Inspection on 15/01/08 for Joybrook

This inspection was carried out on 15th January 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Joybrook 23/08/06

Joybrook 14/02/06

Joybrook 03/11/05

Joybrook 21/03/05

Joybrook 21/12/04

Joybrook 18/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Joybrook 86 Braxted Park Streatham London SW16 3AU Lead Inspector Alison Pritchard Key Unannounced Inspection 12:00 15 & 21 January & 1st February 2008 th st X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Joybrook Address 86 Braxted Park Streatham London SW16 3AU Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company Name of registered manager Type of registration No. of places registered (if applicable) 0208-764-2028 0208679 1138 joybrook@hotmail.co.uk JoyCare Home Services Limited Janet De Haney Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 Brief Description of the Service: Joybrook is a 15-bedded private home for older people operated by a small family business, which includes the manager. It is situated on the corner of a pleasant residential road, within walking distance of a large common. It is a short bus ride from a local shopping centre which has rail and bus transport and full community facilities. The home has 11 single and 2 double bedrooms, some on the ground and some on the first floor accessed by a lift. All of the communal areas are on the ground floor. The Manager has been at the home for approximately 15 years and there is a stable staff group. On the last day of the inspection there were no vacancies. The Registered Manager stated that the fees charged range between £358 and £575 a week. Additional charges are made for: • Clothing • Dry cleaning • Escorting to appointments • Gifts • Hairdressing/barbering • Name branded food • Newspapers and magazines • Private phone installation, international and mobile calls • Satellite/cable television • Toiletries • Treats The Registered Manager stated that information about Joybrook is available to potential residents through the home’s inclusion on the approved list of care homes for Lambeth and Wandsworth Councils. She also said that people who have had dealings with the home make ‘word of mouth’ referrals. Potential residents are referred to the CSCI website to read reports, and if they do not have access to the internet a copy of the most recent report is provided for them by the home. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and carried out over three visits in January and early February 2008. The inspection methods included observation of care practice; discussion with residents and staff; inspection of files and a range of records and policy documents. We also observed a meeting between staff during which information about residents’ progress and needs was handed between staff on different shifts. Residents’ relatives, staff and involved professionals were sent survey forms so that they could contribute to the inspection process if they wished. We are grateful for their contributions. We have access to information gathered through notifications from the home. A document called an ‘Annual Quality Assurance Assessment’ (AQAA) was completed by the Deputy Manager of the home in advance of the inspection and returned to us. The document provides information about how the home is addressing the National Minimum Standards along with factual information about the operation of the home. All of this information has been taken into account in compiling this report. The Registered Manager, Deputy Manager, clients and staff facilitated the inspection visit. They were helpful and courteous throughout the process. What the service does well: • • The home is good at looking after residents’ spiritual needs. They make sure that representatives from local churches visit or people are assisted to attend church with family and friends. Residents enjoy the meals provided at the home. A Caribbean menu is provided every day and this helps people to have a range of food which reflects their culture. Take-away meals are included as part of the menu and residents said how much they enjoyed this. Most of the staff team have achieved NVQ level 2 or above. Staff said that the training they attend is useful to them. Staff feel well supported by senior staff in the home. Supervision is provided regularly and the managers are available for advice. There are few changes of staff on the team so this helps in providing consistent care. The home is good at helping residents to keep in touch with their relatives and friends. • • • • Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: • So that potential residents have the full information on which to make a decision about the suitability of the home more information must be provided for them. The service user guide and statement of purpose must be amended to include full information about what is included as part of the fee. So that care meets residents’ needs improvements are needed to make sure that the care implications of medical conditions identified on assessments are understood, recorded and used in care planning. Care plans must be reviewed monthly to ensure that they continue to meet residents’ needs. To keep residents safe there needs to be greater attention paid to reducing the number of falls experienced by residents, seeking specialist advice and reviewing risk assessments. To reduce the risk of medication errors some improvements to the arrangements for dealing with medication need to be made. To ensure that the home’s safeguarding adults procedure meets best practice liaison with local authority safeguarding adults departments is needed. So that residents benefit from a more homely environment staff posters should be removed from residents’ communal areas. So that residents benefit from staff knowledgeable about their health needs training in their specific health conditions must be provided. To make sure that residents are looked after by suitable staff, some changes to the recruitment procedure are needed. Improvement of the quality assurance systems will help to make sure that the home is run in the best interests of the residents. • • • • • • • • • Please contact the provider for advice of actions taken in response to this Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 7 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. Joybrook DS0000022738.V341629.