Inspection on 25/04/07 for Jubilee Gardens

This inspection was carried out on 25th April 2007.

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

Jubilee Gardens 18/07/06

Jubilee Gardens 11/11/05

Jubilee Gardens 15/06/05

Jubilee Gardens 29/12/04

Jubilee Gardens 07/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Jubilee Gardens 26 Wyegate Close Castle Bromwich Birmingham West Midlands B36 0TQ Lead Inspector Sean Devine Key Unannounced Inspection 25th April 2007 09:40 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 Gardens DS0000036766.V335072.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 Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jubilee Gardens Address 26 Wyegate Close Castle Bromwich Birmingham West Midlands B36 0TQ 0121 730 4560 0121 730 4569 jubilee.gardens@craegmoor.co.uk 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) Parkcare Homes (No2) Ltd Vacant Care Home 50 Category(ies) of Dementia - over 65 years of age (38), Old age, registration, with number not falling within any other category (12) of places Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. The number of persons for whom personal care (DE(E)) is provided at any one time shall not exceed 13. The number of persons for whom nursing care (DE(E)) is provided at any one time shall not exceed 25. Where people with personal care needs and people with nursing care needs are cared for together in a single unit, staffing levels for units for people with nursing care will apply. Staffing of the care units and the day centre must be discreet and clearly distinguished from each other. Mechanisms must be in place to support staffing in both areas without detriment to either service. The number of persons for whom transitional care (OP) is provided at any one time shall not exceed 12, of whom three may be under 65 years of age. The Transitional Unit must be staffed separately to the other units in the home. A minimum of 336 care staff hours (excluding qualified staff) must be provided each week. There must be 24 hour RGN cover at all times. Sensitive and regular reviewing mechanisms must be in place to increase staffing levels when the majority of service users have high dependency needs. Service users admitted to the Transitional Unit must be discreet and clearly distinguished from the other units, and must not at any time be cared for in any of the other units in the home. One named service user under the age of 65 years with dementia may reside at the home. 18th July 2006 7. 8. Date of last inspection Brief Description of the Service: Jubilee Gardens is a purpose built home situated in Smiths Woods in Castle Bromwich. It has extensive secure gardens on a level ground, making access for residents easy, the gardens have matured. The home has facilities for 50 residents in total, 13 requiring personal care, 25 requiring nursing care and 12 transitional care beds, some of the residents occupying permanent accommodation may have dementia. The home has designated communal and private rooms, all bedrooms have ensuite facilities comprising of a toilet and hand washbasin. The bedrooms are decorated to an acceptable standard, and residents can personalise their own rooms if they wish. Two small lounges have been re-allocated for staff use. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 5 The home has adequate parking space and is close to the local shopping area and other local amenities. The Commission has been advised that the fees the home charges range between £423.95 and £491.78. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The home was visited unannounced by three regulation inspectors and lasted for two days. Prior to the inspection visit the home had been sent an Annual Quality Assurance Assessment and comment and survey forms for residents, relatives and other health professional. These were not completed prior to the inspection and the inspectors asked for the documents to be forwarded when completed. Residents and relatives were able to complete comments cards that the inspectors had brought to the visit with them. In total eight were returned explaining their experience of living at the home. The inspectors each spent time doing an assessment about how staff and other people spend time with residents, including how they communicate, what they do and how this affects the daily lives of the residents, this is referred to in the report as SOFI. The inspectors were able to meet with and talk with residents, relatives and staff. Who told us in their opinion of what it is like to live in the home. A tour of the residents’ rooms and communal and service areas was completed and records about safety of equipment and the building were checked. Records about how staff are recruited, trained and supported were seen to help determine whether the staff have the skills to meet the needs of the residents. During the inspection the inspectors followed the experiences of living at the home for five residents, including looking at their care records, conversations with them, viewing their rooms and meeting two of their relatives. This process is known as case tracking. In the past twelve months the home has received two formal complaints about care in the home, which they have responded to. The care of residents at the home and other issues such as poor communication, staff skills and the number of staff on each shift have been areas raised at recent meetings to protect the residents at the home. These meetings have involved the local social services, the primary care trust, the Commission and managers of the home and senior managers from the Craegmoor organisation. These meetings remain ongoing to review the plan Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 7 devised by the Craegmoor organisation and to see if the care and support for residents is improving. Since the last full inspection in July 2006 the home has had a short but focused visit to assess the safety of some of the residents during February 2007. We are also aware that the home has regular unannounced visits from the Social Services again to assess how they are improving or otherwise. Much of this information is shared at the meeting, which is aimed at protecting the residents. What the service does well: What has improved since the last inspection? There has been considerable improvement in how the staff manage and administer medication belonging to the residents, ensuring the residents receive their medicine as it has been prescribed by their doctor. The majority of staff have attended training that is mandatory due to its focus upon health and safety, this includes for example fire safety. The home are following a good risk assessment to help guide the staff and residents involved in money belonging to residents, which is kept in the safe. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 8 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 Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 9 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 Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 10 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): Standards 1, 3 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all areas of the residents’ life and needs are assessed prior to admission, which may result in omissions of care. Suitable information concerning the home is available to assist residents to make an informed choice. EVIDENCE: Whilst looking in the residents’ rooms it was evident that most residents had been provided with a statement of purpose and a service users guide informing them about the homes services and provisions; two relatives confirmed they have copies these documents at home. We have been advised that the pre admission assessments are due to change, these will form part of the new person centred planning model of care. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 11 There were documents on the residents’ files that had been completed about their needs and risks identified before they were admitted to the home. Some areas on the form had not been fully completed and these shortfalls in the assessments were discussed with the manager and the area manager. There were also some concerns that pre admission assessments for one resident recorded different health conditions. However the care plan was correct, we discussed these concerns with the manager. We discussed some concerns that some pre admission assessments known as outcome based evaluation had been completed after the admission of residents. At the time of the visit, residents and their relatives were given surveys to complete. We had eight returned. Of these the majority indicated that they were provided with enough information about the home, comments included “(staff name) was most understanding and made me feel I would be well looked after” and another resident commented “being a local meant I was aware of the high standards”. We were able to confirm that all residents who were using the transitional care unit known as Balmoral, only did so after a period of assessment, which included competent staff from the home. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 12 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): Standards 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not been able to demonstrate that it has the ability to fully meet the health and personal care needs of the residents. Not all health and personal care needs of residents are met which will have a negative effect on their health and welfare. EVIDENCE: At the additional visit on the 26/02/07 staff explained how they handover to the oncoming staff, including walking about the unit ensuring all residents are seen. Staff advised and showed the inspector the handover sheets used at handover. For the period 25/2/07 to 26/2/07 all residents had an entry on this handover sheet. For three residents who live on the residential unit the records were checked for the above two days. Some entries were poor and information did not always follow on and what actions taken were not often recorded, for example on the 25/2/07 8am to 8pm for a resident it states only Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 13 fluids taken, no lunch taken; night entry 8pm to 8am does not mention whether this resident had any food or fluids, and there was no fluid or dietary monitoring chart in use. For another resident the handover sheet for 8am to 8pm advised she had hurt her arm and that cream was to be applied, there were no records the cream had been applied and it was not recorded on the medication administration record. Entries on these handover sheets were compared to the entries made on the daily statements; and different information was seen, for example 25/2/07 8am to 8pm for one resident it states small amount of diet has been taken and on the night report 8pm to 8am states, supper taken well. These findings were discussed with the new care manager who advised that she had not had a handover about these events and was unaware of them. She did describe some of the immediate care needs of one of these residents and had spoken with family. The care manager advised she had been on sickness absence leave, only returning two days prior to the inspection visit. It remains a concern that important information that is often health related is not given to senior staff and or nurses so that appropriate action can be arranged. At this inspection we found that the five residents who were case tracked all had written care plans on their files. One of the issues discussed with the manager and previously identified was that many needs and risks had both a care plan and a risk assessment and could be confusing for staff to follow as some contained different actions for staff to take. We found that some care plans were rather general, in that they did not always describe how the needs of residents were to be met, such as “toilet regularly and pads to be changed as required”, there did not appear to be an individual assessment and this was confirmed through observation as most residents on units were assisted to the toilet at the same times. We found that some care plans recorded that the resident would need assistance from one to two staff and did not indicate when this would be. There were some good care plans such as how staff should manage the anxiety of residents, and this included what they should do including spending time with the resident. There were some concerns that care plans written by nurses for the treatment of poor skin conditions did not indicate the size of wound or description beyond “skin flap” and the prescribed dressing, which was to be applied “when required”. