CARE HOMES FOR OLDER PEOPLE
Jubilee House Jubilee House Bronshill Road Torquay Devon TQ1 3HA Lead Inspector
Stella Lindsay Unannounced Inspection 25th October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 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.V259505.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Jubilee House Address Jubilee House Bronshill Road Torquay Devon TQ1 3HA 01803 311002 01803 311525 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) 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.V259505.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th April 2005 Brief Description of the Service: Jubilee House provides care for up to 28 people over the age of 65. It 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, but the shaft lift is one side of the building, and the 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. Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Tuesday in October 2005, between 10am and 5pm. It included a partial tour of the premises, examination of care records, and discussion with eight residents, five staff and a visiting relative, as well as the Registered Manager. The Commission for Social Care Inspection has introduced key standards to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. What the service does well: What has improved since the last inspection? What they could do better:
The Home has a policy on dealing with abuse, but it needs to be clear about what to do in the event of an allegation of abuse being made, in line with local reporting arrangements. Some staff had received training in recognising abuse, but not all. This needs to be provided, in order to protect residents from potential harm.
Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 6 At lunch, a hot trolley should be provided, so that residents can continue to have their choice, but the food could remain hot by the time all residents are served. It could be helpful to have the menu of the day on display, to remind residents of what is to be served. An extra toilet on the ground floor must be provided, close to the lounges. This addition is of prime importance, as there are queues for the only close toilet, particularly before and after meals. There are two bathrooms, but one of them was not fit for use, as the bath seat had been removed, commode pots were being washed in the bath, and the bathroom was in need of redecoration, including a secure cupboard being provided for the cleaning materials that were being stored there. There is also a quality accessible shower room, but soiled linen was being stored there. A hand basin should be installed in the upstairs communal toilet. There are two slight ramps in the upstairs corridor, which should be highlighted, to avoid risk of tripping. Management should reduce the home’s dependency on agency and bank workers, in order to provide more consistent care for the residents. Reports must be sent to the Commission for Social Care Inspection any time there is any serious injury to a resident, or any event which adversely affects the well-being of any resident, and also reports sent following the registered providers monthly visits to the home, to keep the inspector informed of progress as well as issues arising. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 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 DS0000061444.V259505.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Information for prospective residents and pre-admission assessment were not inspected. EVIDENCE: Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8,10 The health needs of residents are well met, with evidence of good collaboration with health professionals. EVIDENCE: The residents’ appearance had been cared for. All residents said that the staff are kind and helpful. A Senior Carer checks all care plans each month. Risk assessments have been carried out with respect to risk of falling, and checked monthly. A pressure mat is in place beside the bed of a resident who is liable to fall, to alert night staff when they get out of bed. Moving and handling assessments had been up-dated monthly. An Occupational Therapist was expected the following day, to advise on the care of a resident who was prone to falling. Nutritional needs assessments are carried out, and residents’ weight is checked monthly, if they agree. The Manager consulted with social worker and family, and carried out a risk assessment before fitting a gate to a bedroom door, whose occupant is currently liable to wander because of anxiety. If this becomes a long-term situation, a door alarm would be a better safety measure, as it alerts staff
Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 10 rather than restraining the individual. The psychiatric services have been involved when residents have suffered mental distress. Equipment is in place to protect vulnerable people from developing pressure sores. The Continence Nurse has recently assessed four more residents, to ensure that they receive the care that is appropriate. Staff accompany residents to medical appointments, including dentists, if family are unable. An exercise group is held fortnightly. The pay phone is in a public area, but if residents need to make a private call, the handset of the office phone can be taken to their room. Residents confirmed that calls from relatives are brought to their room. The hairdresser visits residents in their own rooms. Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15 This is a busy home with lots of visitors, and some individual and group activities provided. The meals are good, with some choice available. EVIDENCE: Some residents told the inspector that staff had taken them to town or to a shop, in a wheelchair. A musical entertainment took place on the afternoon of the inspection, as well as a Church Fellowship service. Brixham Activity Services visit fortnightly to lead exercises and other activities. Residents can all receive guests in their private room, and there is no restriction. A visiting relative said that they are contacted promptly if there are any concerns. The cook speaks to every resident each morning, to take their tea order, and tells them what is on the menu for lunch. It would help them remember if the menu were displayed. Residents who spoke to the inspector said that they enjoy their meals. Of the questionnaires gathered by the home, six respondents said the catering was good, five said satisfactory, and none said unsatisfactory. There is a variety of cereals, toast and fruit at breakfast time, but not a cooked breakfast, as the main meal is served at 12.30pm. On the day of the inspection lunch was roast pork, roast and boiled potatoes, carrots
Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 12 and apple sauce. Gravy was brought round. Vegetables are served from a trolley. Residents said that the first to be served are hot, but by the time the later tables are served the vegetables are not hot. Meals suitable for people with diabetes are served, and an alternative sweet is always available. There is always a choice at teatime, of hot snacks such as scrambled eggs on toast, or prawns and salad. Tea is served at 5pm. Some residents felt this is a bit early – this could be a subject for consultation. Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 13 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 Further training and clarification of procedures is necessary in order to fully protect residents from the risk of harm. EVIDENCE: The Complaints policy was posted on residents’ bedroom doors as well as on the office window. The Home has a policy on dealing with abuse, but it needs to be clear about what to do in the event of an allegation of abuse being made, in line with local reporting arrangements. Some staff had received training in recognising abuse, but not all. Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 14 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,21,22,25,26 The new and refurbished parts of the house are well designed, attractive and comfortable to live in. There are shortfalls in the provision of toilets and bathing facilities. EVIDENCE: The lounge is warm and comfortable, with good upright easy chairs. It is well lit, with tall windows looking on to the garden, a central set of five lights, and an archway through to the Sun Lounge which is a great benefit to the Home, being a light and airy space. One can walk from the Sun Lounge through to the dining room, which has sturdy and comfortable dining chairs with arms. The ground floor and the garden have level surfaces and are easy to get around. The first floor is not entirely flat. There are two slight ramps in the upstairs corridor, which should be marked or highlighted, to avoid the risk of trips. The premises and facilities still need an assessment by a qualified Occupational Therapist in order to ensure that residents have the specialist
Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 15 equipment and environment to meet their needs. The shaft lift accesses one end of the top floor, close to the new bedrooms, and the stair lift takes you to the older part of the building. Fifteen bedrooms, including all those on the new wing, have an en suite toilet. There are two bathrooms and a quality accessible shower room. The upstairs bathroom is in need of redecoration, and the cleaning materials stored there need a secure cupboard. A bath seat had been obtained in order to make the upstairs bathroom usable, but this had been lifted out, and the bath is being used for washing commode pots. The plans for installing a machine for cleaning the commode pots has been abandoned. The plans for refurbishing the remaining 13 bedrooms and fitting en suite facilities, which would greatly reduce the need for commodes, has no date for commencement. There is only one toilet close to the dining room. After lunch three residents were upset, and disagreeing on who was first in the queue. The Manager said that ADL consider this to be a priority, and have received a quotation for the work of installing a new toilet. The toilet on the new wing upstairs has not got a hand basin. Soiled linen was bagged up and stored in the shower room. This is not good practice. The Manager said that this was not normal practice, but an agency worker had not known that the collection day had changed. The house was clean and bright, and sweet-smelling throughout. Most floor coverings were well maintained. There was a slight split in the kitchen floor which should be sealed, as it could become unhygienic. A contract was in place for the safe disposal of clinical waste. Water in hot taps in baths was running at 43 degrees. Radiators had been attractively covered, to protect residents from risk of harm. Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 There are not sufficient staff to meet the needs of residents at all times of day, because some staff are not sufficiently familiar with the routines. EVIDENCE: The Manager and staff have developed a routine which meets the needs of residents getting up and dressed in the mornings. This must be kept under review, as the dependency levels are gradually increasing. On the day of the inspection there was one established Care Assistant, one ADL bank Carer, one agency worker, and the Manager, who likes to work alongside her care staff until 10am, to ensure that good care is delivered. She needs to be available for management duties at other times of day. After lunch the bank worker had to leave at 1.30pm instead of 2pm to go to another commitment. The agency worker spent longer clearing the kitchen than a regular worker would have done. This left one Care Assistant alone to help all the residents who wished to return to their rooms, go to the toilet, or move to the lounges, which meant that people who needed help to go to the toilet or return to their room or the lounge did not have the help they needed. Two domestic staff and a cook were also on duty. There was no maintenance worker. At the time of the inspection, four night shifts per week and 90 hours of day care needed to be covered. Recruitment efforts were continuing. Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33 The Registered Manager is well qualified, experienced and competent to run this home. Quality assurance systems are in place but could be developed further. EVIDENCE: The Manager is qualified in the management of care, health and safety, and hopes to complete her NVQ4 in Care and the Registered Managers’ Award by Easter 2006. Some care staff expressed respect for the Manager particularly because she works alongside them in all they do. A copy of the September visit by a representative of ADL was supplied to the inspector at this inspection. Copies must be sent to the Commission for Social Care Inspection regularly, in order to comply with regulation 26, and to keep the inspector informed of progress as well as issues arising. Feedback is gathered by individual discussion with residents and relatives, by discussion in monthly reviews, and by questionnaires. The Manager had
Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 18 produced a graph showing the views expressed in the questionnaires, and published this in the Service Users’ Guide. She expects to further develop the quality assurance system following her forthcoming NVQ training. The Manager must inform the Commission for Social Care Inspection of any event in the care home which affects the well being of residents. Two residents had been taken to hospital following falls. Records of all falls and other accidents are kept in the home. Each month the Manager draws up a summary of accidents, so that any pattern or problem can be seen. This is good practice. Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 19 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 X 3 2 2 X X 3 2 STAFFING Standard No Score 27 2 28 X 29 x 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X X X X Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP18 OP21 Regulation 13(6) 23 Requirement The Adult Protection procedure must be clarified, and training provided for all staff. Sufficient toilets must be provided for residents, close to lounge and dining areas. Previous timescale - 30/11/04. Both the bathrooms must be fit for use by residents, and a hand basin must be fitted in the upstairs communal toilet. Management must reduce their dependency on bank and agency workers. The Registered Provider must supply to the Commission for Social Care Inspection a copy of the report of the monthly visit of their representative. Any event in the care home which adversely affects the wellbeing of any resident must be reported to the Commission for Social Care Inspection. Timescale for action 31/12/05 31/12/05 3 OP21 23 31/12/05 4 5 OP27 OP33 18(1)a,b 26(5)(a) 31/12/05 31/12/05 6 OP38 37 31/12/05 Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 21 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 Refer to Standard OP15 OP21 Good Practice Recommendations A hot trolley should be provided, or some other means of delivering hot vegetables to all residents, and the menu of the day should be displayed. The Registered Provider should arrange for an assessment of the premises and facilities to be made by a suitably qualified person in respect of disability equipment and environmental adaptations. The slight ramps on the upstairs corridor should be highlighted. 3 OP22 Jubilee House DS0000061444.V259505.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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