CARE HOMES FOR OLDER PEOPLE
Jesmund 29 York Road Sutton Surrey SM2 6HL Lead Inspector
Alison Ford Key Unannounced Inspection 16th October 2007 11:00a 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 Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Jesmund Address 29 York Road Sutton Surrey SM2 6HL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8642 9660 020 8642 9662 jesmund@uk2.net Mrs Abbie Shiels Mrs Abbie Shiels vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (0), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (0) Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. A variation has been granted to allow two specified service users, under the age of 65 years, to be accommodated in the home until such time that the home is no longer able to provide the care they require. 7th April 2006 Date of last inspection Brief Description of the Service: Jesmund is a nursing home, registered with The Commission for Social Care Inspection, to provide care for up to 25 residents with a history of dementia or mental disorder. It is situated on a quiet residential road in Cheam Surrey about 1.5 miles away from the station and the shopping facilities of central Sutton. There is a substantial well-kept garden to the rear of the property and off street parking to the front. Ramps at both the front and rear doors provide wheelchair access. Bedrooms are arranged over the ground and first floor and most of them have en-suite facilities. There is a large sitting room on the ground floor with an additional dining room, kitchen and office facilities. At the time of this inspection fees for the home range from £550 - £600 per week. Extra charges may be payable for services such as hairdressing and chiropody and would be discussed prior to admission. Copies of the homes Statement of Purpose and the latest inspection report would be available from the home or, in the case of the latter, directly from the Commission for Social Care Inspection via their website. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key inspection visit was unannounced and contributes to the inspection process of the home for the year 2007/2008. In compiling this report consideration has also been given to information received about the home throughout the year such as comment cards, complaints, and the notification of any incidents. In addition, the Registered Providers had completed an Annual Quality Assurance Assessment which is a document that they are obliged to return to let us know about their service and how well they consider that they are meeting the needs of those people that they are caring for. During this visit all of those standards considered, by The Commission for Social Care Inspection, to be key to the inspection process have been assessed. A tour of the premises was undertaken and several residents, members of staff and three relatives, who were visiting, were spoken with. A sample of care plans was assessed and various records and documentation, required to be kept by the home as evidence of their commitment to the health and safety of their residents, was seen. Staff files of those who have been employed since the last inspection were also checked, to ensure that appropriate pre - employment checks had been completed and that people who use this service are protected from those who should not be working with vulnerable adults. What the service does well:
This home provides clean, comfortable and well-maintained accommodation for up to twenty-three residents with dementia or other mental health problems. The premises are suitable for their purpose and ramps and a lift make all areas of the home are accessible to residents including those who rely on wheelchairs. People who live in this home have all been encouraged to personalise their bedrooms with familiar objects and pictures from home and these reflect their individuality. There are pleasant gardens to the rear of the property, which are enjoyed by residents in the warm weather and the resident cat enjoys strolling around the home. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 6 The local authority funds the majority of the residents in this home and they are subject to their assessment and review processes. In addition they all have an individual care plan, which describes the support that they require. Verbal communication is difficult with many of the residents who on the day of the inspection, all looked clean and well cared for, although those who were able commented that “staff were kind” and “it was nice living in the home” Those relatives who were visiting at the time agreed that they considered the residents were well looked after in the home and that they were always made to feel welcome when they visited. The Registered Manager has many years experience in caring for this client group and several of the staff members have worked in the home for some time, providing continuity of care and familiarity for the residents. The incidence of complaints about the service is low. What has improved since the last inspection? What they could do better:
The Statement of Purpose for the home and the Service User Guide have not been updated for some time and some of the information that is in them is not accurate. These documents explain how it is intended that residents will be looked after in the home and they provide essential information to help people decide whether the life there will suit them. Both documents need to be updated in
Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 7 line with current regulations and the Service User Guide must be readily accessible to all of the residents and their families. Some consideration must also be given to ensuring that there is some ongoing procedure in place to ensure that those people who use this service are given the opportunity to comment on how well it suits their needs. Care plans are in place for all of the residents and are intended to set out exactly how each person prefers to be cared for. Some work still needs to be done to ensure that they accurately identify all of the healthcare needs of each resident so that staff are all able to support them in the same way. They also need to reflect the wishes of residents and their families in the event of declining health or death. In this way resident’s wishes will always be taken into consideration and unwanted hospital admissions will be avoided. Medication procedures have all been updated however, care must be taken to ensure that all unwanted items of medication are disposed of according to current guidelines. Health and safety procedures are generally good and provide evidence of the commitment to the safety of both residents and staff however, a fire risk assessment still needs to be completed in line with the regulations. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service that are admitted through a Care Management arrangement, can be sure that a comprehensive pre-admission assessment will be undertaken to ensure that the home will suit their assessed healthcare needs. Information that is available to resident and their relatives about the home and the services provided is limited and not up to date. This home does not provide intermediate care, this standard does not apply. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 10 EVIDENCE: Four care plans were assessed at this visit including two of residents admitted since the last inspection. As before, all residents funded by the local authority have comprehensive assessment and review procedures in place. Care plans are now being improved by reflecting more detail regarding resident’s social needs and preferences. This will help them and their relatives to decide if the home will suit them and also provide information about activities that they would like to participate in. The Statement of Purpose, a document setting out the aims and objectives of the home, and the Service User Guide, a guide for residents and their relatives about the home and the services provided, both need to be updated. Currently, the information that any potential resident or their relatives could be given to read is limited, not up to date and not in line with current legislation. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards7, 8,9,10 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service generally have their healthcare needs met and individual care plans are in place which reflect the care, and support currently required Medication policies and procedures are in place to ensure that residents are protected and they can be confident that they will be treated with respect and in a way that respects their privacy and dignity. EVIDENCE: All residents have an individual plan of care based on their initial assessment and reflective of the support that they now need. The Standex system is in use, completion of the documentation continues to improve and reflects good outcomes for those living in the home..
Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 12 Four care plans were inspected, all were comprehensive and contained evidence of regular review to assess skin integrity and the risk of residents developing pressure sores. Visits from other healthcare professionals were recorded and specialist equipment was in use. It was noted that one resident, a diabetic, did not have an appropriate care plan in place. Care must be taken to ensure that all identified problems are monitored and evaluated on a regular basis. Also some daily notes are quite generalised and entries should be made more specific to reflect the actual care given and activities undertaken. Work still needs to be undertaken to gain the views of residents and their families regarding actions to be taken in the event of them becoming seriously unwell or their death. In this way staff will all be made aware of residents wishes and unwanted hospital admissions will be avoided. Information regarding residents past lives and acheivements is beginning to be added into care plans, giving staff an insight into their present behaviour and their interests.This will also help staff to plan activities which suit their preferences. Medication records and storage were asessed and were in order. A monitored dosage scheme is now being used which makes it easier to check that administration of medication is in order.Photographs of residents are on MAR sheets and nurses signatures are recorded on the front of the records. It was noted that some medication is still in the trolley which is no longer being given and this must be disposed of in line with current legislation. If residents do not have any allergies to any medication the space on the MARS for this is left blank. It was recommended that an entry should be made to this effect anyway, in order to show that due consideration has been given to this issue. Staff were observed to be treating residents kindly and with respect and dignity. Many care staff are quite softly spoken and residents appear to respond well to them. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service are able to make choices within their daily lives and they are able to participate in a limited range of activities, arranged to stimulate them and add interest to their lives. Food served in the home is of satisfactory quality, well presented and suits the needs of the people who live there. Relatives and friends will always be made welcome when they visit. EVIDENCE: Residents that were spoken with, agreed that they are all able to choose the clothes that they wear,what they eat and the time they get up or go to bed. Some organised activities are provided for them during the day and those that are able to join in say that they enjoy these.There are plans to increase these and staff have been trained to provide chair based excersises for them. Some residents are able to go out to the shops or to the bank accompanied by a member of staff.
Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 14 Visitors are always made welcome and those spoken with agreed that they are able to visit at any time and always greated warmly and offered refreshments. Residents all commented that they were very happy with the food served in the home. Choices are always available to them and they would be able to get extra snacks and cups of tea when they want them. There must be a record kept of the food that is eaten by each resident in sufficient detail to provide evidence that they are receiving a balanced nutritious diet. Residents are weighed regularly and it was noted that consideration is given to the reasons for any weight loss that is noted. And appropriate supplements would be offered. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service are unaware of the complaints procedure however there is evidence that concerns raised on their behalf are taken seriously and addressed appropriately. The policies and procedures that are in place within the home will ensure that people who live there are protected from abuse. EVIDENCE: The complaints book was seen and showed that all the concerns that had been raised by representatives of those using the service had been dealt with appropriately in a timely manner. All the residents and relatives that were spoken with expressed confidence that any issuess would be dealt with a by the homes manager.There is a policy available however the cognitive impairement of those living in the home means that it would not be easily understood by many of the residents. No complaint have been received by The Commission since the last inspection. All staff have received training in abuse and this has been discussed at supervision sessions. Those staff spoken with displayed an understanding of the relevant issues.
Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 16 Staff files show that appropriate pre-employment checks are undertaken to protect residents from people considered to be unsuitable to be working with vulnerable adults. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards19, 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service find that the location and layout of the home is suitable for its purpose and it meets their Residents can be confident that the location and layout of the home will meet their healthcare needs in a clean comfortable and homely way. EVIDENCE: A tour of premises was undertaken. Some redecoration has been undertaken since the last inspection and although the building is an old house it is clean, bright and homely.Many of the bedrooms would not comply with new registration standards however, they are comfortable and residents have been encouraged to personalise them with pictures and ornaments from home. The home was clean and free from malodour and additional soap dispensers and paper towels have been supplied for staff use.
Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 18 All staff have been trained in isuse concerned with the control of infection and waste and unwanted medication is managed according to professional gudelines. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service are looked after by sufficient numbers of appropriately trained staff and there are robust recruitment procedures in place to ensure thair protection. EVIDENCE: Staff rotas were seen and complied with previously agreed standards. There are always trained nurses on duty in the home as well as care staff. All care staff are currently qualified to at least NVQ level 2 standard or are undertaking the course. Some are working towards a level 3 qualification. New members of staff that have been apponted since the last inspection are trained nurses from oversas who are not eligible to apply for the Overseas Nurses Programme at the present time however, they are all very skilled. Staff training is ongoing in the home and all mandatory trianing has been completed. Personel files were seen relating to new staff members and, in line with regulations, all the information relating to recruitment procedures and
Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 20 providing the evidence required to ensure the protection of residents was present. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People who use this service can feel confident that the home is run by an experienced person who will protect their interests however, they are not always able to influence the running of the home by making their views known. Residents can be assured that their safety and financial interests are protected and that policies and procedures are in place to ensure their health and safety. EVIDENCE: The Registered Provider /Manager is a trained nursewith additional qualifications and has worked within health and social care for many years.
Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 22 She has many years experience in managing the home and working with this client group, has recently completed her Registered Managers Award and displayed a great depth of knowledge about the problems experienced by residents in the home. There is still no formal system in place place to enable residents to voice their views and influence the running of the home. A quality assurance tool was developed and questionnaires sent out some while ago however it appears that this process has never been repeated. There are no meetings for residents or relatives to contribute their ideas or comment on the care and services that are provided. Given the cognitive impairment of many of those people living in the home consideration must be given to developing some innovative ideas to gain their views. The Annual Quality Assurance Assessment provides evidence that equipment and services are appropriately maintained and serviced to ensure the safety of residents however a Fire Risk assessment has still not been compiled. It is suggested that professional advice should be sought to help complete this according to current professional guidelines. Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 X 3 X X 2 Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 (1)(2) Requirement The Service User Guide and Statement of Purpose must be updated in line with current legislation, presented in a format suitable for the needs of those people who use the service and made available to them. This will enable them to access all of the information that they need in order to decide if the home will be suitable for them and to understand the services and support that they can expect. Care plans must identify all of the problems for which residents will require support with details of how these will be managed so that all staff are aware of how this should be done. Care plans must reflect the wishes of residents and their families in the event of them becoming increasingly unwell or their death so that staff are all aware of the procedures to be followed and unwanted hospital admissions are avoided. A record must be kept of the food eaten by each resident in
DS0000019100.V350653.R01.S.doc Timescale for action 30/01/08 2 OP7 5(1)(2) 30/01/08 3 OP7 15(1) 30/01/08 4 OP15 Schedule 4 (13) 30/01/08 Jesmund Version 5.2 Page 25 5 OP33 24(3) 6 OP38 23(4)(a) (b)(c)(D) (e) enough detail to provide evidence that they are receiving a nutritional and balanced diet. The quality assurance tool must be improved in order to provide a regular indication of the views of those people using the service and their families. A fire risk assessment must be produced for the home in line with current legislation. 30/01/08 30/01/08 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 OP7 Good Practice Recommendations Is recommended that entries that are made in care plans are made more specific in order to provide evidence of the care and support that is actually being provided Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Jesmund DS0000019100.V350653.R01.S.doc Version 5.2 Page 27 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