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 Joybrook DS0000022738.V341629.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5. Standard 6 was not assessed as the home does not provide intermediate care. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Amendments to the documents provided before admission will make sure that potential residents have full information to decide about whether the home is suitable for them. Assessments, which fully consider the implications of heath conditions, will ensure that the home can make, informed decisions about whether they can meet the residents’ needs EVIDENCE: The home’s Statement of Purpose and Service User Guide were reviewed in January 2008. The Service User guide and attachments include most of the information required but further information is needed about the charges made. If a resident needs to be accompanied to an appointment by a member of staff there is a charge made for this. This, and other additional charges, are specified in the home’s Statement of Purpose but not in the Service User Guide. One item for which additional fees are made (name branded food) is not included in either document and should be added. This will make sure that Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 10 potential residents and people acting on their behalf know what services are provided for the standard payment and for what items additional payments are required. This will allow them to make an informed decision about the suitability of the home for their needs. See requirement 5. Potential residents and their families are informed about the availability of CSCI inspection reports on the CSCI website or, if they do not have access to the internet are given a copy by the home. Each of the residents has a contract of residence with the home. A pre-admission assessment form is used to assess the needs of potential residents. The form is very thorough and includes details of the range of a person’s needs. Some of the information gathered on the form needs to be used by the home to better effect. An example of this was one resident’s assessment form included information that the person has diabetes, but in a different part of the form in response to a query about whether there was a need for a special diet the response was ‘none’. This is important because a person with diabetes could be put at risk if their dietary needs are not met. Similarly there was no entry under a section relating to the person’s foot-care needs of a person with diabetes. In the information provided to CSCI before the inspection visit, the home recognised that their procedures would be improved by obtaining medical information and professionals’ reports before admitting a new resident to the home. Pre-admission assessments and reports are used as the basis of the home’s judgement on whether they can meet the person’s needs and for care planning. This means that it is important to have full information on the implications for care of medical conditions to make sure that the home fully meets the person’s health and welfare needs. Improvements are needed to make sure that the assessments and information gathering leads to benefits for residents. See requirement 6. Potential residents, their relatives or advocates are invited to the home to have a look around and meet with staff and residents so that they can make a decision about whether the placement is suitable. The first month of a placement is regarded as a trial period. Joybrook DS0000022738.V341629.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to the care plans and more regular reviews will ensure that residents’ needs are properly addressed in the plans. The medication procedures need to be improved so that residents’ safety is assured. Residents are treated with respect and their privacy and dignity are protected. EVIDENCE: We looked at four residents’ files during the visits to the home. All of the files contained care plans. The care plans include details of a range of needs including physical health and social needs. The include statements that they should be reviewed every three months. As older people’s needs can change quickly the standards specify that they should be reviewed each month. A monthly review will make sure that the plans and the care provided reflects residents’ current needs and the specialist advice of health care professionals. See requirement 7. There were some areas in which the information available in the assessment documents was not adequately included in the care planning. Although one resident who has diabetes had been registered with the GP at the time of Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 12 admission two months earlier they only saw the GP and had blood tests taken on the day after the first inspection visit. This person’s dietary needs were not adequately reflected in the care plan as it included the statement that she likes to have sugar in drinks. The risks of this had not been assessed and neither was there any information about how to manage this. See requirements 1 and 8. The home is good at informing the CSCI about falls that residents have had in the home. In order to keep residents safe there needs to be greater attention paid to reducing the number of falls experienced by residents, assessing the reasons why they are happening and seeking specialist advice. The risk assessments