Inspection on 21/05/08 for Jubilee House

This inspection was carried out on 21st May 2008.

CSCI found this care home to be providing an Good service.

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

Jubilee House 06/08/07

Jubilee House 06/06/06

Jubilee House 25/10/05

Jubilee House 19/04/05

Jubilee House 20/10/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Jubilee House Bronshill Road Torquay Devon TQ1 3HA Lead Inspector Michelle Finniear, Clare Medlock, Lesley Brown Unannounced Inspection 10:00 21st May and 9th July 2008 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 DS0000061444.V364811.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 House DS0000061444.V364811.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jubilee House Address Bronshill Road Torquay Devon TQ1 3HA 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) 01803 311002 01803 311525 jubileemanager@adlcare.com ADL Plc Mrs Eileen Grace Pope Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th August 2007 Brief Description of the Service: Jubilee House provides care for up to 28 people over the age of 65. The house is a detached property, set in an accessible garden, with mature trees, close to Torquay town centre. All accommodation is in single rooms, 15 of which have an en suite toilet. There are two bathrooms and an accessible shower. There are some small steps and a slope on the upper floor. There is a shaft lift on one side of the building and a stair lift the other end, to give access to all parts of the building. There is a lounge, a dining room and a bright sun lounge. The current fees on the day of this inspection (July 2008) ranged from £310.00 depending on need. This fee did not include hairdressing, newspapers, chiropody and personal items. The Statement of Purpose and Service User Guide can be found in the entrance hall along with the latest inspection report. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was unannounced and took place over two days 21st May 2008 and 9th July 2008. During our visit we spoke to eight people who use the service, the manager, four staff members and three relatives. We also spoke with two external health care professionals. We case tracked five people who looked in detail at the care these about their care; looked at records made observations. We also looked use the service. Case tracking means we people were receiving. We spoke to staff that related to them, spoke with them and at a further three records. We looked at five staff recruitment records, training records and policies and procedures. We did this because we wanted to understand how well the systems work and what this means for people who use the service. All this information helps us to develop a picture of what it is like to live at Jubilee House What the service does well: The procedures followed prior to admission ensure people have enough information to decide whether Jubilee House is the right place for them to be. The process also enables staff to assess whether they can meet their needs and prepare equipment that will be needed. The statement of purpose and service user guide are informative and contain the required information about what services the home offers to allow a person and/or their advocate to make an informed choice regarding whether or not the service could meet their needs. People like the staff at the home and say staff listen and act on what they say. People also receive the medical support they need. Health care professionals describe the care as ‘good’ and say they have ‘no concerns’ People know how to complain and who to complain to. When this happens, complaints and concerns are dealt with appropriately. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 6 People at the home are looked after well and access their GP, specialist nurse and NHS services when necessary. Staff identify risks for people at the home and plan ways to minimise these risks. Care plans are well written and reviewed to show what care needs each person had and how they are be met. Staff are knowledgeable about the need and requests of people at the home. Record management at the home is organised. There are good systems in place for the management, receipt, administration, safekeeping, and disposal of medicines. People living at the home can see visitors at any time of the day. Visitors are always made to feel welcome at the home. All areas of the home were well maintained and well decorated. All lighting is domestic in style and furnishings are good quality. People like their rooms and the facilities provided and are pleased small items can be bought in to make the room feel more like home. There is good kitchen hygiene with a record of the heat of the food served, a daily cleaning rota and a daily record of the fridge temperatures. Repairs are carried out quickly and efficiently at the home. The laundry service at the home is ‘very good’ with people telling us that they ‘get their clothes back the next day’. There are robust recruitment procedures in place at the home to ensure all staff have the necessary pre employment checks. CRB (Criminal record Bureau-police check) and POVA (Protection of vulnerable adults) pre employment checks are performed before staff are able to work. This shows that staff are checked before working with vulnerable people. Staff are encouraged to do NVQ training, which means they will be provided with the skills to care for people in an appropriate way. The interactions between staff and people who use the service are positive. What has improved since the last inspection? Care plans have improved since the last inspection. Records are now drawn up with people who use the service where appropriate. Care plans now reflect the standard of care that is provided and show that care is regularly reviewed. People are protected by changes at Jubilee house. Fire doors were not propped open and staff have received training in the prevention of abuse. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 7 Staff now have regular supervision sessions and have records of the induction process they have followed. This means staff are provided with information and support to perform their roles safely. Assessments are performed for each person when a need for equipment or adaptation is identified. The provision of equipment is prompt. Infection control processes at the home have been improved with incontinence pads being transported correctly and use of protective equipment used by staff. This reduces the spread of infection. Environmental changes have also been made. Flooring has been replaced in areas of the home and rooms have been redecorated as part of the refurbishment programme. What they could do better: The safety of people should be seen as a priority at the home. Staff should be given a suitable induction so they are able care for people in a safe and appropriate way. The information provided to people and their representatives should also be regularly checked to ensure it is accurate. The quality of training should also be reviewed. Whilst in house training regarding protection of people from abuse is provided, further external training is suggested. This would mean that staff are provided with information on how to correctly report allegations of abuse locally. Staff should be given local contact numbers of the multi agency team responsible for managing allegations of abuse. This would mean alerts are managed promptly and quickly. People who use the service should also be protected by improving the recruitment procedures to ensure references are from a suitable source and ensuring staff are issued with the General Social Care Council Code of Practice. This would ensure the organisation have taken all the steps to ensure people who use the service are cared for by staff who have received codes of practice and undertaken robust pre employment checks. Protection of people who use the service should also continue by ensuring safety checks are carried out by all staff. Staff should also be reminded to correctly store shampoos and cleaning products safely. Staff should also look at the environment to ensure risk assessments are performed where people are able to wander. A risk assessment for the outside patio would identify and risks of falls for people who have restricted sight or restricted mobility. The manager should also constantly review the lifestyle for people who use the service. Whilst set routines currently work well, a constant review of work Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 8 practices should be monitored to ensure routines do not become institutional and restrict choice for people at the home. People should be asked about whether they are happy with the type and quality of activities, and should be consulted about other choices such as meals and religious activity. The manager should continue with the quality assurance processes in the home. Staff meetings should be frequent for staff to share concerns and ideas. The manager should also look at the management styles within the home to ensure they do not have an impact on people in the home. 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 DS0000061444.V364811.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 House DS0000061444.V364811.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): 1,2,3,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The robust procedures followed prior to admission ensure people have enough information to decide whether Jubilee House is the right place for them to be. Minor amendments to some documents would mean that people have more up to date information. EVIDENCE: The Statement of Purpose and Service User Guide are available. These documents are found in the entrance hall along with latest inspection report and certificate of registration. The service user guide contains information about peoples of rights and responsibilities, the ethos and philosophy of the home, room sizes, and aims and objectives. Although changes had been made to the Service User Guide that is handed out, some updating was due on the document in the hallway, with regard to the senior management structure within the organisation. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 11 The statement of purpose also contains a copy of the homes written contract/statement of terms and conditions which tells people about their rights, what are they can expect for the fees to be paid and information on periods of notice required. Copies of signed contracts could be seen in some of the files seen. The manager told us of the process that is followed before a person moves to the home. The home manager or senior staff assesses people before a decision is made about whether staff at the home can meet their needs. In most cases this involves a visit to meet the person in hospital, or at their own home. At this point a pre admission assessment is completed which is used to base the plan of care. Relatives are invited to participate in this process, and people are encouraged to visit the home wherever possible. Information on peoples needs is also obtained from social services or other agencies. The manager told us she would decline an admission if staff feel they are unable to meet the persons need. The manager also told us she continually reviews the health and wellbeing of people to ensure staff at the home continue to meet their needs. People we spoke with said they or their families were involved in the process to move to the home. One person said they had been too unwell to visit the home, but their family had looked around to choose a room. The home does not provide intermediate care. This means they are not a specialist home providing care and intensive rehabilitation with an aim to returning people to their own home. Jubilee House DS0000061444.V364811.