CARE HOMES FOR OLDER PEOPLE
Jobs Close Lodge Road Knowle Solihull West Midlands B93 OHF Lead Inspector
Jill Brown Unannounced Inspection 27th February 2006 09:15 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.V284821.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V284821.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Jobs Close Address Lodge Road Knowle Solihull West Midlands B93 OHF 01564 773499 01564 774333 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) Job`s Close Residential Home for the Elderly Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28th November 2005 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 and 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 lounges, 2 sun lounges and dining room. There is also an activities room, which is used as an additional dining room. The Home also benefits from a library cum lounge and hairdressing salon. There are 2 passenger lifts and a stair lift. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place over almost 4 hours in February. The inspection only covered some of the core standards. It is recommended that this report be read in conjunction with the report of the announced inspection that took place in November 2005. Four residents case files were inspected and four residents were spoken with at this inspection. A tour of some areas of the building was undertaken. A number of documents were looked at and a number of the homes previous requirements were assessed. What the service does well: What has improved since the last inspection?
The home has improved its information to residents and has revised the homes contract. The home now charges an averaged out price to include residents’ care needs. The home has spent time improving the assessment and care planning processes to reflect the strengths and abilities of residents as well as their needs. This assessment and care planning process ensures that information on the interests and life history of residents is collected and this can help in ensuring residents are satisfied with the service they receive.
Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 6 Risk assessments were being completed and reviewed including, moving and handling and self-administration of medication assessments and this protects residents. Care plan reviews were taking place and residents’ comments such as I would like a larger room suggest that residents are becoming involved in these. The home had ensured that radiators were covered and that window restraints were in place to protect residents. The home had very quickly after the last inspection ensured that staff had all the checks required, staff rotas were devised for the full 24 hours and changes were made to the records kept of residents’ money. This showed the home was willing and wanting to improve. The home has submitted an application for the home’s manager to become registered with the Commission. What they could do better:
The home needs to ensure that residents on respite have the same level of assessment as permanent residents and that these are updated if the resident has more than one stay. Assessments and care plans should always be dated so that changes can be tracked. It was recommended that the summary of care to be provided is more prominent in the resident’s records to assist staff accessing the information. The homes adult protection procedure needed adjustment to show that the home is not to investigate without agreement from Social Care and Health and the Commission. This process is to ensure that the evidence is not contaminated if a police investigation is required. The home has not had to use the policy. Whilst residents of the home are able to bring in personal possessions the home must ensure that the amount of furniture does not pose a risk to residents with poor mobility. The home has increased in size over the years and the electrical systems have been added to. There is a need to unify both homes resident call alarm systems and the homes fire alarms systems. The resident call alarms are not in place in some communal areas and are not always switched off in the room they are activated. The home has had a number of residents that have increased needs on a night. The home no longer has a manager that lives on site. The home needs to review its night staffing levels to take account of these facts.
Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 7 It was clear that the home was arranging training but it was not possible to determine if all staff had had the training required by Skills for Care organisation. This level of recording is needed to ensure that staff have the required updated training. 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. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 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 Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5 The information and contract given enabled choice and protected residents. Residents’ assessment of need had improved and this assists in the planning of how care is to be given to residents. EVIDENCE: The home had re submitted its Statement of Purpose since the last inspection and this met with the required standard. The home had subsequent to the last inspection reviewed its contract and charging policy to ensure that residents were charged a fee including their care needs. The Commission viewed this as a good change. Residents that are admitted have an assessment these are not always dated and this important as it can show times of improvement and deterioration in residents health. Assessments were seen to be more thorough and contained more information about the individual and this ensures that there is a good plan of care for residents. Residents that come to the home for respite equally require the same level of information in care plans and monitoring records.
Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 Care plans were good and were updated as residents’ needs changed. Residents’ health care needs were met. EVIDENCE: The home has improved the level of information that is kept both to inform a resident’s care plan and to assist staff in providing care. Care plans had information about a resident’s strengths, their life history, their routines and activities that they like, as well as any health concerns. This detail assists carers in seeing the resident as a whole person and helps care plans develop in a way that responds to choices as well as meeting need. This care planning process involves a lot of paperwork and a discreet summary would assist the staff in provision of care. It was clear that residents were having regular reviews of their care and that where needed care provision was reviewed and updated as resident’s need changed. Residents that had deteriorating health conditions were referred to their GP and where needed to specialists. One resident spoke highly of the arrangements made by the home to ensure that she got to her health appointments.
Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 11 The inspector saw that residents were talked to kindly and their concerns listened to and explanations given for decisions made. Residents personal hygiene needs were met and attention was paid to their laundry needs. Residents spoken to said they were able to have baths or showers when they wanted. Residents’ weight was monitored and this was an improvement from the last inspection. Residents appeared to gain weight once admitted into the home. Reviews of moving and handling and risk assessments were being undertaken on a routine basis. Personal choices were recorded when residents’ care was reviewed such as ‘I would like a larger bedroom.’ This showed that residents were becoming more involved in how care is delivered. Information was retained on the resident’s file about relevant health conditions for the resident and this is good practice. Medication administration was not checked on this occasion. However files inspected showed, where appropriate, risk assessments had been completed for residents that self-administer medication and that residents continued competence to administer had been assessed routinely. This was an improvement on the previous inspection. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed on this occasion however residents spoken to were happy with the events provided by the home. One resident spoke about how good the art classes were and the quizzes. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home had appropriate procedures in place that needed some revision to ensure that residents were protected satisfactorily. EVIDENCE: The home has an extensive adult protection policy that appropriately raises issues that need consideration. However it needs some alteration in the wording to ensure the home does not investigate any allegation without consultation with Social Care and Health and the Commission. This consultation is to ensure that there is an agreed way of investigation and that should a police investigation be necessary the evidence is not contaminated. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 26 The homes environment was of a high standard, clean and fresh. Improvements had been made on health and safety issues further improvements on call alarms would protect residents. EVIDENCE: The home demonstrated that they were working on the requirements made at the previous inspection. The home provides an environment of a good standard with quality furnishings and furniture. The home was clean and fresh at the time of the inspection in all areas except for one bedroom and this was being attended to. Residents spoken to said you couldn’t get better the home is always clean. The home has a large amount of communal space with large and small lounges. Fridges were available in the small lounges and although a record was kept of the food in the fridges a record of the fridge temperature was not maintained to ensure the food was kept fresh. The home immediately put a
Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 15 system in place for these to be recorded and this will be monitored at the next inspection. The home has increased in size over the years and has a mixture of call alarm systems. In some areas of the home this means the when a resident uses the alarm the alarm can be switched off outside the resident’s room. This is not as safe as an alarm that is switched off where the resident is. The alarm system needs reviewing to ensure a safe system is available through out the home. The inspector was informed that the home had received some quotes for this work. Residents can bring in some furniture and personal belongings in to the home. Residents’ rooms showed these individual styles and tastes. The home should show where residents have mobility difficulties that the amount of furniture does not put the resident at risk. The home had ensured that all radiators in residents’ areas were now covered and that window restrictors were in place. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 The home had improved their staff records and rotas in the home. The home needed to ensure that staffing levels and training reflected the needs of the residents at the home. EVIDENCE: Home was well staffed during the day and residents were well cared for. However the needs at night of a number of residents had increased and there was no longer a manager living on the premises. The home must ensure that it is adequately staffed to meet these increasing needs. The home was now keeping an adequate record of the staffs rotas. It was clear that training was being arranged but the home was unable to produce a record of how the staff team’s training matched with the Skill for Care required training. The home had ensured that all appropriate checks were in place for all staff. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35, 38 The arrangements for the management of resident’s float of money had been improved and this safeguards residents. Further work on quality assurance systems would ensure that these improvements continue. EVIDENCE: The care manager has applied to the Commission to become the Registered Manager for the home and this application was in progress. As the manager was not on duty it was difficult to assess the home’s performance on quality assurance systems. The Responsible Individual undertakes the required monthly visits and provides a report for the Commission. This requirement will remain until it can be fully assessed at the next inspection. The home had changed its method of recording money that was left by relatives for residents. This was much improved from the previous inspection
Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 18 with separate records for each resident. Residents or their representatives that had left valuables with the home had for the most part been approached to either take these away or fuller records had been kept. An inspection by the West Midlands Fire Service also took place on the on the day of the unannounced inspection. It recommended in line with the alarms that a unified updated fire alarm system be put in place and that the home stops storing items on stairs to the second floor. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 19 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 3 3 3 X 2 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X 2 X 2 X 3 STAFFING Standard No Score 27 2 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 X X 2 Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP5 Regulation 14(1)(a) (d) 12(3) Requirement The home must ensure that all assessments are dated and that full information is collected on residents prior to respite stays. Flexible times must be available for meals and service users must have a choice of where they prefer to take their meals. (Not assessed on this occasion. Previous timescale of 15.12.04 not met) The adult protection procedure must be revised to ensure that an investigation does not take place without the sanction of the lead authority (Social Care and Health) All emergency pull cords must be accessible to service users. (This standard was not assessed and is brought forward) The call alarm system must be unified so that all calls have to be cancelled in the resident’s bedroom or lounge where they have been activated. Timescale for action 30/03/06 2 OP14 30/06/06 3 OP18 13(6) 31/03/06 4 OP22 13(4)(c) 28/02/06 5 OP22 23(2)(n) 30/06/06 Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 21 6 OP24 13(4)(c) 7 OP27 18(1)(a) 8 OP30 18(c)(i) 24 24 9 OP33 The home must ensure that residents’ furniture does not compromise residents safety in walking. The home must improve the night care staffing arrangements to reflect the needs of the residents and to ensure the residents safety. The home must ensure that evidence of the staff team training is available in an auditable form. The Home must establish and maintain a system for reviewing and improving the quality of care provided by the Home. The system must include consultation with Service users and their representatives. (Not assessed during this inspection) 30/04/06 30/04/06 30/04/06 28/02/06 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 OP7 OP38 OP38 Good Practice Recommendations It is recommended that a full summary of actions required to deliver care to residents is more prominent in resident’s records to assist staff. It is recommended that the home update the fire alarm system. It is recommended that the home does not store items on the stairs to the second floor. Jobs Close DS0000060958.V284821.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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