Inspection on 19/06/09 for Joseph House

This inspection was carried out on 19th June 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Joseph House 21/06/07

Joseph House 03/07/06

Joseph House 24/01/06

Joseph House 23/06/05

Joseph House 28/02/05

Joseph House 06/01/05

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 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Joseph House The Old Rectory Reedham Norwich Norfolk NR13 3TZ Lead Inspector Mrs Judith Last Key Unannounced Inspection 18th June 2009 12:30 DS0000027295.V376131.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Joseph House Address The Old Rectory Reedham Norwich Norfolk NR13 3TZ 01493 700580 01493 700994 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) Joseph House (Reedham) Ltd Mrs Beverley Mary Terry Care Home 35 Category(ies) of Learning disability (35), Learning disability over registration, with number 65 years of age (35) of places Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total number of people accommodated must at no time exceed 35. Any person must, on admission, be at least 45 years of age. One person, named in the Commission’s records and less than 45 years of age, can be accommodated. 21st June 2007 Date of last inspection Brief Description of the Service: Joseph House is a care home currently registered to provide personal care and accommodation to 35 elderly adults with learning disabilities. The home is privately owned and has been run by the same proprietors for a considerable period of time. The service, located in the village of Reedham, approximately 20 miles from Norwich, is a large period house, which has been extended. Joseph House is on a no through road so there is little passing traffic and stands in large grounds. There is off-road parking. There are also two other small units providing accommodation adjacent to the main house. The home has a total of 21 single bedrooms, most of which are en-suite, and 7 shared rooms, all of which have en-suite facilities. The main house has accommodation on the ground and first floors, which residents can also access by the lift. There are 30 people living in the home at present. The manager needs to apply for a variation to her registration conditions in respect of younger people she wishes to accommodate in the Annexe or the Lodge. Charges for living at the home range from £367 to £2,198 per person per week according to their assessed needs. There are additional charges for hairdressing, chiropody, newspapers and magazines, outings and personal spending. The manager says she ensures that inspection reports are made available to residents or their representatives. Joseph House DS0000027295.V376131.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. This represents a decline since our last visit because of some concerns we have about health and personal care. Before we visited the home we looked at all the information we had about it. This included the information we asked the manager to send us in her annual quality assurance assessment (AQAA). We sent surveys to some people living and working at Joseph House. Eight people living in the home completed these with assistance. We had five surveys from staff. We also looked at the last review of the service, concerns that have come to us and our last random inspection, to see what this tells us about the history of the home. When we visited we did this unannounced. The manager did not know we were coming. We spent almost 9 hours in the home. While we were there, the main method of inspection we used is called “case tracking.” This means that we look at records to see what they say about people’s needs and then try to find out from observation and discussion how well those needs are being met. We used the information we gathered and the rules we have, to see what outcomes are being achieved for people in their daily lives. What the service does well: The home has good outcomes for people in most areas. This includes delivering a fulfilling lifestyle, responding to complaints and the way the home is staffed and managed. People find Joseph House homely and comfortable. Despite its size staff work hard to try and create a family atmosphere. People can keep their rooms how they would like and have their personal belongings around them. People have access to a range of activities to promote a fulfilling lifestyle for them. They say that staff treat them well and help them when they need it. We had comments like “I especially like bingo and the live entertainment.” Staff can complete a range of training so that the team have the knowledge and skills to meet a range of individual needs. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The records of care and support given to each person need to show that the care they get matches their individual needs. At present, staff are making very similar entries for each person that do not show individual interventions they need to make. We know that the medication system in use is new to the home and so staff may still be getting used to it. However, we found gaps in records where it was not clear people had the medication they are prescribed and that the doctor considers is necessary to keep people well. This means that the manager cannot show there are suitable arrangements for recording and checking that medicines are being given properly and safely. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 7 Staff records did not contain all the information they need to. This includes full employment histories that the law says the home needs to ensure the recruitment process protects people as much as possible from staff who may not be suitable. Staff who are employed need to have proper supervision to discuss their work and development. The manager needs to make sure that she tells us in writing about all the things set out in regulations. This is so she can show she is being open in her dealings with us and we can see that she is taking any action that might be needed to deal with problems. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. People have their needs assessed and can try out the home so they could be sure it will suit them and meet their needs. EVIDENCE: Seven out of nine people who wrote to us say that they were asked about moving into the home and had enough information about it. One person felt they did not but they had to move to the home in a hurry. We checked the records of people admitted to see if their needs were assessed before they moved in. For one person admitted since our last visit, these showed that the process of gathering information about the person’s needs began before they moved in. It involved gathering the person’s background history, an assessment of their support needs and abilities, and a risk Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 10 assessment in relation to diabetes. This shows that people’s needs are assessed properly before they come to the home. One person we spoke to said they had been able to visit the home before they moved in. Other people made comments to show they had been for a visit and a stay before they were asked if they would like to move into the home for good. This shows people get a chance to make a decision about whether it is the sort of place they would like to live in. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People’s personal care needs are met. The way that medicines are managed is not robust enough to ensure they are given to people safely and as prescribed to keep them well. EVIDENCE: We looked at the individual care plans for four people. These set out what care staff should deliver to meet people’s personal needs properly. They are not presented in any alternative format at present and are accessible to people living in the home. However, we could see that – where they were able to do so – people had signed their care plan information and risk assessments. Records of “keyworker talk time” show staff do spend time talking to people about their lives, aims and needs. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 12 Goals for intervention in care plans have now been broken down so that it is easier to see how the person is making progress and when the care plan has been reviewed to make sure it is up to date. Five staff wrote to us that they feel they “always” have up to date information about people’s needs. One commented that care plans contained information about all aspects of service users’ needs and then went on to give examples of what was in them:“Methods that encourage individuals to use their strengths and potential” “Health and social care conditions that affect the individuals with whom we are working “Factors that affect the behaviour, skills, abilities [ ] and willingness of individuals to be involved in their own care and decisions about the assistance we should give to them.” This shows that staff understand why care plans are useful and needed. There is no formal nutritional assessment in place for people who might need this. However, staff do monitor people’s weights and special diets are available. We spoke to staff about people who need their food to be softened and their drinks thickened. We were given clear accounts about this and staff confirm that they are given training to help people to eat, as well as to recognise signs of aspiration so that they can support people safely with eating their meals. There is no formal assessment of people’s vulnerability to pressure sores – including for those people who have a history of problems. However, records do support that there is prompt referral to the district nurse for treatment or equipment to assist in prevention and recovery. However, advice given to staff by the district nurse and recorded by her in the nursing notes did not result in a review or update of the care plan. For example, advice had been given in May this year about how to relieve pressure on the person’s ankle when they are in bed. The care plan does not show this and what staff should do when they are helping the person to bed. This means that staff would not have had clear up to date written guidance about how to meet the person’s health care needs at that time. Records show a current pressure sore as reducing in size. This indicates that although interventions have not been successful in preventing the ulcer developing staff are securing improvement in the person’s health. A care plan for mobility reflects that the person should be encouraged to walk a few steps (to avoid pressure sores and regain some mobility). As at our Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 13 random inspection, daily records do not show this happens as the care plan says it should. This means that they do not show care set out as needed, is always happening to promote someone’s health. Records and correspondence show that people are supported to attend appointments and that they are able to consult with health professionals – including nurses (district and mental health), eye clinic, psychiatrist and GP’s. The outcomes of appointments are recorded so that staff know what needs to be followed up. We could see that where care plans say it is needed, staff carry out regular monitoring of blood sugar (and have clear guidance about what levels should be and what they should do if they are too high or too low). This means they support someone with managing diabetes effectively and will pick up any problems promptly. Professionals are consulted, as part of the quality monitoring process, to see what their views are. Their comments include a range of views from “excellent care” to health and personal care being seen as “quite good.” Eight people wrote to us that they always feel well treated by staff and one responded to