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): 7,8,9,10,11 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The health and personal care people receive is good. Consistent care planning systems and documentation at the home mean people have their health needs identified and met in a safe way. Medicines are well managed at the home. Privacy and dignity are well managed at the home but future attention should be paid to the appropriateness of using a private bedroom for communal use. EVIDENCE: People at the home looked well cared for with the finer details of care being provided such as appropriate footwear and glasses in place, and access to call bells and mobility aids. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 13 People told us they see their GP when is necessary and see specialist nurses according to their need. Records showed that out patient appointments and foot care treatment is also accessed by the home. All staff we spoke with were knowledgeable about the current needs of the people they were caring for. Care plans also reflected this knowledge to show how care should be given in a safe and consistent way. All people who use the service had an A4 ring binder file, which contained the pre admission assessment, information from health care professionals and social services, set of care plans and risk assessments. Risk assessments were available for such things as mobility, and nutrition Staff told us that each care plan is reviewed monthly and there was a full re-write every year. Plans seen contained a number of assessments, and evidence of support being given by outside professional agencies. A community nurse who visited the home during the course of the first day of the inspection, said that the care in the home was very good, the staff worked well as a team and that their palliative care (care of the dying) was of a very high standard. Training records showed that staff had attended the Liverpool Care Pathway training where end of life care is shared between health care professionals to ensure the person has a high standard of care. The community nurse also said that the home contacted them if they had any concerns so that problems could be dealt with early rather than escalating. On the second day of inspection another community nurse told us that she had “no concerns about the home” and thought “the care provided was good”. She stated that the care staff were always keen to accompany her when she carried out a nursing assessment, so that they could learn. This demonstrates that staff are motivated and interested in their work and the people they care for. Staff told us accessing equipment was not a problem at the home. Staff said that occupational therapists visit the home to assess what equipment is needed and then equipment is obtained from the community equipment store. Plans contained evidence of moving and handling assessments for people with reduced mobility. Aids and equipment are provided to encourage maximum independence for people using services. Other risk assessments in care plans included general risks and risk-taking. An example of this was an assessment for a person who wished to manage his or her own medication. The outcome was that the person was able to keep their own medication with occasional support and supervision from staff. Senior care staff who have completed medication training manage and administer medicines at the home. There are good systems in place for the management, receipt, administration, safekeeping, and disposal of medicines. Storage facilities were seen to be acceptable, however creams were unlabelled and undated which could mean creams could be shared or used past the use Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 14 by date suggested. The local doctors have agreed homely remedy policies. Blister pack systems are used which staff say were easy to manager. Medication administration records were well completed. Evidence could be seen in the file of ongoing monitoring of nutrition for people with poor appetite. People are weighed every month and evidence was seen that any significant change is reported to general practitioners. People we spoke with said staff are very good at protecting their privacy when personal care is being provided. Staff were seen treating people with kindness and respect. Interactions between staff and people who use the service were generally good. People told us they receive any post at lunchtime and that it is bought to them unopened. We were told they see the doctor or community nurse in their own room. We were told people see the hairdresser regularly and that one person’s room is used for all people needing their hair cut that day. The Manager told us consent had been obtained from the person and their family. Discussion was held regarding the appropriateness of this from a privacy and infection point of view and the manager gave assurances that when this facility comes to an end an alternative would be sourced. Staff said people who use the service enjoy the social aspect of this communal arrangement. People living at the home told us staff coming and going into their bedrooms treated them with respect, always knocked on the door and paid attention to their privacy. One person said that being helped to into the bath was a new experience about which they felt embarrassed, however, they went on to say that the carers helped them in such a nice manner and covered them up with towels as soon as possible. People told us that one of the carers always accompanied them for hospital appointments, and how pleased they were to have a familiar face with them. The manager confirmed that suitable cover is arranged so that the home is not short staffed when a carer is on escort duty. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The improvements in activity programme are beginning to provide people with more meaningful stimulation. Further improvements would mean that people have access to more frequent stimulation and activities. The lack of consulting people at Jubilee house about new menus at the home is poor. EVIDENCE: Since the last inspection the home has been working on providing social histories/and lifestyle diaries for each person. These contain information about the lives people have led, and the activities that they choose to follow now in the home. A further development of this would be to make sure that the activities on offer are more person centred to the individual likes and dislikes as identified in this plan. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 16 During the inspection relatives were seen to visit the home and see their relative either in the privacy of the persons own room or within communal areas. One relative told us that she was always made to feel welcome at the home and could visit at any time. One person told us they sometimes went out with their relative and even stayed overnight on occasions. Other people we spoke to said they looked forward to having visitors and felt sorry for those who didn’t have many visitors and who couldn’t get out, as there wasn’t much to do. Several people said they would like “just to chat to others more”. Staff said that on occasions the manager would provide staff cover so staff could take a person out for specific task, such as shopping. The staff worked well together, they were cheerful, friendly and were witnessed having a very good rapport with everyone present. At the time conversations were most often about tasks; but there were no particular ‘social conversations’ going on, which would benefit the community spirit of the home. Care plans contained information on when people choose to go to bed or get up. Staff told us there are set routines within the home to ensure the smooth running of the home. Discussion showed that despite these routines being quite set, people are only part of these routines if that is their wish and if they are ready. One person was asked if they wanted to go to the toilet during the time when people are taken to the toilet. This person declined and staff respected this response. Staff said they ‘tend to know’ who will be ready to get up or get ready for bed, but still ask if they are ready. Staff were also knowledgeable about which people would prefer to stay up later in the evening depending on television preferences. Two people we spoke with said they got up when they wanted to, as they were self-caring. Other people told us they liked the routine and structure that the home provided. People who use the service told us they were able to chose how staff addressed them and what they wore each day. We were told that generally staff were polite and kind, but also worked very hard. Posters displayed various activities provided at the home. People said that when these happened they were very good. One person said sometimes she was bored at the home and would like more quizzes to keep her mind occupied, another said she would like to start knitting again. Staff told us there are bingo sessions fortnightly and singers once a month. Staff also said an activity coordinator visits the home twice a month and one of the care staff also has started doing some activities. Staff told us that after they had provided care to people, done the laundry and washed dishes, there was no extra time to give 1:1 time or arrange activities. Some people told us that they were happy with the amount of activities as they had many visitors, others preferred to read and watch TV rather than mix with others. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 17 There was no evidence within the home to show that religious services are available for those that choose. Staff said that they did not think there was anyone who would want to go to church, but they could organise this if they requested. The manager said that a communion service used to be offered at the home but the minister stopped because of lack of attendance. On the first day of inspection the home had no Chef so care staff were cooking. By the second day of inspection a new Chef had transferred to the home. The Chef said that he was currently introducing a new menu to the home. The Manger explained that the menu had been introduced by the organisation and was based on nutritional guidelines such as ‘five a day’. The Chef said some food was popular whilst other dishes were less so. Two people told us they had not been consulted about the new menu. On the whole people also told us that the food was very good and they looked forward to mealtimes. On the second day of inspection roast chicken or beef was served for lunch, it looked well presented and was enjoyed by those seen. Meals were an unhurried affair and were taken in a pleasant setting with those that need help getting this individually. Staff serve meals within the dining areas and are able to monitor reduction in appetite. People are asked about their choice of menu option on the morning regarding supper and in the evening regarding main meal at lunchtime. There is good kitchen hygiene with a record of the heat of the food served, a daily cleaning rota and a daily record of the fridge temperatures. