspection? What they could do better: It was evident that the assessment of residents is not being fully addressed There were gaps evident in those care plans selected for case tracking. Essential information such as manual handling assessments had not been completed. The Manager must ensure that all staff have an understanding of, and a working knowledge in adult protection issues, this may require additional training in the matter. The kitchen area was in parts in need of deep cleaning particularly behind the work surfaces. The morning of the first site visit there was little in the way of activities taking place the TV was continually playing with little else. The Manager stated that organised activities are planned for every afternoon with the morning reliant on staff engaging with residents for individual activities. Recruitment procedures need to be tightened up to ensure staff are suitably and safely recruited. Jansondean Nursing Home DS0000010138.V343300.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. Jansondean Nursing Home DS0000010138.V343300.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 Jansondean Nursing Home DS0000010138.V343300.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was evidence that residents are subject to assessment procedures and supporting information obtained from the multi disciplinary team , although this was not fully complete. Without comprehensive information it is difficult to address the care needs or ensure that all needs can be met within the home. EVIDENCE: The inspector selected two care plans including assessment records, to case track of those residents who had been recently admitted. Within the first file there was a pre admission assessment dated 20/8/07, which was reasonably well completed although the information for the reason for the admission was limited. Also in this first care plan on the form headed “Jansondean residents assessments “, there were many areas which were incomplete .On checking this with the staff on duty they stated that this would be completed on admission or within a couple of days. Those areas, which Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 10 were incomplete, included the headings skin, appointee, medical report, personal cleansing, eating and drinking, eliminating, personal history, hearing, vision, dentures, orientation and communication. Some of the information appeared to contradict itself .For example on the assessment form it stated “ Bronco problems”, yet under the “assessment of activities of daily living”, the section headed breathing it stated “no problems”. There was a fax from Enfield Council who were the placing authority. This had information contained within it which was not fully included in those assessment documents used in the home. The Enfield assessment stated that the resident was deaf in his right ear yet the Jansondean assessment stated “can communicate well” with no reference to hearing impairment . Other assessment information received via a letter from the GP stated severe arthritis and anxious at night, yet neither of these were included in the home’s assessment. The second file inspected was that of a resident who had been admitted 8/8/07. There was an admission enquiry form and a pre assessment form, which was reasonably well completed. On the assessment form, again it had areas, which were incomplete. On the assessment form it was indicted that this resident had problems relating to glaucoma, diabetes, pulmonary oedema and right-sided weakness. As with the first file, there were areas, which were incomplete. This form was also without the date or staff signature. There was information from Bromley hospital and a Social Services care plan. The Occupational Therapist had completed an assessment 3/7/07, the report was included. There was a diabetic monitoring chart as well as a community discharge transfer letter. The staff on duty advised the inspector that new admissions telephoned the home and were sent out information, then would view the home by appointment. They had no knowledge of introductory visits or of what other information was provided prior to admission. Within the AQAA document it stated that prospective resident were provided with relevant information including the Statement of Purpose and Service User Guide and introductory visits were available. The information also stated that a named nurse is allocated on admission to ensure consistent care is provided. Please see requirement 1. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There were care plans in place to address the needs of residents although not fully comprehensive or with sufficient supporting risk assessments to address their full care needs. Medications are managed safely although more attention to record keeping needs to take place. EVIDENCE: The inspector followed the two care plans of recently admitted residents to continue to case track. In the first care plan the resident had been admitted 27 August 2007. This resident’s assessment information is referred to in the previous section. The assessment information provided an overview of the resident’s health and it seemed to include a number of physical and some mental health needs. In this file there was a waterlow assessment, which was scored at 9 dated 27 /8/07. The bedrail assessment was on a standard form, incomplete without a date or staff signature. The manual handing assessment was blank even though this gentleman had a history of severe arthritis nor was there reference to his use of a zimmer frame. The dependence assessment Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 12 sheet was blank. It was noted that in this home there appeared to be a large number of dependent residents, and this form would have provided further information, which may have indicated the need to increase staff. The care plan of this resident was set out in standard pre prepared formats, which if used, need to be tailored to meet the individual needs with the specific care identified, that they require. There were three areas identified as follows: preparation for placement, personal hygiene and hard of hearing. The inspector was unable to locate the weight of this resident which should be recorded to identify weight loss/ gain and for manual handling and waterlow assessments. More areas should have been covered by the