CARE HOMES FOR OLDER PEOPLE
R Janmayur 15 Osmond Gardens Osmond Road Hove, East Sussex BN3 1TE
Lead Inspector Glynis McLeod Unannounced 4 April 2005 11:30 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 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. R Janmayur Version 1.10 Page 3 SERVICE INFORMATION
Name of service R Janmayur Address 15 Osmond Gardens Osmond Road Hove East Sussex BN3 1TE 01273 777424 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) Mr K Ramadas and Dr Ramadas Mr Kumarasamy Ramadas Care Home 7 Category(ies) of Old age, not falling within any other category registration, with number (OP) 7. of places R Janmayur Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The maximum number of service users to be accommodated must not exceed 7. 2. Service users will be aged 65 years or over on admission. Date of last inspection 8 November 2004 Brief Description of the Service: R Janmayur is a small family-run care home registered for up to seven older people. The detached property is situated in a residential area close to shops, transport routes and other local amenities. Paid parking is available in the street outside the home. A large lounge/dining room is available on the ground floor, and there is access either via steps or by the side of the building to the garden at the rear of the property. There is no lift to the first floor of the home where the majority of service users’ bedrooms are located, and therefore the home is more suitable for people who are mobile. The home provides care, incuding respite care, for a mixed group of service users, some who are quite vulnerable. The home does not provide nursing care. The joint proprietors are resident at the home and provide the bulk of the overall staffing. They employ a small group of part-time staff. R Janmayur Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over five hours and was one of the two inspections required over the year. A tour of the premises took place and records relating to care and the home’s maintenance were inspected. Two of the staff on duty, two of the residents, and the manager were spoken to. The inspector would like to thank the residents, staff and owners for their hospitality and co-operation during the inspection. What the service does well: What has improved since the last inspection? What they could do better:
Residents should be asked to contribute their own ideas and information to their plan of care whilst they are at the home. Also, the complaints policy in the information guide needs to be made clearer and more straightforward. To ensure that the home is safe for people living there, the required records, such as visitors to the home, need to be kept properly, and regular maintenance checks on appliances like gas boilers need to be carried out. All
R Janmayur Version 1.10 Page 6 rubbish from the building work in the home needs to cleared away as soon as possible. The home does provide some activities but residents spoken to said they would like to have more activities available and to go out more. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. R Janmayur Version 1.10 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 Standards Statutory Requirements Identified During the Inspection R Janmayur Version 1.10 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 standard(s) 1 and 3. Information in booklet form that gives a clear picture of the service offered has been produced. This information needs to be given to people preferably before they move in so that they can make a proper choice about where they wish to live. People are assessed before they move in to ensure that the home is able to offer the care needed. EVIDENCE: The service user guide contains most of the information detailed in Standard 1 but needs to include views of people living in the home and contact details for relevant health and social care agencies. One resident spoken to had been in the home for five days and had not yet received a guide. The manager visits people either at home or in hospital to tell them about the home and make an assessment to ensure that their care needs can be met. Information from the hospital and the social worker had been obtained prior to the admission of the most recent resident to the home. R Janmayur Version 1.10 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 standard(s) 7, 8, 9 and 10. Care plans contained basic information but could be made more relevant and provide a basis for better care if they were more thorough and residents were asked to contribute to them. Physical and medical care is generally good in the home. EVIDENCE: Individual care plans were available for four out of the five residents and had been reviewed monthly. Residents are not given copies of their care plans but there was evidence that they had seen the plan at the monthly review. Significant events are recorded in case notes but daily entries are not routinely made. The care plan for the most recent resident had not been completed and contained mainly information received from the hospital and social worker. The resident had not been asked to contribute to her plan although she was fully capable of doing so. Residents’ physical and medical needs are closely monitored and the home calls in specialist services when necessary. One resident said that his dentures did not fit properly and the manager agreed to arrange a dental appointment. Medication procedures and records were up-to-date and accurate. Residents confirmed that they could see friends and other visitors in their rooms and that staff were polite and considerate.
R Janmayur Version 1.10 Page 10 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 standard(s) 12, 13 and 14. People are asked about their preferences and interests and are able to make choices about daily living activities. Although the home is small and residents have varying degrees of need, more structured activities throughout the day would provide interest and be appreciated by residents. EVIDENCE: The home tries to offer flexibility and people spoken to said they were able to have their meals either in their own room or in the dining room and could go to bed, get up, or rest whenever they wished. They can also see their visitors in their own rooms or in the lounge. Residents’ interests are recorded and staff try to engage residents in discussion of current events. One resident visits the library regularly, but some residents said they would like to have more activities on offer in the home or to go out more. The manager said he would be arranging more outings now that the warmer weather was coming. Families and solicitors help residents with their finances and advocacy services, such as MIND, have been called in where necessary. R Janmayur Version 1.10 Page 11 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 standard(s) 16 and 18. A complaints policy is available but is rather complex and would be difficult for most of the home’s residents to understand. Adult protection training has either been undertaken or arranged for all staff and the home is now aware of local adult protection arrangements in the event of any concerns. EVIDENCE: The complaints policy is available in the service user guide and contains information about how complaints will be investigated. However, the document is quite complex and contains additional information that is not relevant to people in the home wanting to make a complaint. The manager agreed to clarify the policy and make it more suitable for residents. Following a requirement at the last inspection, the manager and another member of staff have attended adult protection training and the two other part-time staff are due to attend later in April 2005. The relevant policies and procedures are in place and the manager is aware of the new guidelines (POVA) regarding workers who may not be fit to work with vulnerable adults. R Janmayur Version 1.10 Page 12 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 standard(s) None of the above standards were assessed at this inspection. EVIDENCE: R Janmayur Version 1.10 Page 13 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of the above standards were assessed at this insepciton. EVIDENCE: R Janmayur Version 1.10 Page 14 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38. Health and safety issues are generally well attended to but there are a number of areas where things have been overlooked or ignored. EVIDENCE: Staff receive training on fire safety, medication, and moving and handling, and policies and risk assessments covering all aspects of safe working practices are available. Weekly environment checks are carried out and incidents and accidents are recorded. In order to ensure residents’ confidentiality, a special HSE accident book needs to be purchased. All visitors to the home must also be asked to sign in as part of the fire safety procedures. There was a lot of debris outside the front of the home and in the back garden, which needs to be removed as soon as possible to ensure the safety of residents, staff and visitors. A maintenance check to the gas boiler system was very overdue and the manager agreed to arrange a check as soon as possible. Work is due to start on updating the kitchen and a new fridge/freezer and dishwasher were due to arrive within days of the inspection.
R Janmayur Version 1.10 Page 15 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 x 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x x x 2 R Janmayur Version 1.10 Page 16 NO 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. 2. Standard 1 7 Regulation 5(2) 15 Requirement Service users must be given a copy of the service user guide. The service user must be consulted in the preparation of their care plan and a copy of the plan must be made available to them. A record of all visitors to the home must be kept. Maintenance checks to all gas appliances must be made. Rubbish from around the site must be cleared away. Timescale for action Immediate 31.5.05 3. 4. 5. 38 38 38 17(2)(3) 13(4) 13(4) Immediate 30.4.05 15.4.05 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. 2. 3. Refer to Standard 1 7 16 Good Practice Recommendations The service user guide should contain all the information detailed in standard 1. A daily record of all care given should be maintained in individual case notes. The complaints policy should be made clearer and more suitable for the people it is intended. R Janmayur Version 1.10 Page 17 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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