Inspection on 17/11/06 for Jubilee House

This inspection was carried out on 17th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Jubilee House Seckford Almshouses Seckford Street Woodbridge Suffolk IP12 4NB Lead Inspector Jill Clarke Key Unannounced Inspection 17th November 2006 09.30 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 House DS0000067583.V320616.R02.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 House DS0000067583.V320616.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jubilee House Address Seckford Almshouses Seckford Street Woodbridge Suffolk IP12 4NB 01394 382399 01394 387449 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) The Seckford Foundation Mrs Tania Elizabeth Collins Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate up to two people, aged 50 and over, who require respite care and accommodation. 9 December 2006 Date of last inspection Brief Description of the Service: Jubilee House is run by the Seckford Foundation and registered to provide care for 19 older people. The home is able to offer respite (short break) care for up to 2 people between the age of 50 to 64 years. Access to Jubilee House is through the new Very Sheltered Housing complex. Once inside, visitors are directed to the front door of the home, which enables staff to monitor access. Residents living in Jubilee House can use the small shop, hairdresser and chapel located in the housing complex. The home is within walking distance of Woodbridge town centre, which has a range of facilities on offer. These include a swimming pool, library, restaurants, public house, Post Office, a range of shops, rail and bus links. The accommodation consists of 19 single bedrooms located on 2 floors. All have en-suite toilet and wash hand basin, 4 also have showers. There are 2 assisted bathrooms and a shower room. Communal rooms include a dining room, 2 lounge and 3 toilets. Residents can access all parts of the home by ramp, stairs or passenger lift. Outside, there is a selection of patio areas and gardens, and parking spaces are available at the front of the home/housing complex. Fees range from £331 to £490 per week, which includes accommodation, meals and care. Mrs Tania Collins manages the home. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 8 hours, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to, and during the inspection. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in May. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (3), joint relative/visitor (7), and staff (1) feedback cards have been included in this report. Residents, staff and management were helpful and cooperated fully throughout the inspection. Time was spent with 5 residents, to hear their views on the level of service provided. A tour of the building, took in all the communal rooms and a sample of 5 bedrooms, bathrooms and shower room. Records viewed, included care plans, staff recruitment, supervision and training records, Fire Risk Assessment, Statement of Purpose, Service Users Guide, Quality Assurance questionnaires, Menus and medication records. Previous visits to the home identified that people living at Jubilee House prefer to be known as residents, this report respects their wishes. What the service does well: The home offers a high standard of accommodation, which is kept clean and well maintained. Residents like the dedicated staff, and the homely atmosphere, which gives a ‘feeling of care and safety’. Comments from the residents throughout the inspection were positive. They included “very good home”, “food good” and “like it very much – very kind”. This was also reflected in a relatives comments who was impressed by the ‘professionalism and helpfulness of all the staff - nothing is ever too much trouble’. Other relatives comments included ‘the care my father is receiving is excellent, kind considerable and very caring’. One relative had written on their CSCI feedback card ‘I believe the care my mother receives in Jubilee House to be the best, and my mother herself say she is very happy and well cared for. Please would you pass on to the staff and thank them from my mother and her family’. Relatives also praised the management of the home. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 House DS0000067583.V320616.R02.S.doc Version 5.2 Page 7 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 House DS0000067583.V320616.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. The home does not offer intermediate care, therefore standard 6 was not assessed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wishing to move into the home, will be given information on the level of care provided, and can expect their needs to be fully assessed. This supports the prospective resident in identifying if the home is suitable, and ensures the home only admits residents whose care needs they can meet. EVIDENCE: Prospective residents are given a copy of the home’s Statement of Purpose and Residents Guide on, or before their admission. Before the resident moves in, a comprehensive pre-admission check is completed by the home. Staff use this as a prompt/checklist to ensure prospective residents have been sent information on fees, which room they will be occupying, plus information on the home and its facilities. The checklist also includes work to be undertaken to ensure the new residents bedroom is ready for occupation, and any required mobility aids have been obtained. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 9 The care records for a resident who arrived during the inspection for 2-week respite (short break) care was looked at. This showed that the manager had visited them before their admission, and completed a pre-assessment of their physical, mental, and social care needs. The manager confirmed that this was normal practice for all new admissions. In undertaking the assessment, they are able to gain a view as to whether they will be able to meet the persons assessed needs. It also gives a chance, for the prospective resident to ask any questions, and discuss any concerns they may have. Although the manager will go and visit all prospective residents, they also encourage people to visit the home, and spend time meeting the other residents and staff. Time spent with 1 resident identified that they had known the home well before moving in, as they had stayed in the adjoining ‘Alms’ houses, and had also used the respite care facilities. They felt the home met their needs, and expectations. Previous concerns had been raised by the CSCI with the last manager, due to the home not undertaking a full pre-assessment, which had potentially led to people being admitted with dementia. The current manager confirmed that all residents have been re-assessed and where it was identified that they had dementia, supported to more to another more specialist care home. The manager confirmed that the staffing levels, and layout of the building was not suitable for residents requiring dementia care. One resident whose mental health care needs had changed since they had moved in, was currently being re-assessed as the home can no longer meet their needs. Care records for the 3 residents looked at, showed that all private and social funded residents had received a contract which included information on what is, and what is not included in the fees. Discussions with 2 residents confirmed that they were aware of the costs. Copies of letters held, also evidenced that residents had been sent information on annual rises, and were applicable, fees to be paid by Social Care and the resident themselves. One of the 19 beds is contracted by Social Services, to provide respite care. This is used to support residents who live in their own homes, or with relatives. However, the home does not offer the more specialised ‘intermediate care’. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9,10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect staff to monitor their care, based on their individual needs, and take appropriate action to support their changing physical and mental health. The principles of respect, dignity and privacy are put into practice. Residents cannot be assured that staff has systems in place to give them their medication, if the resident is not able to take the medication at the time it is being given out. EVIDENCE: Since the last inspection, the home has continued to work on the information held in residents care plans. This is to ensure it reflects how residents want to be cared for, whilst giving staff clear guidelines on how their care needs will be met. Two residents care was tracked, which involved looking at their care plans, medication records, and spending time with the residents to hear their views on the level of service provided. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 11 Care plans seen held a good level of information, showing work undertaken to monitor residents physical (personal care, nutrition, pressure areas, continence), safety (manual handling, falls and environmental risk assessments) and social interests and activities. Information obtained from the pre-assessment forms, was used as the bases of the first ’36-hour’ care plan. This supported staff in knowing enough information, to safely care for the resident whilst staff identified any further areas, which they may need support/assistance with. Staff felt it was important that the resident was given time to adjust and get to know the routines of the home, before developing the care plan further. When staff, jointly with the resident have identified areas they need support with, it will be written up into their main care plan, and reviewed when required, or at least monthly. Care needs assessments seen, held in the care plans, focused on supporting the resident to maintain their independence. Staff were given guidance on what residents were able to do for themselves, and how much help staff should offer. One resident in a letter to the home, praised the contents of the care plans stating ‘ The care plan is so meticulous and comprehensive that it gives tremendous confidence that needs are fully catered for’. Good practice was seen with the home, having just starting to put a summary of the care plans in the bedroom for the resident, and staff to use. The manager said it was also useful for new and agency staff to read. This led to discussions that a copy of the manual handling assessment in the bedroom, would also be informative to new and agency staff. Completed resident’s surveys, confirmed that medical support was available when they required it. One resident had written ‘the District Nurse who visits can deal with my routine medical needs’. They went on to say that they also go to ‘Ipswich for health checks every few weeks’. During the inspection, time was spent talking to the visiting Community Nurse. They felt that they had a good relationship with the home, and that staff would always contact them to report any concerns. They also appreciated that staff met them on arrival, and offered assistance as required. When asked if they had ever any concerns over residents’ hygiene, or general care, they replied they had not, praising the work of the staff. Care plans incorporated residents preferences, such as (name of the resident) ‘likes to go to bed about 9pm – get up 7 to 8am’. Residents had signed the different pages of their care plan as confirmation that they had read the contents, and it portrayed their wishes. Staff consistently used the wording ‘the resident has requested’, which was seen as good practice, evidencing further, that residents had been involved in putting together their care plan. Time spent talking to the residents on the level of support they relieved, reflected the information held in the care plan. All the relatives completing the CSCI said that they were satisfied with the level of care provided, with 1 relative describing the care as ‘first class’. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 12 During the inspection, staff were observed to address residents politely, using their preferred first name, or surname. Residents said that staff ensured their privacy and dignity was maintained when receiving personal care. Whilst sitting talking to residents in their bedrooms, staff were observed to knock and seek permission before entering. The home uses a commercial monitoring dosage system to dispense medication, which is supplied from the local pharmacist every 28 days. The home said that they had a good working relationship with the Pharmacist who carries out audits at the home, to ensure medication is being stored correctly. Medication is held securely in a locked medication trolley with restricted key access. Training records showed that staff had received training in the dispensing of medication, and how to complete residents Medical Administration Records (MAR) correctly. The home has systems in place for recording all medication received into the home, and returned to the pharmacist if no longer required. However, a check for the amount of antibiotics received for 1 resident showed that 21 had been received, but according to the MAR charts – 22 had been given out. This raised concerns that staff were not always checking the medication against the MAR chart before giving out. It was noticed on 1 resident’s MAR chart, that they were not regularly receiving their morning medication (given to reduce a build up of fluids in the body). Staff had written ‘F’ on the MAR chart, a code used in this case to inform staff that the resident was asleep when the medication was being given out. However, records showed that staff had not taken further action by giving the once a day medication later, when the resident was having their breakfast. The home was asked to take immediate action to ensure the resident received the mediation as prescribed, and if required seek further guidance from the Doctor or Pharmacist on the timing of the medication. Following the inspection correspondence received showed that the home had acted promptly to address the concerns raised, to ensure it did not happen again. The fridge used to store medication is located in the office, which normally is kept locked, however on the day of the inspection was found to be unlocked at the start of the inspection. The temperature of the fridge was being checked daily, to ensure drugs were stored at the correct temperature. Medication held by the home for the 2 residents whose care was being tracked, was checked against the information given on the MAR chart, which was found to be accurate. A random audit check of controlled drugs held, against the amounts listed in the control drugs register was also found to be correct. Care plans showed that residents had stated their end of life wishes, giving information if they preferred to be cremated or buried, the location they would like to be laid at rest, and which funeral directors should be overseeing the Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 13 arrangements. One resident had made plans to donate their body for research, and had signed paperwork clearly stating out their wishes. There was also a list of people to be informed when they died, and why, for example the solicitor who holds their will. One relative had written to the CSCI, stating their relative had died earlier in the year, and praised how well staff had looked after their relative, making them feel ‘loved’. Jubilee House DS0000067583.V320616.R02.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are offered a choice of nutritiously balanced home cooked meals, using fresh ingredients. Residents are able to choose their life style, social activity and keep in contact with family and friends. EVIDENCE: One of the 3 residents completing the CSCI survey, said that there was ‘always’ enough activities arranged by the home that they could take part in. They listed the range of activities, which included bingo, card games, cake baking and gardening. They said they enjoyed a daily walk ‘around the establishment informing staff before I go and when I returned’. They went onto say that ‘residents are discouraged from sitting around in large groups for long periods’. The other 2 residents said that the home ‘sometimes’ provided activities for them to join in with. One stated that their poor eyesight stopped them in being able to ‘participate in many of the activities’. The result reflected the home’s own survey, with 5 out of the 8 residents saying they ‘usually’ enjoyed the activities on offer, and 3 saying ‘sometimes’. Time spent with 1 resident identified that they found it difficult to hold a conversation with other residents who were mentally frail, or hard of hearing. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 15 The management said that they had recently recruited 5 volunteers – who will be starting once all their clearance checks has been undertaken. To start with, the volunteers will be organising more group activities. Then, as they get to know the residents, they will also be able to act as a ‘befriender’. This will especially support residents who have few visitors. This was seen as a positive move forward in using resources creatively, in the best interest of the residents. The management confirmed that the volunteers have been made fully aware that they are not to undertake any care duties, and if a resident requires help they must to use summon assistance using the call bell. At the time of the inspection pupils from a local school who are undertaking their Duke of Edinburgh’s award were visiting. Discussions with 1 of the pupils identified that this happens every Friday, when they spend time talking and playing games, such as cards with the residents. The residents’ notice board, located near the dining room displayed ‘a what’s on list’ for the forthcoming month. There were also details of the hairdresser, chapel services and Christmas lunch. A resident showed the list of activities they had been given for November. The inspector was worried that they may not be able to read the small print, due to their poor sight. However, the resident showed the special reading aid they had, which enable them to read the information out. In the lounge there is also a telesensory machine for partially sighted residents. Residents care plans showed that they had been consulted on their social interests and hobbies. Staff had also written information on what activities residents had taken part in, although these were not always being updated. Planned activities showed that the home followed a multi cultural theme, celebrating Chinese New Year Lunch, Burns Night, St Patrick’s Day, Indian New Year, and St Georges Day. One resident’s social sheet, showed in June they had joined in/attended Music to movement, Strawberries & Cream Tea, Midsummer BBQ, reminiscing, Cheese and Wine party, and a Fish & Chips lunch. The home has its own mini bus, which they share with the sheltered housing tenants. However, nothing had been entered for the next few months, although the resident said they had been joining in with activities and going out. Time spent talking to residents showed that they were supported to keep links with the community through different clubs, which they attended monthly, and shopping trips into the local Town. One resident’s verdict on the food was that it was “terrific at the moment”. This reflected other comments made by residents, through the CSCI surveys and during the inspection, which included “Good meals”, and “Food Very Good”. When the resident was asked if the menu included fresh fruit, they replied that they “get a lot of fruit either in hot puddings such as crumbles or Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 16 as fresh fruit salad”. They said that bowls of fruit used to be left out for residents to help themselves, but this resulted in some residents eating too much and getting an upset stomach. Since then, staff have gone around offering residents a choice from the fruit bowl daily. However, they could not remember this happening for the last couple of days, and thought perhaps the kitchen had run out. A resident confirmed that catering staff visited them each morning to ask what they would like for lunch. They said they always get a choice of 2 main meals, and if they did not like the choices on offer - they would talk to the Chef about an alternative. The menu for the week was displayed on the ‘resident’s information board’, and showed that on the day of the inspection the choices for lunch were ‘Pork & Prunes casserole or Fisherman’s pie and vegetables’. This was followed by Sticky Toffee pudding and cream, or stewed Rhubarb and Custard. The menus showed a good variation of hot meals were offered, which included Roast Turkey, Smoked Salmon & Prawns, Steak & Ale Pie and Lemon Sole fillets. Residents can choose to be served breakfast in the dining room, or their bedroom, which is a choice of fruit juice, cereal, porridge and toast. Care plans gave information if residents liked a hot drink last thing at night, during the night or on waking. Discussions with 1 resident, whose care was tracked, showed staff brought them drinks as requested in their care plan. The lunchtime atmosphere was relaxed, with the manager joining residents for lunch, with staff offering residents assistance discreetly. Residents were seen to enjoy the music being played, with 1 resident observed tapping their foot to the beat. Residents spoken with felt that moving into Jubilee had not restricted their life. They still felt in control, although would appreciate if there was more staff available so they could go out for walks when they wanted. However, as mentioned earlier, the introduction of volunteers may help the situation, and enable wheelchair users more support in accessing the community. Minutes of staff meetings showed that the manager had identified that some of the night staff were getting residents up too early. The manager said they were trying to identify and get rid of any set practices that staff felt that they had to follow. For example, some staff felt they should assist a certain number of residents to get up, otherwise it might be looked upon by other staff that they were not doing their job. They said that although staff came on duty at 7am, there is a handover first, and residents are assisted to get up as they wish. Care plans contained an area on achieving the residents ‘Spiritual fulfilment’ and how this was to be achieved. One care plan viewed said that the resident liked to attend a ‘service on site on Wednesday each week and receive communion on 1st Wednesday each month’. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 17 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, 17 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected from abuse, and have their legal rights protected. People can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: All relatives completing the CSCI survey said that they were aware of the home’s complaint policy, with 1 relative saying that they had only ever needed to make a ‘minor’ complaint. Time spent talking with residents confirmed that if they were unhappy with their care, they knew who to speak to. Which reflected the information given in the CSCI resident surveys, with 1 resident saying it was ‘not often necessary’. One resident said that they had raised a concern with the management, which had been dealt with, however this had not been recorded in the complaints book. The manager said that staff automatically dealt with any concerns as they are raised, and if received as a formal complaint appropriate this would be documented, including what action taken in the resident’s care plan. This led to discussions that it would be beneficial to record concerns as well as complaints, to evidence the pro-active work undertaken by staff in addressing them. A copy of the homes complaints procedure is contained in the Statement of Purpose, and displayed in the corridor leading to the dining room. However, the height it had been displayed at was unsuitable for wheelchair users to be able to read. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 18 The complaints policy needs to be updated/amended to reflect that the CSCI is not a complaints agency. However, if the person making a compliant is not satisfied in the way the home had dealt with it, they can contact the CSCI to seek further advice. This had happened with 1 relative in May 2006, when a family contacted the Commission, sending a copy of the complaint, and the response they received. However, the homes complaint log showed that no complaints had been received. The manager said that the complaint had been made direct to Head Office, who held all the information, as the person was no longer a resident at the home. Time was spent discussing the complaint, and why the family were unhappy with the outcome. This led to discussions on the circumstances leading up to the complaint, which concerned admitting a resident with dementia. The home was not able to give the required level of support, which resulted in the resident requiring another move to a specialised care setting. This had happened prior to the new manager taking up their appointment, and action has now been taken to ensure the situation does not happen again ( see Choice of Home section of this report). Discussions with a resident identified that they had raised a concern with the management, which had been dealt with, however this had not been recorded in the complaints book. The manager said that staff deal automatically with any concerns as they are raised, and if appropriate this would be documented, including what action taken in the residents care plan. Staff personal files showed that they had signed a form to confirm they had received a copy of Seckford’s policy for the prevention of abuse. The homes training matrix and individual staff training records did not clearly evidence that all staff had received training, and refresher training in awareness of abuse. The manager showed the new induction training records, which included a unit on responding to abuse and neglect. Staff who had achieved a National Vocational Qualification (NVQ), had also undertaken a unit on protecting vulnerable adults as part of the course. Previous discussions with staff evidenced that they would report any concerns over residents welfare, and would advocate on residents behalf. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Access to the home is via a doorbell system whereby a staff member speaks through an intercom prior to opening the door. Once in the home visitors turn left to go to the sheltered housing complex, and right to the front door of Jubilee House. Access is again via ringing the doorbell and informing staff who you are via the intercom. A visiting Health Professional said the system always ensures staff know when they have arrived, and would come and meet them, where at other homes they could be left walking around trying to find staff. The Day Centre, which operates from Jubilee House, has its own entrance and facilities, therefore does not impinging on the residents living in the home. The décor of the home is well presented, clean and tidy. All the bedrooms are of single occupancy, and have en-suite facilities. Time spent visiting 6 Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 20 residents in their bedrooms, confirmed that the room met their needs, and they were well furnished. Residents are encouraged to personalise their rooms, and bring in their own belongings taking into account the size of the rooms. Bedroom doors are lockable and residents are offered their own key, to their door and lockable drawer. All areas of the home visited during the inspection were found to be cleaned to a high standard, tidy and well presented. Two residents spoken with confirm that this was the usual standard, which also reflected comments made by residents in the CSCI surveys. One resident had written that the cleanliness of the home was maintained to a ‘very high standard’. During discussions with 1 of the housekeeping staff, the inspector congratulated