CARE HOMES FOR OLDER PEOPLE
Jobs Close Lodge Road Knowle Solihull B93 0HF Lead Inspector
Jill Brown Announced 28 November 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Jobs Close Address Lodge Road Knowle Solihull Birmingham B93 0HF 01564 773 499 01564 774 333 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Jobs Close Residential Home For The Elderly Mrs Jane Ellis Care Home 35 Category(ies) of Old Age (35) registration, with number of places Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 18 March 2005 Brief Description of the Service: Job’s Close, which was established in 1984, 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 34 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 35 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 E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. An announced inspection took place in November with two inspectors over 7 hours. During this inspection 18 residents were spoken to and two staff. The care manager, responsible individual and deputy manager were present. The Commission received 16 comment cards; 14 from residents and 2 from relatives of residents. The inspectors joined residents for lunch, the main meal of the day. The care records of four residents were inspected and of three staff. Some maintenance and inspection records of services such as gas and electricity were also checked. The kitchen area was looked at but a full tour of the premises was not undertaken on this occasion. The care manager had recently taken up the post within the home and changes were being made in several areas of the home. What the service does well:
Comment cards and discussions with residents showed that there was a high degree of satisfaction with the service the home offered. Residents thought that their health needs were met, that staff were kind and caring and respected their privacy. The home makes visitors feel welcome and the homes committee members are involved in visiting and some activities run at the home. Residents thought that although it was early days the new manager would listen to their concerns and act. One resident said that she had already acted on a concern she raised. The home was clean and fresh on this visit and on a previous visit to the home in connection with changes in the building. The home has over 50 of its care staff trained in NVQ2 and the care manager has achieved the Registered Managers Award. It was clear that the staff were receiving up date training and such training helps to protect residents. Records on staff were generally well maintained with appropriate checks being made on staff prior to employment.
Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 6 The home has the appropriate maintenance and inspection certificates for services such as electrical wiring, gas equipment and service and lifting equipment. What has improved since the last inspection? What they could do better:
Newly admitted residents and residents on respite must have risk assessments in place for any area identified as a risk including self-administration of medication and these risks must be monitored. Assessments and care planning were new to the home and required some time for staff to be familiar with the paperwork. It was clear that there were gaps and some misunderstandings how some parts of the paperwork should be completed and a process for checking was needed. A number of care plans needed more detail on care to be provided to ensure the safety and comfort of residents. A number of residents said that they restricted to the number of baths or showers they could have if they needed assistance. Rotas for staffing the home needed to be formalised and cover the full 24hours and detail which staff member was in charge. This is important in fire procedures. One staff member had not had all the appropriate checks prior to their appointment however the home immediately took action to remedy this.
Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 7 The care manager will need to apply to the Commission to become the Registered Manager under the ‘fit person’ process. The home generally manages residents’ money well however separate individual receipts for services such as hairdressing is needed. It has been recommended that the home also consider separate record sheets for residents to ease filing. Some personal items of residents are also stored for safekeeping and these must be labelled appropriately. The home had some outstanding requirements and some requirements from the previous inspection that were not inspected on this occasion. The outstanding requirements were about the covering of radiators to ensure they do not scald residents and call alarm points being available in all the lounges. Requirements brought forward were about the home’s statement of purpose and contract being reviewed, flexibility being offered of meal times, call alarms being accessible in residents’ rooms, window restrictors on the ground floor and risk assessments being available for extra heaters. 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 E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 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 standard(s) 3 Arrangements for the assessment of residents had changed and needed to be checked so that these were clear enough to ensure residents’ needs were met. EVIDENCE: The new manager had started implementing a new system for assessment of residents’ needs this had not become routine practice at the point of the inspection. The paperwork was not completed fully and there appeared to be some misunderstanding on how complete some areas of it. Areas such as cultural needs needed more thought and there were inconsistencies of completion of assessment about care needs. The paperwork was trying to reflect a move to a person centred approach of caring by developing ways of retaining residents’ strengths and abilities; ultimately this will improve outcomes for residents. A recent admission to the home however did not have a number of key areas of assessment undertaken such as risk assessments and these could put a resident at risk. Previous requirements about the Statement of Purpose and the home’s contract with residents were not inspected on this occasion and these were brought forward.