our question by saying “yes they do dear.” Five people we spoke to say staff treat them well and that they feel staff help them when they need it. We looked at medication and asked staff about the process and their training. A new monitored dosage system is in place and we were given a clear account about the procedures that were to be followed and the checks made. However, records do not support that the procedure is followed consistently to ensure medicines are given to people as intended by their doctors. Omissions from the records for 9 people mean that it is not possible to determine that medicines have been given as prescribed or withheld for some reason. This includes some medication to control depression, epilepsy and diabetes which is important in keeping people well. One tablet remained in a blister pack for one person. There was no coding or signature to show why this was. It was not recorded as refused and others due at the same time were signed as administered. Daily notes record that medicines were given as prescribed on that day. This means the person did not have the medicine their doctor considers necessary to keep them well. We checked medication needed occasionally for one person for agitation. The medication record showed clearly when this was given and daily notes showed its administration was justified in line with guidance for staff. This shows that staff are clear about when they may need to offer this medicine to support the person’s wellbeing. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 14 People told us that staff treat them well and that they knock on doors before they come in. At our random visit we found people’s dignity was not always promoted as they did not always wear their own clothes. (Items were wrongly allocated around people’s rooms when their laundry was returned.) Since that visit, the manager has implemented a checklist for staff to use to monitor people’s belongings and minimise the likelihood of this error being unnoticed. During our visit one person was very concerned about the state of their clothing because they had been incontinent. A staff member came back into the room and went to help. However, another staff member who had been present and next to the person did not reassure them. There was no response to persistent requests to “look at my dress. Feel my dress.” Screening is provided in the treatment room so that if the visiting doctor wishes to see people there, their privacy will not be compromised. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. People have opportunities for a fulfilling lifestyle, which suits their needs and preferences, than when we did our random inspection EVIDENCE: Since our random inspection staff have improved the way they record people’s opportunities for social activities and interaction. We could also see from records of residents’ meetings that staff try hard to provide ideas and act on suggestions. For example, knitting and gardening clubs have been set up and a photography club has been proposed. Records show people participate so far as they are able or willing. Since our last visit, use of the swimming pool has increased. The manager says she likes this to happen while she and her supervisor are present to increase staff numbers. One person told us we “paddle if it’s hot when [staff name] and Bev are here”. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 16 Records and discussion at handover show that there had been an ‘Elvis tribute’ the evening before our visit. Hand over, records and discussion show that most people took part and enjoyed dancing or singing along. People told us “it was really good”, “we had a party”. The day we visited, the same person had presented Buddy Holly songs in the morning. One person says, “We always have a vote on the day’s activities. I especially like bingo and the live entertainment. I decide what to wear for the day and any other decisions that need making.” Another says, “We have lots of entertainment.” Staff work hard to offer people holidays. One person says “we had a lovely holiday last year.” There is a dedicated activities coordinator who works part time. This helps to support people to do the things they want and also allows care staff some time to do other things with people. However, staff comment it is sometimes difficult to find time to spend with people in smaller groups or with a key client. The views of professionals vary. One sees the rural location as an advantage. Another feels that the home’s rural position disadvantages people in connecting with the local community. However, one person told us they liked the fact that “it is a quiet and peaceful place to live.” The visitor’s book shows that people are able to receive visits from friends and family. The manager says she has plans to increase the involvement of people’s families in daily life in the home. Records also show that the home has secured an advocate and befriender for one person to help them with decisions and activities outside the home. One person told us “they look after my money – staff do.” We asked if the person was happy with the arrangement and they told us they were. They said they sign for money they receive. We could see that the dining room is no longer locked and people are free to access it. There are two chillers on a counter there with squash to drink that people can access at any time if they are thirsty. One person told us “I take a drink to bed with me in case I get thirsty.” The manager has signed up to the “good hydration charter” which as been established in care homes to ensure people have adequate fluids so that risks to people of dehydration and associated complications are avoided so far as possible. The manager says there is now a qualified chef and that the mealtime experience has improved for people. She says it is a calmer and more pleasant experience