CARE HOMES FOR OLDER PEOPLE
Jansondean Nursing Home 56 Oakwood Avenue Beckenham Kent BR3 6PJ Lead Inspector
Mrs Susan Hall Unannounced Inspection 31st January 2006 09:45 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.V279945.R01.S.doc Version 5.1 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.V279945.R01.S.doc Version 5.1 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.V279945.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Staffing Notice issued 28 April 1997 Date of last inspection 11th October 2005 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 3 floors (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. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The visit took place from 09.45 to 12.45. The Inspector was welcomed into the home by the Manager, who assisted throughout the morning with documentation and information. This inspection was carried out to check the progress of the home since the last inspection in October 2005, and only a sample of standards was inspected at this visit. For a detailed understanding of the home, it would be advisable to read this report in conjunction with the previous report. The home’s Lead Inspector had also carried out an additional night visit during October 2005, and some additional requirements had been made as a result of that visit. The Inspector viewed several bedrooms and communal areas. New carpeting in corridors, stairs, and lounge/diner enhanced the general appearance of the home. The Inspector talked with 2 nurses, and briefly with 2 care staff and a cleaner, as well as with the Manager. Other care staff were seen attending to Service Users. The Inspector talked with 2 Service Users, who appeared well dressed and groomed, and were smiling and showing evident contentment. Other Service Users were sitting in the lounge, or their bedrooms, according to choice, and some were unwell and in bed. The Inspector viewed care plans, staff files, and some other documentation, and discussed staff training and ongoing improvements with the Manager. There are plans in place for an extension to the property at the rear of the building, which will increase the number of single en-suite bedrooms, and the amount of communal space. The plans include some internal structural changes, and, until the Manager is clear about the agreements between the architect, Provider and planning, is unable to carry out re-carpeting of some bedrooms. What the service does well:
Service Users are able to get up or go to bed when they wish, and there is an emphasis on ensuring that Service Users are treated as individuals, and able to make choices regarding their daily living. The home is committed to ensuring good levels of training for staff, and there had been recent updates in statutory training subjects (fire training, moving and handling, health and safety, first aid and infection control). Four care staff were in the process of commencing NVQ 2, and several others had said they wished to do this in the future. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
Newly recruited staff members had been asked to bring in a passport sized photograph to be included in their file, for confirmation of identity. However, files for existing staff did not yet include photographs, and this must be carried out. The Manager had not yet been able to make any arrangements for better medication storage facilities, but said this was being considered along with plans for structural changes in the home, and an extension at the rear of the premises. The Manager stated that monthly Regulation 26 visits were being carried out by the Registered Provider, but he had still omitted to leave a copy in the home or send one to CSCI.
Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 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. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 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.V279945.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): No standards were assessed in this section. EVIDENCE: Standards 1-5 were assessed during the 2 previous inspections, and were being met. Standard 6 does not apply in this home. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Care plans were being well maintained, and provide sufficient information for staff to give effective care. Medication storage areas remained unchanged, and a larger clinical room would be beneficial for safe storage of medicines. EVIDENCE: The Inspector viewed 5 care plans, and looked particularly at wound care documentation, as this had been included in a recommendation at the previous inspection. This was seen to be much better, with clear details of the state of wounds, and the dressing to be applied at each dressing change. Where service users had more than one wound (e.g. 2 areas close to each other on the same foot), these were documented separately enabling the Inspector to see the individual progress of each wound. The Manager has allocated each nurse the responsibility for keeping a certain number of care plans up to date, with monthly reviews of assessments, and 3 monthly reviews of care plans. Some of these were up to date, but some were not, and the Manager said that he would identify where staff had lapsed in
Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 11 keeping assessments and care plans up to date, and speak to them accordingly. The Inspector also discussed the format of the care plans with the Manager, and both agreed that a different format could enable nurses to keep clearer records. The Manager stated that this was a subject which would be discussed with nursing staff, so that they could work together on the benefits of using a different system. Standard 7 indicates that “the service user’s plan should be reviewed monthly”, and a new system may enable nurses to review care plans monthly, as well as the assessments. Medication cupboard storage remains the same, and the recommendation to review storage facilities has been repeated. The Manager said that there may be opportunity to alter internal structural walls to create a better clinical room for storing medication. The Inspector observed staff interacting well with service users, and treating them with respect and dignity. Staff are careful to ensure that personal care is given in private. Service Users were well groomed, and appropriately dressed for the time of year. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,14 The home provides a suitable range of activities for service users. Service users are supported in making their own decisions. EVIDENCE: Service users are able to stay in their own rooms, or sit in the lounge/diner according to choice. Many are too ill or frail to join in with many activities, but a programme of entertainment is provided. This includes monthly musical entertainment from different soloists or groups. An art therapist carries out one to one painting with some service users, and they enjoy talking with her on an individual basis. The Manager said that he was also arranging for a member of the care staff to carry out specific training to enable more activities to be available. The Inspector viewed several bedrooms, and saw that service users are able to bring in their own personal possessions, including furniture items (where discussed with the Manager). Staff enable service users to make personal choices as much as possible, especially in regards to their lifestyle and their capabilities. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 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 the following standard(s): 16 There is a satisfactory complaints procedure in place. Service users and relatives are able to make any concerns known, and are confident that these will be dealt with appropriately. EVIDENCE: One complaint had been made in the home since the last inspection. The Manager showed the Inspector the evidence for dealing with this, and the documentation confirmed that the complaint was being given due consideration. It was still in the process of being investigated, and the Manager was giving up to date feedback to those concerned. No complaints had been made to CSCI since the last inspection. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 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 the following standard(s): 19,20,24 The premises provide a homely, clean and comfortable environment for service users. There is a maintenance plan in place for replacing worn carpeting, and for redecorating. EVIDENCE: The Inspector saw immediately that new carpeting had been laid in corridors on both floors, and on the stairs, and this is a big improvement on the previous old carpeting. There was also new carpet in the lounge/dining room, which was much better. The Manager said that there were several bedrooms which needed new carpets, but until the architect and Provider had completed discussing plans about internal structural changes, they could not go ahead with this. The Inspector saw that the carpets in these rooms were of reasonable quality, and that domestic staff were working hard to keep them clean. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 15 The Manager has a programme in place to replace old bedroom furniture when rooms become vacant. The Inspector saw new furniture in one room, and this was of satisfactory quality. Plans have been drawn up to alter some current rooms to single rooms, as well as to build an extension at the rear with some new single en-suite rooms. There is a large rear garden, and the plans include re-landscaping this area. There is a large lounge/dining room looking out on to the garden, and this would also be extended, providing above the recommended communal space for service users. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 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 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): 29 The home has good recruitment procedures in place. EVIDENCE: The Inspector examined the staff file for a newly recruited nurse. This showed that the required checks had been made. The applicant had been asked to provide confirmation of training, and the nurse PIN number had been checked with the Nursing and Midwifery Council (NMC). A Criminal Record Bureau (CRB) check and POVA checks had been completed. The file included proof of identity and a recent photograph, two written references, work permit, and vaccination record. The application form was well completed, and there was a health questionnaire. The member of staff had been given a letter to confirm employment, and a staff contract. A requirement was given at the last inspection about providing a staff photograph for each staff file. The Inspector was pleased to see that new staff are now asked to provide a recent photograph. However, existing staff do not yet have photos on file, and there is an ongoing requirement with a new timescale for this. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 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 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): 33,38 There is a system in place to enable service users and relatives to share their views about the home. The Manager ensures that mandatory training for staff is kept up to date. EVIDENCE: The Manager had commenced a new format for gaining feedback from service users and relatives. This was an easy to use “tick box” form, asking questions about the home – e.g. “Is it clean and tidy”, “friendly and welcoming”, “ clean, and with satisfactory décor?” There were also questions about the staff e.g. “are they welcoming and polite?” The Manager had received 13 replies from this recent survey, and this provided a good cross section from service users and relatives. He said that he planned to carry out more frequent surveys, with just one or two subjects each time, so that it would not be too difficult for people to complete. There is room at the
Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 18 bottom of each form for additional comments, and forms can be completed anonymously if preferred. Staff training had been booked for fire awareness, moving and handling, infection control, first aid, and health and safety, showing the Manager’s commitment to protecting the health and welfare of service users. He had purchased a new programme for fire training, which included a video that could be used for future updating. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME 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 N/A 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 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 X X X 3 X X STAFFING Standard No Score 27 X 28 X 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 20 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 OP7 Regulation 15 Requirement Service Users’ care plans must be kept up to date, with monthly changes to assessments and care plans where necessary. To include an up to date staff photograph on each staff file. (Previous requirement with new timescale). To supply a copy of Regulation 26 visits directly to the Commission, or to keep a copy on file for viewing at the home. (Previous requirement with new timescale). Timescale for action 01/03/06 2. OP29 19 (1) (b) 31/03/06 3. OP33 26 (5) 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 21 1. 2. OP7 OP9 To review the possibility of changing the format of care planning, with the aim of improving the system for ease of finding information. Ongoing recommendation to review the storage facilities for medication; and making a new clinical room available for storage if possible, in line with proposed structural changes in the building. Jansondean Nursing Home DS0000010138.V279945.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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