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 14 We found care plans on the residential unit had not been changed following consultation with the GP, for example when a new diet was required for a resident. We found that all residents had risk assessments on their file. These included assessments of the moving and handling, nutrition, skin condition and whether they were at risk of falling. There were also risk assessments for individual risks such as for use of bed rails and specific health conditions such as diabetes. Risk assessments mainly contained clear actions staff must take to help reduce risks. There was concerns and this was discussed with the manager and area manager that one risk assessment had been written to cover several individual risks for one resident and it did not contain clear and concise actions that the staff must take to reduce the risks for this resident. This may well be confusing for staff and increase risks to the resident. There were concerns that staff do not always follow the risk assessment management plan as one resident who needs to sit on a special cushion did not always do so. A serious concern discussed with the manager was staff not fully following the moving and handling risk assessment and policy, they were observed using a under arm manoeuvre putting a resident at risk of injury. However there were many good observations of staff clearly following the moving and handling risk assessments and communicating very well with the residents. Records about professional health care support from the community were well maintained for each resident, there was good evidence that they see their GP and attend for hospital appointments when needed. There were other records for residents about meeting with social workers, and appointments with chiropody, dentist and optician. The management of residents’ medication was assessed for some residents on all of the units. We found records were completed when medicines are received into the home, administered to residents and when disposed of. This included the management of some controlled drugs. It was evident that medicines are safely stored, including monitoring the temperatures of the medicines refrigerators. There is a comprehensive medications policy, which does include covert administration of medicines. It was not evident this is fully followed as for one residents the GP had given consent for administration off a spoon, yet the risk assessment contained details about putting medication crushed into food and drink, this concern was discussed with the manager and she advised of her immediate actions to ensure residents did not have medication inappropriately administered. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 15 Following recent concerns that there are not enough staff on the residential unit competent to manage medication additional staff have received in-house training to ensure they are competent, evidence staff have completed this training was available on their training records. One member of staff was observed administering medicine to residents and this was done safely. There have been recent concerns that the needs of residents are not accurately reported upon and not adequately communicated between the staff. This has formed part of a recent general strategy meeting, and the manager has made changes to improve this. Including senior staff on each unit reporting to her about the care and needs of residents. We found through observation that staff assist many residents to eat who could not do so themselves, this was done with dignity by most staff but one member of staff did not do this in a dignified way. We found some concerns that the staff were not always completing charts to monitor where required what the residents had been eating and drinking. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 16 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): Standards 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not fully demonstrated that it has the ability to meet the daily life and social activity needs of the residents. The lack of daily and social activity for some residents will result in their health and well-being deteriorating. EVIDENCE: We found that the majority of residents who returned the surveys “have your say about…” indicated that there are activities arranged by the home that they can take part in. Some residents comments about the food included “its first rate, its great” and “my meals are blended but are still good”. During the inspection all three inspectors conducted a Short Observational Framework for Inspection (SOFI), for approximately 40 minutes on three units. A SOFI was not undertaken on the Balmoral (Transitional Care) unit. On Two units there were similar findings in that four residents were fully reliant on staff and visitors to interact with them if not they would often sleep or Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 17 withdraw from what was happening around them. Two units had a resident who slept throughout the time period and although staff tried to gently talk with them they did not respond, these residents did appear comfortable and staff returned later to try again. Two residents on one unit were talkative and interested in people, as a visitor had arrived and staff joined in the friendly conversations. We found that staff on one unit whilst caring for two residents did not talk with the residents even though they were assisting them