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that concerns will be dealt with appropriately. Improvements in the quality of training and accessibility of local reporting information would improve the protection of vulnerable adults at the home. EVIDENCE: A complaints procedure is displayed in the entrance hall and also contained within the homes Statement of Purpose and Service User Guide. Up to date information on how to make a complaint was displayed on the back of each person’s bedroom; however, some people we spoke with had not realised what these notices were about and hadn’t read them. Other people said they knew how to make a complaint and felt able to do this if the situation arose. Staff also said they knew how to make a complaint or inform people of how they could complain. There was a record of in-house complaints and of how these have been resolved. Discussion was held with the manager regarding the approach to complaints at the home. The Manager told us she currently only logs formal or serious complaints within the complaints register. All other issues were recorded within each care plan or staff file. It was suggested for the manager Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 19 to record all minor concerns and complaints to enable her to monitor trends in complaints. The Manager gave assurances that she would do this. The Commission for Social Care Inspection have received information from an anonymous source since the last inspection. We have found no evidence at all during this inspection that would indicate any poor practices. People told us they felt safe living at the home. People said they were treated well by all staff at the home. Relatives told us they felt their relatives were cared for in an appropriate way. All staff spoken to say they had received training in the protection of vulnerable adults by an in house trainer. Training records confirmed this training had taken place in Autumn 2007. Although staff gave assurances that they would report abuse to a manager, not all staff knew whom to contact in the absence of the manager. Not all staff knew about the local safeguarding adults teams. All staff said if they were unsure they would contact Commission for Social Care Inspection. The manager also informed us that she had recently attended the Devon County Council abuse alerter training, which she found very useful. It was suggested that staff also attend this external training so they are aware of local multi agency agreed reporting procedures. Staff told us they had received CRB (Criminal record bureau-police check) and POVA (Protection of vulnerable adult) pre employment checks before they were able to work. Staff sign a criminal declaration on the employment application form. One staff file inspected did not contain a CRB check. Evidence was seen that this employee had completed the declaration on the application form. Evidence was also seen to show that repeat CRB applications had been made by the manager. This employee does not work directly with people who use the service. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 20 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): 19,20,21,22Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, clean, well-maintained home EVIDENCE: Jubilee house is a detached property, set in an accessible garden, with mature trees, close to Torquay town centre. All rooms are for single occupancy. Fifteen of the rooms have an en suite toilet. There are two bathrooms and an accessible wet room/shower. There are some small steps and a slope on the upper floor. There is a shaft lift on one side of the building and a stair lift the other end, to give access to all parts of the building. There is a lounge, a dining room and a bright sun lounge. All areas of the home were well maintained and well decorated. Some rooms were being redecorated as part of the refurbishment plan. All lighting is Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 21 domestic in style and furnishings are good quality. People were able to bring small items to the home to provide personal touches to their rooms. The majority of areas were free from offensive odours and were clean despite the domestic staff being absent that day. There are grab rails, ramps and lifts throughout the home to promote independence of people who use the service. Staff said obtaining equipment was efficient at the home. Following individual assessments, equipment is provided by the community equipment store. Call bells were answered promptly, where used. The home employ a part time maintenance man who is responsible for routine and ad hoc repairs at the home. The maintence man told us that he enjoys working at Jubilee House; that he and the rest of the staff work well together. Staff are good at letting him know what needs repairing and that if replacement parts are needed the head office acts promptly to agree an order. Evidence was seen of appropriate maintenance of the building, including for example things like routine checks of fire equipment, and electrical appliances. Hot water supplies have their temperatures restricted, and these are regularly monitored. The home has recently had an audit from an environmental management team from the company and some minor works have been identified. Other works identified have been as part of the homes refurbishment plan, which since the last inspection has included the provision of new flooring and furnishings in the conservatory and refurbishment of a number of rooms. Relatives said the home was always clean and tidy and that they had never noticed any offensive smells. People spoken to said their rooms are cleaned daily. Carpets were generally clean and there was little evidence of dust in any of the bedrooms seen, despite the absence of the cleaner on the second day of inspection. Staff use appropriate personal protective equipment when providing personal care and dealing with soiled pads, clothes and linen. Gloves, aprons and hand washing facilities were used throughout the home. Staff told us commodes are washed in individual ensuite bathrooms. This is done using gloves, aprons, wet wipes and disinfectant. Different tabards are used at meal times. Staff said they had all received infection control mandatory training by the in house training provider. Staff told us that foul laundry is sent to a company to be cleaned. People who use the service have their clothes washed in the home. One person said this service is ‘very good’ and another said ‘you give them your clothes at night and they are back with you the next day’. The laundry is located within the home but away from dining areas. Washing machines with sluice cycle facilities are available. Jubilee House DS0000061444.V364811.R01.