CARE HOMES FOR OLDER PEOPLE
Jubilee Court Care Home Nabbs Lane Hucknall Nottingham NG15 6HB Lead Inspector
Richard Ramsden Unannounced Inspection 6th September 2007 10:00 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 Jubilee Court Care Home DS0000043200.V341821.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. Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Jubilee Court Care Home Address Nabbs Lane Hucknall Nottingham NG15 6HB 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) 0115 983 4630 0115 983 4640 Nottinghamshire County Council Mrs Colleen Russell Care Home 60 Category(ies) of Dementia (30), Dementia - over 65 years of age registration, with number (30), Old age, not falling within any other of places category (60), Physical disability (5) Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Out of the total number of beds (60), there will be 30 beds for DE 55 and over and/or DE(E) Out of the total number of beds (60), 5 may be used for PD 55 and over Service Users shall be within category OP Date of last inspection 6th September 2006 Brief Description of the Service: Jubilee Court is a purpose-built care home for up to 60 older people some of whom may have dementia. The home is owned and managed by Nottinghamshire County Council. The accommodation is provided on two floors with two shaft lifts to assist independent access. The home is divided into four units each with kitchen, dining room, sitting room and assisted bathing facilities. All bedrooms are for single occupancy and have ensuite facilities. One of the units is dedicated to provide respite care. There are pleasant well-maintained gardens, which are accessible to all residents. The weekly accommodation charges for those residents who are self funding would be £377.00. A copy of the most recent inspection report is available in the home. Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One Inspector completed this unannounced visit over one day it took approximately 8 hours. It included the inspection of care and other records, a discussion with the manager, two team leaders and a member of care staff. The inspector spoke with three residents and one relative. Two residents’ satisfaction questionnaires and two relative/advocates satisfaction questionnaires were received prior to the inspection. A partial tour of the building was also completed. Two residents were case tracked, which means that their care plans were examined against the actual care they receive. The inspector also discussed the Commission for Social Care Inspections proposals to reduce some of the restrictions placed on the homes registration categories. Prior to completing this visit the inspector assess the home service history, the Pre-inspection information provided by the homes manager and the last inspection report. What the service does well:
The people living at Jubilee Court and their representatives are generally very satisfied with the services provided. One person said that the home is like a ‘four-star hotel’. Another person said that they couldnt have chosen anywhere better to live. The home is well managed and run in the best interests of the residents. Residents and staff spoken with during the inspection confirmed that they have confidence in the management teams ability and that they are involved in the decision-making within the home. Residents meetings and frequent discussions with care managers also helps to ensure that people living at Jubilee Court are able to voice their opinions about the way in which the home is run. Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 6 People said that they are very satisfied with their bedrooms and confirmed that they had been encouraged to personalise and with small items of furniture photographs etc. The care staff are well trained and many of them have worked in the home since it opened. This experience and training helps to provide continuity and stability for the residents. Residents said that the home provides a good programme of activities and entertainment. Care plans are comprehensive and reviewed frequently enough to ensure that staff always know what assistance and support each resident requires. Health care records are particularly well maintained. Residents said that staff are always friendly and respectful and ensure that their privacy and dignity is maintained at all times. Two people said that staff are always busy but still find time to socialise with the residents. The observed interaction between staff and residents was of a very good standard. There were many aspects of good practice highlighted throughout the main body of this report. What has improved since the last inspection?