care plans to reflect that information obtained through the assessment process. There were three entries in relation to GP visits and one from the Optician. The second care plan was that of a resident admitted 8/8/07.This file contained a manual handling assessment with the weight record. There was a” risk of falls” assessment which was dated and signed with a review date of 10/9/07, although no evidence was available to say it had been reviewed. There was a waterlow assessment indicating very high risk dated 10/8/07 although the review date was omitted. The dependency and the monthly observations chart were completed. This residents nutrition risk indicated “at risk”, when evaluated 8/8/07 yet no further review had been conducted. There was a hospital letter regarding anticoagulant treatment. There was a standard care plan in place for this resident, and this included items relating to glaucoma, diabetes and incontinence. This resident also had a pressure sore. There was information and a wound care chart for this. This indicated that the resident had intermittent pain, which needs to be dealt with effectively. His bedroom was inspected. The resident was nursed on a pressure-relieving mattress and positional change charts were in use. Hi calorie drinks were available in the bedroom. A TV was in this bedroom but the resident’ was actually positioned facing the wall facing away form the TV, and it was unclear if the resident was awake. More thought should have been given when staff are positioning the resident, so if he wished to, he could see the TV. Alternative stimulation, if the resident was awake, could also have been explored. In several bedrooms cot sides were in use with padding applied. A standard cot side risk assessment is in operation within the home. In this file there was information relating to one GP visit and one Optician visit. Some of the residents demonstrated significant levels of confusion. Whilst interviewing one resident she replied by saying “ yes it is nice here we come Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 13 every year for the kids they do plain food for the kids”. The home should ensure that when confused resident are in the home staff are competent to deal with this and efforts to reduce it are explored. The inspector selected the weight charts of some of the resident she had met during the tour. In one file the weight had gone from 81.7kilos to 86.3 kilos in a period of less than one month although there was no reference to increased monitoring, referral to the multi disciplinary team, the GP, or changes to dietary intake. Other weight charts indicated weights were stable with no significant gain or loss. The inspector was advised that no residents required fluid balance charts. From the AQAA it was stated that the Manager had attended a seminar and met with the co-ordinator responsible for implementation of the Gold Standards Framework and the Adult Palliative Care Guidance Book was now available in the Managers office for staff. Nurses and carers have attended courses at local hospices and the current nursing staff includes experienced nurses with hospice and community backgrounds. The medications were inspected with a qualified staff member .The clinical room was clean and tidy. The home had no controlled drugs in use during the first site visit. The fridge temperature records were completed daily. The eye drops were dated on opening. There was a list of staff signatures of those who administer medications. Medications disposed of have two staff signatures to confirm the disposal. Those medications, which are prescribed, “as required”, had the maximum dose included, reason for administration and an information sheet outlining the medication. One resident was self medicating her inhalers. She had been observed undertaking the procedure and was safe to do so. With any residents who are self medicating a risk assessment should be undertaken to ensure that they are competent and compliant with the procedures. This should be kept under close monitoring and reviewed at intervals. On the” Medication Administration Records “(MAR) charts, there were some medications not administered and without sufficient explanation. The code “ O” had been recorded – which on one chart was stated as non-administration due to soft stool. This had been recorded for 9 days, if this was the case the GP should have been informed. There is space on the reverse of the charts to clearly state the reason although on those charts inspected this was not used. On some of the records where a variable dose had been indicated it was unclear what amount had been given, this needs to be clearly recorded. Please see requirement 2. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 14 Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities are available within the home, and the Manager has investigated external bodies to address individual’s preferences. Some staff remain focused on providing physical care and in some cases psychological aspects of care had limited input. EVIDENCE: Many of the residents were in bed during the first site visit, due to their medical conditions. Other residents were seated in there bedrooms and this remained the position until about 11.30am, when six residents were brought in to the lounge area. One staff member was in this vicinity during the morning. Those residents who were in their bedrooms had fluids at hand and those who were able to use them, their call bells. In two bedrooms the TV’s had poor reception namely bedrooms 3 and 19,these kept fading and crackling. This was very distracting when the inspector was trying to talk to the resident, and as residents themselves were not able to get up to re tune the TV, staff should be alerted and have acted upon this. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 16 Without exception residents and relatives provided good feedback regarding the home and the staff who worked in it. One resident, someone the inspector had met in another facility, was chatty and in the main positive about her stay. One comment, which she did relay to the inspector, was that she would like more freedom to use a phone as currently calls come through the office line. Alternative communication links should be explored such as her own phone line or a mobile phone. The inspector did note that a number of clothing articles were marked with black marker pen either with the residents name or the bedroom number this does not look very good an does not promote dignity for the resident. The TV was on throughout the day in the lounge and during the lunchtime meal. Two residents would have not been able to fully see the TV if they had wanted to due to the position of their chairs. One staff was seen to serve a residents meal although was not engaging with the residents and at times watching the TV. There should be consideration given to whether it is appropriate to have the TV on during meals, as this can be a distraction to eating. Visitors were seen to come and go throughout the inspection without restriction. They were welcomed and offered a drink by staff. There is a programme of activities in the home, but it is not structured, residents decide what they would like to do from a variety of activities displayed in the lounge. In the communal areas there were numerous CDs of age approprite artistes and a DVD player was available. The following information was extracted from the AQAA: “Four members of staff have had training in leisure activities for older people; we are members of the National Association of Activities for Older People (NAPA). There is a monthly external entertainer and other artistes, including an exmember of the Black and White Minstrels who visits the home. A local gentleman also appears approximately every month with a selection of music which covers the period from the music hall to the 60s. He will play anything requested from his library of thousands of songs. During the Christmas period an in-house pantomime is arranged and the relatives and their families are invited,following the show;a buffet is provided. It is an ideal opportunity for relatives to meet each other. We have very good relationships with local clergy of all denominations and they visit when requested. This has been of crucial importance for our Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 17 terminally ill residents and in fact the local vicar who supported one resident was asked to conduct her funeral service. Lay visitors provide Communion for those requesting it on a weekly basis. One resident was assisted by the Soldiers, Sailors and Air Force Association (SSAFA) after the Manager contacted them to visit her. Another resident was sent a catalogue by Royal National Institute for the Blind (RNIB) at the Managers request. A new menu was introduced last year and sent to the nutritionalist at our Grocery Supplier; she suggested more oily fish and adjustments were made, otherwise she was happy to approve it. The Manager met with the residents on 8 February 2007 to discuss the menus and following that meeting some dishes appear more frequently (eg liver and bacon, lamb chops) and some things are no longer provided. The chef provides meals that are well presented and can provide an alternative to the two choices available at lunch; the printed menus reflect this. Some residents requested a cooked breakfast and this is always provided. Theraputic diets have been catered for and a resident who had Coeliacs Disease was able to have appropriate meals. Lists of products suitable are available. The sandwich fillings for the supper menu have been changed and a greater variety of more appertising fillings are available”. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information on how to make a complaint is available and issued to all residents. The information includes external avenues to refer complaints to. Staff have received training on adult protection issues although their knowledge of the subject was limited and would not afford residents with sufficient protection. EVIDENCE: The complaints procedure was on display in the hall and incorporated in to a number of information brochures. The complaints procedure is also on display in bedrooms. The home retains a complaints register, which provided details of the complaint, copies of correspondence and the outcome. This should actually specify whether the complainant is satisfied with the outcome. There were four complaints recorded for the year to date, which had been investigated by the home. The register of complaints detailed relatively minor concerns and it was felt to reflect an honest picture. The home is currently undertaking an investigation received from the London Ambulance Service via the CSCI. The inspector met with a number of staff to talk about adult protection procedures, this included the two qualified staff on duty. The two qualified Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 19 nurses demonstrated a reasonable knowledge in relation to adult protection procedures although less in respect of external reporting of such matters. There was available in the office the Social Services safeguarding leaflet. Staff with whom the inspector met were not wholly familiar with how or whom to contact in Social Services nor were they able to locate a contact number. The care staff were quite vague on what action to take and nor did they refer it on. They were concerned for the resident’s welfare although did not state they would record it. This was in spite of POVA training received by staff in 2006. The Manager is a trainer on abuse and all staff are issued with a Bromley Adult Protection booklet. The two qualified and one care staff understood the term whistle blowing and its implications. There were gaps identified in the CRB checks made on prospective staff please see staffing section for the details of these. Please see requirement 3. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 20 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Efforts have been made to improve the home for residents to live in and the extension will provide more communal space, which will benefit residents. Staff need to be more vigilant in relation to personal space and location of possessions, to ensure this is maintained to maximise and enhance residents lives. EVIDENCE: The inspector undertook a tour of communal and individual bedroom areas. In those bedrooms, which had been refurbished new bed linen, furniture curtains and flooring had significantly improved those areas. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 21 Bedrooms were personalised in the main. In one bedroom there was a Christmas tree, on top of the TV, which when disorientation is evident, as in this home, this may further compound the problem. Bedroom 3 was very dark with little natural light and two electric lights on even through it was a bright sunny day. The resident in this bedroom was nursed in bed the majority of the time the inspector was advised, and this was the case throughout the first site visit. Another bedroom should be considered in consultation with the resident, as spending the majority of time in such an environment must have an adverse effect. Clocks were evident throughout the home but in bedroom 16 the two clocks showed different times. In bedroom 19 the calendar was showing July 2007. The majority of areas in the home were clean and free from odours. The sluice room opposite bedroom 16 was open and easily accessible this should have been locked when not in use. The lounge area was cluttered in appearance not only with items of furniture but other items such as a hoist. It had an untidy appearance. This was said to be due to the building work going on. The kitchen was inspected after lunch at 2 pm, there were no staff on duty in the kitchen. There were areas in the kitchen, which were unsatisfactory and need improvement. The inspector noted that some areas required deep cleaning that must be addressed. It was noticeable behind the work tops spillages were evident. The steel cupboard doors were also marked .The tiles behind and adjacent to the sink were also in a poor condition. The kitchen is due to be relocated to the lower ground floor shortly, however in the meantime this must be maintained in a clean hygienic state. Once the building work is completed the garden will be landscaped. The nurses rooms wil be expanded or relocated within the building. There is a strong commitment to improvindg the current environment including bedrooms, corridors and communal areas in addition to addressing some unsuitable floor surfaces. The laundry will be extended and machinery wil be replaced, where necessary, to provide a laundry service for 28 residents. Please see requirement 4. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are provide in sufficient numbers to meet the residents needs. Training provided equips staff with the skills and knowledge they need to undertake their work. Recruitment procedures are insufficiently robust to ensure that all staff recruited are safe and competent to work in the home. EVIDENCE: During the first site visit there were two qualified staff on duty with five care staff, a number of ancillary staff and an administrator. During the afternoon there was one qualified staff with four carers. Night duty is covered by one qualified and two care staff . The house keeper who was on duty throughout the first site visit was observed to interact with residents very positively, and they with her. One care assistant was observed to clap her hands in front of the resident to draw her attention to her presence. This is inappropriate. Once the administrator had left the phone was heard to ring many times throughout the building until eventually staff members answered it. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 23 The inspector met with one care staff that had been in post for three years. She was seen to be sat in bedroom 5, although there was no resident in this room. She was observed to spend a long time in there, and was observed by the inspector for some 45 minutes intermittently. When the inspector asked why she was sat in a bedroom with no residents she said she had to listen and watch the front door, although the bell was clear to hear throughout the home. This was raised with the qualified staff on duty although she continued to sit in the bedroom. The inspector spoke to her whilst she was conducting this observation. She confirmed that she had previously worked with elderly people and children. She confirmed recruitment including an interview, two references and CRB. Induction had covered the statutory topics. She confirmed updates in fire and had completed a one day first aid course September 06 .She had completed Dementia training 2007 and POVA 2006. In this subject she demonstrated a limited knowledge. Other areas which questions were asked on included infection control and clostridium dificile . She demonstrated a basic working knowledge of infection control procedures and the precautions needed. One area, which was causing her concern, was the length of time taken to complete NVQ training, which was said to have started 2005. The reason for the delay was due to the fact that there had been 4 tutors and a number of disruptions throughout the training. This needs to be addressed. A second staff who was also a carer had been in post for four years. She had previously worked in care. She too confirmed recruitment procedures and induction. She was another staff waiting to complete NVQ 2 training .She confirmed that she had received training in manual handling, fire, Dementia, health and safety and first aid 2006,a one day course. She was unable to confirm that she had received adult protection training or supervision. The qualified staff with whom the inspector met stated that supervision had been introduced but was not yet fully operational for staff. This staff also demonstrated a working knowledge of infection control procedures although no knowledge on Clostridium Dificile. Again she provided limited information in respect of dealing with Dementia . Minutes of staff meetings were seen. The inspector selected personnel files to view during the second site visit. In the first file the work history covered a period 2000- 2004 although this was said not to be paid work. However, in the additional information it stated that the applicant had worked in different care homes. The references also added to a confused picture, one stating they were a “Revered”, providing a personnel reference, yet had known the applicant as an “employee”. The second reference was from a Manager who indicated the applicant had been a carer. Niether of the references had official company stamps . This is confusing and Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 24 should have been explored at interview. Included in the personnel file there was evidence of POVA and CRB clearance through an umbrella body, identity checks terms and conditions and training certificates. The second