them on how clean they had found the home, the member of staff replied that they cleaned Jubilee House as they would their “own home”. The home has 2 spacious bathrooms, with assisted baths and a shower/wet room. Hoist equipment for the baths was clean and was last serviced in June 2006. Communal toilets were located close to the dining room and lounge areas. The home has individual thermostats fitted to hot water outlets. A thermometer available for checking the water temperature, which was recorded by staff and within accepted temperatures 41–43 degrees Celsius. Linen bins were stored in the bathroom, appropriately colour coded and with lids, used as part of their infection control procedures. The Housekeepers trolley, which held cleaning fluids had been left unattended. This practice needs to be reviewed taking into account 1 resident is currently being reassessed for dementia care. In the sluice area all cleaning products were locked away, there was one commode pot, with a lid on, that needed cleaning as it had residue of what looked like dried urine. Staff said that they do not use the commode pots often, however, if they required cleaning they would be left in the sluice, with the lid on ready to be cleaned. There was a notice board with information relating to continence pads and catheter bags disposal. The linen cupboard was tidy and the fuse box accessible. According to staff meeting notes there had been an issue with it being blocked, so there was a notice to remind staff to keep it clear. The dining room is spacious and light, however the carpet, which was replaced during the refurbishment in December 2005, was showing signs of wear and tear. The light coloured carpet was clean, but stained, where spilt liquids had discoloured. There are two lounge areas, with comfortable chairs, settees and fireplaces, completed with mock flame fires, enhancing the homely atmosphere. There is a telesensory machine for partially sighted residents. Although there was a sign directing people to the public phone, staff said it had been removed. This was due to most residents having their own phone line Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 21 put in, so they found that it was not being used. Some respite residents bring in their own mobile phones. Telephones are located through the home for staff use, which they can also be used to transfer incoming calls. Assurances were given that if a resident wanted to make a call, they could use the homes mobile phone. Corridors were wide with grab rails and well lit areas. The lift was easily accessible with a call bell inside. All radiators had safety covers on. Residents were seen to freely move around the home, using the passenger lift, or stairs if they preferred. Signage is generally very good, there were three signs relating to fire information waiting to be put on the walls. The manager informed us the maintenance man was currently completing this work. The home benefits from having a Chapel, hairdressers and small shop on site. Externally the car park has now been completed, and steep slopes viewed from some bedrooms and the communal rooms have been laid to grass. Many of the residents who have small patio areas leading off their bedrooms, have planted flowerpots and erected bird tables, as points of interest and colour. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 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. People using the service can expect to be cared for by trained, skilled staff in sufficient numbers to support their physical needs. However residents cannot be assured that the current staffing levels will meet their social needs. EVIDENCE: All but 1 of the relatives completing the CSCI surveys felt that there was enough staff on duty. One felt that ‘sometimes the staff are stretched when there are so many vulnerable patients who need immediate attention’. This reflected information given in CSCI surveys, with 2 residents saying that staff was ‘always’ available when they needed them, and 1 saying that staff were ‘usually’ available. Discussions with 1 resident during the inspection identified that sometimes call bells took a little longer to be answered during busy times, although they were not complaining, as they acknowledged that some residents required more care. There was no concerns raised that residents were not getting the support they required with their personal care, discussions with a visiting Health Professional conformed that they always found the level of residents personal hygiene was good. Staffing levels during the inspection were 2 carers throughout the 24-hour period. At the start of the inspection, 1 member of staff was busy giving out medication in the dining room, whilst the second member of staff was assisting residents with their care needs. The current rotas, with 2 staff working each Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 23 shift, does not give flexibility in supporting residents during peak or busy times, such as breakfast and lunch times or when 1 member of staff is giving out medication. The home also takes residents on respite care, who will require extra support to assist settling in. Staff were observed to work well as a team, which helped ensure all the work was undertaken. However as a resident commented, it did always allow time for staff to sit and talk to them or take them for a walk. The introduction of volunteers (see Daily Life and Social Activities section of this report) although not allowed to undertake personal care unless they have been trained, will support residents in having time to sit and talk to. In