Inspection on 05/03/08 for Jomar House

This inspection was carried out on 5th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Jomar House 24/03/09

Jomar House 11/04/07

Jomar House 04/10/06

Jomar House 24/04/06

Jomar House 18/01/06

Jomar House 11/07/05

Jomar House 04/01/05

Jomar House 21/06/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Jomar House 38 Townhouse Road Old Costessey Norwich Norfolk NR8 5BS Lead Inspector Mrs Judith Last Announced Inspection 5th March 2008 2.30 Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 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 Jomar House DS0000027579.V361584.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 Adults 18-65. 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. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jomar House Address 38 Townhouse Road Old Costessey Norwich Norfolk NR8 5BS 01603 745974 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) Mr Mark Cocker Mrs Joy Cocker Not applicable Care Home 2 Category(ies) of Learning disability (2) registration, with number of places Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration of two people with a learning disability refers solely to the two people currently accommodated at Jomar House and who are named in the Commission’s files. Only these people can be accommodated at Jomar House. 11th April 2007 Date of last inspection Brief Description of the Service: Jomar House is a care home providing personal care and accommodation for 3 adults with learning disabilities. The Proprietors are Mrs Joy Cocker and her son Mr Mark Cocker. Mrs Joy Cocker lives on the premises and is the manager. The home is located in Old Costessey on the outskirts of the city of Norwich. The Home is close to shops, pubs and all other local amenities. The accommodation is provided on two floors and all service users have single bedroom accommodation. The Proprietor, Joy Cocker lives in the home and shares all communal facilities with the services users. The home has an attractive garden with a patio area. The Proprietor has three dogs and a cockatoo that live as part of the family. The home has steps to the back and front and would not be suitable for adults with mobility difficulties. There are no vacancies at the home. The last reported charge for each person was £1392 per month. Fees include food and domestic services (laundry, heat and light), and also transport in the provider’s car. Residents are required to fund their own personal expenditure and holidays. The provider has inspection reports in the room used as an office, which is accessible to people at the home. Jomar House DS0000027579.V361584.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. We told Mrs Cocker we were coming. That is because she supports people on her own and no one else works at Jomar House. We needed to be sure she would be there when we visited. We were there about two and a half hours. We got information from the annual quality assurance assessment (AQAA) that Mrs Cocker filled in and sent to us and from records we looked at. Other information came from people living at the home and from looking and listening to what was happening. We used all this information and the rules we have, to see how well the home was being run. What the service does well: What has improved since the last inspection? Mrs Cocker has done some training in diabetes and also in food hygiene. She has also worked hard to continue improving the records. People who live at Jomar House are now signing these to show they know what is in them. She has particularly improved the way she records money that is held by her for safekeeping and when this is given back to people. They sign the record when this happens. This means that we can see she is looking after this properly and that people are more involved in the process. She has also looked more at the quality of the service and how well it meets standards. This includes the form she filled in for us before she visited, where Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 6 she included good information and showed where she thinks she can improve even more in the way she supports people. 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. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Were existing systems to be followed and used fully in future, the outcomes would be met. Mrs Cocker has improved the way she records people’s needs and choices. However, there are no vacancies at present. EVIDENCE: Mrs Cocker continues to be aware of her obligations to fully assess any prospective service user should a vacancy arise and she decide to admit another person. She outlines this in the annual quality assurance assessment (AQAA). We have not inspected this in detail as outcomes were met at the last inspection and there are no vacancies with no recent admissions. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been an improvement in showing that individuals are involved in decisions about their lives, and are more involved in planning the care and support they receive. With further work to look at increasing independence, underpinned by improvements in setting out risks and how these would be managed, outcomes may well be good in future. EVIDENCE: Mrs Cocker has improved recording practices at the home. Care plan files are more organised so that she can easily access information for review purposes or monitoring although there were one or two pieces of information that had not yet been filed appropriately. As at the last inspection, Mrs Cocker has set out people’s support needs. She participates in reviews with them. One person confirmed their involvement in this. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 10 Daily records show what people have done and people sign these from time to time when they have read them, or Mrs Cocker has gone through them. Mrs Cocker says that both people can read and we have seen this (newspaper, TV magazine). Recording of people’s finances has improved to showing when money has been handed to Mrs Cocker for safekeeping, or returned to the person concerned. People have signed for money that has been returned to them. Balances held were accurate. There was clearer indication in records that Mrs Cocker was supporting people to work towards the goals that have been identified at their reviews – either directly herself, or by encouraging someone who is supported by a community worker. In her AQAA Mrs Cocker has recognised the need to encourage people with participation in the running of the home and encouraging opportunities and says that people are getting better at helping with cooking. Risk assessments, as before, are in a narrative style and would benefit from breaking down into the various steps of an activity so that she could show more effectively how she would minimise risk when looking at promoting more independence. One person told us they keep their room tidy. People may also prepare their own breakfasts, pack ups and drinks. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use services are able to make choices about their life style. There is room to continue improving the way that people are supported to develop their life skills. People feel their lifestyle suits them and meets their expectations. EVIDENCE: One person now has increased opportunities to make use of the computer both at classes and in the home, where he helps Mrs Cocker to use the Internet. He clearly enjoys this opportunity and was waiting to use the computer when we left, on his arrival home from day placement. Both people told us about the plans they had made for holidays. They go away together in a group and one person had chosen Bavaria, the other – Christmas market in Edinburgh. They were both looking forward to these trips. Mrs Cocker says in the AQAA that people are encouraged to manage Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 12 their own Euros while away and that they have already done so in both Ireland and Italy last year. One person told us about this. The AQAA says one person has recently started to do “short mat bowls” and records show this. They also go to some home football games. People confirmed that they enjoy the social clubs and bingo sessions that they go to. One person told us that they use the paper to see what is happening where. This confirms what Mrs Cocker says in the AQAA. They also have the opportunity to go out for meals in different places and trips to other towns, which Mrs Cocker arranges. People say they are happy with the way things are. Records have improved in showing what people have done in their free time, including outings, shopping trips and family contact. Records told us that one person visits their family (confirmed by the person concerned who had gone to visit for mother’s day taking a present and card). Where there is more limited contact and Mrs Cocker has made efforts to promote this. Records show that the relative was invited to visit at Christmas and to have a meal at the home with the person living there. The AQAA says that that they could do better in encouraging more independence outside the home. Mrs Cocker needs to look at this at review with other professionals. She also needs to look with them at the risks involved and how these would be managed. Mrs Cocker says people open their own mail and will ask her if they don’t understand it or there is need to follow it up. She also says that people have always voted if they wish to do so. She says no one goes into people’s rooms if they do not want this. We know this from previous discussions that privacy was respected with one person telling us no one went in their room without permission. Mrs Cocker says that people are getting better with their cooking. They told us that they like the food. Records show that Mrs Cocker monitors weight where this is a problem and that she follows up concerns (see next section). Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s personal and health care is based on their individual needs and Mrs Cocker advocates strongly on their behalf. As at the last inspection, she needs to ensure that she always updates records promptly so that these do increased justice to practice. EVIDENCE: Mrs Cocker provided information in the AQAA that people managed their own personal care, such as showering and washing their hair. Information in care plans about people’s abilities supports this as does our previous discussion with people living at the home. One person’s plan continues to show the need for an exercise programme that Mrs Cocker would need to check was being done and monitor or prompt accordingly. Daily records do not show her involvement with this or whether the person has completed them as set out by the health professional concerned. We made a recommendation about this at the last inspection. Records and correspondence on file show consultations with appropriate health professionals. However, these need to be kept up to date. For example, one Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 14 person’s care plan shows that they are to visit the consultant psychiatrist annually. The record does not show this has happened. Mrs Cocker says that appointments of this frequency are not considered necessary any longer. The care plan has not been updated to show this. There are records in files that show when people have appointments – such as for chiropody. However, the rigour with which records are completed is variable – as there were no records on the dedicated sheet since February 2007. Mrs Cocker was able to show these appointments on the calendar. We have made a requirement to cover these issues. Mrs Cocker has completed training in diabetes and so has complied with the requirement made at our last inspection. During our visit she followed up concerns about blood sugar levels and any necessary adjustments in medication that she might need to support the person with, with the diabetic nurse. This shows that she monitors the person effectively although they do their own blood sugar testing and manage their own medication. She confirms that she makes checks. Medication records are improved, showing strengths and dosages and when Mrs Cocker has given the supply to the person concerned. She monitors this (see above). Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People could be confident their concerns would be listened to and that there are measures in place to help safeguard them. EVIDENCE: There have been no changes in support arrangements or the service user group since we last visited. People have information about how to complain in their files and tell us they are happy at the home. We listened to interactions between people living at the home and Mrs Cocker when they arrived home. We heard laughs on both sides and people exchanging information about their activities. This supported they felt comfortable in Mrs Cocker’s presence. The AQAA says that there have been no complaints and that Mrs Cocker considers she is flexible enough to address issues promptly so they do not develop. She gave one example of a minor concern and how this had been addressed. Mrs Cocker has had training in the protection of vulnerable adults (November 2006). The complaints guidance needs to be updated so that people know how to contact the Commission if they need to. This is because the local inspection team has relocated. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs Cocker has consistently ensured that people live in a homely, comfortable and clean environment. EVIDENCE: We did not look at the environment in detail. Mrs Cocker has a good history of compliance with the key standards. Areas we did see (lounge, hallway and office) were clean and with no immediate safety hazards. One person is to have their room decorated and refurbished in the near future and is aware of this, together with the need to move into another room on the ground floor temporarily while this work is completed. Mrs Cocker has completed a fire risk assessment. The garden and exterior of the home to the front are well maintained. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 33 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are no staff employed at the home against which to evaluate key standards, but Mrs Cocker is able to support the two service users and help them meet their needs. EVIDENCE: Review notes confirm that purchasers are aware one person spends short periods of time alone in the home and that they consider this acceptable. At other times, people join activities together. People living at the home are happy with their lifestyles and opportunities to go out and about indicating that, at present, no additional staffing is needed. However, Mrs Cocker is aware that if day care arrangements change significantly as she is aware they may do in the near future, she would potentially need to review the support that she is able to offer and to supplement this. This means she will need to look properly at the standards for recruitment and training that we would expect to see implemented. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Mrs Cocker has continued to make progress in looking at the quality of the service and how she can increase the participation of and opportunities for people living there. Safety aspects have improved since our last visit. EVIDENCE: Since we last visited, Mrs Cocker has continued to work her own way through the induction guide she has, where she has reflected on situations that have arisen and how these relate to the standards. As before it is not possible for her to complete the programme properly given the circumstances at the home (she is the sole carer and registered manager). She is not able to complete the registered manager’s aware and NVQ 4 because the size and nature of the home mean that she does not have the appropriate relevant learning and practice opportunities open to her. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 19 She has completed diabetes training, as we required at our last visit. Mrs Cocker has not yet been able to identify other sources of training. She reports that sometimes the start and finish times of sessions she has seen are difficult for her because of her care commitments while people are at the home. She will therefore need to ensure that she receives support from the other registered person to enable her to complete any training identified as relevant and to meet requirements. We saw no immediate concerns for safety. The fire risk assessment Mrs Cocker identified as needed when we last visited, has been completed. Her first aid training is still in date (from 17/08/06 for three years based on the certificate we saw) and she has completed food hygiene training since we last visited. There is public liability insurance in place (certificate seen). The gas system has been checked. Mrs Cocker has always found it difficult to complete paperwork. However, she has worked hard at completing the annual quality assurance assessment that she needed to send to us, and has used the standards properly in the things she looked at. She has also recognised the things that she could improve and how people living at the home need to be involved and written these into the quality assessment. This means that we will be able to look at her work towards meeting the improvements she says she plans to make, when we next visit. Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 x 33 3 34 x 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 2 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 x 2 x 3 x x 3 x Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 21 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 YA19 Regulation 131)(b) Requirement Where support plans show that there is a need for particular intervention to promote people’s physical or mental health, records and support plans must show this happens. This is so Mrs Cocker can show people’s health needs are being fully met. Outstanding requirement The manager must ensure that she identifies and completes training to ensure her knowledge of learning disability issues and good practice is up to date. This is so the needs of people living at the home can be better understood and met and opportunities increased. Timescales of 01/07/06, 31/01/07 and 31/07/07 have not been met. Timescale for action 30/04/08 2. YA37 9, 10, 12 31/12/08 Jomar House DS0000027579.V361584.R01.S.doc Version 5.2 Page 22 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 YA6 Good Practice Recommendations The way risks are written down and assessed should be reviewed so that all issues are looked at, to show people are not exposed to undue risk, and that their choices are not unnecessarily restricted. Mrs Cocker will need to look further at this if she is to increase people’s opportunities to make choices and develop more independence. 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