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The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 The home’s care plans had changed a number of additions would ensure appropriate care for residents. The health care of residents in the home was good. The home has liaised closely with the community pharmacist to improve practice for medicine management within the home. EVIDENCE: Where the home had put new care plans in place these were appropriate. There were signs that the home was trying to consult with residents about the plans. In a number of cases there was a lack of detail in areas, such as continence pad and hoist sling sizes, and a night plan for a resident that walks during the night was needed. However in other areas of care planning there were good instructions to staff. In one care plan for example there was good detail about the need to talk to the resident whilst assisting her to eat. The home had good records of health professional visits and it was clear that residents had their health needs attended to. Residents said that they felt their health needs were met. Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 11 Residents personal hygiene needs were met, and it was clear that residents had access to facilities such as hairdressing, chiropody and so on. Residents were weighed, however a resident that had respite had not been weighed and this was important to get a starting point to measure against. The home had started to record falls in way that assisted them in looking for patterns. This means that falls reduction plans can be more effective. At the last inspection requirements had been made to improve medication administration. A follow up visit from the pharmacist inspector found that the home had improved and the following were the findings of that visit. Systems had been installed to improve practice for medicine management within the home. Service users were encouraged to self medicate their own medicines but at the time of the inspection inadequate risk assessments and compliance checks had been undertaken. The requirement in respect of this was brought forward as a respite resident had inadequate checks on medication on admission. Service users receive an annual medication review. Residents thought that they received good care in the home and that the carers were kind and treated them with respect. All of the resident comment cards said that their privacy was respected. Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15 The arrangements for activities, visits, choice and meals had improved and this enhances residents’ lives. EVIDENCE: The home has employed an activities co-ordinator and residents spoken to welcomed this appointment. One resident put in a comment card ‘life is much more pleasant’ (since this appointment). One resident spoke of being encouraged to take up an activity that they had lost interest in and how they now enjoy this especially as a member of staff joins in. The home’s new paperwork was moving to a person centred approach and this would assist the activities co-ordinator in determining activities in the future. Daily records showed activities such as visits into Knowle, playing the piano and going to church. There appeared to be no undue restrictions on visitors to the home and a number of people from the home’s committee also visit. Residents did not feel that they were restricted in their freedom to move around the home many spent time in their rooms watching their television or reading. The requirement of flexibility around meal times was not discussed with residents and this requirement was brought forward. A number of residents felt the number of times they could have showers or baths were restricted to one a week and this must be addressed.
Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 13 Residents’ thought that the breakfasts at the home were excellent and ‘the best meal of the day’ and ‘worth getting up for’. There were mixed opinions about the main meal of the day many finding it very good others wanting some changes to dressings and gravy. The tea was thought not to be as good as the rest but residents said that there recently had been improvements in that direction. One resident was found to be having a meal in their room on the day of the inspection. The home’s kitchen had adequate stocks of food and this was stored appropriately. Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The complaint process of the home worked and residents thought they were listened to. EVIDENCE: The home had one complaint since the last inspection in March. This complaint was about the home’s admission of a resident on a trial period, their medication and the home’s non acceptance of the resident on a permanent basis. This was investigated by the home but the relatives complained further to the Commission where the complaint was partly upheld. The requirement on medication remains and the homes contract with residents is still to be reviewed. Residents spoken to thought that their concerns would be listened to and many thought the new manager would take these issues up. One resident raised an issue that had been concerning them and said that the new manager had solved it as soon as she was told about it. Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 The home was clean and fresh. EVIDENCE: The building was not toured on this occasion, a tour had occurred as a result of changes to the building between the last and current inspections. The home was clean and fresh on the day of the inspection. There were some outstanding requirements from the previous inspection however a number had been resolved. A hot water restrictor had been fitted to the sink in the hairdressing room. The home manager said that residents had been assessed for their current walking aids. Previous requirements that emergency pull cords in individual bedrooms were accessible, that window restraints were in place on the ground floor windows and that the provision of additional heaters was risk assessed were not assessed and these were brought forward. The home stated the requirements for pull cords in all communal lounges and the covering of unguarded radiators had yet to be completed. Although the measurement and fitting of radiator covers was being undertaken during the inspection.
