CARE HOMES FOR OLDER PEOPLE
Jubilee Court Care Home Nabbs Lane Hucknall Nottingham NG15 6HB Lead Inspector
Richard Ramsden Unannounced Inspection 9th February 2006 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.V282799.R01.S.doc Version 5.1 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.V282799.R01.S.doc Version 5.1 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.V282799.R01.S.doc Version 5.1 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 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 Social Services. 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. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was completed in one day and lasted for approximately 5 1/2 hours. It included the inspection of care and other records, a discussion with two team leaders, one member of the care staff, as well as speaking with six residents. A partial tour of the building was also completed. What the service does well:
The residents spoken with during this inspection said that the best thing about the home is the staff. One person said that the staff cannot be faulted they are always friendly, courteous and cannot do enough for you. Two people said that the staff are lovely and that they never lose their temper, “even when they are provoked”. One person who was in the home for respite care said that she believes Jubilee Court is the best home in the area. The observed interaction between staff and residents was of a very good standard. All of the residents said that they like their bedrooms and confirmed that they had been encouraged to personalise them with small items of furniture, ornaments and photographs. People said that the home is always clean and tidy. The premises, which are purpose-built, are spacious well decorated and comfortably furnished. The gardens are well maintained and accessible to the residents. Three residents said that they find the manager very approachable and that they are confident that any concerns they may raise would be dealt with appropriately. Residents and staff said that the manager encourages them to voice their opinion about the way in which the home operates. People said that they are generally satisfied with the food provided by the home and confirmed that there is always a choice of food provided at lunchtime. The lunch on the day of this inspection appeared wholesome and nutritious, there was a choice of four main courses and all of the vegetables were fresh. However two people did say that they would like a more varied menu at teatime.
Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 6 . What has improved since the last inspection? What they could do better:
The literature supplied to prospective residents and their representatives must include the resident’s views of the home. All care plans must be reviewed and where appropriate updated at least once each month to ensure that staff are always aware what support and assistance each resident requires. Where possible residents or their representatives should sign to confirm that they have been involved in the care planning and review process.
Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 7 All residents must be offered a bath or shower at least once each week if the residents declined to bath their decision should be recorded in their care plans. There must always be an alternative to sandwiches provided at teatime. Although there has been a significant improvement in the way in which medication is managed, staff must ensure that individual risk assessments are completed with all residents who wish to administer their own medication. All residents must be offered a Key to lock their bedroom door unless a risk assessment suggests otherwise. There must be a qualified first aider on duty at all times. 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. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 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.V282799.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3. The literature supplied to prospective residents now contains the majority of information required to enable prospective residents to make an informed choice as to whether the home will meet their individual needs. The staff ensures that they will be able to meet prospective residents needs by obtaining written assessments prior to their admission to the home. EVIDENCE: There has been a considerable amount of work completed to improve the literature supplied to prospective residents and their representatives. The literature now contains all the required information except the resident’s views of the home. Three residents files were assessed as part of this inspection. A written preadmission assessment had been obtained for each resident. This helps to enable staff to ensure that they will be able to meet the individual residents assessed needs. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10. The residents individual care plans are not all being reviewed and updated frequently enough to ensure that staff are always aware of what support and assistance each resident requires. There has been a considerable improvement in the way in which the homes medication is managed. However some aspects of the medication management are still putting resident’s health and safety at risk. Residents believe that they are treated with respect and that their rights to privacy are upheld. EVIDENCE: Three residents care plans were assessed as part of this inspection. One of the care plans had not been reviewed since October 2005. The bathing records for this residents showed that for the last five months she had only been bathed or showered once a month. When this was checked, staff stated that because the resident was having dressings applied by the district nurse she could only be bathed at certain times and her key worker had not been available. The inspector advised that this is unacceptable and that all residents must be offered a bath or shower at least once each week.
Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 11 The care plan, which had been handwritten, contained many alterations making it incredibly difficult to read. It was also noted that the member of staff completing the care plan had not signed two of the care plans nor had the residents or their representative. There has been a significant improvement in the way in which medication is administered within the home. However one resident had been administering her own medication, no risk assessment had been completed and the resident stated that she had kept the medication in an unlocked draw in her bedroom. As she had not been provided with a Key to her bedroom door all of the other residents could have had access to the medication when she was not a room. This is considered dangerous as many of the residents of the home have dementia and their health and safety has been put at risk. All of the residents spoken with during the inspection said that the staff are always friendly and respectful and ensure that their privacy and dignity is maintained at all times. The observed interaction between residents and staff was of a very good standard. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,15. Residents are encouraged to maintain contact with their family and friends. People are generally satisfied with the food provided at the home although there is often not enough variety of food at teatime. EVIDENCE: The literature supplied to prospective residents includes details of the homes policy to maintain residents contact with family and friends. The residents spoken with said that their relatives and friends can visit them at any time and that they are always made welcome. One person confirmed that their visitors are always offered refreshments and said that they believe that people could have a meal with them at the home if this was booked in advance. People said that they are generally satisfied with the food provided by the home. Two people said that the breakfasts and lunches are very good but that at teatime there are frequently only sandwiches provided, even though the menu states that a light cooked meal is available. One person said that they do not like sandwiches but as they are diabetic, they have to eat them when there is no alternative is provided.
Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 13 The team leader was advised that an alternative to sandwiches should be provided every day. Where the food suggested on the menu is not available that staff must be record of the alternatives provided. The lunch on the day of this inspection looked appetising and nutritious and four alternative main courses had been provided. (This is good practice). Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16. Residents are confident that their complaints and concerns are dealt with appropriately. The staff must keep more comprehensive complaints records. EVIDENCE: A copy of the homes complaints procedure is displayed in the main reception hall and is available in the literature supplied to residents and their representatives. The procedure contains all the required information. The residents who expressed an opinion said that they were confident that any concerns or complaints they may have would be dealt with appropriately. When the homes complaints records were checked there had been no formal complaints recorded since 2004. The Team Leader was reminded that the home must keep a record of all complaints both formal and informal to provide an overview of the nature and frequency of complaints received. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19.24. The purpose-built accommodation is maintained to a very good standard. Residents bedrooms meet their individual needs but some people are not being offered a key to lock their bedroom doors. EVIDENCE: A partial tour of the premises was completed as part of this inspection. The purpose-built accommodation is spacious, well decorated, comfortably furnished and maintained to a very good standard. The gardens are attractive and are accessible to the service users. The residents spoken with all said that they are very satisfied with their bedrooms, they confirmed that there are encouraged to bring photographs ornaments and small items of furniture to personalise their individual rooms. People said that they could use their rooms at any time. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 16 Two people said that they had not been offered a Key to lock their bedroom doors although one person said that they were aware that of the residents had been offered this facility. All residents must be offered the opportunity to lock their bedroom door unless a risk assessment suggests otherwise. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29. The rota provided for the week of this inspection showed that adequate staffing levels are being maintained. Residents are supported and protected by the homes recruitment policies and procedures. EVIDENCE: The staff rota for the week of this inspection showed that adequate staffing levels are being maintained, however the senior staff stated that the residents dependency levels are very high and that the staffing ratios were being assessed at the time of this inspection. It was noted that the homes Registered Manager had been absent from the home for approximately 6 weeks. This should have been reported to the Commission for Social Care Inspection, who should have also been informed of the temporary management arrangements for the home. The homes staff recruitment policies and procedures were checked in detail at the last inspection. One member of staffs personal records was checked at this inspection. The records did not contain any written references however these were faxed to the home, during the inspection and were satisfactory. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,35,38. The home is well managed and run in the best interests of the residents. Generally the homes accounting and financial procedures do safeguard residents. There are occasions when there are no staff on duty who are qualified to provide first aid. This is potentially putting residents health and safety at risk. EVIDENCE: The registered manager is experienced and has been the registered manager at Jubilee Court since 2003. She was not at the home at the time of this inspection and consequently it was not possible to discuss her qualifications and specific experience in detail. The residents and staff stated that the manager is very approachable and seeks to involve them in making decisions about the way in which the home
Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 19 operates. One member of staff said that she would find it beneficial to have more staff meetings. At the last inspection the records of residence finances showed that one resident should have had £16 in the safe but that this money was missing. The registered person was required to investigate what had happened to this money. An investigation has been completed and it transpires that the resident was discharged home with the money but that the appropriate records were not completed. The manager has written to the family asking them to confirm receipt of this money. The response had not been received at the time of this inspection. At the last inspection the records of items handed over for safekeeping could not be located. The inspector was informed that all senior staff have now been made aware of where these records are located. These records were checked at random and were satisfactorily maintained. At the last inspection a requirement was made that there must be a qualified first aider on duty at all times. The team leader stated that three members of staff would need to complete first aid training to enable them to comply with this requirement. He stated that he has applied for the training on behalf of the staff but as yet no date has been identified. This requirement was made in October 2005 and must now be pursued as a matter of urgency. Since last inspection a digital lock has been provided on the door to the small first-floor laundry, ensuring that residents health and safety is not put at risk by them having access to cleaning products. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 20 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 4 X X X X 2 X X STAFFING Standard No Score 27 2 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X 3 X X 2 Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement It is required that the literature supplied to prospective residents contains the resident’s views of the home. (Previous timescales of 21/04/05 & 05/12/05 not met) 2. OP7 15 It is required that residents are 09/02/06 offered a shower or bath at least once each week. If they decline this offer their decision must be recorded. It is required that all care plans 09/02/06 are reviewed and where necessary amended at least one each month. Residents & where appropriate there representatives should sign to confirm their involvement in the care planning and review process. It is required that individual risk 09/02/06 assessments must be completed and regularly reviewed with all residents who wish to administer their own medication. Staff must ensure that the medication is stored securely at all times.
DS0000043200.V282799.R01.S.doc Version 5.1 Page 22 Timescale for action 03/04/06 3. OP7 15 4. OP9 13 Jubilee Court Care Home (Previous timescale of 20/10/05 not met) 5. OP15 16 (2) It is required that there is always 09/02/06 an alternative to sandwiches provided at every teatime. It is required that the home keeps a record of all complaints formal & informal to provide an overview of the nature & frequency of complaints received. It is required that all residents are offered a key to lock their bedroom door unless a risk assessment suggests otherwise. It is required that the Registered Person informs CSCI if the Registered Manager will be absent from the home for more than 28 days. The notification must include the name qualifications & experience of the person who will be managing the home in the absence of the registered manager. It is required that there is a qualified first aider on duty at all times. (Previous timescale of 05/12/05 not met). 09/02/06 6. OP16 22 (8) 7. OP24 12 (4) 09/02/06 8. OP27 38 09/02/06 9. OP38 13 03/04/06 Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 23 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 are always updated in a user friendly format which avoids crossings out and alterations which make them difficult to read. Jubilee Court Care Home DS0000043200.V282799.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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