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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory recruitment processes mean that that people are protected from being cared for by unsuitable staff. Improvements would make the process more robust. Improvements to the induction would show that staff have been provided with sufficient information to care for people in a safe way. Providing more staff would mean that routines could be less formal and would improve the quality of care given. EVIDENCE: Off duty records generally reflected who was on duty. On the second day of inspection, domestic staff were not present where the off duty said there were two on duty. The manager said one domestic had not been scheduled to work and one domestic had not turned up for work but changes to the off duty had not been made. The home has recently had some problems with retention of domestic and catering staff, which have led to care staff filling in. This means some have been working high number of hours, but has recently been improving. On the Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 23 day of the first site visit there were three senior carer staff on duty, and another senior carer doing the cooking. The manager was also on duty. The home have used occasional agency staff, including the night before the first inspection visit. Discussion was held on ensuring that staff do not become overworked, which might include the needs to employ more agency staff. On the second day of inspection there were nineteen people at the home There were three carers, a chef, and the manager on duty. The domestic had failed to turn up for duty. All staff were very professional polite and cooperative throughout the inspection. Feedback from people who use the service and their families was positive about the staff. Staff told us there are usually three carers on duty and when the manager works she is the fourth member of staff and sometimes helps out if they are busy. Staff said they had set routines to follow to enable them to provide personal care, do the laundry and assist in the kitchen. Staff said although they worked hard, there was not often time to be able to sit and talk with the people who use the service, or time to arrange activities. People who use the service said the staff were ‘kind and caring’’ and ‘you couldn’t ask for more’, ‘the manager keeps them in line’. People said they didn’t have to wait that long for someone to help them. After lunchtime for residents the three staff on duty were all eating their lunch (provided by the home) together, however it was noted that as soon as a call bell sounded they immediately went to answer (they were unaware of the inspector’s prescence). There are satisfactory recruitment procedures in place at the home. Each file showed that each staff member had a photograph, proof of identification, home office information where appropriate, evidence of CRB and POVA checks, health declarations and two references. However, the suitability of three references was questioned in files where other staff within the same organisation had provided staff with references. One reference was from an acquaintance rather than previous employer. There was no evidence to show that care staff had been issued with the General Social Care Council Code of Practice, although the manager told us staff had received these. All files contained some evidence of an induction, although staff told us this involved a more informal process rather than a robust national recognised process. Staff told us they were encouraged to do NVQ training by the Manager. One member of staff said the organisation was supporting her to do NVQ 4 training. Staff told us they had received CRB (Criminal record bureau-police check) and POVA (Protection of vulnerable adult) pre employment checks before they were able to work. Staff sign a criminal declaration on the employment application Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 24 form. One staff file inspected did not contain a CRB check. Evidence was seen that this employee had completed the declaration on the application form. Evidence was also seen to show that repeat the manager had made CRB applications. This employee does not work directly with people who use the service. Staff said there was an ‘in house’ trainer provided by the organisation. Staff said there were training sessions on specialist subjects such as dementia care. Staff also said they are supported to attend training provided by healthcare professionals. Examples of this were Liverpool care pathway (End of Life training) Jubilee House DS0000061444.V364811.