Inspection on 30/05/06 for Jerome House

This inspection was carried out on 30th May 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Jerome House 03/09/07

Jerome House 07/12/05

Jerome House 03/06/05

Jerome House 04/10/04

Jerome House 02/06/04

Jerome House 05/02/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Jerome House 71 Randall Avenue Neasden London NW2 7SS Lead Inspector Julie Schofield Key Unannounced Inspection 30th May 2006 09:05 Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 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 Jerome House DS0000017485.V289605.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 Adults 18-65. 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. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Jerome House Address 71 Randall Avenue Neasden London NW2 7SS 020 8450 8544 020 8452 8544 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) Mrs Lucille Rabor Mrs Lucille Rabor Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4) of places Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 Brief Description of the Service: Jerome House is situated within walking distance of the shops at Neasden. Randall Avenue is close to a bus route and there is access at one end of Randall Avenue to the North Circular Road. The nearest underground station is Neasden. It is a large semi-detached house with a small area at the front of the house and a garden at the rear of the property. The house has a driveway providing on site parking. There is also parking space available on the street outside the house. The home is registered for 4 adults with mental health problems and there are bedrooms on both the ground, first and second floor with bathing and toilet facilities on all floors. Communal space is situated on the ground floor and consists of an open plan lounge and dining area, which leads to a small, indoor smoking area. There is an office on the first floor. At the time of the inspection there were no vacancies. Information regarding the level of fees charged is available, on request, from the manager of the home. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a Tuesday in May and started at 9.05 am and finished at 5.10 pm. The registered manager was on annual leave but Ms Amanda Rabor, a manager from another care home within the company, came and assisted with the inspection. The Inspector would like to thank Ms Rabor, the staff on duty and the residents for their comments during the inspection. The inspection consisted of discussions with the manager, members of staff and residents, a tour of the building, examining records and observing care practices. What the service does well: What has improved since the last inspection? A training and development plan has been drawn up, which refers to the National Minimum Standards includes costings. A business plan has been drawn up for the home and this includes projected income and expenditure information. The format of the care plan has been redesigned so that it is focuses on the specific needs of the client group i.e. mental health issues. Within this format it addresses the personal, social and health care needs of the resident. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 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. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,4 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A comprehensive assessment of the needs of the resident, prior to admission to the home, enables the home to determine whether a service tailored to the individual needs of the resident can be provided. A programme of preadmission visits to the home enables the prospective resident to sample life in the home and to decide whether the service provided is acceptable. A record of these visits must be kept so that the home can demonstrate that the needs of the prospective resident are compatible with those of existing residents. EVIDENCE: Since the last inspection a resident has been admitted to the home. The case file was examined and it was noted that prior to their admission the home had received a copy of the OT report, the care management approach and care management form, minutes of the CPA review meeting and a summary of the needs and care plan. It was noted that the resident had been present at their CPA meetings. Since the admission this information had been used to form the basis of a plan of care. Although the manager said that the registered manager had met the prospective resident twice at the hospital and had carried out an assessment of need this had not been recorded. A discussion took place with the resident that had been admitted to the home in April 2006. The resident confirmed that they had been given the Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 9 opportunity to visit 3 care homes and that 71 Randall Avenue was the care home that they had chosen for their placement. They confirmed that they had visited the home several times and had been able to have a meal in the home and to stay overnight. This enabled the resident to meet members of the staff team, to meet the other residents and to view the accommodation, particularly the room that they would occupy. The home had not recorded the observations of staff that were on duty during these visits or the reactions of the existing residents or any responses from the prospective resident. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive care plans have been drawn up for each resident so that the service provided can meet the individual needs of the resident. The home is able to demonstrate that changes in the needs of residents are identified and addressed through a system of regular review meetings. The resident’s right to make decisions about their life in the home is respected. Responsible risk taking contributes towards the resident leading an independent lifestyle and reviewing these ensures that the changing needs of residents are identified and addressed. EVIDENCE: Three residents’ case files were examined and it was noted that the format of the care plan had been changed since the last inspection. A discussion took place with a member of staff who had been involved in the development of the new format. The member of staff was an RMN and said that previous care plans had been developed between 2000 and 2002 and although they had been reviewed on a regular basis a more in depth plan, which was related to specific needs arising from the mental health condition of the resident was Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 11 appropriate. The new format on one case file consisted of the areas of building a trust relationship, schizophrenia, social