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The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Arrangements for staffing, employment and training staff were improving and this protects residents. EVIDENCE: The home appeared well staffed at the time of the inspection and residents and staff thought staffing levels were acceptable. Staff rotas did not show the full 24 hours of staff employment or which member of staff was in charge of the shift and this is important for fire procedures. The home has the required amount of care staff trained to NVQ2 or above. Staff files were generally well maintained and staff were employed as a part of a robust employment procedure. The home has application forms and references and so on. In one case a member of staff had been employed without a Criminal Records Bureau check or Protection of Vulnerable Adults (POVA) check. The home immediately remedied this and prior to writing the report both a risk assessment and a POVA check were in place. The requirement to have these in place remains until next inspection. One gap in employment had been explored but the reason for it not recorded and this should be done to ensure good employment processes. Staff interviewed had received a number of up date training days but the home’s performance on the staff teams training was not inspected on this occasion. Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 35, 38 The arrangements for the management of the home were generally good and improving. EVIDENCE: The care manager has been in post for approximately 2 months and according to residents was making positive changes to the home. The care manager stated that she has completed the Registers Managers Award. The Commission have yet to receive an application for her to become the Registered Manager of the home. The home’s arrangements for quality audits were not inspected on this occasion and the previous requirement was brought forward. The home assists residents’ families by managing small amounts of money to pay for hairdressing and chiropody and so on. Generally this is managed in an appropriate way although individual records rather than a book would enable records to be archived by person when needed. Hairdressing receipts should be
Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 18 individual to the resident so these can be traced if needed. Some items had been kept for individual residents many years ago and these must be tracked to the owners or relatives of the owners. The balances of money held for residents tallied with the home’s record. The home had appropriate insurance, maintenance and inspection records in place for the homes services such as electricity and gas. The kitchen had the appropriate food safety risk assessment. The home is investigating a full refit of the kitchen in the New Year. Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 2 x x x 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 2 15 3
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 2 28 3 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x 3 x x x 2 2 x 3 Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 6(a)(b) Requirement The Statement of Purpose and Service User Guide must be reviewed on a regular basis and revised as required. Service users and prospective service users must receive a copy of these documents. A copy of any revised version must be provided to the Commission. (This standard was not inspected on this occasion. Previous timescale of 15.12.04 not met) The decision to implement the additional charge of ‘Supplementary Care Services’ should be based on a multidisciplinary assessment of needs and subject to regular reviews. This must be documented. (This standard was not inspected on this occasion. Previous timescale of 15.12.04 not met) Assessments must be audited to ensure information collected is a true reflection of the resident. Risk assessments must be completed on residents admitted temporarily as well as long stay residents. Detail of how care is to be Timescale for action 28/02/05 2. 2 5,14, 17(2) Sch 4(8) 28/02/05 3. 4. 3 3 14(2) 13(4)(c) 31/01/06 15/01/06 5. 7 15(1) 31/01/06
Page 21 Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 6. 7. 8 9 12(1)(a) 13(2) 8. 14 12(3) 9. 14 12(3) 10. 22 13(4)(c) 11. 22 23(2)(n) 12. 25 13(4)(c) 13. 25 13(4)(c) 14. 25 13(4)(c) 15. 27 Sch 4 (6)(e) delivered such as night care plan and hoist sling size must be added to care plans. Residents on admission must be weighed to ensure a baseline for any gains or losses in weight. Any service user wishing to self medicate their own medicines must be suitably risk assessed as able against a robust policy and compliance checks be regularly undertaken and documented. 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) Residents must have the ability to have baths or showers as often as they reasonably would wish. All emergency pull cords must be accessible to service users. (This standard was not assessed and is brought forward) All communal areas must have an accessible emergency call system in place. (This remains outstanding from 01.07.05) All windows must have the appropriate restrictors fitted to window openings. (This was not assessed and is brought forward.) All radiators must be guarded or replaced with guaranteed low surface temperatures. (This remains outstanding from 01.06.05) Any additional heaters must be risk assessed. (This was not assessed and is brought forward) Rotas must be available for the full 24 hours they must show the 15/01/06 29/11/05 28/02/06 31/01/06 28/02/06 28/02/06 28/02/06 31/01/06 31/01/06 29/11/05
Page 22 Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 16. 29 19 (6) 17. 18. 31 33 9 24 19. 35 Sch 4(9) 20. 35 Sch 4(9) role of the member of staff and who is in charge. The home must comply with the Criminal Records Bureau Guidance and explore gaps in employment before employing a member of staff. The care manager must apply to become the registered manager under the fit person process. 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) The home must ensure that there are individual receipts for any spending of residents money. Loose items kept in safe keeping must be labelled with the owner and if necessary returned to them or their relatives. 29/11/05 28/02/06 28/02/06 15/01/06 31/01/06 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. Refer to Standard Good Practice Recommendations Jobs Close E54 S60958 Jobs Close V245523 281105 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor , Ladywood House 45-46 Stephenson Street Birrmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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