personnel file was that of an employee who had commenced work April 2002. Within his file was confirmation of CRB clearance through the umbrella body dated February 2005 and there was a CRB application form dated October 04. It was unclear what POVA or CRB checks had been made prior to this time. There was confirmation of her nursing qualifications and expiry date. A job description terms and conditions and application were all on file. This application form contained a gap between 2000- 2002, and indicated between 94 and 2000 work in Zimbabwe. There was no employment in the UK indicated yet a reference was received from a local nursing home and a nursing agency. Under the section headed “ additional information”, work with agencies was indicted although not under the employment history. This again was unclear. In addition there was induction material and training certificates covering statutory topics and related subjects. In the file of another trained nurse there was no confirmation of her current PIN number status. The information on file indicated her registration had expired July 06. The nurse herself confirmed that she had renewed this and provided confirmation of such, however this could not be located. The personnel file of a care staff was inspected who had started 2003. Again confirmation of identity was on file. There was an application form, which provided a work history back to 2000,although the application form actually asks for a work history for the last ten years. Two references were on file, neither with official stamps. The CRB was dated May 2004 there was no POVA clearance indicated. The top of the CRB form was cut off so the inspectors were unable to determine if this was a standard or enhanced CRB. There was no evidence of CRB clearance prior to this. Training certificates were on file. Please see requirement 5. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service is managed by an experienced individual who is a qualified nurse. Health and safety measures are in place to ensure the environment is safe for residents to live in. Quality assurance measures are in place and incorporate the views of relative’s staff and residents. EVIDENCE: The Manager of the home is a qualified nurse with relevant management experience in care homes. He is due to embark on the RMA qualification. In those bedrooms inspected hot water was to satisfactory temperature. A selection of service certificates were inspected. Portable appliance testing was valid up to 23 September 2007 and the five-year electrical wiring was Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 26 satisfactory when inspected 2004. The inspection under the LOLER regulations was dated as 08/07 on lifting equipment. The lift maintenance was conducted July 07 and the lift examination May 07.Legionella testing had just been conducted. The fire equipment had been serviced August 07. Weekly fire alarm testing was recorded although two gaps were apparent in the records. Fire drills and training records indicated regular sessions with staff and in a separate file staff signatures were in place as confirmation of attendance. The fire training needs to be conducted regularly to ensure that night staff have training four times a year and day staff at least twice annually. Training in relation to fire safety included video sessions. Manual handling instruction had been addressed September 06 and was due imminently. Ten staff have received first aid training and seven infection control instruction. The employers liability insurance was current. Quality assurance was an area identified in the AQAA as requiring improvement. The Manager has introduced a new quality assurance tool although to date this has not been tested. Staff meetings are held regularly and the minutes for those were seen. There is an open door policy where staff or relatives can see the Manager at any time hence there are no specific relatives meetings held . In 2006 the Manager conducted a relatives survey, which dealt with such areas as staff, the home environment, care, food and general issues. The results of this survey were collated and a summary of the findings made. Overall there was expression of satisfaction in the majority of the areas except the environment. Residents and relatives with whom the inspector met did confirm that they felt able to raise any issues with the Manager and the staff in the home. In those questionnaires received the open and professional managements style was commented upon. The home owner conducts Regulation 26 visits, which have been forwarded to the CSCI . Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 27 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 2 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 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 x x X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 28 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 OP3 Regulation 14 Requirement The Registered Manager must ensure that full and comprehensive assessment information is obtained prior to admission. The Registered Manager must ensure that care plans are fully reflective of needs, completed with dates and staff signatures and where possible residents signatures to confirm the care plan. Supporting risk assessments need to be in place. There had been some progress on this requirement although not fully addressed. Previous time frame for action 31/10/06. This was partially met The Registered Manager must ensure that all staff have a working knowledge of adult protection procedures including reporting of such events. The Registered Manager must ensure that all parts of the building are maintained in a clean a hygienic condition. The Registered Manager must DS0000010138.V343300.R01.S.doc Timescale for action 31/10/07 2. OP7 15 31/10/07 3 OP18 13 30/12/07 4 OP26 5 16 31/10/07 OP29 18 30/12/07 Page 29 Jansondean Nursing Home Version 5.2 ensure that robust recruitment procedures are in operation for all newly recruited staff 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 OP12 Good Practice Recommendations The Registered Manager should review the activities available to residents in line with their needs and preferences. Jansondean Nursing Home DS0000010138.V343300.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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