isolation, non-compliance and risk for others. Each aspect of the plan identified the problems, listed the expected outcomes and set out the interventions necessary and the rationale behind these. All but one of the residents had signed each individual area of their care plan and these had been evaluated on a monthly basis. (It was noted on one case file that the resident had refused to sign the care plan and the manager said that the resident declined to give a reason why). Another case file contained a previous care plan relating to aggressive behaviour but this need has since been deleted after the progress made by the resident over the last 4 years. A resident confirmed that he had been given a copy of his care plan. Both of the case files in respect of two residents who had lived in the home prior to the last inspection contained a recent review, which had been carried out by the home. Two residents confirmed during the inspection that their placement review was to be held in June. One placement review had taken place recently and the resident discussed the proposals for “moving on”. The fourth resident has only lived in the home for 4 weeks. The home uses a system of key workers. During discussions with residents examples were given of the residents’ right to make decisions and of the choices they had within their day to day to living. Residents decide when they go to bed at night and when they get up in the morning. Although most residents attend a drop in centre, and are encouraged to do so by staff as it helps to prevent social isolation, the decision on whether to attend remains with the resident. Residents choose what to wear, when to go out of the home and when to return, what to spend their money on, how to use their leisure time etc. The manager said that all residents manage their own finances although the home will provide support with benefit problems. Each case file contained risk assessments, tailored to the individual needs of the residents. The risk assessment identified a particular task or activity, detailed the potential hazards involved and set out the support needed. There were risk assessments in respect of walking, cooking, manual handling, moving into a new bedroom, going to the local shops, walking up and down the stairs, smoking, aggressive behaviour, provision/non-provision of keys to the front door and bedroom door etc. There was evidence that these were reviewed and changes made if necessary or assessments removed when no longer relevant. It was agreed recently with the resident, the CPN and the social worker that a front door key is not provided to a resident who is vulnerable and who has been leaving and returning to the home during the night. It is recommended that a system be introduced to review all risk assessments when the care plan is reviewed. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Taking part in activities, attending drop in centres and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle. The home is to be commended for its introduction of sessions in the home arranged by an OT, which have provided residents with new interests, which could help with future employment opportunities. Residents are encouraged to maintain contact with their families and friends so that their need for fulfilling relationships are met. Residents are encouraged to become more independent by making decisions and by having their wishes respected. Residents are offered a balanced diet to promote their well being and the diet respects their cultural needs. EVIDENCE: It was noted on the case file of the new resident that an educational update form had been completed. It listed the resource centres that the resident would attend and the groups that had been arranged. This is now in place and on the day of the inspection the resident left to attend one of the group Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 13 sessions. Two of the other residents attend a drop in centre and one of the residents said that mathematics and English sessions took place. A member of staff said that if one of the residents did not finish their piece of work at the drop in centre they brought this home as “home work” and the member of staff supported them to finish the work at home. In the past referrals have been made to Qest but residents have declined to follow this further. Residents discussed their use of community resources and facilities. Residents said that they used buses and taxis and staff said that each resident had a freedom pass. They confirmed that they used local shops, the post office, markets, parks etc. It was noted on the case files that residents’ names had been included on the electoral roll. The member of staff said that although residents have voted at elections in the past they did not choose to do so at the recent local elections at the beginning of May. The home now employs an OT who visits the home twice a week and works with residents on an individual basis. The OT does computer training, cookery and needlework sessions. One of the residents showed the Inspector the calendar work that they had done with their laptop and they were pleased with the new interest and skills, which they have developed. They have been learning to use the printer and have decorated their room with pictures they have printed and during the inspection they were using the laptop to access music channels. Another resident said that they enjoyed the sewing sessions and learning to cook (making a chocolate cake). The manager said that the computer sessions were something which residents may find useful in the future in terms of employment. The manager said that residents had refused to go on holiday last year and a resident said that they preferred to stay at home rather than go away. A resident said that they kept in touch with a sibling and that their relative visited them at the home. They confirmed that visits could take place in the privacy of their room and that the member of staff on duty made their relative welcome. All of the residents have contact with family members and confirmed this. The privacy of the resident is respected and when they are in their room the member of staff knocks on the door and waits for a response from the resident. Although residents are able to spend time in their rooms they are encouraged to socialise and to leave their room as part of the support given for their mental health problems. Most residents have a key to the front door or to their bedroom door, unless there is a risk assessment on file for the nonprovision of keys. They have access to the communal areas in the home and to the garden. A member of staff said that residents