to have a drink of tea. The residents did not appear distressed by this however the staff did not demonstrate that they understand the importance of talking with the residents during this social occasion. This was not aided by the lack of room in the lounge areas, as staff had to kneel on the floor and lean up to give residents drinks. One resident on Clarence unit was assisted by staff to do a puzzle and a staff member on Clarence unit attempted to sing to and with the residents, this was mainly unsuccessful and most residents were not interested and either slept, watched or looked away. However we found that this was helpful for some other residents with more able communication skills and one resident in the study enjoyed the singing. There was not a lot of interaction between staff and residents on Kensington and Clarence units, when staff did spend time in the lounge it was always to assist residents with a physical activity, such as sitting up or having a drink and when staff did spend time with residents it was often done in a rush, such as telling a resident which seat to sit in, putting a clothes protector on a residents chair and walking away saying its for your tea and staff giving sips of tea calling the residents name but not looking at them whilst giving the tea. This will have had a negative effect on the residents’ emotional well-being However on Windsor unit, which is a residential unit and where the residents are more able to communicate and be physically active than residents who live on the nursing units, they did not sleep so much, there were organised activities being skittles, throwing beanbags, visitors, biscuits and tea. Most residents participated and enjoyed the activities; there were no poor interactions by staff. Further observations made included; the people that could interact got more time, activity sessions clearly did increase the alertness of most residents and the residents involvement with all others around them were so much better when their relatives arrived. All units had the SOFI assessment between 10.30am and 11.30am. We found at times staff did not always respond to residents who asked for assistance that a statement by a resident that she was cold be pretty much ignored. We observed one resident sleeping until the staff brought her a cup of tea put it in her hands and left it until she had to ask for it to be taken away, we suspect it was too heavy for her. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 18 The home does employ an activities co-ordinator, and individual tick charts are completed when residents do take part in an activity. The records of daily activity recorded such events as one to one chats with staff, playing ballgames, sing-along, music, reminiscence books and parties at the home. Most residents have some information on their files about their likes and dislikes regarding socialising, hobbies and pastimes, yet this is not always formally recorded. Several relatives commented that it would be good if staff could spend more time speaking and doing activities with residents including going out occasionally, they felt that the staff were often far to busy to be able to do this. The lunchtime was observed on two different units, Kensington and Windsor. On Kensington unit seven residents in wheelchairs used the dining room, some residents chose to stay in the lounge some were in their rooms and one resident wished to use the table and chairs close by the staff station. Staff assisting residents were found to be using their mobile telephones, whilst assisting residents, this is unacceptable behaviour as it distracts staff from their work who are often providing close and intimate support to residents. The lunch meal was brought to the units by the kitchen staff on heated trolleys. When all the residents were in the dining area, room to move about between tables was very limited, staff struggled to move between chairs, it was very cramped and this did not help the lunch meal be a social event. The menu was available in a drawer when the inspector asked for it, it was not clear how the residents would have chosen their meal, however that was evident as all residents had pork as their was no other option. It was served in soft option, diabetic and normal diet, yet the soft option vegetables had all been blended together and looked less that appetising. Some staff assisted residents thoughtfully, advising them what was on their plates, whilst other staff did not and only repeated the residents name and said “come on”. The radio was playing and lost its channel, staff tuned it to a “rock” channel, this was evidently not for the benefit of the residents and did not aid the staff that wished to talk to the residents. Residents needs were well assessed by some staff, extra gravy, additional food and cold drinks was offered, no condiments were offered to residents. The dining room was pleasantly furnished, including pleasant looking tables with table cloths, napkins and placemats. There was no social conversation between residents and only limited general conversation between residents and staff. Each table was served at the same time, which seemed to be a good service, practical and helped focus residents on their own meals. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that the home manages concerns and complaints well. The service does not ensure that residents are protected at all times. EVIDENCE: Residents who completed the survey did not have any complaints or concerns to raise with the inspectors. They all confirmed they knew who to talk to but had never had the cause to. Relatives who met and had conversations with inspectors did not have any complaints. The home does keep a record of complaints made, and since the last inspection there had been two. One complaint had been redirected through the general strategy meeting to be responded to and the second had been passed to the home from the Solihull Social Services Complaints. Both had been investigated and responded to in line with the homes policy. There are ongoing general strategy meetings lead by the local authority, involving contracts, the primary care trust and the home. More recently the Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 20 concerns raised at these meeting have been considered by the home manager and senior manager and action plans to make improvements have been drawn up. Where previously the home had failed to fully address their responsibility to work with the strategy team, examples of this are not ensuring the immediate healthcare needs of residents were met, not providing reports, not adequately increasing staffing levels, poor moving and handling of residents and not improving communication. At recent strategy meetings there has been evidence that all these areas are improving. The training records at the home indicate that most staff have received adult protection training and for staff who still require such training there are regular training courses for them to attend. The home has a detailed policy about adult protection, which guides the staff about their roles and responsibilities to protect residents from abuse, there is also a policy for all staff to follow about Whistle blowing should they have concerns for the safety of residents. Yet as recorded above the home has failed to take responsibility and make improvements to safeguard residents. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 21 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): Standards 19, 20, 21, 22, 24 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has not demonstrated that it has the capacity to provide the residents with an environment that fully meets their needs and which will have a negative on their well-being. EVIDENCE: The surveys completed by the residents were positive about the environment, stating it was mainly kept clean and fresh. The AQAA completed by the manager post inspection advised that to maintain an environment that is comfortable for residents the home conducts monthly health and safety checks, yet the manager and area manager are looking at better design management of spaces in the home and how best to utilise these spaces in light of Health and Safety. This confirms the issues raised with staff having to Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 22 kneel to give residents drinks in some lounges and the lack of space due to residents using wheelchairs in the dining room. The manager commented that in the past 10 weeks the environment is being regularly deep cleaned and that checks are more frequent. The plan for the next 12 months is to be more proactive with the redecorating programme and replacing items such as carpets and they are employing a new maintenance person. The relatives’ view of the home was that it was nice, it was tidy and that the residents liked it. The inspectors sampled the communal areas, service areas and residents rooms. The four units communal areas are generally well maintained, safe for resident to walk about and are pleasantly furnished. Yet some areas require improvement such as keeping carpets clean, ensuring that where cushion covers go to the laundry for cleaning there are replacements, managing strong odours and improving sign posting to all rooms. Most residents’ rooms were found to be personalised with photographs, televisions, radios, plants and other items they are fond of such as pictures, soft toys, books and magazines. All rooms are en-suite; these were clean and contain many items of personal toilet. Two residents rooms were found to have a strong odour of urine, which means residents will live and sleep in rooms that are very unpleasant and which put them at risk due to poor hygiene control. Each unit has its own communal bathroom and shower facility and also communal toilets. These were seen to be clean, but most were clinical in appearance and would not have helped with bathing being a relaxing experience for residents. There were some toilets that did not have adequate hand washing facilities as either soap or hand-drying facilities were not available. Staff were observed using hoists to assist residents, there are also other aids and adaptations such as appropriately sited grab rails in en-suites, communal toilets and washing facilities and residents where required were able to use special seats that reclined. However most communal seating was identical, and may not have always been appropriate to aid with the residents posture and may have had a negative affect in how they stand and upon the resident’s awareness of their surroundings, especially armchairs with winged sides. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 23 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): Standards 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not at present able to fully demonstrate it has the ability to meet the staffing needs of residents. There are skill gaps and areas of staff support that require attention to enable the staff team to meet the specific needs of residents; if this is not addressed residents may not have their needs met. EVIDENCE: The residents who completed surveys all indicated that the staff all listen and act on what they say and that they are always available to assist them. Comments included “yes, your staff are a 100 ”. Relatives commented about the staff working very hard and that they are dedicated to their work and are always friendly. The staff who were informally interviewed commented upon the recent changes in handover, that at times they were having to stay past their shift to ensure the oncoming staff did receive the handover, that this was due to some staff being late for duty. The staff had good knowledge of the needs of residents, they advised on their mobility, diet and family involvement. As identified earlier in the daily life outcomes, not all staff were observed as Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 24 attentive to residents needs and not all staff completed the required records. The staff explained about the new training provider, that on the day of inspection