seen in residents’ files were not detailed enough and had not been reviewed after falls. Written advice issued by CSCI was given to the Registered Manager about this issue at the end of the inspection. See requirement 9. Residents confirmed that they can see the GP when they wish. There was also information that the residents are supported to see other health care professionals, although, if resident needs to be accompanied to an appointment by a member of staff, a charge is made. Each individual resident has copies of letters included in their files but details of the outcome of appointments are not recorded there, but in another record. A system must be found to include information from these appointments in the care plan review process so that care reflects specialist advice. See requirement 7. There is a medication policy dated March 2004. The policy needs to be reviewed and amended as it does not include the need for medication to be kept in the home for a period of seven days in the event of the death of a resident. This is required in case there is a coroner’s inquest. See requirement 10. Medication stocks and records were checked with staff members. The medication is stored safely. Records showed that staff sign the medication record to confirm that medication is given as prescribed, there were no unexplained gaps in the record. The records of medication returned to the pharmacist were clear and full. This ensures that an accurate audit trail can be carried out and helps to protect residents from errors. Staff were last given training in medication matters in March 2006. The Registered Manager stated that training is to be arranged to take place in March 2008. The medication file includes documents signed by staff to confirm that they have received and understood the medication training. The Registered Manager is responsible for ensuring the competency of the staff to administer medication. In order to ensure the safety of residents it is required that the Registered Manager assess the competency of each member of staff responsible for the administration of medication. A written record must be maintained of the assessment. See requirement 11. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 13 Staff with whom medication matters were discussed did not have sufficient awareness of the reasons for medications being given and any side effects that might be caused, nor was this information available. This should form part of the training provided. See requirement 2. The need for staff to have access to have access to patient information leaflets about the medications was discussed with the Registered Manager. She confirmed that this had been discussed amongst the senior staff team and agreed to keep copies of the leaflets in the medication file for staff to refer to as necessary. One resident takes a large number of medications. In order to manage this a senior member of staff fills a dosette box each week. Re-packaging medicines into another container with the intention that a different care worker will give it to the resident at a later time is called ‘secondary dispensing’. Both the Royal Pharmaceutical Society and the Nursing & Midwifery Council state that this is unsafe practice that can potentially cause drug errors. This was discussed with the Registered Manager and guidance information issued by CSCI was provided. The Registered Manager stated that she would discuss the issue with the home’s pharmacist to find a resolution. See requirement 12. Staff and residents were seen to have warm and respectful relationships. A professional gave feedback that the home is good at respecting residents’ wishes and protecting their dignity. Residents confirmed that when they wish to spend time alone in their rooms they are able to do so without being disturbed. There are two double rooms in the home, screening is provided in the rooms so that privacy is not compromised. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy the activities provided and expressed their wish for more opportunities to go out. Residents’ benefit from the attention to their spiritual needs. The regular contact with relatives and friends helps residents to keep in touch with people important to them. The residents benefit from a varied diet which is nutritious and takes into account cultural preferences. EVIDENCE: We spoke to residents in the home about their preferences in relation to activities and social contact. Some people can go out independently and they said that they liked going about the local area. Several people, who are unable to leave the home without assistance, said that they would like to go out more often. Outings have been provided but these are limited by staffing numbers and transport. Some residents who have lived at the home for some time said that they enjoyed an outing to the coast in the summer. The information provided before the inspection identified this as an area which they could improve, and that they plan to organise more outings over the next year. See recommendation 2. An activities organiser had been employed at the home but has now left her post. As the post has not been filled the responsibility for providing activities is Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 15 now included in the daily duties of care staff. Staff were seen organising dominoes and darts matches between residents and these are regular features of life at the home. Once a week a gentle exercise session is organised by a visiting tutor. Some residents go to church accompanied by family and friends. The home is visited by a Roman Catholic priest and this helps to meet the spiritual needs of some of the residents. Family and friends of the residents visit the home freely without unreasonable restrictions. Other people keep in touch by telephone and will e-mail the home for messages to be passed to family