CARE HOME ADULTS 18-65
Jubilee House Therapy Centre Eamont Park Eamont Bridge Penrith Cumbria CA10 2BN Lead Inspector
Lorraine Frost Unannounced 03 August 2005 09:45 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Jubilee House Therapy Centre Address Eamont Park Eamont Bridge Penrith Cumbria CA10 2BN 01768 890009 01768 891212 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Care Home Mrs Jacqueline Southern-Leigh Care Home 4 Category(ies) of PD - Physical Disability registration, with number OP - Old Age of places Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 28 February 2005 Brief Description of the Service: Jubilee House is a 41-bed purpose built rehabilitation and therapy centre that is situated next to the river Eamont near to Penrith. This facility is accessible to members and their families of the fire service. Four of the beds are registered with the Commission for Social Care Inspection to accommodate service users who require nursing input during their planned programme of therapy. The remainder of the beds are used by those who are self caring. Potential service users are referred to the Fire Service Benevolent fund via the general practitioner. The registered beds are located on the ground floor in large rooms that enable service users with a wide range of needs to be accommodated and who may require additional equipment in their rooms. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced commencing at 09.45 and finishing at 13.00hrs. The inspection included a full tour of the building, talking with the clients receiving nursing care as well as some who were not. Staff were observed and were spoken to. Relevant documentation was read. The Registered Manager was on leave, but the Clinical team leader assisted throughout. What the service does well:
The aim of the stay at the Centre is to either improve or maintain skills and independence and to promote a healthy lifestyle that they can maintain once discharged. This is done through a well-planned intensive therapy programme that is discussed with all teams involved in the persons care as well as with the client himself. The documentation was good and contained the details required to ensure that limitations had been discussed and agreed. One client said that he felt fully involved in the whole process, felt welcome by others using the Centre as well as the staff and that he would like to return to the Centre in the future. Another client said that he was already feeling many benefits of attending the Centre and said that it was very good because he was encouraged to work to his own limitations and not that of others. This gave him confidence to try, but also took away the pressure of competition. Others spoken to echoed this. Staff are well trained, competent and professional. They were spoken of highly by the clients interviewed and it was clear that the staff respect each other’s role and areas of expertise. The environment meets the needs of the clients in that it is bright, open and spacious. Clients said that they did not feel compelled to socialise in large groups and said that they could sit on their own or in small groups if they wished to. The bedrooms are very large and provide good accommodation for those with a whole range of needs. The bedrooms are comfortable with tea and coffee making facilities nice views of the well-kept grounds and have an en suite facility. Call bells and personal alarms are provided and the four clients requiring nursing input have access to a clinical assistant and a registered nurse during the day and a registered nurse at night. The meals are very good and the menu is changed weekly. Snacks are available at anytime. Meals are taken in the dining room, which is spacious, providing clients with a choice as to whom they sit with to eat their meals. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 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. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, and 5 The pre admission process is very thorough ensuring that clients are fully informed of the aims and objectives of the Centre and that they are only admitted if it is thought that they would benefit from an intensive therapy programme tailored to their individual needs. However, the Centre was not acting in accordance with the Regulations in that one client had been admitted who should not have been which placed him at risk. EVIDENCE: The clients spoken to explained the admission process from and this included the initial referral, the self-assessment forms, and the subsequent telephone calls from the Centre to clarify information. The files confirmed the process described by the clients and by the staff. The information was very detailed ensuring that the client would benefit from time at the Centre and enabled staff to consider a suitable type of programme and any assistance required to meet the persons’ goals. A contract issued on admission clearly explains amongst other things, who is financially responsible for what and the circumstances under which termination of the programme would be instigated. The Centre staff had admitted a client who did not fall within the categories of registration for Jubilee House. The Centre appeared to be meeting his needs and the client confirmed this, however some safeguards as would be expected by the Commission for Social Care Inspection were not in place to protect him. A requirement has been made to address this shortfall.
Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 9 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 and 10 The care planning and therapy planning process is very good clearly identifying the needs, goals, and capabilities of the clients ensuring that the client has support and assistance when required, but is fully supported to be as independent as possible. No information is shared with other parties without the knowledge and consent of the client. This gives the clients the confidence to attend the Centre knowing that only they have the authority to divulge information held on them to any other person. EVIDENCE: Clients are actively involved in the planning process of their care, therapy, and rehabilitation. They have care plans that identify their goals and aspirations and a therapy programme to help them attain the goals. Unrealistic goals are discussed and more realistic targets set with strategies in place to minimise risk. The clients spoken to were fully aware of the processes and the consultations. They spoke of their individual programmes and they were seen being assisted during exercise sessions in the way shown on their exercise sheets. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 10 The clinical team escorted and assisted clients to therapy sessions. They monitored the clients ensuring that if they became tired then they could choose not to participate in a session enabling them to rest. There are very strict rules in place regarding client confidentiality this so that the clients can be confident that the information held on them will not be divulged to unauthorised individuals. On discharge a discharge summary is given to them and this remains their property. No other discharge letters or summaries are sent to any other person. All records were held securely. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 11 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 17 Clients are supported and offered many opportunities to take part in varied activities and therapies based on individual choice, capability and interest. This leads to each person having an interesting and individualised time at the Centre. Social activities and meals were varied providing a good range of choices and opportunities on a daily basis. EVIDENCE: There is a set routine for the clients during therapy hours, but once the therapy day is finished the clients are able to choose how to spend their leisure time. This can include taking part in group social evenings or relaxing in their rooms. There are large open areas in and around the home too so that clients can choose whether to socialise or not. The social evenings are displayed on the notice boards and for the week of the inspection it included a fundraising night and going out for a Chinese meal. The clients requiring nursing care said that they felt included by everyone and did not feel different or uncomfortable whilst at the Centre. They said that they
Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 12 were encouraged to join in with others and were helped and assisted as agreed in their care plans and therapy programmes. The meals are changed weekly and the weekly menu is clearly displayed. The clients said that the meals were very good. The mealtimes cannot be flexible as the routines of the Centre are set around the very structured therapy programmes however, tea and coffee making facilities are provided in the bedrooms and snacks are available at anytime. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, and 20 A skilled staff team who are sensitive and knowledgeable of the needs of each individual expertly manages clients’ healthcare. Clients are supported and are involved in understanding how having a healthy life style is important to their health and rehabilitation. EVIDENCE: Healthcare needs are identified before admission and plans are developed with the client on admission. The assessments include physical, psychological and health care needs. The appropriately trained person carries out these assessments and develops care plans and therapy programmes from the information obtained. Clients said that their programmes were set to help them as individuals and that they were encouraged to be independent, and to exercise at their own pace. They are also encouraged to remain independent with regards to administration of medication in accordance with their usual routines prior to admission. Sessions such as pain management, anger management and sleep therapy are now included in the main part of the daily programme whereas before they were optional extras. This enables staff to concentrate with clients on mental health and general health issues that may affect their progress in other parts of their programmes.
Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 14 The good communication between the clinical and therapy staff ensures that programmes are suitable and that any issues arising can be discussed and addressed at an early stage. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) none This was not assessed at this inspection. EVIDENCE: Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25, 26, 28, 29 and 30 Jubilee House provides good quality accommodation that is bright, light, spacious, safe and clean. The bedrooms are particularly impressive being large, with aids, and equipment provided enabling clients to be as independent as possible. EVIDENCE: A tour of the Centre showed that the place was very clean and that it was being well maintained. The bedrooms for clients requiring nursing care are very large, have en suite facilities and ample space is available for equipment. The rooms are furnished to a high standard with vertical blinds, low mirrors, adjustable beds, and a call bell system as well as a personal alarm. Aids and equipment provided throughout the Centre maximises independence and helps to prevent injury to staff and clients. One client said that he could move around the Centre with relative ease and that the tables in the dining room were at a suitable height for him. There are many spacious and open communal areas that have plenty of natural light. The bedroom corridors are not so well lit, but no complaints were voiced about this.
Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 17 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 35 Clients receive good quality care and therapy from staff at the Centre who are qualified and competent in their area of expertise and who enjoy working within this environment. EVIDENCE: Through talking with clients, and staff and through observation of interactions it was clear that there was a very good rapport and that staff were skilled and knowledgeable. Clients said that they felt confident with them. Staff readily explained their roles and the aims of the Centre and said that the Centre was good at providing training opportunities. They spoke of how the teams worked separately, but at the same time involved each other to ensure the needs of the clients were being met and that the aims of the client were being respected. Clinical staff are involved in the physical rehabilitation of clients too in that they help and support them and are included in the meetings to plan and discuss the programme of the individual. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 18 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 42 There is clear leadership, guidance and direction to staff ensuring that clients receive consistent good quality care and are treated as individuals. Ongoing monitoring and evaluation of the service through good Quality Assurance systems ensure that the service continues to improve and remains focussed on the clients needs. EVIDENCE: The management and staff promote an inclusive atmosphere that is aimed at ensuring that clients receive as much as they can out of their short stay. Staff meetings are held regularly and discussions include how to improve and ways to take new ideas forward. The Centre staff seem to enjoy challenges and look to develop the service further to benefit all clients eligible to utilise the service. For example there have been trial family focussed therapy weeks and this was researched thoroughly, training for staff was arranged and feedback from those who took part in the trial was sought. Staff were encouraged to voice their views too.
Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 19 Documentation was good before, but the staff felt that it could be better and they had worked together on new formats and developed the one seen in use at this inspection. Therapy sessions have been altered because they felt that although it was being well utilised it could be made more accessible and new sessions could be introduced. The Centre is well maintained and during the tour of the building no obvious hazards were noticed. Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 4 3 x 3 Standard No 22 23
ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score x 3 3 3 4
Score Standard No 24 25 26 27 28 29 30
STAFFING Score x 3 3 x 3 3 x Standard No 11 12 13 14 15 16 17 x x x x x 4 4 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Jubilee House Therapy Centre Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 4 4 x x x 3 x F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 21 NA 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. 1. Standard YA1 Regulation 12 Requirement Service users must not be admitted who do not fall within the categories of Registration unless a variation has been sought and approved by CSCI Timescale for action 04.08.05 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 Good Practice Recommendations Jubilee House Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith, Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 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 Therapy Centre F58 F10 s10096 jubilee house v235904 030805 ui stage 4.doc Version 1.40 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
