CARE HOMES FOR OLDER PEOPLE
Jobs Close Lodge Road Knowle Solihull West Midlands B93 0HF Lead Inspector
Lesley Beadsworth Unannounced Inspection 11:30 24th September and 3 October 2008
rd 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 Jobs Close DS0000060958.V372498.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. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Jobs Close Address Lodge Road Knowle Solihull West Midlands B93 0HF 01564 773499 01564 774333 care@jobsclose.org.uk Telephone number Fax number Email address -00 ovider 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) Job’s Close Residential Home for the Elderly Mrs Eileen Isobell Carlton Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That one named person who is diagnosed as having dementia at the time of admission can be accommodated and cared for in this home from October 20th 2006 to October 30th 2006. Date of last inspection Brief Description of the Service: Jobs Close, which was established on the 1st July 1957, is an extended and adapted Edwardian House built in 1904. The Home, which is adjacent to and overlooks a park, has very attractive gardens with ample car parking facilities. The Home provides permanent placements for up to 33 frail older people over the age of 65 whose care needs can be met within a residential setting. Additionally one room is designated for respite/short stay placements. The Service Users receive accommodation, full board, 24-hour care, supervision and personal care as required. Of the 34 single bedrooms, 33 have en-suite facilities. Daily routine is organised on a group living basis although the Home is flexible in meeting individual needs and preferences. Communal facilities include two large lounges, one of which is used as a library, a dining room and a separate sun lounge/dining room/activities room. There is a hairdressing salon and two smaller lounges in the annex building. There are two passenger lifts and a stair lift. The fees at the home were not published in the home’s Service User Guide but the manager advised that hairdressing and chiropody are additional charges. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
The inspection included a visit to Jobs Close. As part of the inspection process the registered manager of the home completed and returned an Annual Quality Assurance Assessment (AQAA), which is a self-assessment and a dataset that is filled in once a year by all providers. It informs us about how providers are meeting outcomes for people using their service. Ten surveys were sent to service users. Nine were completed and returned to us. Information contained within these surveys, the AQAA, from previous reports and any other information received about the home has been used in assessing actions taken by the home to meet the care standards. Three residents were ‘case tracked’. Case tracking involves establishing an individual’s experience of living in the care home by meeting or observing them, talking to their families (where possible) about their experiences, looking at resident’s care files and focusing on outcomes. Additional care records were viewed where issues relating to a resident’s care needed to be confirmed. Other records examined during this inspection included, care files, staff recruitment, training, social activities, staff duty rotas, health and safety and medication records. The inspection process also consisted of a review of policies and procedures, discussions with the manager, staff, visitors and residents. The inspection visit took place over two days on the first day between 11.30am and 9pm and between 3.30pm and 7pm on the second day. What the service does well:
In the surveys returned to us by residents positive comments were made about the verbal information given and all respondents answered “Always” to the question, “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” All care files looked at had a pre-admission assessment completed to ensure that the home could meet the person’s needs prior to offering a placement. All care files looked at included a care plan to give staff the information they required to provide the appropriate care and support. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 6 Residents’ surveys showed that all those who responded always received the care that they needed, including medical support, and that staff listened and acted on what they said, with one person adding, “Most helpful and understanding.” Residents spoken with confirmed that they could see the doctor if they wished, that they had regular visits from the chiropodist, optician and dentist. Measures were taken to minimise the incidence of pressure sores (a break in the skin due to pressure, which reduces the blood supply to the area) by carrying out risk assessments and using preventative equipment, such as pressure relieving cushions, as assessed to be appropriate. Other risk assessments were in place to safeguard the health and welfare of the people living at the home. Residents are cared for in a respectful manner and this ensures that their dignity and self-esteem are maintained. All bedrooms have a connection to the home’s telephone system for a personal phone to be fitted at their own cost. This gave residents the opportunity to have private phone calls and to easily keep in contact with family and friends. Observations made, discussion with residents and the surveys showed that there was sufficient activity provided to stimulate and occupy the people living at the home. Observations made and discussion with residents showed that people living at the home had the opportunity to make choices in their daily lives. Resident spoken with and the surveys returned to us told us that there was a choice of meals each day and that these were enjoyed. Menus showed us that the meals were varied and nutritious. The residents are provided with comfortable and attractive surroundings that were clean, safe and well maintained. Garden areas were pleasant and well maintained with garden furniture for the residents’ use. Residents spoken with and who responded to the surveys said that they knew who to speak to if they were not happy and knew how to make a complaint. The home has appropriate records, policies and procedures for complaints and safeguarding to protect residents. There are sufficient staff of all designations employed at the home to meet the needs of the people living at the home. All recruitment practices safeguard residents from the employment of unsuitable people. All financial practices viewed safeguard residents’ financial interests.
Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 7 Seventy five percent of the care staff have achieved National Vocational Qualification Level 2 or 3 in Care, 25 higher than is required. People with these qualifications have been assessed to show that they are competent in their role. The staff at the home had undertaken other mandatory training. The health and safety practices, policies and procedures ensure that the home is a safe environment to live and work. What has improved since the last inspection?
All pre-admission assessments seen were dated and included all the areas detailed in the National Minimum Standards. Care plans were written soon after the person was admitted to the home to enable staff to know how to meet the residents’ needs. The plans seen reflected the assessments. Short-term needs of the residents were reflected in the care plans. Moving and handling risk assessments detailed the action that staff should take in transferring the person in the event of a fall. In the care files seen there was a plan in place for any risk that had been identified for individual residents, in order that these risks could be minimised. Balances of medication at the end of a cycle were carried over to the next cycle on the Medication Administration Record Sheets (MARS). Records of food being served included breakfast. The adult protection procedure had been revised to ensure that investigations did not take place without being sanctioned by the safeguarding team in social services. Where able to do so handrails had been fitted along all corridors to assist residents’ when walking around the building. Stained sinks in the laundry area had been replaced. Staff records showed that overseas staff were eligible to work in the UK. All staff training was recorded on a matrix so that training could be audited. Care staff undertake induction training that meets with the Skills for Care specifications, ensuring that they have the knowledge and skills to care for the people living at the home. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 8 The Quality Assurance system in place included seeking feedback on the service from residents by the use of surveys. The home puts an action plan into place as a result of these, in order to improve the services they provide. All transaction made for money held on behalf of residents required two signatures to prevent errors occurring and to safeguard the residents’ finances. Relatives of residents unable to fully contribute to their life history records were asked to contribute. This information about a person before living at the home creates a background for staff to get to know the person, thereby giving more person centred care. A complaints log was in use to record all concerns and how they were addressed. This showed that residents were listened to and their concerns were acted upon. Staff application forms had been revised to give sufficient space for applicants to provide details of all their previous employment. The AQAA and discussion with residents showed that they were now consulted about their menus and meals and that their requests for evening snacks to be included in the menus had been listened to. 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. The summary of this inspection report can be made available in other formats on request.
Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 9 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 Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 10 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): 1,3,5 Quality in this outcome area is good. Information required to make a decision about choice of home is available when needed with shortfalls in the Service User Guide. Pre-admission assessments are carried out to assess if the needs of prospective residents can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a Statement of Purpose and Service User Guide but the current fees were not included in these. The Service User Guide made available was missing other information and the registered person should check the document against the appropriate regulation to ensure that the required information is included in this document. The admission criteria list in the Service User Guide showed that prospective residents need to be mainly independent on their admission to the home. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 11 In the surveys returned to us all nine residents answered “Always” to the question, “Did you receive enough information about this home before you moved in so you could decide if it was the right place for you?” Comments made in the surveys included, “The manager gave me a most informative and helpful talk about the home at my first interview almost five years ago.” Residents, surveys, the AQAA and the manager told us that people tend to spend time as a short stay resident (referred to as ‘guest’) before any application for a permanent place at the home, followed by a trial period of one month if this decision is made. Relevant comments made in the surveys were, “Came in twice as a guest”. “I stayed as a guest before being offered and accepting permanent residence.” Three care files were looked at as part of the case tracking process. The AQAA and records looked at showed that pre-admission assessments are carried out. The assessment format included all the required areas of need and consisted of a pre printed tick box but with additional notes added to ensure there was sufficient information to make a decision about whether a person’s needs can be met or not. Discussion with the manager, observations made and assessment records looked at showed that the majority of the people currently living at Job’s Close remained mostly independent and had the minimum need of support. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is adequate. Care plans cover the support required by the people living at the home and are revised as an individual’s circumstances change but not reviewed monthly. Residents have access to health care professionals and are cared for in a respectful manner. There are some concerns around the medication process that could impact on the residents’ health and welfare. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three care files looked as part of the case tracking process included a care plan that had been devised soon after the person was admitted to the home from the pre admission assessments. These were brief as most of the residents required minimal support but gave sufficient information to advise care staff of the support that each individual needed, both long and short term. The care plans were specific to the individual and up to date in order to give person centred and relevant care and support. Each one included the person’s life
Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 13 history summary, most of which had been provided by the resident but the manager advised that where necessary relatives had contributed. The AQAA told us that the plans were reviewed only every twelve months although those looked at had been reviewed every three to four months. The suggested interval for this is monthly and although there was no evidence that needs were not being met or that changes were not recorded as individual circumstances changed there is the potential risk that this might happen. All nine residents answered, “Always” in the surveys in response to the question, “Do you always receive the care and support that you need?” One person made the comment, “Most helpful and understanding.” All the residents answered “Yes” to the survey question, “Do staff listen and act on what you say?”, but the following comments were added to three of the surveys, “Most of the time” “Not always.” and, “The staff are very patient and considerate. Always willing to listen and talk things through.” Three of the residents spoken with made positive and complimentary comments about the attention and support given to them by staff at the home. All nine respondents to the surveys answered “Always” to the question, “Do you receive the medical support you need?” but conflicting comments were made in response to this question, “Sometimes complaints (re health) not taken seriously” and, “Most efficient and helpful.” Discussion with the manager, with residents and the AQAA showed that the GP visited the home weekly and that some residents continued to be cared for by their own GP. Care files showed that residents on going health care needs were being met with evidence of visits to or visits by the GP, District Nurse, optician, chiropodist and Community Psychiatric Nurse. Residents spoken with confirmed that they could see the doctor if they wished and that they had visits from the chiropodist, optician and dentist regularly. One care file, and subsequent discussion with the resident, showed regular hospital out patient appointments. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 14 Pressure sore (a break in the skin due to pressure, which reduces the blood supply to the area) prevention measures such as pressure relieving cushions were in use in the home. Records for falls, pressure areas (areas where a pressure sore can develop), weight, bathing and nail checks were in place within the files looked at. Completed risk assessments for nutritional risk screening and a moving and handling risk assessment, including if the person had sustained a fall, were also in place. These would help to minimise any risk. The medication system was inspected. A medication policy was in place and kept in the staff office where it was easily accessible to the staff. Medication was supplied by the pharmacist in multi dose storage packs (blister packs), although some tablets and all liquids have to be dispensed in their original containers. The home uses a lockable trolley to transport medication around the home. There was also secure medication storage in a locked room. Medication keys are kept on the person of the senior member of staff responsible for medication on each shift, ensuring the safety of the medicines. The Medication Administration Record Sheets (MARS) were looked at. Records of medication received were on these sheets and balances from the previous cycle were carried over. There were a large number of unexplained gaps in these, where staff had not signed to say that the medication had been given or used a code to explain why it had not been given, leaving doubts about the administration of these medicines and creates difficulty when auditing and monitoring medication. A random audit was carried out on the medication dispensed in its original packaging. Several errors were found when there were either too many or too few tablets remaining compared to the number of signatures. These errors indicated that medication had not been given when it had been signed for or had not been signed for when given, thereby putting the resident’s welfare at risk. Some medication had been prescribed as PRN (as required) and several of these had rarely or never been administered in the current cycle. There was a comparatively large supply of these little used tablets, which was stored in the medication cupboard rather than in the trolley. The home should consider asking the GP to discontinue these prescriptions and to implement an effective homely remedy procedure that allows the staff to give ‘over the counter’ medicines safely and with the agreement of the GP. The manager advised us on the second day of the inspection visit that the excess medication had been returned to the pharmacist and the GP was to be consulted. Risk assessments were in place for those residents who self-administered their medication. The manager informed us on the second day of the visit that she Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 15 had improved the compliance records for these to enable the making and recording of more checks by staff. Anticipatory medication was shown on one of the MARS, to be used if the resident’s skin condition worsened. However the MARS instructions were not clear that this should only be used if required and did not instruct under what circumstances it would be used. Some medication instructions were “as directed”. The staff checking prescriptions need to ensure that instructions on them are specific so that those administering the medication know the dose and frequency that this should be administered. Other medication instructions said ‘one or two tablets as required’. There needs to be a code (with a key) to show how many have been given. Some MARS were handwritten. To ensure the accuracy of these records they should be countersigned by a second member of staff and should denote where the instructions had originated. There were no residents currently on controlled drugs. Terms of preferred address were on the residents care plan and heard to be used by staff. Observations showed that residents were cared for in a respectful manner ensuring that their dignity and self esteem were maintained. Residents spoken with confirmed that care staff were respectful and, for example, always knocked on their doors before entering. Personal telephones from a central exchange in the home were available to each resident in their own room, at their own cost, but they could choose not to have one if they wished. This gave them privacy and independence and enabled them to maintain contact with family and friends more easily. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 16 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): 1213,14,15 Quality in this outcome area is good. Residents were occupied and stimulated. Visitors were made welcome and their needs considered. Residents had choices and control over their daily lives. Residents enjoyed the nutritious and varied meals provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a designated activity organiser who works 21 hours over four days a week. It was the activity organiser’s day off at the time of the visit. The activities programme included, Extend Keep Fit classes, crosswords, word games, quizzes, card games, piano sing-alongs, weekly bible readings and monthly communion services. Five residents were asked if they had enough to be occupied during the day. They all said that they did, and gave examples of how they spent their day. Most of the residents answered “Always” to the question in the surveys, “Are there activities arranged by the home that you can take part in?” One respondent said that due to poor eyesight they were unable to read the notices informing residents about forthcoming activities. On checking the notice boards
Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 17 most of the notices on display, including the activities that were on offer that week, had been printed in a regular font that would be difficult to read easily. A general comment made in one of the surveys said that activities were very good, stimulating, and included quizzes and outings. This survey also said that residents enjoyed sing-alongs on the piano. The piano had been donated by one of the residents who regularly entertained the people living at the home. Residents spoken with said that their visitors were made welcome and that they could visit at any reasonable time. Visitors spoken with confirmed this. There were several areas as well as their bedroom, where residents could entertain visitors, including the lounge known as the library, the two smaller lounges in the annexe and a seated area overlooking the gardens by the rear stairs. The lounges in the annexe and a kitchenette on the first floor had been set up to enable residents and their visitors to make their own drinks but these areas were without supplies. Observations made and discussion with residents showed that people living and staying at the home have the opportunity to make choices in their daily lives, such as when to get up and go to bed, what to eat, whether to join in activities or not and where to spend their time. The AQAA told us that, “there are no rigid rules or routines in the home that infringe on the liberty or choice of residents.” Quarterly residents’ meetings are held where residents can give their views. Residents spoke of the meeting that had taken place at the time of the visit and how they were able to talk freely there. Residents answered “Always” or “Usually” in the surveys when asked if they liked the meals at the home. One comment said that it depended which cook was on duty and criticised the way some foods were not cooked to their liking. Another resident commented in the survey, “Most meals are very good and nicely presented. Also the food and warm drinks are hot and pleasant.” The menus were varied and nutritious. The AQAA told us that residents were consulted about the menus and this was confirmed in discussion with them. On the day of the visit the choices for lunch were roast chicken or steamed fish and a choice of dessert between, fruit meringue nests, ice cream and cheese and crackers. Residents had chosen their meal earlier in the day but residents spoken with said that there was no choice regarding vegetables. Lunch was taken with the residents and this was also our experience. Condiments, gravy and sauces were available on the tables for residents to help themselves. Residents spoken with said that they usually enjoyed their meals although there were inconsistent views about how they liked their vegetables cooked. The meals were very well presented, but served in the kitchen and brought to the residents already plated, thereby limiting the residents’ choice of what and how much is put on the plates. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 18 Discussion took place with the residents at the table with regard to serving their own meals from the table. The response was that this had been tried at Jobs Close but had not been successful because the more able had to assist the less able and their own meal went cold. with residents saying that they could make choices from the menu of the day. The meals are taken in the pleasant dining room that had many of the original features, and in the adjoining conservatory. The dining areas were attractively furnished and furbished. The Service User Guide stated that all meals are usually served in the dining room unless a resident is unwell or having a bath or by special request when they can be served in their room. A cooked breakfast is provided between 8.30am and 9am and a self service trolley of cereal, bread and butter and marmalade is available in the conservatory between 9am and 10am. The Service User Guide states that residents can also make tea, coffee and toast in the day room or the residents’ kitchen on the first floor, however there were no supplies during the visit. There were no up to date records to show that the appropriate temperatures of the fridges had been maintained. Staff were observed interacting with residents and offering support as needed while they served meals or assisted them to eat. The kitchen was clean and well managed, a record of the fridges, freezers and high risk cooked food temperatures were held and regularly maintained. A cleaning schedule was in place and used to make sure all areas of the kitchen were regularly cleaned. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 19 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): 16,18 Quality in this outcome area is good. Complaints are taken seriously. The home has appropriate training, policies and procedures to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents spoken with and who responded to the surveys said that they knew who to speak to if they were not happy and knew how to make a complaint. The complaints procedure was displayed in the reception area of the home for residents and visitors in order to advise them of the process to make a complaint. Complaints records are held showing the details of the complaint and how it had been addressed. There had been two complaints that had been managed appropriately and showed they listen to concerns and take them seriously. Since the previous inspection the home had revised their safeguarding (adult abuse) procedure and acquired a copy of the Local Authority Multi Agency Guidelines and records showed that training related to safeguarding had been provided for staff since the previous inspection. This training gives them the skills and knowledge they required to identify abuse and what to do if they suspect or witness abuse. Staff spoken with confirmed this and said they would report any concerns to the manager. There had been no complaints or safeguarding referrals made to us since the previous inspection.
Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 20 Recruitment practices safeguard residents from the employment of unsuitable people and financial practices safeguard residents’ financial interests. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 21 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): 19, 20, 21, 24,26 Quality in this outcome area is good. The home offers the people living there attractive and comfortable surroundings, which are clean, free of offensive odour, safe and well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Jobs Close is a converted Edwardian building that has been extended and is situated in a pleasant part of the village overlooking parkland. It has a deep frontage with long ‘in and out’ driveway and generous parking. The reception hall is part of the original building and retains original and character features, including an impressive staircase and wood panelling walls. All areas lead off the hall with the manager’s office and the library entrances being directly off it. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 22 The home has three lounges and a dining room in the original part of the building, which along with the conservatory off the dining room overlook the well-maintained and attractive gardens and the park. Ample and appropriate garden furniture was provided on the patio areas of the home. The conservatory is used as an activity room and as extra dining space. There are a further two smaller lounges in the extension (annexe). All are comfortably furnished and attractively decorated. Residents’ bedrooms varied in size, some being much larger than others. Those viewed had been personalised with the occupants’ possessions, such as photos, pictures, televisions and small pieces of furniture, and were comfortable with good quality bed linen, soft furnishing, decorating and carpets. Each had a lockable space for their valuables. All bedrooms had an ensuite bathroom and all but four of them had a shower. Residents spoken with said that they enjoyed their surroundings and were happy with their private accommodation. The home was well maintained in all areas viewed. A maintenance person is employed over a six-day week and attends to all immediate maintenance needs. The home was clean, free of offensive odour and was well maintained. Eight people answered “Always” to the question in the surveys, “Is the home fresh and clean?” and a comment was made by one resident, “All thoroughly clean and well presented. Health, safety and hygiene is good.” All communal areas where staff and residents were expected to wash their hands were provided with disposable towels and soap dispensers in order to maintain infection control. Staff had access to protective clothing to enable them to further maintain infection control. Laundry facilities were inspected and found to be well organised, clean and hygienic. Stained sinks in this area had been replaced. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29,30 Quality in this outcome area is good. There are sufficient staff of all designations available to meet the needs of the residents. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager advised that the normal staff available in the home were four care assistants and at least one senior member of staff during the hours of 8am and 8pm; one senior member of staff from 8pm to 10pm; three night care staff from 8pm to 8am; a cook and kitchen assistant on each shift; one laundry assistant from 8am to 5pm on weekdays; four or five domestic assistants weekdays and one at weekends; a handyman working 9am to 4.15pm on weekdays and 10am to 2pm on Saturdays. Rotas and the complement of staff on duty during the visits confirmed this. Given the low dependency of the people living at the home there were sufficient staff to meet the residents’ needs. However one resident made a general comment about staffing levels in one of the surveys, “Sometimes not enough staff, staff numbers seemed better when I first came in (year of admission).” The manager advised and records showed that care staff had undertaken induction training that met with the Skills for Care specifications and that
Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 24 seventy five percent of the care staff have achieved National Vocational Qualification Level 2 or 3 in Care, 25 higher than the requirement. People with these qualifications have been assessed as being competent in their role. Training records were recorded in a form that was easily auditable. These and discussion with the manager showed that staff have undertaken mandatory training in health and safety issues i.e. moving and handling, First Aid, fire training, Health and Safety, Food Handling and Infection Control. All staff had undertaken training related to safeguarding adults. Three staff files were examined and included all the information required, including Criminal Records Bureau and Protection of Vulnerable Adults checks, two validated written references and validated employment history. The application forms had been revised to include enough space for applicants to be able to enter their employment history. The home has one overseas member of staff and they held proof of the person’s right to work in the UK. All recruitment practices safeguarded residents from the employment of unsuitable people. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 25 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): 31, 33, 35, 36, 38 Quality in this outcome area is good. A person with the appropriate qualification and who has previous management experience manages the home. The monitoring and auditing of the service and practices ensure that all services operate in the best interests of residents. Health and safety training and practices protect residents and staff at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had been in post for 18 months and had previous experience of managing a residential care home. She had achieved the Registered Managers Award and National Vocational Qualification Level 4. She also had BTEC in Dementia qualification and joins all staff in the mandatory training discussed in the previous section. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 26 Lines of accountability in the home are clear, there being the Director of the charity who is in the home several times a week and the Trustees of the charity, two of whom were visiting the home at the time of the inspection visit. the manager and the deputy manager are supported by them and assisted in their management of the home by three permanent senior care officers and three bank senior care officers, who will cover absences amongst the permanent senior staff as needed. residents spoken with spoke highly of the manager and deputy manager and said that they felt that they listened to them and were very approachable. The home has a quality assurance system, with responsible members of staff and Trustees addressing the areas they were responsible for. For example the cook audited the kitchen, the manager monitors the staff, the deputy manager audited the medication. The Responsible Individual inspects the home monthly and reports on his findings. An annual development plan is in place based on audits and the feedback from residents and other interested parties. Residents meetings, where feedback is sought, are held four times a year and one took place during the inspection visit. These systems indicate that the home monitors the service in order to enable growth and improvement. The manager and the AQAA told us that the majority of residents handle their own financial affairs. The home holds some money for safekeeping for five residents and this cash and the records were inspected. There were appropriate records of transactions made with two signatures, receipts for any purchases and cash that balanced against these records. This safeguarded their financial interests. These residents are able to access their own money whenever they wish and are encouraged to keep some money to manage themselves. All the other residents manage their own money. A safe had been purchased in the last year to improve security. The manager advised that they were on target with staff supervision to be given six times a year. She supervises the majority of the staff with some input from the deputy manager for staff that she does not see so often. Staff supervision is necessary as it allows the management to meet with staff on a one to one basis to discuss practice, personal development and philosophy of the home issues. It is also an opportunity for staff to contribute to the way that the service is delivered. Records were available in the staff files. The manager told us that she meets with the Trustees every three months but does not have one to one supervision sessions. Staff had undertake mandatory training related to health and safety issues to support the home being a safe place to live and work. There was evidence from a random check of records, that equipment was regularly serviced and maintained, health and safety checks were carried out and that in house checks on the fire system were up to date. Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 28 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 OP9 Regulation 13(2) Requirement There must not be unexplained gaps in the Medication Administration Record Sheets. This will safeguard the health and welfare of the people living at the home. An unannounced audit of medication and staff competence needs to be carried out at regular intervals. This will ensure that residents receive the correct medication at the correct time. There must be a protocol in place to instruct staff when to give ‘as required’ medication. This will ensure that residents receive the correct medication at the correct times for the relevant symptoms. Clear instructions must be recorded to ensure that staff are informed of when anticipatory medication should be used. Staff need to ensure that any prescribed medication has specific instructions regarding its dose and frequency. Any handwritten Medication Administration Record Sheets
DS0000060958.V372498.R01.S.doc Timescale for action 15/12/08 2. OP9 13(2) 15/12/08 3. OP9 13(2) 15/12/08 4. OP9 13(2) 15/12/08 5. OP9 13(2) 15/12/08 6. OP9 13(2) 15/12/08 Jobs Close Version 5.2 Page 29 should be countersigned, to ensure their accuracy, and include where the instructions originated. 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. Refer to Standard OP1 OP7 OP9 Good Practice Recommendations The Service User Guide should be reviewed and revised to include all the required information. All care plans should be reviewed at a minimum of monthly intervals and up dated as the person’s circumstances change. Consideration should be given to implement a homely remedies policy in conjunction with the pharmacy and GP that enables minor ailments to be treated safely. Notices intended to inform residents should be easily readable. Staff rotas should clearly detail the hours worked by all staff and include the manager’s hours. 4. 5. OP22 OP27 Jobs Close DS0000060958.V372498.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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
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