addition to the carers, there is a part-time activities co-coordinator who works 3 days, covering both the home and adjoining sheltered accommodation organising a range of activities. The manager works supernumerary to the rota to ensure that they are able to complete their management takes, however, will work a ‘hands on’ in an emergency situation. The manager also stated if last minute sickness left them short staffed, they would also look to use staff working in the adjoining sheltered housing complex. This is due to the staff who are also employed by the Seckford Foundation, having received the same training of training as their own staff. Information given by the home, showed that the home currently employ 10 care assistants, 4 of which are qualified to National Vocational Qualification (NVQ) 2 or above. Although it was noted by the inspector that the home has less than 50 of their staff qualified to NVQ 2, at least 2 of the 10 were still on their induction training. Therefore as part of their on-going development, should access NVQ training at a later date. Since the last inspection, the Manager has been on training to support staff on the new induction standards. The content of the new training package was looked at during the last inspection (9/12/06), and records seen showed that the home has now put this into action for all new care staff. Since the last inspection the manager has produced a training book, which gives information on each member of staffs training undertaken, and identified training needs. On the computer the manager also keeps an overall record of ‘staff training requirements’, such as training in medication, giving the date they attended, and when refresher training is required. To monitor that the home is following safe recruitment practices, 3 staff records were looked at. This showed that work was being undertaken to validate new staff’s identity, with Criminal Bureau Checks (CRB) and references being obtained before they commenced employment. Records checked, identified that the home had not obtained a full employment history, and validating reasons (where reasonably practicable) why staff had left previous employment which involved working with vulnerable adults. Good practice was seen with the use of new interview sheets, which gave written feedback on their interview, and how they answered questions. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect a well managed home, where staff are committed to providing a good level of care within a safe environment. EVIDENCE: The manager Mrs Tania Collins has now been in post over a year. Since the last inspection (9/12/05), Mrs Collins has been registered with the Commission as fit to run a care home. As part of the process Mrs Collins was invited to attend an interview with the lead inspector for the service. During the meeting Mrs Collins was able to demonstrate their commitment to working with the CSCI, and addressing any shortfalls identified in the CSCI report, following the December 2005 inspection. They had clear ideas on how this would be undertaken, which included, updating and reviewing systems for keeping information, such as residents care plans. One relative’s comments about the Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 25 management reflected that this work had been carried out. Their comments included ‘the management systems which are in place have impressed me greatly as well as the excellent manner in which they are implemented’. Relatives also commented on the ‘friendly and relaxed atmosphere’. The manager holds a NVQ 3 in Care, and is currently studying towards a combined qualification, which on completion in April 2007 will give them a Registered Managers Award and level 4 in Care. Besides undertaking this course, the manager has also been attending training days to update their knowledge, in Health & Safety issues, and changes in staff induction training. Time spent during the inspection, showed that staff were aware of their responsibilities, and worked well as a team. Minutes of staff meetings, evidence that the manager continuously monitors staff practice, for example reminding staff that residents’ nails must be kept clean. Completed staff supervision records, showed that staff receive regular 2-monthly supervision. Written records of the content of the supervision had been dated and signed by both parties. Areas covered included ‘achievements that you are most proud of, any work related concerns, professional development and issues staff would like to discuss’. The running of the home is also monitored through monthly-unannounced visits from a member of senior management, who writes a report of their findings, and undertaking quality assurance surveys. The home showed the results of their recent quality assurance survey which residents were asked to complete. Eight had been returned. Completed surveys showed feedback given by residents was positive. Asked what they liked most about the home, 1 resident had written ‘the feeling of care and safety’. Staff will analyse the results, and feedback will be given to residents, using a suitable format. This led to discussion that the outcome, including comments should be included in the Residents guide, as it would be informative to hear resident’s views of the home. Other residents spoken with during the inspection also commented that they felt safe living in the home. Records looked at showed comprehensive environmental risk assessments had been completed by the management, which covered activities undertaken in and outside of the home. For example ‘Falling in the Town Centre’, staff were given guidelines on what action they should take to minimise any risk – and what to do if it happened. Any accident or incident, which affects the well being of a resident, is recorded on a log, and placed with the residents care records. The staff completes a monthly analysis sheet, which showed for October 2006 there had been 4, 2 falls and 2 trips. The analysis also gave information on incidents during the last 3 months and over the past 12 months. Care plans held copies of completed falls risk assessments, including action taken to eliminate or reduce the risk of re-occurrence. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 26 Since the last inspection the home had completed their fire risk assessment. This included a list of where all 59 Fire extinguishers were located around the premises, and checks undertaken to ensure that they had not been moved or tampered with. Fire extinguishers were wall mounted and had been serviced in June 2006 by an external company. Records showed that staff undertake weekly checks to ensure the fire systems are working correctly, which includes setting off different fire alarm call points. Records showed that 11 staff had attended Fire awareness training on the 30/8/06. During the tour of the building it was noticed that there was 3 fire signs, which whilst located with the fire extinguishers, giving appropriate information, were not fixed to the wall. This was fed back to the manager who confirmed that the maintenance person was currently undertaking this. Following the inspection confirmation was given by the home that the work had now been completed Records showed that staff receive mandatory training to ensure the safety of residents, which included Health & Safety training and manual handling. Staff had also received training in the ‘safe release of passengers’ when using the lift. Upstairs, located on a wall for easy access, was a specialist ‘rescue mat’ used to aid resident’s evacuation down the stairs during a fire. Records also showed that all the hot water outlets, accessed by residents were being checked monthly, and were recorded to be within the required range (41 43°C). Good practice was seen with the staff rotas ‘highlighting’ using different colours, to identify who was trained as a First Aider or Fire Warden on each shift. The home encourages residents to look after their own money, however they do have facilities set up for any resident who preferred the home to look after their spending money safe for them. Records showed that each resident had been issued with a ‘resident cash/or valuables sheet’, which gave information on the date money had been deposited or withdrawn, and balance. The monies held for 2 residents in safekeeping, was checked against the home’s records and found to be correct. Residents had signed the cash sheets to confirm the transactions. Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 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 3 18 3 3 3 4 3 3 3 3 4 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 2 3 Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 28 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 OP9 Regulation 13 (2) Requirement The home must ensure that medication is given out as prescribed. The home must ensure staff complete MAR sheets accurately. The home must continue monitoring staffing levels, to ensure that they have sufficient staff on duty at busy periods, and to support residents with their social care needs. The home must obtain a full employment history for staff, and where applicable validate the reason they left that employment, before they commence work at Jubilee House. The home must review the practice of leaving the housekeeper’s cleaning trolley unattended, as part of their general risk assessment. Timescale for action 17/11/06 2. 3. OP9 OP37 OP27 13 (2) 18 (1) 17/11/06 10/12/06 4. OP29 OP37 19 Schedule 2 24/11/06 5. OP38 13 (4) 10/12/06 Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 29 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 OP8 Good Practice Recommendations The home should look at including a copy of the resident’s manual handling assessment with the care plans left in the bedrooms. The home should monitor to ensure that the office door is locked when not in use, or look at moving the medication fridge to another secure area. The home should review their complaints policy, to ensure that the reader is aware that the CSCI is not a complaints agency, however if they are unhappy how the home has investigated their complaint, they can contact the CSCI to seek further advice. The complaints procedure should be displayed at level where it can be easily accessed and read by all persons. As well as having a complaints and compliments book, the home should consider including recording concerns raised, and action taken by staff to address them. The home should keep a clear list of the dates staff have attended stand alone training on abuse awareness, or as part of their induction training, to ensure they are able to monitor when staff require ‘refresher’ training. The home should seek further professional advice on how to remove the stains on the dining room carpet. If unable to remove, the home should look at using a more suitable floor covering. To stop confusion the home should remove the sign directing people to the public telephone, which no longer exists. 2. OP9 3. OP16 4. 5. OP16 OP16 6. OP18 7. OP19 8. OP22 Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Jubilee House DS0000067583.V320616.R02.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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