Risk assessments are now being completed with all residents who wish to administer their own medication. The laundry door is now being kept locked when there are no staff in situ. This should ensure the residents do not have access to the industrial laundry equipment and foul linen. The manager has used the information gathered as part of the quality assurance system to produce an annual development plan for the home. This helps to ensure that residents and their representatives are influencing the way in which the home is run. A considerable amount of staff training has been provided since the last inspection. Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 7 The manager stated in the information provided prior to this inspection that discussions concerning racism have become an agenda item in service users meetings. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Jubilee Court Care Home DS0000043200.V341821.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 Jubilee Court Care Home DS0000043200.V341821.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): 2,3. Staff are ensuring that they can meet the needs of prospective residents by obtaining preadmission assessments. Residents are provided with written terms and conditions of residence documents. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents records were assessed as part of this inspection. Both of the records contained pre admission assessments, which had been completed by a social worker. Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 10 On the day of this visit the manager was visiting a prospective resident in hospital to assess whether Jubilee Court would be inappropriate to placement for them. (This is good practice). Terms and conditions of residence documents, which had been signed by the residents were available on each of the files viewed during this visit. The home does not provide intermediate care. Jubilee Court Care Home DS0000043200.V341821.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. Residents individual care plans contain sufficient information and are reviewed regularly enough to ensure that staff are always aware of what support and assistance each resident requires. The homes medication is generally well managed though some minor improvements need to be made to the way in which medication is stored. Residents believe that they are treated with respect. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents care plans were viewed as part of this visit. The care plans contained sufficient information and were reviewed frequently enough to
Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 12 ensure that staff have up-to-date information about the care and support each resident requires. The individual residents had each signed the care plans to confirm their involvement in the care planning and review process. (This is good practice). None of the care plans viewed during this visit contained photographs of the individual residents. Photographs would help staff to identify, which residents the care plans referred to. The bathing records for one resident indicated that she had only been offered a bath twice in August 2007. Senior staff stated that the resident would have been offered more baths and that it is likely that staff have forgotten to complete the records. When the resident was asked she could not remember how many baths she had had, but stated that ‘you only have to are ask and staff will assist you to have a bath’. Records show the residents health care needs are being appropriately met, this was confirmed by three of the residents and one visitor who were spoken with during this inspection. The homes medication systems have generally been well maintained. Some residents have chosen to administer their own medication. An appropriate risk assessment had been completed with the residents who wish to self medicate and staff were regularly auditing the medication to ensure the residents safety. It was noted that one resident who was administering their own medication had left the key in the bedside locker where the medication was stored. Staff stated that they believed this to be safe, as the resident never actually leaves his room. It was advised that the key should be removed for extra security. The key was removed during the inspection and given to the resident for safekeeping. All medication administration records had been appropriately signed each time the medication is given to the resident for whom it was prescribed. The records of receipt and disposal of medication had been well maintained and medication is generally stored securely. However it was noted that the keys were left in the refrigerators in which medication was stored. Staff were advised to remove these keys for additional security. Staff are recording the temperatures in the rooms and in the refrigerators where medication is stored however the records were not been completed every day. It is important that staff monitor the temperature at which medication is stored as it can deteriorate and become less effective is stored at higher temperatures than those recommended by the manufacturers. The temperatures must be recorded every day. The manager confirmed that air-conditioning units have been ordered to control the temperature in rooms where medication is stored.
Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 13 The homes controlled medication was checked at random and had been well maintained. All of the residents spoken with said that the staff are friendly and respectful and ensure that their privacy and dignity is maintained at all times. The visitors spoken with during the inspection also confirm this. The observed interaction between staff and residents was of a very good standard. Jubilee Court Care Home DS0000043200.V341821.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. The lifestyle experienced in the home appears to match the resident’s expectations and preferences. People are encouraged to maintain contact with family and friends and residents are satisfied with the food provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The senior staff were able to demonstrate that the home provides a good range of activities and entertainment to stimulate the residents. The programme of activities is prominently displayed in each of the units. The residents spoken with confirmed that the home does provide a variety of activities although one person stated that they choose not to participate, as they prefer to spend the time in their bedroom.
Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 15 One person said how much they enjoyed the quizzes organised by the staff and another said they had enjoyed an entertainer who played the organ & sang songs. Residents and a visitor confirmed that visitors are made welcome in the home at any time and the refreshments are always provided. The visitor stated that he visits his wife in the home at least four times a week. Individual residents care plans give details of how residents can be encouraged to make decisions about their daily lives. (This is good practice). There are also residents meetings where people are encouraged to express their opinions about the way in which the home is run. All of the residents spoken with said that they are very satisfied with the meals provided by the home and that alternatives will be provided if they do not want the food suggested on the menu. One person said that they find the food portions to large and that this sometimes puts them off eating their meal. The manager agreed to address this issue with the staff who work in this resident unit. The meal on the day of inspection was well balanced and appeared appetising. The rice pudding was made with sweet and low so that the residents who have diabetes could have the same pudding as everyone else. (This is good practice). Jubilee Court Care Home DS0000043200.V341821.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. The home has an accessible complaints procedure and staff are insuring the residents are protected from abuse. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints procedure is displayed in the home and in the literature supplied to all residents. The homes complaints records show that there have been a number of complaints since the last inspection. The complaints have been appropriately investigated and where necessary action taken. The resident spoken with confirmed that they would speak to one of the senior staff if they had any concerns or complaints. They all stated that they had never had to make a complaint but that they believe if they had any concerns these would be dealt with appropriately. All staff have received basic training in safeguarding adults.
Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 17 The home has an appropriate Whistle blowing procedure, which is displayed, in the staff room. The member of staff spoken with during the inspection was clear about her responsibility to report any possible abuse she may observe. Jubilee Court Care Home DS0000043200.V341821.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): 19,26. The accommodation is purpose-built and maintained an excellent standard. At the time of inspection the premises were pleasant and hygienic. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A partial tour of the premises was completed as part of this visit. The accommodation has been maintained to an excellent standard. Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 19 The residents bedrooms viewed during this visit were comfortably furnished and people had clearly been encouraged to personalise the rooms with photographs, ornaments and small items of furniture. All of the residents spoken with stated that they liked their bedrooms and confirm that they can use them at any time. One person said that the accommodation is like a ‘four-star hotel’. All of the residents and the visitor spoken with during the inspection confirm that the home is always clean and hygienic. The gardens are well maintained and accessible to all residents. Jubilee Court Care Home DS0000043200.V341821.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. There are sufficient, competent and qualified staff to support the residents. The homes recruitment policies and practices are supporting and protecting residents, the registered person was able to demonstrate a commitment to staff training and development. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The rota provided for the week of this inspection showed that adequate staffing levels are being provided to meet the assessed needs of the residents. Resident stated that although staff are always busy they do find time to socialise and ensure that residents individual needs are always met. One resident stated in their satisfaction survey that the home needed to provide better staffing levels. Having spoken with some of the residents none were able to identify any areas where they are assessed needs were not being appropriately met.
Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 21 The personal records of two members of staff were assessed as part of this visit. The records each contained two satisfactory references and appropriate criminal records bureau clearance forms. However neither of the records viewed contained any proof of the staffs identity or details of their physical and mental health. The manager stated that staff do not commence employment until this information has been received. It was faxed through to the home during the inspection. The information provided by the manager shows that out of 41 care staff 22 have completed NVQ level 2 or above and a further 7 members of staff were completing this training at the time of this visit. (This commitment to staff training is good practice). Staff training records observed during this visit show that a considerable amount of training has been provided. The member of care staff spoke with during the inspection confirmed this. Jubilee Court Care Home DS0000043200.V341821.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): 31,33,35,38. The home is well managed and run in the best interests of the residents. Where checked the health and safety of residents and staff is promoted and protected. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is well qualified and very experienced. Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 23 Resident’s staff and visitors said that the management team are very approachable and that they seek their views about the way in which the home is run. Quality monitoring systems are in place and the manager has used the information gathered to produce annual development plan for the home. (This is good practice). Staff do manage some residents personal money, the records were checked at random and were well maintained. The laundry door was locked at the time of this inspection ensuring the residents health and safety is not put at risk by them gaining access to industrial machinery and potentially soiled or infected clothing. The areas of health and safety checked during his visit had all been well maintained. The homes Fire records and water temperature testing records were up-todate and accurate. The manager was reminded that all staff, including night staff, must attend at least one fire drill each year. Jubilee Court Care Home DS0000043200.V341821.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 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 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 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No 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 12 (1) a b Requirement All residents must be offered at least one bath each week. If the resident does not wish to have a bath their decision must be recorded in their care plan. The keys must be removed from the locks on the doors of the refrigerators where medication is stored. This will help to protect the residents’ health and safety. Staff must record each day, the temperature in all rooms and refrigerators where medication is stored. The temperature must not exceed the storage temperatures recommended by the medication manufacturers. The medication can deteriorate and become less effective and stored at higher temperatures Timescale for action 06/09/07 2. OP9 13 (2) 06/09/07 3. OP9 13 (2) 06/09/07 Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 26 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 OP7 Good Practice Recommendations It is recommended that care plans always contain a photograph of the individual resident so that staff are always sure which resident the care plan refers to. Jubilee Court Care Home DS0000043200.V341821.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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
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