they were attending moving and handling training, that the theory was very good and that they were due to have a practical session in the afternoon. The manager provided an up to date training matrix for all staff employed. It was evident that most staff have completed mandatory training regarding health and safety, POVA and equal opportunities awareness. It was evident that less than 50 of care staff had completed or were working towards the National Vocational Qualification at level 2. There was little evidence on the training matrix that the staff have undertaken training to help meet the needs of residents who have a dementia. Yet the manager and senior manager have advised that they are introducing a new care planning system that is person centred and that all staff will receive training. The AQAA completed by the manager said that the home does well in the following areas, maintaining adequate staffing levels to ensure quality care, effective employment checks and training and development. This is contrary to the findings of the inspectors, as staff training records indicate care staff have not been trained to meet the specific needs of residents, for example dementia. This was confirmed in discussion with staff. The manager believes they could do better with being more pro-active with staff recruitment and retention and by using less agency staff. She believes the improvements in staffing in the last 12 months include improving the staffing mix and that she plans to initiate further recruitment drives and wishes to develop an active and positive bank of staff. The staffing levels on the days of inspection were seen to reflect what had been agreed at recent strategy meetings and appear to be adequate to meet the needs of residents. There are other dedicated staff employed in service areas such as administration, laundry, catering and cleaning. Staff recruitments records, three were seen and all contained the required information, including completed application forms, evidence of interviews, background checks being Criminal Records Bureau disclosures, POVAfirst and two written references. For one member of staff who has been recently employed there was no evidence of an induction, it was evident from the records that this employee had previously worked at the home. For this employee there was no evidence she was interviewed for the position. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is not fully demonstrating that the management and administration is conducted in a manner that meets the needs of residents. How improvements are to be made and how staff are to be supported have been ongoing issues that have not been addressed, which may mean that residents will not be provided with a quality service that meets their needs. EVIDENCE: At the additional visit on the 26/02/07 the new care manager was found to be working in the kitchen as a domestic assistant and administration staff were cooking; the care manager advised that this was due to a staffing emergency Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 26 as staff had not turned up for duty and kitchen staff had walked out whilst on duty. Since the additional visit we have received an application to register the manager, yet since this inspection it has been withdrawn by the organisation. The area manager has advised that the manager will remain at the home in the position of deputy manager and is being supported by other home managers who come to the home, and by the area manager who is visiting more than once a week. Recruitment of a new manager has commenced. The AQAA returned to the Commission post inspection visit indicates that the manager believes they do well in safeguarding the finances of residents in respect of the money the home has in safekeeping for the residents. She also comments that the home could do better in being more focussed on the needs of the residents. The manager advised of the new management team, (herself, new area manager and new divisional operations director) that they are committed to taking the management forward with clear leadership and through good planning. She advises that the plans for improvement include adhering to policies, and that the aims and purposes reflect current good practices and that all staff will be supervised to the required standard and that fire drills will be completed. The home has a quality assurance system and files relating to this, including their policies and procedures. These were seen to reflect the outcome areas of the national minimum standards for older people. There was evidence of clinical audits such as medication. Within the quality assurance records there was evidence of staff and residents meetings. For staff this includes briefing and discussions for example about their roles, communication, team building and care planning. In total 26 audits were seen including such areas as kitchen and tissue viability. Each audit included the outcomes and improvements needed yet did not state how the shortfalls would be met and when they would be met. The home does provide a safekeeping service for residents to place their money and valuables. How this was managed for three residents was assessed. Accounts were seen to be well maintained and reflected their current balance, where money had been spent on behalf of the resident by the home receipts were all available. There are regular internal audits of the residents account to ensure it is safely maintained. It was evident that the insurance for the safe matched current accounts of residents. The supervision records for three staff were sampled; it was evident that staff are not having regular meetings with a senior member of staff. For a new member of staff there was no evidence that her probationary period of employment had been reviewed and for a trained nurse there were no records about discussing clinical practices. There was evidence that the divisional operational director had sent all nurses a letter which recorded that they were to be supervised and appraised. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 27 The manager maintains comprehensive records about health and safety including servicing, tests and maintenance of utilities and equipment. The fire risk assessment was seen to require a review to comment on compliance and further measures / actions needed to manage identified risks. A detailed discussion about the requirements of previous inspections did take place, it was evident that many which had previously been carried forward had not been addressed. This was not fully reflective upon the new management team yet it is disappointing that the required improvements had not been made to improve the quality of life for the residents of the home Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 28 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 3 X 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 29 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 OP3 Regulation 14(1)(2) Requirement Timescale for action 30/06/07 2 OP7 3 OP7 You must ensure that the needs of the residents are fully assessed by a competent person before admission, which will help determine whether the home can meet the needs of the residents. 12(1) You must ensure that care plans 30/06/07 15(2)(b)(c are revised to meet the changing )(d) health conditions of residents. This will ensure they receive the correct care and treatment for their current condition. 13(4)12(1 You must ensure risk 30/06/07 ) assessments contain specific actions taken to reduce risks and they must be written by a competent person, this will ensure that risks to residents are safely managed. You must ensure that your staff follow the management plan in the risk assessment which will promote the health and welfare of the residents. You must ensure that for residents with nutritional needs and risks that detailed records are maintained of food and fluid DS0000036766.V335072.R01.S.doc 4 OP8 12(1) 13(4)(c) 31/05/07 Jubilee Gardens Version 5.2 Page 30 5 OP8 6 OP18 7 OP19 8 OP26 9 OP36 intake to identify any health deterioration. 12(1)13(4 You must ensure that staff meet ) the moving and handling needs of residents and do this in a safe manner. Previous timescale of 31/7/06 not met this requirement is carried forward. 13(6) You must ensure that actions agreed for you to take at strategy meetings under adult protection procedures are fully implemented to ensure the health and welfare of the residents. 23(b)(c)(d You must ensure that the ) environment including decoration, furnishings and its equipment are maintained in a good state of repair, this will ensure the health and safety of residents. 16(2)(j)(k You must ensure that the home ) is kept clean and that odours are effectively managed, there must be good hand washing facilities in high-risk areas; this will help maintain the health and welfare of the residents. 18(2) You must ensure all care staff have regular supervision and that this is recorded to ensure that staff have an opportunity to talk about concerns and so their performance can be managed. Previous timescale of 30/6/05 not met, this requirement is carried forward. 31/05/07 31/05/07 31/07/07 31/05/07 30/06/07 Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 31 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 You should ensure residents have a care plan detailing how the home will meet their interests, hobbies and pastimes. This will inform staff of how to meet these needs. The staff should ensure that how residents are occupied with activities are fully recorded. You should ensure that all residents at all times are cared for in such a away that is courteous, respectful and which always promotes their dignity. This will have a positive effect on their self image and esteem. You should ensure an assessment to identify the activity needs of residents is completed; this should include their likes. You should ensure that meals are well presented and appear appetising to residents to encourage them to eat a healthy diet. You should ensure that the residents are provided with alternative meals and that they are able to make a choice of what they would like to eat for their main meal. This will encourage their individuality and help them eat the food they most like. You should ensure that mealtimes are social occasions and that environmental issues such as background noise are reduced to help. You should ensure that all residents are provided with seating that will meet their individual needs; there needs should be assessed by a competent person. This will ensure that residents are comfortable and safe when seated or when transferring. You should ensure that bathrooms are not clinical and that they help the residents to have an enjoyable relaxing experience whilst bathing. You should ensure that 50 of the care staff are trained to National Vocational Qualification level 2 in Care. This will provide the staff with a good knowledge base for further training and may help improve the care and support they provide to the residents. You should ensure that all staff are subject to company DS0000036766.V335072.R01.S.doc Version 5.2 Page 32 2 OP10 3 4 5 OP12 OP15 OP15 6 7 OP15 OP20 8 9 OP21 OP28 10 OP29 Jubilee Gardens 11 12 OP30 OP31 13 OP33 policy and are subject to probationary assessment during their induction period. This will ensure residents are cared for by appropriate care staff. You should ensure that staff receive training in dementia care and are competent to meet the needs of the residents. You should make an application to register a manager, this will ensure the home is managed by a person deemed competent to do so and should improve the care and support provided to residents. You should ensure that the quality assurance reports clearly records how and when you will make the considered improvements, this will inform interested persons including residents of what they can expect and how you intend to make the improvements. Jubilee Gardens DS0000036766.V335072.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. 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