were encouraged to be independent and that they would make their own snacks or cups of tea. A resident said that they were involved in the daily routines in the home and that they did their own laundry. Residents confirmed that they were responsible for keeping their rooms tidy. During the inspection one of the residents went to Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 14 the supermarket with a member of staff to help with the shopping for the home. The menus were available for inspection and a copy is printed for each individual resident and used as a basis for a record of the meals consumed, with alternatives recorded on the sheet. The menus were varied and wholesome. A resident said that the food was OK and that African Caribbean food was included in the menu to meet his cultural needs. An African resident said that there were African staff that were able to prepare traditional dishes to meet their cultural needs. However a resident said that when the meal was prepared in the home an alternative was not available. Another resident commented that although they had said that they did not like pasta, main meals containing pasta were still prepared. One of the residents is diabetic and there is an information booklet about healthy eating for diabetics. The manager said that the home is trying to offer more dishes that are suitable for this resident although the resident was clear that the suggested plan of eating in the booklet was not what they considered to be a meal. Monthly records are kept of the weight of individual residents. The staff on duty confirmed that they had undertaken food hygiene training. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive prompting with personal care in a manner, which respects their privacy and dignity. Residents’ health care needs are met through access to health care services in the community. Residents’ general health and well-being is promoted by staff that assist the resident to take prescribed medication in accordance with the instructions of the resident’s GP and psychiatrist. EVIDENCE: Most residents do not require direct assistance with personal care but will need prompting to maintain good standards of personal hygiene. A member of staff gave an example of how this was provided in a manner that preserved the dignity of the resident. Residents said that the staff were good and were helpful. Routines within the home were flexible and residents chose their own clothing and hairstyles. The residents are African Caribbean and African and there are African Caribbean and African members of staff. When examining case files it was noted that there was evidence of access to health care services within the community e.g. the optician, the dentist and Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 16 the GP. There was a record of appointments with the psychiatrist and of CPA meetings. Out patient appointments had been arranged when necessary e.g. with the urology and cardiology departments. Appointment cards were included in the files for the dietician and for the diabetes clinic. There was evidence of routine screening e.g. blood tests and annual medical checkups. The manager gave an example of prompt action in response to concerns about the health of a resident. Staff had received training in respect of diabetes and although a resident had not noticed any deterioration in their general health a member of staff had concerns. After a referral was made to the GP it was found that the resident had diabetes. Appointments have been made for another resident that was concerned that the level of medication was causing him problems and as a result the psychiatrist has made changes. Staff confirmed that they had attended medication training and a member of staff discussed the content of this training with the Inspector. The records were inspected and were up to date and complete. The storage of medication was safe and secure. Two residents have a weekly dosette box and the tablets had been removed from this in accordance with the records. One resident has tablets supplied in the packets and liquid medication to take. The fourth resident who was admitted to the home has a named box where their medication is kept. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are aware of their right to complain if the care that they receive is not satisfactory. An adult protection policy and protection of vulnerable adults training for staff contribute towards the safety of residents. EVIDENCE: A complaints procedure is in place in the home. The manager said that no complaints have been recorded since the last inspection. Residents said that they were satisfied with the service provided but if there was anything that they were not satisfied with they felt able to speak to someone in the home and mentioned the names of members of staff, the registered manager and other managers within the company. The manager said that residents give feedback at any time and it was noted that when she was in the home residents came to the office. The home prefers to deal with matters before complaints develop and has a system of meetings, which are recorded, taking place between the resident and manager and/or key worker. Recent examples of these which were on case files included a discussion with a resident about settling into a new room and another with the newly admitted resident about what the home can offer and what is expected of the resident. A protection of vulnerable adults procedure is in place. The manager said that no allegations or incidents have been recorded since the last inspection. There was evidence on the staff files that protection of vulnerable adults training had taken place and a member of staff on duty confirmed this. The manager said that the home does not practice restraint. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 18 Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 30 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home, which is comfortably furnished and provides a pleasing environment for residents to relax and enjoy. The privacy of residents is respected by the provision of single bedrooms. Bathing and toilet facilities in the home are sufficient in number and are conveniently located within the home to protect the privacy and dignity of residents. Residents live in a home where overall standards of cleanliness are good although supplies of goods to maintain hygienic standards need to be provided at all times and odour control measures are needed in the ground floor shower room. EVIDENCE: During the inspection a tour of the building took place. The home was recently redecorated and refurbished in 2005, when the loft was converted into a resident’s bedroom and shower room. It was noted that furnishings and fittings were of good quality. The home was bright and airy and appeared “homely”. A small pool table has been provided in the communal area. Residents said that they were pleased with the upkeep of the home and with its location. One resident said that it was a “very comfortable house” and that it was in a “nice area” and was “handy for shops and buses”. Although there is Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 20 a designated area for smoking inside the home, it is furnished in a basic style with milkmaid stools to sit on. Each of the 4 residents showed the Inspector their bedroom room. Each room was a single room, contained a wash hand basin and was at least 10 square metres in size. Two of the rooms were situated at the front of the house and were large rooms with a bay window. There are 3 bathing facilities for the 4 residents in the home. There is a shower room on the second floor, which is used by the resident accommodated on this level. There is a bathroom on the first floor, which is used by the 2 residents accommodated on this level. There is a shower room on the ground floor, which is used by the resident accommodated on this level. There is a toilet on each floor in the home. Toilet and bathroom/shower room doors are lockable. Communal areas, bedrooms, kitchen, the shower room on the second floor and the bathroom and toilet on the first floor were clean and tidy. The floor covering in the shower room on the ground floor was damp and there was an odour of urine. This was brought to the attention of the manager during the inspection and she said that one resident is experiencing problems with continence. It was also noted that in the ground floor shower room the waste bin did not have a lid and that there were no paper towels by the wash hand basin. The manager said that staff had undertaken training in infection control procedures. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff working with residents who have mental health problems need specific training that will enable them to provide support, which is based on knowledge, and understanding. However NVQ training enhances the general skills and knowledge of carers and the home has met the target of at least 50 of carers achieving an NVQ level 2 or 3 qualification. The rota demonstrated that there were sufficient staff on duty to support the residents and to meet their needs. The manager’s hours on site need to be added to the rota to demonstrate that staff are appropriately supervised and that the manager is monitoring the quality of care provided to residents. Recruitment practices, which include checks and references, protect the welfare and safety of residents and the home needs to ensure that an enhanced CRB disclosure is obtained for each member of staff and for new staff prior to working in the home. The home has a training and development plan, which is linked to the aims of the home and it provides new staff with induction training. The home needs to demonstrate that the induction programme meets Sector Skills Council’s specification. EVIDENCE: Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 22 Staff demonstrated a commitment to providing good support to residents and one member of staff said that communication was the key to this. Another member of staff gave examples of how they encouraged residents to lead a more active and fulfilling lifestyle and related how they had incorporated techniques, discussed during a recent training course, to assist with this. The member of staff said that they had already received some training in mental health issues and that further training has been arranged for 2 days in June. (The manager said that the 2 days training would be for all members of staff). This is in respect of a statutory requirement identified during the previous inspection that staff must have training in mental health issues and although the timescale for compliance has expired the training has now been arranged. One of the members of staff on duty said that they had completed their NVQ level 3 studies and had passed their portfolio to the internal verifier. Another member of staff said that they would be starting their NVQ level 2 training soon. The manager said that of the remaining members of staff on the staff rota (10 names on the rota in total) 1 member of staff is an RMN, 1 member of staff is studying MH nursing, 2 members of staff have completed their NVQ level 2 and are now studying for their level 3, 2 members of staff are studying for their level 2 and 1 member of staff is doing a course in counselling. The home is meeting the target of 50 of carers qualified to NVQ level 2 or 3 (or equivalent). A statutory requirement was identified during previous inspections that the hours worked by the manager in the home are recorded on the rota. As the manager was on annual leave at the time of the inspection the rotas for April 2006 were examined and it was noted that although the manager is expected to be on site for at least 17.5 hours per week (as she is the registered manager for 2 care homes in Randall Avenue) there was only one entry on the weekly rotas as “extra staff” on Sundays, no hours specified. This statutory requirement remains outstanding. Staffing levels in the home are being maintained and are sufficient to meet the needs of the residents. Four staff files were examined. They included the files of 2 members of staff who were the most recent to join the staff team. It was noted that each file contained an application form, 2 references, proof of ID and a contract. The references on one file had been sent to the personal addresses of members of staff working in a nursing home and not addressed to the manager or to the home. Three enhanced CRB disclosures had been obtained by the member of staff’s previous employer. A statutory requirement was identified during previous inspections that the home has a training and development plan. A copy of this has been forwarded to the CSCI and there is now compliance. The home provides induction training for staff and there is a record of this on the staff file. The manager said that the introduction to the home, which takes place on the first day of employment, is supplemented by a programme, which is recorded in a booklet. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 23 The manager could not confirm that the programme met Sector Skills Council’s specifications. Staff do not receive equal opportunities training. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42, 43 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager continues to develop her knowledge through further training and this contributes towards understanding the needs of residents and staff. Service satisfaction questionnaires help to monitor the quality of the service provided to residents and contribute towards the development of the service and when these are returned the information needs to be incorporated into the development plan. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents. Regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use and the manager needs to ensure that appointments for these checks are made before certificates expire. The welfare and safety of residents, staff and visitors to the home is promoted and protected by insurance cover in the event of an accident or incident occurring. EVIDENCE: Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 25 The registered manager has completed her Registered Manager’s Award and has shown evidence of this on a previous inspection. She is also a qualified RGN. Since the last inspection she has attended “Prevention of Relapse” training. A statutory requirement was identified during previous inspections that information obtained from quality assurance systems is used to draw up a development plan for the home. The manager said that satisfaction survey forms have been developed and they were available for inspection. The home has distributed these to family members of the residents, to the CPN’s, to social workers etc and one form has been returned so far. This was available for inspection. When a significant number have been returned the manager said that the information would be collated and used in the development of the service. Feedback is obtained both informally, on a day-to-day basis and formally during meetings with the manager and key worker and during residents’ meetings. At the moment the home has a combined business and development plan. This was available for inspection. After being welcomed into the home the member of staff informed the Inspector of the location of the fire exits in the home. Staff confirmed that they have received training in safe working practice topics e.g. manual handling, food hygiene, fire safety, infection control and first aid. There were a number of recorded risk assessments, which have been reviewed on a regular basis. These were in respect of all parts of the home and included an identification of potential hazards, current corrective action, the severity, the likelihood of occurrence, the risk score, further action required-by whom and the date for completion. There was also a fire risk assessment. The COSHH register was available for inspection and a note of the protective clothing to be worn, if any, recorded for each product. Records of fire drills and the testing of the fire alarm were up to date and demonstrated weekly procedures. However the fire drill records did not record which residents or staff members were affected or the time it took to evacuate the building. There were valid certificates for the testing of the portable appliances and the electrical installation. The fire extinguishers and fire precautionary systems in the home have been serviced/checked and there was evidence of this. The Landlords Gas Safety record had expired on the 12th May 2006 and the manager said that an appointment had not been made. It was noted during the tour of the building that there was not a fire extinguisher close to the laundry and designated smoking areas. A statutory requirement was identified during previous inspections that the home has a financial and business plan, with costings for each budget code. A copy of this was made available during the inspection and there is now compliance. The home has a valid certificate for public liability cover, which is on display in the entrance hall. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 2 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 2 3 Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 27 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA4 Regulation 12.1 Requirement That records are kept of the visits made to the home by the prospective resident during the transition plan. These records are to include the observations of managers and staff, reactions by existing residents and feedback from the prospective resident. That the ground floor shower is odour free, that paper towels are provided at the wash hand basin and that the waste bin is a pedal bin. That staff receive training in supporting residents with mental health problems. (Previous timescale of 31st December 2005 not met). Timescale for action 01/07/06 2 YA30 16.2 01/07/06 3 YA32 18.1 01/08/06 4 YA33 17.2S4.7 01/07/06 That the hours worked by the manager in the home are recorded on the rota. (Previous timescale of 1st February 2006 not met). That references are addressed to the manager or proprietor of the business and sent to the business address. DS0000017485.V289605.R01.S.doc 5 YA34 19.1 01/07/06 Jerome House Version 5.1 Page 28 6 YA34 19.1 7 YA39 24.2 That an enhanced CRB disclosure 01/08/06 is obtained by Jerome House for each member of staff and for new members of staff prior to their employment in the home. That information obtained from 01/09/06 quality assurance systems is used in drawing up a development plan for the home. (Previous timescale of 1st April 2006 not met). That the home forwards a copy of a valid Landlords Gas Safety Record to the CSCI. That the home contacts the Fire Officer and asks them to confirm that they are satisfied with the positioning of fire extinguishers in the home. 01/07/06 01/07/06 8 9 YA42 YA42 13.4 23.4 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 6 7 Refer to Standard YA2 YA9 YA17 YA24 YA35 YA35 YA42 Good Practice Recommendations That the assessment of need for the prospective resident, which is carried out by the registered manager, is recorded and a copy placed on the resident’s case file. That all risk assessments for a resident are reviewed when the care plan is reviewed. That residents are made aware of alternative dishes available if they do not like the main meal. That the furniture in the designated smoking area is reviewed and more comfortable seating considered. That the induction training programme in the home meets Sector Skills Council’s specifications. That staff receive equal opportunities training. That fire drill records list the members of staff and residents who were present in the building and the time taken to evacuate the building. Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Jerome House DS0000017485.V289605.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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