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): 31,32,33,elements of 34,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in an organised and efficient way. Improvements to some practices would improve the safety of the home. Changes to communication would also improve the ethos of the home. EVIDENCE: The manager is experienced to manage the care home. She is registered with the Commission for Social Care Inspection. The Manager told us she is responsible for performing quality visits for the other homes in the organisation. The manager told us the responsible individual performs the quality assurance visits for Jubilee house. The manager told us this is an Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 26 opportunity to look at the ways other homes run and to review practices at Jubilee house too. We were told about the quality assurance systems within the home. A recent cycle of questionnaires had been sent out and returned. An analysis was due to identify where the home is working well and what needs to improve. The questionnaires in use were very simple. Discussion was held regarding ways to improve this, to gain more useful information about the service the home provides and how people perceive the quality. Staff told us there have been staff meetings but these are not frequent. Records showed the last meeting was held in September and November 2007 last year. Staff said the manager provides clear leadership. Some people told us that the manager had raised her voice on occasions, but never at people in the home. All staff said the manager was approachable and expects a high standard of care. One member of staff said that working in the home had improved in recent months. Staff told us they have received supervision at the home where care practice is discussed. The manager told us she has a budget for running the home and can have most requests met ‘within reason’. Insurance certificates were displayed within the hallway, although these were not closely inspected on this occasion. People told us that their family deals with their finances but they do have a small amount to pay for their hair. The manager told us each person has lockable facilities to keep valuables and cash. Transactions such as hairdressing and chiropody are either paid for by the resident or sent to the family/fee payer to settle. The manager stated that personal monies are not held by the home. Generally records are well managed at the home. Lockable storage facilities are used where appropriate. Staff have signed statements to say they will maintain the confidentiality of people at the home. The health, safety and welfare is generally promoted at the home. Staff told us they have received mandatory training in infection control, fire safety, health and safety and moving and handling. Training records showed that this training is performed as part of the rolling programme. A tour of the building showed that generally the home appeared free from risks. However, some bathrooms contained shampoos and cleaning products, which should be safely stored. Not all staff had completed shower and bath temperature records. The outside of the building appeared well maintained. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 27 The patio area of the garden leads onto a garden area. This change in terrain is not protected and could mean that a person with poor sight may be at risk of falls. The practice of reporting faults works well at the home. One person told us that faults are dealt with promptly. Evidence was seen of appropriate maintenance of the building, including for example things like routine checks of fire equipment, and electrical appliances. Hot water supplies have their temperatures restricted, and these are regularly monitored. The home has recently had an audit from an environmental management team from the company and some minor works have been identified. Jubilee House DS0000061444.V364811.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 2 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 3 3 3 x x x 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 2 3 3 3 3 2 Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action 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 2 3. 4 Refer to Standard OP1 OP9 OP10 OP12 Good Practice Recommendations The information provided in the Statement of Purpose and Service User Guide within the hallway should be accurate and changed to reflect management changes Creams used for topical use should be labelled and dated to ensure they are used within use by date. Communal activities such as hairdressing should not be occurring in people’s private rooms. The manager should regularly review the routines and work practices in the home to ensure they are in the best interest of people. Evidence should be kept to show that people who use the service continue to have choice and control over their lives The manager should show that people have access to religious services if they chose. The manager should consult people who use the service about activities they may chose The manager should consult people who use the service DS0000061444.V364811.R01.S.doc Version 5.2 Page 30 5 6 7 OP12 OP16 OP15 Jubilee House 8 9 OP16 OP18 10 11 12 13 14 15 16 17 18 OP26 OP29 OP29 OP30 OP32 OP32 OP38 OP38 OP38 about the menu that has been introduced The manager should ensure that a record of all complaints and concerns is kept to monitor trends People should be protected from abuse by: • Considering the Devon County Council alerter training • Provide contact details for staff to correctly report allegations of abuse locally The manager should consult the health protection agency about how to clean commodes appropriately The manager should ensure references come from a suitable source The manager should show that all staff receive a General Social Care Council Code of Practice The manager should ensure the induction programme prepares staff effectively and should ensure the programme meets nationally recognised standards The manager should hold regular staff meetings The manager should ensure her strong management style cannot be seen or misinterpreted by people who use the service. The manager should ensure all staff maintain safety records The manager should ensure all COSHH (Control of Substances hazardous to health) products are stored safely The manager should ensure a risk assessment is performed on the patio area in the garden where safety rails are not present. Jubilee House DS0000061444.V364811.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000061444.V364811.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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