CARE HOMES FOR OLDER PEOPLE
Jeanne Jugan Residence Little Sisters Of The Poor 228 Garstang Road Fulwood Preston Lancashire PR2 9RB Lead Inspector
Elaine Clare Unannounced Inspection 8th November 2005 11:30 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 Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Jeanne Jugan Residence Little Sisters Of The Poor 228 Garstang Road Fulwood Preston Lancashire PR2 9RB 01772 717454 01772 712368 Address 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) Little Sisters of the poor Sister Marie Brennan Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The home may accommodate 43 service users in the old age (OP) category 16th June 2005 Date of last inspection Brief Description of the Service: Jeanne Jugan Residence (Little Sisters of the Poor) Care Home with Nursing offers care and nursing to 43 residents aged 65 years and over. Care is offered to residents based on an ethos of Christianity with management and senior staff belonging to the religious order. The home is situated in the popular area of Fulwood, Preston. Local services are close by. The home is on a regular bus route, with the town’s railway a short distance away. Accommodation is provided on ground and first floor levels, in a large detached Victoria property designed to care for the sick and dying since the early 1800’s, and retains many of its original features and characteristics. There are 43 single bedrooms, 27 of which have en-suite facilities. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 4.5 hours and started at 11.30am on a day during a normal working week. The inspector spoke to five residents, two of who had very recently moved into the home, five staff members and the acting manager. Part of the inspection was spent looking at care documentation together with the homes Statement of Purpose. The inspector toured the home to assess the physical standards as well as eating lunch with the residents. What the service does well: What has improved since the last inspection?
There were no identified requirements and recommendations at the last inspection but the home regularly monitors all areas of the home to strive for continued excellence. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4 The home provides a consistent and reliable service that meets resident’s individual needs. Information about the home is clear and concise but it could be utilised better. EVIDENCE: The range of information available to prospective residents about the service is contained within the Service Users Guide and the Statement of Purpose. This is an excellent document as is also available for residents and relatives to read at any time. However when speaking with residents and a written comment from a relative found that they were not aware of inspection report, which details the assessment of the care in the home. The manager needs to ensure that residents receive their own personal copy of the Service Users Guide and that updated copies of the report are available to residents, relatives, staff and any other interested parties. The service users guide could be more innovative and include staff photographs and feedback from quality assurance programmes. People often
Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 9 like the fact that they are asked to give their views and that these are then published in information about the service. The care documentation and comprehensive assessments are undertaken for each resident and three residents files were case tracked during the inspection process. All documentation was in excellent order and provided a good overview of the care being given to the resident. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 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): 9,11 The personal care needs of residents are met by knowledgeable and welltrained care staff that consistently makes sure that people living at the home are comfortable and safe. The staff members treat each resident as an individual and work hard to ensure they promote their independence and autonomy. EVIDENCE: The care plans and assessments in the home were personalised and well maintained and it was evident where possible that family members and residents had been involved in the development of the plan. The medication in the home is administered by a qualified member of staff who general issues the medication to all 43 residents. There is a designated medical room where the storage of the medication is kept. This is kept in good order and an audit of the controlled drugs in the home found that correct procedures had been followed for the storage, administration and disposal of the substances.
Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 11 The care documentation of a resident that had recently died in the home was looked through. From the notes taken it appeared that the up most care and dignity was given to the resident. Staff spent the whole time at her side and were with her in her final moments. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 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 Some residents want an active, well-organised social life; in contrast, others want a level of privacy and independence from other residents; in this home residents can achieve both. EVIDENCE: Residents are given a wide variety programme of activities and social events that they can choose to attend or not. On Tuesdays, the day of the inspection, it was bingo. Residents congregate in the large activity hall and play with special adapted board games of bingo in return for small prizes. One resident spoken with spoke about his huge involvement as a volunteer on the Lancashire Ambulance Executive board. His work he says keeps him busy and staff encourage and support him to get to events. During the inspection the inspector spoke with the financial administrator in the home who detailed the procedure followed for resident monies. It was explained that some residents can choose to handle their own financial affairs for as long as they wish, but only a few choose to do so. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 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): 18 Arrangements are in place to minimise risk so that the safety and welfare of residents are promoted. The polices and practices of the home ensure that residents are safeguarded from abuse or harm. EVIDENCE: Risk assessments for individual residents, and for the environment they live in, are carried out so that the risk of potential accidents is reduced. These were seen within the care documentation of the residents that were case tracked. The manager and staff spoken to had a full understanding of potential indicators of abuse and what to do if they became aware of an allegation of abuse. Some training had been provided but it was recommended that the manager attend a training to update her knowledge in the area. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 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): 19,20,21,22,23,24,25,26 Within this large home each area is divided into smaller units each with its own communal focus and offers a domestic, family scale environment. EVIDENCE: The location and layout of the home is suitable for its stated purpose. The home has recently undergone an extensive renovation to the property, which has provided the home with a more updated image. The grounds, which include a small areas to sit and enjoy the garden is kept safe, attractive and accessible to the residents. Residents spoke how they enjoyed the quietness of the area and it’s semi- rural setting. Residents were able to sit out in the grounds when they wished. The home has four lounge spaces for residents to enjoy and there are a two activity rooms and an additional smokers room. There is also a separate dining facility.
Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 15 There are accessible toilets for residents, which are clearly marked, and close to the lounge and dining areas. Some bedrooms have ensuite facilities. The home has a number of aids, hoists and assisted toilets and baths. Individual bedrooms were looked at and found to be furnished and equipped to assure comfort and privacy. Bedrooms were tastefully decorated and personal items had been brought in from the resident’s own home. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 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): 27 The home makes sure the right staff are employed to look after vulnerable people but the ratio of qualified members to non-qualified members needs to be assessed. EVIDENCE: Currently the home is registered as a Care Home with Nursing and can accommodate up to 43 residents with nursing needs. According to legislation the home has to be staffed according to the homes registration with sufficient qualified members of nursing staff. During the inspection it was found that there were two nurses on duty one of whom was the manager. The manager had a meeting during the day and left the building to attend it leaving only one member of nursing staff. During the inspection the home had only seven residents assessed as nursing and one nursing staff member was sufficient to meet their needs however it was not sufficient to meet the whole homes needs. It is required that the manager of the home provide the Commission Social Care Inspection (CSCI) with a suitable staffing structure to reflect the current needs of the residents accommodated. If the home is not intending to provide care to 43 nursing residents then a proposal needs to be forwarded to the Commission Social Care Inspection (CSCI). The inspector looked through some minutes of meetings held with staff on individual units. There was a great deal of inconsistency. Meetings appear not
Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 17 to be regular and minutes are not always taken. Currently there are no minutes available of staffing meetings between the manager and her senior members of staff and this needs to be addressed. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34,35,38 The home is run in the best interests of the residents. EVIDENCE: The quality assurance and quality monitoring systems based on seeking the views of the service users have not been put into place to measure the homes success or failings. The system developed by the previous manager is good but now needs to be activated. The results of the findings should then be published within the service users guide. There is suitable accounting and financial procedures in place, which are overseen by the financial administrator who was spoken with during the inspection. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 19 Resident’s money is given out on a weekly basis or as according to the residents or relative’s wishes. Should a large amount accrue then it is banked for the residents into their own account. Certificates of the regular inspections undertaken at the home were view and found to be in date and in good order. Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 4 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 4 4 3 3 3 3 3 3 STAFFING Standard No Score 27 2 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 3 3 X X 3 Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 21 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 OP1 Regulation 4 Requirement The registered person must make available and supply a copy of the service users guide to each resident, which includes the last inspection report. The registered person must staff the home in accordance to the homes Statement of Purpose. The home must provide arrangements to enable staff to inform the registered person of their views. The registered person must establish and maintain a system for reviewing and improving the quality of care provided in the home. Timescale for action 31/12/05 2 3 OP27 OP27 18 21 30/11/05 31/12/05 4 OP33 24 31/12/05 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 OP18 Good Practice Recommendations The manager should attend an adult protection course.
DS0000006052.V252142.R01.S.doc Version 5.0 Page 22 Jeanne Jugan Residence Little Sisters Of The Poor Jeanne Jugan Residence Little Sisters Of The Poor DS0000006052.V252142.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1 Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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