members. We were told by that the home is particularly good at ensuring that letting relatives know about important matters to do with their relative. The home has recognised that some of the residents might benefit from the opportunity to join local community groups. Research on what opportunities might be available is identified as a goal for the next year. Some of the residents manage their own financial affairs, and some have relatives or other advocates to take on this task on their behalf. Rthis is encouraged by the Registered Manager. There is a four-week menu which is changed to reflect the seasons. A copy of the winter menu showed that a Caribbean option is included at each evening meal. Residents said that they liked the food and confirmed that, if they do not like the main dish on offer then, with sufficient notice, they can choose an alternative. A professional gave feedback that residents looked forward to their meals in the home. Take away food is included in the menu and residents said that they particularly enjoy the fish and chip meals which are delivered from a local shop. The staff are aware of the residents’ food preferences and these are noted in the residents’ files. The menu and the food stocks showed that fresh fruit and vegetables are included in the residents’ diet. The food is bought from a local supermarket and most of the time their own ‘value brand’ is purchased. One person’s relatives supply some items of branded food as this is his preference. The Statement of Purpose makes clear that additional charges are made if name branded items of food are requested. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident that their concerns with be addressed and staff are clear about how to report concerns. Further liaison with local safeguarding authorities will ensure that residents benefit fully from clear procedures for the investigation of allegations of abuse. EVIDENCE: The complaints procedure is clear and available in the home’s statement of purpose. It is also attached to the service user guide to ensure that everyone has access to information about the procedure. There have been no formal complaints made to the home in the last twelve months. Residents have the opportunity to raise issues of concern at their monthly meetings with the Registered Manager and Deputy Manager. Notes of concerns raised are detailed in the minutes. It would be useful to have an update on the action taken in response in subsequent meeting minutes to give information to residents and to monitor the patterns of concern and action taken. Staff are clear about the action to take if a resident or relative wished to raise a concern. Residents confirmed that they felt confident that their complaints would be dealt with properly. Staff have received training in adult protection issues over the last year. The senior staff in the home have co-operated with adult protection investigations in the past. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 17 The ‘elder abuse policy’ includes information on the range of behaviours that could be defined as abuse and any signs which may indicate it is taking place. A procedure document gives guidance on the action to take in the event that concerns about abuse are brought to the attention of the home. The procedure includes reporting procedures to ensure the safety and protection of residents including passing on concerns to statutory authorities. The procedure states that the Manager should carry out an investigation of any allegations. This may not be appropriate and there will be circumstances when the responsibility for such an investigation would rest with the local authority or with the police. The Registered Manager must liaise with the local authority safeguarding departments to ensure that the home’s procedures meet their expectations. See requirement 13. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a comfortable and well maintained home. The communal areas will be improved by the removal of staff notices displayed there and this will ensure that the residents benefit from a homely environment. Hygiene is good. EVIDENCE: The home is comfortable, and well maintained with adequate communal space, consisting of a large through dining room / lounge and a conservatory. Generally the furnishings are reasonable but some of the dining chairs cushions were in need of recovering or replacing, as they were dirty and unsightly. There are appropriate bathing and toilet facilities. There are plans to convert a downstairs bathroom into a ‘wet-room’ with a shower. In the communal areas on the ground floor are many posters and information leaflets displayed on the walls. They are useful for staff and would be better placed in staff areas as they detract from the homeliness of the residents’ communal areas. This was discussed during the tour of the premises and Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 19 assurance was given that the items would be removed. See recommendation 3. Residents benefit from an accessible garden to the rear of the home. Barbecues have been held in the garden and enjoyed by the residents. There is an attractive decking area under cover which can be reached from one of the communal rooms. Most residents have their own rooms which are personalised and comfortable. Residents are encouraged to bring their own furniture for their bedrooms if they wish to do so. Residents said that they liked their rooms. One person said that he was happy to share his room and documents on files confirmed the residents’ agreement to sharing. Residents are supplied with keys to their rooms if they wish. The laundry room and arrangements for dealing with soiled linen are suitable for their purpose and hygienic. Staff have received training in infection control issues. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally residents benefit from staff in adequate numbers to meet their needs. Care needs to be taken to ensure that there are always enough staff on duty. The staff feel prepared for their work by the training and induction. Residents would benefit further from staff trained in their specific health conditions. Changes to the recruitment procedure would ensure that the residents are adequately protected. EVIDENCE: The rota shows that there is a total of nine care staff working at the home in addition to the Registered Manager and the Deputy Manager. Some of the care staff work part time. During the inspection there were two members of staff on duty between 7.45am and 8pm. Generally, on weekdays, there is at least one of the managers on duty in the home. At the particularly busy time of 8am to 10am an additional member of care staff is on duty. Examination of the rota showed that there had been occasions when the staffing numbers were low, including some days with just one member of staff on duty between 8pm and 10pm. The Registered Manager said in discussion that this was a rare occurrence when the resident numbers were low and she judged that this staffing level was adequate. It is essential that the staffing levels are kept under review with reference to both the numbers and the needs of the residents so that their safety and welfare needs can be met. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 21 The shifts are arranged to ensure that there is adequate time to allow information to be passed between staff at a ‘handover meeting’. Observation of a handover meeting showed that, as well as a verbal account of residents’ progress and welfare a written account is made. This assists in the ensuring that the communication systems are effective. Nine of the total care staff team are qualified to NVQ level 2 or above, this is 69 of the team and meets the standard required that at least 50 of care staff hold the qualification. All staff receive induction training and the feedback from them was that it prepared them well for their role. They felt that the training provided is relevant and useful. The team have undertaken a range of training in the last year, including health and safety issues (including food hygiene, first aid, moving and handling) and adult protection. Staff will benefit from further training in care issues, including best practice in working with people with the range of health care conditions that the resident group have. Training in working with people with dementia is arranged to take place in February and March 2008. Residents would also benefit from a staff team informed about specific conditions such as diabetes, stroke and lupus. See requirement 14. A sample of recruitment records was checked. All of the files contained details of Enhanced Criminal Records Bureau (CRB) checks but the checks carried out since the last inspection had not been retained. Although CRB guidance on some other employment sectors states that disclosures should be destroyed after 6 months, for CSCI regulated services, disclosures should be kept and not destroyed until after the CSCI inspection is complete to enable CSCI inspectors to see a sample at the next inspection. See requirement 16. Each of the files seen included two references. Residents would be further protected by the recruitment process if the reference request is amended. The letter currently sent to referees requests their opinion of the person’s timekeeping, along with factual information about how long they have known the person. The importance of requesting details about the person’s suitability for the caring role, using the relevant person specification and job description was discussed with a senior member of staff. This improvement will contribute to the protection of residents by ensuring that the applicants’ suitability for working with vulnerable people is assessed throughout the process. See requirement 15. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from the home’s supportive management team. Improvement of the quality assurance systems will ensure that the home is run in the best interests of the residents. Health and safety is well managed but the fire risk assessment needs to be reviewed. EVIDENCE: The Registered Manager has worked at the home for many years. She has completed the NVQ level 4. Staff said that they feel supported by the Registered Manager and Deputy and that they are available to talk to when needed, including out of hours through the on-call system. Residents questionnaires were used in 2006 to assess their satisfaction with the service. The quality assurance systems should be improved to include an external assessment, such as by appointing someone outside the home to Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 23 carry out monthly visits, an issue which was raised during the last inspection in 2006. The Registered Manager said that she has some initial ideas about how to take this issue further and make the necessary improvements. See requirement 4. An annual development plan, also the subject of a requirement of the last inspection, needs to be undertaken, see requirement 3. Regular supervision is provided for staff but the Registered Manager and Deputy are not supported by supervision. The information provided by the home prior to the inspection identified this as an area which would like to improve. See recommendation 1. Most residents have a relative or other advocate to look after their financial affairs. No valuables are kept on residents’ behalf. The Registered Manager looks after finances of a small number of residents. The records were inspected and procedures discussed with the Manager. Residents would gain greater protection by two improvements. The records confirming expenditure must be always signed by two members of staff, and a running balances must be maintained in the records of the money held on residents’ behalf. See requirement 17. Health and safety records showed that checks of equipment are carried out regularly. Fire drills are carried out every six months, the last one was in December 2007. The Registered Manager said that the fire brigade has approved this frequency, documentary evidence of this agreement should be kept on file. The fire risk assessment is dated September 2006. This document needs to be reviewed annually, see requirement 18. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 24 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 2 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 X X X X 3 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 2 3 X 3 Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15(1) Requirement The Registered Person must ensure that care plans cover all areas of service users’ needs. This requirement is carried forward from the last inspection. The target date was 31/12/06. A new date for compliance is set. 2. OP9 13(2) 17(1)(a) sch 3 (k) The Registered Person must ensure that staff are knowledgeable about the medications they administer. This requirement is carried forward from the last inspection. The target date was 31/10/06. A new date for compliance is set. 3. OP33 24(1)(a) (b)(2)(3) The Registered Person must ensure that there is an annual development plan. This requirement is carried forward from the last inspection. The target date was 31/03/07. A new date for compliance is set. 4. Joybrook Timescale for action 01/04/08 01/05/08 01/07/08 OP33 26 The Registered Person must DS0000022738.V341629.R01.S.doc 01/07/08 Version 5.2 Page 26 ensure that arrangements are made to find a person to undertake monthly monitoring functions This requirement is carried forward from the last inspection. The target date was 31/11/06. A new date for compliance is set. 5. OP1 4 5 The Registered Person must 01/05/08 make sure that the full information is provided for potential residents about fees and additional charges. This will allow them to make an informed decision about the suitability of the home for their needs. Copies of the amended statement of purpose and service user guide must be sent to the CSCI. The Registered Person must make sure that information gathered on assessments is used to assess the care needs of potential residents and whether the home can meet them. 01/04/08 6. OP3 14 7. OP7 15(1) (2)(b) The Registered Person must 01/04/08 make sure that care plans are reviewed at least monthly and include information on the residents’ care needs which come from their health conditions. The Registered Person must make sure that if residents choose not to follow health care advice that this reported to the GP, fully documented and subject to a risk assessment. 01/04/08 8. OP8 13(4)(c) 9. OP8 13(4)(b) The Registered Person must 01/04/08 make sure that greater attention is paid to reducing the number of falls experienced by residents, DS0000022738.V341629.R01.S.doc Version 5.2 Page 27 Joybrook assessing the reasons why they are happening and seeking specialist advice. Risk assessments about falls must be detailed and reviewed regularly. 10. OP9 13(2) The Registered Person must 01/04/08 make sure that the medication policy is reviewed and amended to include the need for medication to be kept in the home for a period of seven days in the event of the death of a resident. In order to ensure the safety of 01/04/08 residents the Registered Manager must ensure that each member of staff responsible for the administration of medication is given training and that their competency for the task is assessed. A written record of the assessment must be kept. The Registered Manager must 15/03/08 make sure that care workers only give medicines to people from the container that the pharmacist has provided. Repackaging medicines into another container with the intention that a different care worker will give it to the resident at a later time is not a safe practice. The Registered Manager must 01/05/08 liaise with the local authority safeguarding departments to ensure that the home’s procedures meet their expectations. The Registered Person should 01/09/08 ensure that staff are trained in how to meet the care needs arising from residents’ health DS0000022738.V341629.R01.S.doc Version 5.2 Page 28 11. OP9 13(2) 12. OP9 13(2) 13. OP18 13(6) 14. OP27 18(1) (c)(i) Joybrook conditions. 15. OP29 19 schedule 2 para 5 The Registered Person must 01/05/08 ensure that the referees are asked to comment on applicants’ suitability to work with older people. The Registered Person must 01/04/08 ensure that Criminal Records Bureau checked are kept until the next inspection of the home. The Registered Person must 01/04/08 ensure that • the records confirming expenditure made on residents’ behalf are signed by two members of staff, and • running balances must be maintained in the records of the money held on residents’ behalf. The Registered Person must 01/05/08 ensure that the fire risk assessment is reviewed annually. 16. OP29 19 schedule 2 para 7 13(6) 17. OP35 18. OP38 23(4)(a) 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 OP36 Good Practice Recommendations It is recommended that the Registered Manager receive supervision to support her in her role. This is a inspection. 2. Joybrook repeated recommendation from the last OP13 The Registered Person should consider how residents can DS0000022738.V341629.R01.S.doc Version 5.2 Page 29 be assisted to have more trips out of the home so that they can take part in activities such as shopping and visiting local facilities. 3. OP19 The Registered Person should ensure that staff notices are displayed in staff areas rather than in residents’ communal rooms where they detract from the homeliness of the area. Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 Joybrook DS0000022738.V341629.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!