for people. Staff support this. A staff member says the choice and range of food on offer is much better - “really good now. People Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 17 are eating better, they really like the food.” We were told some people have fortified diets and others have low fat meals. Those we spoke to say that the meals are very good and they enjoy their food. “We have lunch outside when the weather is nice.” “We had a barbecue the other week.” The menu is displayed in the serving area (in written form). However, staff say the chef checks with people what they would like for their meal and explains what is on offer. They feel the chef communicates well with people. They expressed the view that previously, if people did not like the meal that was on offer they had limited options. This has improved they say. Staff say people now have more fresh fruit and vegetables than previously and that soft diets are more varied, with more cooked and pureed fruit rather than pre-prepared mousses or sweets. The dining room has been redecorated and we saw tables laid with cloths, placemats and condiments so that it is a more pleasant environment for people. Three people also told us that they have their “meals outside sometimes if the weather is nice” and “we had a barbecue.” Staff say they are given training to assist people who have eating and swallowing difficulties. We have seen previously that staff sit alongside people who need assistance. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. People’s concerns would be taken seriously and followed up. There are systems in place to help safeguard them from abuse. EVIDENCE: People we spoke to say they “speak to Bev” or her deputy if they have any concerns or complaints. They say they do not have any complaints at the moment and are happy with the home. All of the people who wrote to us say they know how to make a complaint if they need to and the staff who wrote say they know what to do if someone (or a representative/relative) raises concerns about their care. One staff member says they can go to the manager if there are any issues or concerns. There is a complaints book for recording any issues that the manager has needed to investigate and the outcomes of investigation. We could see from the way that one had been resolved that the manager had taken action to ensure the issue was followed up properly and promptly. A complaint was made to us last year and referred as a potential safeguarding issue. The allegations were not substantiated. The manager cooperated with the safeguarding team and provided full access to information and to the people concerned. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 19 Staff say they have training to help them recognise and respond to abuse. This is confirmed by training records. Staff are clear about their responsibility to report all concerns. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. Significant progress has been made in improving the quality of the environment to ensure that people benefit from a home that is safe, comfortable and hygienic and suits their needs. EVIDENCE: The manager has plans to improve and redecorate parts of the home as funding becomes available. We know from previous visits she has not been able to do this as she would like in the past but the process has accelerated since our last visit. We saw that the two smaller units are being redecorated and refurbished to provide additional facilities for service users. Some ensuite facilities have been improved and work was taking place to create walk in shower facilities to create easy access. In the main part of the home, the Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 21 dining room has also been redecorated to provide a better environment for people to eat their meals. A “library” has been created near the front door that can be used for people who wish to sit quietly, for them to receive visitors in private, for meetings and reviews. There are plans for other areas of the old part of the home, including one of the lounges, and to redecorate some bedrooms. We saw that people are able to choose colours, furniture and soft furnishings and a “colour board” is created from their choices ready for the work to begin. This work has to take place over time and as funding becomes available. Although some areas of the home are looking ‘tired’, repairs that affect people’s safety are being attended to. Visiting professionals have commented in the quality assurance survey that the “large communal area needs some updating” but also that “the home is in the process of being modernised and developed. The completed works look very good so far.” Another professional considers that, despite the size of the home it does create a “family atmosphere.” We looked at a sample of records to do with fire safety which shows systems are in place to ensure fire detection systems, alarms and emergency lighting are maintained so that people’s safety in the event of fire is promoted. There are extensive grounds at Joseph House. Areas people currently access are maintained in a tidy manner. Some other parts are not well maintained but there are plans to improve facilities – including the creation of a sensory garden for people who have impairments and would benefit from this. The gardening club has started a vegetable and fruit growing area where people can join in or sit and watch what is happening and what is growing. Laundry facilities have been improved with larger equipment and sluice cycles. This means that measures to help control the risk of infection have improved. A staff member confirmed they had completed infection control training by a distance learning package, and that they have food hygiene training. The manager says that all care staff have had training in infection control and training records supported this for the sample checked. This means staff have the underpinning knowledge they need to help minimise any risk of cross infection. We asked people in our questionnaires whether they thought the home was always fresh and clean and they told us it was. One says “yes, the home is cleaned daily.” Another says “a lady cleaner she does my bedroom lovely.” This means that people feel they live in a clean environment. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. People are supported by staff who have a clear understanding of their roles. EVIDENCE: Staff are allocated to “teams” during the day so that there are clear areas of responsibility and accountability for delivering care and support to people. Senior carers told us that they do try to monitor and check that people have received support as expected, especially when staff are less experienced. Not all staff feel that there are “always” enough of them. Three out of five who wrote to us did feel this was the case, but two felt it was “usually” so. Two staff we spoke to say they feel that they are very stretched if there is a busy shift with lots of appointments. We had comments like “we have had spells of being short staffed but we always try to meet the needs of our clients”, and “occasionally a member of staff may fail to turn up for work. Such a situation would be covered by a member of the management or even the supervisor would step in.” This means that efforts are made to ensure staffing levels, while sometimes difficult, are appropriate for people’s safety and welfare. When we visited we could see that people were not being rushed or hurried in a way that would suggest staff were under pressure or that there were not enough of them to meet people’s needs properly. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 23 Staff also tell us that team spirit and cooperation is much better and things are on the “up and up”. We were told the staff team is “a good team. People are very supportive.” Domestic staff are employed and we did not have concerns about cleanliness in the areas we saw. The manager tells us in written information she sent that over half of the care staff have National Vocational Qualifications. We spoke to the staff member who arranges training and were informed that more staff have been put forward for this and one we spoke to confirms this is the case. This means care staff have access to underpinning knowledge and training to understand their roles, the needs of people living in the home and how they are to support them effectively. We could see that staff are checked against the register for the protection of vulnerable adults. Dates show these are carried out before people start work. People then work under supervision until they have full checks for criminal records. This helps to make sure they are suitable to work with vulnerable people. However, there are other shortfalls in the process. Specifically, full employment histories are not obtained together with written explanation of gaps where this is appropriate (and of reasons for leaving if the person was a carer before). This acts as a further check on the suitability of staff to work with vulnerable people. Because there are no proper interview records it is difficult for the home to demonstrate that a structured process is in use that is fair to all applicants. It also does not support that any anomalies or gaps in information have been explored and accounted for. Staff told us about their induction and how they were supported and supervised by others before they were allowed to carry out any personal care tasks on their own. Senior staff say they monitor staff when they first start to work unsupervised to make sure they have understood what is expected and can work competently. All the staff who wrote to us feel their induction covered what they need to know to do their job. We had comments like:“The manager was very thorough” “The induction was extensive and detailed.” “It was very helpful. It was full of relevant information to the job, i.e. policies and procedures” “We were very well initiated”. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 24 However, the personnel records we saw did not wholly support the induction was delivered fully and promptly. For example, one person started in March last year and there was no evidence that their induction had been “signed off” as completed satisfactorily and competently during that time. The manager had not told us in writing about one incident to do with staffing that she should have done so that we could see she deals with things robustly and thoroughly. All staff who wrote to us say they feel they have training that keeps them up to date and helps them to understand people’s needs. One person says “not a fortnight goes by without something.” A lot of this training is delivered “in house.” However, people also told us that they have the opportunity to complete courses like dementia care, medication and infection control by distance learning packages. They also told us they had completed abuse awareness training, first aid, food hygiene and moving and handling. Staff have had training in how to support people with eating and swallowing difficulties, including recognising signs of aspiration. This shows that they have been given training to help support people safely. There are plans to register more staff for distance learning packages in drug awareness, providing suitable activities for service users, malnutrition and health, and stress management. A member of the management team is also to have training in delivering palliative care. These things mean that collectively, the staff team have the skills and knowledge to deliver care to meet the specific needs of individuals. Joseph House DS0000027295.V376131.