CARE HOMES FOR OLDER PEOPLE
Jesmund 29 York Road Sutton Surrey SM2 6HL Lead Inspector
Alison Ford Announced 16 August 2005 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Jesmund Address 29 York Road, Sutton, Surrey, SM2 6HL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8642 9660 020 8642 9662 Mrs Abbie Shiels Mrs Abbie Shiels Care Home with nursing 25 Category(ies) of Dementia - over 65, Mental Disorder - over 65 registration, with number of places Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: A variation has been granted to allow 2 specified residents under the age of 65 to be admitted. Date of last inspection 20 December 2004 Brief Description of the Service: Jesmund is a nursing home offering nursing care to people with a history of mental disorder, and dementia. The home is registered with The Commission for Social Care Inspection for a maximum of 25 residents. and is situated in a quiet residential road in Cheam, Surrey. It is approximately equal distance from both Cheam and Sutton rail services which are about 1.5 miles away, as are the shopping facilities and bus services of the centre of Sutton. There is a substantial well-kept garden at the rear, parking and a flowerbed at the front. Ramps are available at the front and rear of the building, which provide access for wheelchair users. Bedrooms are on the ground and first floors, twenty-three are single and most of them have en-suite facilities , The home has a large lounge, a smaller dining room, kitchen and office facilities all situated on the ground floor. There are also rooms for the use of staff. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was the homes first inspection for the year 2005/2006 and was an announced visit lasting five and a half hours. It included a tour of the premises and the inspection of a sample of care plans and records. The majority of the residents and five relatives, who were in the home at the time, were spoken to. The lunchtime meal was served during the inspection and residents were observed enjoying a musical entertainment session. The inspection was conducted with the manager/ provider, her deputy and two of the senior nurses who were all welcoming and receptive to the inspection process. Prior to the inspection comment cards had been received from six residents, seven relatives and the homes General Practioner; all of them reflected a positive experience of the home and were complimentary about the staff, care and services that were provided. Since the last inspection one complaint that was dealt with under a Vulnerable Adults Procedure had been made to the home. This has now been resolved and the member of staff involved is no longer employed by the home. What the service does well:
This home provides clean comfortable and well-maintained accommodation for up to thirty-five residents with dementia or other mental health issues. The premises are suitable for their purpose and adaptations are in place to ensure that all areas of the home are accessible to residents. They have been encouraged to personalise their bedrooms with familiar objects and pictures from home. There are pleasant gardens to the rear of the property, which are enjoyed, in the warm weather. The majority of residents are placed by the local authority and are subject to their assessment and review processes. All residents have an individual plan of care, which is subject to regular review so that interventions are always appropriate. Communication is difficult with many of the residents however they all looked clean and well cared for. Those who were able to chat agreed that “they were well looked after” “staff were very kind “ “the food was always good” and “they felt safe and cared for” These views were supported by their relatives who expressed their appreciation for the staff and the care that they provided. There is a planned programme of suitable activities, including visiting entertainers, for those residents who wish to join in although they are always able to choose whether or not they want to. They are also encouraged to retain some independence by being able to choose what they wear, at what time they
Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 6 get up or go to bed and what they eat at meal times. They are encouraged to maintain their contact with relatives and friends and visitors are always welcome into the home. What has improved since the last inspection? 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. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,6 Those residents referred through a Care Management arrangement can be confident that a full pre-admission assessment will be undertaken so that they can be sure that the home will meet their assessed healthcare needs. This home does not offer intermediate care. EVIDENCE: A sample of care plans were viewed and for those who are funded by the local authority; the majority of residents, a Care Managers assessment was present in the files. A minority of residents are self - funded and have been living in the home for some time and the pre-admission information on them was limited. There is also a form that is used, on admission, for initial assessment by the staff in the home however there is very little information there about the psychosocial needs of the resident. The nursing staff in the home must produce an assessment tool that can be used for any future self- funding residents and it would be good practice to develop the initial assessment information for all prospective service users.
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The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,10 Individual care plans, regularly reviewed, accurately reflect residents assessed healthcare needs so that appropriate interventions and care are given. Residents in this home are treated with kindness and respect so ensuring that their dignity is maintained. EVIDENCE: Considerable improvements have been made since the last inspection in relation to residents care plans. The Standex System is now being introduced and there was evidence that plans are being draw up with consultation from residents and their relatives. Senior staff explained how this was giving them more insight into the problems experienced by residents and how this information was now going to be cascaded down to care staff. The plans were beginning to show evidence that all aspects of the healthcare needs of the resident were being addressed and that interventions were regularly reviewed. Progress on these will be assessed at future visits. All residents are registered with the same GP and care plans showed that regular assessments are in place to identify those at risk of developing pressure sores. Pressure relieving equipment was seen in use throughout the home and visits from other members of the multidisciplinary healthcare team are recorded.
Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 10 All personal care is delivered in resident’s own rooms; most bedrooms have en-suite facilities. Staff were observed treating the residents with kindness and respect; these issues are addressed during staff induction and at supervision sessions. Relatives that were spoken to agreed that staff were generally polite and always caring towards residents. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 Residents in this home would be supported to exercise choices in their lives, as far as they are able, so that they can maintain their independence and they would be encouraged to maintain contact with their families and friends so that they have interest and variation in their day. Meals are well prepared and varied to ensure that nutritional needs are met. EVIDENCE: Residents are able to exercise an amount of choice over the times that they go to bed and get up, their choice of meals and their clothes. There are planned activities throughout the week for those who wish to join in and the activities undertaken are recorded. Contact with relatives and friends is encouraged and there are no restrictions to visiting; relatives that were spoken to all agreed that they were always made to feel welcome and offered a drink. The lunchtime meal was served during the inspection and looked appetising and well presented. Those residents requiring assistance with feeding received it discreetly in an unhurried manner. The menus were seen and were varied and nutritionally balanced and choices are always available. Snacks are offered between main meals. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Residents and their relatives in this home are confident that any concerns or complaints that they might raise would be dealt with promptly and so they feel reassured that they are protected from abuse and neglect. EVIDENCE: There is a clear complaints procedure in place although relatives that were spoken to were confident that any concerns that they might raise would be dealt with promptly without requiring the more formal approach. The Registered Manager / Provider is frequently in the home and available to speak to them. The complaints book was seen and no entries had been made since the last visit. One more serious episode had been dealt with via The Vulnerable Adults Procedure and the member of staff is no longer employed in the home. Staff have all received training in the awareness of adult abuse and documentation showed that recent training sessions were held recently. All staff employed by the home have received satisfactory clearance from The Criminal Records Bureau. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,26 This home provides a clean comfortable and well-maintained environment with specialist adaptations, so that resident’s can be assured that their needs will be met. EVIDENCE: The home is an attractive extended house set in a quiet residential road. There is a large well-maintained garden to the rear, with two gazebos on the terrace, which was being enjoyed by the residents on the day of the inspection. Public transport links are good and there is ample car parking. There are ramps and handrails throughout the home and a passenger lift ensures accessibility to all areas. A tour of the premises was undertaken; decoration is suitable and homely and furniture and lighting is domestic in style. A planned programme of decoration is in place and resident’s bedrooms have been personalised by them to reflect their character. The home was clean and free from odour on the day of the inspection. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 14 Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 Resident’s healthcare needs are met by sufficient numbers of suitably qualified and appropriately recruited staff so that they can be sure that their welfare is protected. EVIDENCE: Copies of the off duty rotas were seen and complied with previously set staffing levels. There are always two trained nurses on duty in the morning and one in the evening although in some instances one is the Registered Manager. Four care staff join them in the morning and three in the afternoon. At night there is one trained nurse and one carer. In addition there are catering, domestic and laundry staff on duty. All the care staff were previously enrolled on an NVQ introduction course however problems with obtaining suitable assessors have meant that they have not been able to continue. The Registered Manager must supply an action plan as to how they will be able to achieve their qualification. However, various other training including manual handling, adult abuse and first-aid has occurred and a list of this was supplied and it was seen recorded in staff files. The Registered Manager and two of the senior members of the nursing staff are undertaking an NVQ level 4 and the Registered Managers Award. Four Staff files were examined and evidence of appropriate Criminal Records Bureau clearance was not available in all of them. Although this was later supplied, the Registered Manager must ensure that it is correctly placed in staff files and available for inspection. All other necessary documentation was in place.
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The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,34,35,36,38 Residents in this home cannot always be confident that their health, safety and welfare are promoted and protected or that they are able to influence the running of the home. EVIDENCE: Previous inspections highlighted the need for a quality assurance programme. There was some evidence that this had been started but only very recently. The Registered Manager must ensure that this is developed further to ensure that the views of residents and their families are audited. A business plan was seen however it was not reflective of the reality of the issues that were gong to be dealt with. The Registered Provider must ensure that the plan accurately outlines the forthcoming ideas for the home. The Registered Provider has some responsibility for the money of two residents in the home. The records were seen and although it was eventually ascertained that these were accurate the process was not easy to understand. The
Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 17 Registered manager must ensure that these records are clear and easy to inspect. The money was kept in a locked safe. Previous inspections had been concerned about a lack of staff supervision. This has now been started and the records were seen in staff files. It is intended that this will be undertaken with staff every two months. Examination of kitchen records revealed that the two fridges in the kitchen consistently registered higher temperatures than is acceptable. The Registered Provider must ensure that this is rectified. Certificates of worthiness of equipment were not examined at this visit. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 18 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 x x x x x x 3 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 Standard No 16 17 18 Score 3 x 3 x x 2 2 2 3 x 2 Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 19 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP 28 Regulation 18(1)(a) Requirement The Registered Manager must ensure that documentary evidence is supplied to The Commission for Social Care Inspection which illustrates that at least 50 of care staff are undertaking NVQ level 2 this year. (Previous timescale 30/1/05 not met) The Registered Manager must ensure that a tool is developed to assess healthcare needs of self - funding residents prior to their admission. The Registered Manager must ensure that there is evidence of appropriate clearance from the Criminal Records Bureau in all staff files. The Registered Manager must ensure that the quality assurance plan is developed so that residents satisfaction with the services they receive can be measured. The Registered Manager must supply The Commission for Social Care Inspection with a business plan which accurately outlines the intentions for the Timescale for action 30/11/05 2. OP3 14(1)(a) 30/11/05 3. OP29 19(1)(b) 30/11/05 4. OP33 24(1) 30/11/05 5. OP34 25(2) 30/11/05 Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 20 forthcoming year. 6. OP35 24(3)(a) The Registered Manager must ensure that the accounts kept in relation to esidents finances are clear and easily interpreted The Registered Manager must ensure that the recorded fridge temperatures remain within acceptable limits. 30/11/05 7. OP38 13(4)(c ) 30/11/05 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 OP3 Good Practice Recommendations It is recommended that the initial assessment process of newly admitted residents is developed in more detail especially in regard to their psychosocial healthcare needs. Jesmund G53-G53 s19100 Jesmund v217177 160805 stage 0.doc Version 1.30 Page 21 Commission for Social Care Inspection 8th Floor, Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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