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to this service. The home is being effectively run by an experienced manager in a way that provides clear direction for staff and takes into account the views, health and welfare of people living there. EVIDENCE: We know from previous visits that the manager has the necessary qualifications and experience to run the home effectively. We were able to see that a range of people from outside the home had been consulted to see what they thought of the quality of the home. There have been positive comments about the way the service is delivered and how it is able to respond flexibly to people’s needs. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 26 The manager has also fully completed the annual quality assurance assessment we asked for. This contains a better range of information and evidence than she has given us before. It tells us what has improved and we were able to see this, as well as areas that the manager intends to work on over the next year. She has plans to try to use this electronically so that she can regularly update it with the progress that has been made towards meeting her aims for the service. This shows she is taking responsibility for continued improvement in the service. We know from previous visits that the home handles some money for safekeeping on behalf of people living there. We did not check balances and records on this occasion but have found systems satisfactory in the past. One person we spoke to was happy with the arrangements being made on their behalf and signed their own records when they had money given to them. We have told the manager before about staff needing supervision. This is so staff could have formal meetings with a member of the management team to discuss their work with individuals, practice, the home’s philosophy and their own development needs. However, the improvement we saw at our last key inspection has not been sustained. Two people in post for over a year each had only one recorded supervision. However, a staff member who had presented concerns had been given extra support and supervision to achieve the expected standards of performance. We looked at a sample of records to do with promoting people’s health and safety. We could see that there are risk assessments about the premises, and in relation to fire safety. These are updated and reviewed from time to time. Temperatures at hot water outlets are also tested regularly to make sure that there are no developing faults with regulators that could place people at risk of scalding if they were not detected promptly. We could also see that servicing contracts are in place to ensure the fire detection systems, lifting equipment and the boiler remain safe and effective. Staff have training in moving and handling so that they know how to do this safely where people need assistance or equipment. Records show that the manager had appropriately recorded and reported to an incident under reporting of injuries, diseases and dangerous occurrence regulations (RIDDOR). These things show that the home helps promote the safety of people living and working there. Joseph House DS0000027295.V376131.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 2 8 2 9 2 10 2 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 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 2 x 3 Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 28 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 OP8 Regulation 12(1) Requirement Outstanding requirement Daily records must show that the care identified as necessary to promote people’s health, is delivered. This is so aspects of people’s health care are not overlooked. This is so the home can show better how people’s health is promoted. Medication records must be fully complete and accurate. If this does not happen the manager cannot show that arrangements for safe administration and recording are in place. If this does not happen, the home cannot show people have been offered medication that has been prescribed to promote their health. Records for staff employed at the 31/07/09 home must be full and complete. If this does not happen, the Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 29 Timescale for action 31/07/09 2. OP9 13(2) 31/07/09 3. OP29 19 and Schedule 2 4. OP29 37 manager cannot show that she is operating a wholly robust recruitment procedure that protects people. The manager must tell us in writing about things that happen in the home and the law says she must tell us about. This is so she complies with the law and keeps us informed of incidents so we can follow them up if we need to. This is also so she can show us what action she is taking to deal with important issues. Staff must receive adequate and appropriate supervision. If this does not happen the management team will not be providing opportunities to discuss people’s work, performance and development with them, as well as the philosophy and aims of the home. 31/07/09 5. OP36 18(2) 31/07/09 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. Refer to Standard OP9 OP19 Good Practice Recommendations A system for checking and monitoring the accuracy of medicine records should be set up so that omissions or errors can be addressed promptly. Interviews should be structured so that the process is always fair and even handed for all applicants. This is to make sure that the process of recruitment is consistent and can withstand challenge if necessary. Staff records should show evidence of competence achieved during induction and be ‘signed off’ in a timely DS0000027295.V376131.R01.S.doc Version 5.2 Page 30 3. OP30 Joseph House manner. This is to improve the way the home can show what training has been delivered and the manager can satisfy herself that people are competent. Joseph House DS0000027295.V376131.R01.S.doc Version 5.2 Page 31 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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