CARE HOMES FOR OLDER PEOPLE
The Hockeredge & Jasmine Centre 2-4 Canterbury Road Westgate-on-sea. Kent CT8 8JJ Lead Inspector
Sandra Crosby Announced 18/07/2005 at 9:30hrs 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. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Hockeredge & Jasmine Centre Address 2-4 Canterbury Road, Westgate-on-sea, Kent, CT8 8JJ 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) 01843 831585 Bedstone Limited Mrs Jane Crisp Care Home 50 Category(ies) of Older People (29) Dementia (21) registration, with number of places The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 23/09/05 Brief Description of the Service: The Hockeredge and Jasmine Centre, provides two distinct services. The two Jasmine units provide residential care for adults with dementia and the main Hockeredge house provides residential care for adults who may be over the age of 65 and have past or present mental health care needs. The home is situated on the main road in a residential area between the seaside towns of Westgate and Margate. Local facilities are within walking distance of the home. There is a secure well maintained garden area to the rear, and on road parking is available to the front of the premises. A private company owns the home, and the day-to-day running of the Home is the responsibility of the Registered Manager. Service User’s health care needs, are met by the local primary health care team and includes the services of the community psychiatric nurse. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection visit was announced and carried out over two days on Monday from 09.30 – 14.00 and on Tuesday from 09.30 – 13.30. During the inspection the Inspector spoke individually with eight Service Users, the Registered Manager, Deputy Manager, the Welfare Officer, Team Leaders, Care staff and the Cook and Laundry Person. Records were seen and an accompanied tour of the premises was made. The atmosphere of the home was welcoming, calm and relaxed, and the home was clean and orderly at the time of the inspection visit. The Inspector spent time talking with Service Users, who commented that they liked the staff of whom it was said that they were friendly and helpful. They said they enjoyed the food provided at the home. Unfortunately for this inspection visit no Service User Comment Cards or Relative Comments Cards were returned. The Registered Manager confirmed at the start of the inspection visit that the comment cards had been put to one side ready to be given out, and that this had not then happened. The Pre-inspection Questionnaire and the Assessment and Inspection Record completed by the home prior to inspection and information provided by Service Users and staff at the time of the inspection, has been used in this report. What the service does well:
The attitude of staff was positive, friendly and helpful and practices seen indicated a supportive and caring service was provided to meet the needs of Service Users. Service Users confirmed they liked the food at the home, and a varied and nutritious diet is provided with alternatives available. Food observed on the second day of the inspection visit supported this. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 6 The records of administration of medications were well recorded and up to date, and the storage of medication was appropriate for the current group of Service Users. The recruitment procedures are thorough which protects Service Users, and staff training is ongoing. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 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 The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 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) 1,3,6 The homes Statement of Purpose and Service User Guide provide Service Users and prospective Service Users with the information they need to make a decision about moving into the home. Service Users move into the home knowing that their needs can be met and that their independence will be maximised and promoted. Standard 6 was judged as not applicable at this inspection visit. EVIDENCE: The Statement of Purpose for the home was seen, and the Registered Manager agreed to make small amendments to the document, and also stated that she was in the process of updating the Service User Guide for the home. A completed pre-assessment documentation was seen for the most recently admitted Service User, and the Registered Manager was asked to ensure that all documentation is appropriately signed and dated.
The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 9 It is not the general policy of the home to admit Service Users on a short-term basis, and the Registered Manager confirmed that short-term care was only provided occasionally. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,11 The care planning system meets the requirements of the minimum standards and regulations and the assessed needs of the Service Users. The health needs of Service Users are well met with evidence of good multidisciplinary working taking place on a regular basis, however good practice in relation to pressure area care records needs to be improved. The systems for medication administration are good with clear and comprehensive arrangements being in place to ensure Service Users medication needs are met. Personal care is offered in a way to protect Service Users privacy and dignity. Staff are supportive and sensitive to the needs of Service Users at the time of their death, and they and their family are treated with all due respect. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 11 EVIDENCE: Three Service User plans were seen, and the records included a care plan, daily records, reviews, risk assessments and various other forms for example bathing records, GP visit record. Discussion took place in relation to the reviews, as it was seen that it had been recorded that ‘no change’ had taken place when in fact the other records indicated that changes had taken place. In relation to the information on skin integrity records, these have improved since the last inspection visit, but following discussion it was agreed that further improvement could be made in order that the records showed clearly what areas were being treated and what the current position is. Medication records were seen and indicated that they were appropriately signed and up to date. Discussion confirmed that the Deputy Manager had taken appropriate action in relation to a day when medications administered had not been signed for appropriately. The storage of medication was seen and this appeared appropriate for the current group of Service Users. The home has agreed to purchase a suitable lockable medication fridge, although currently it was stated that there are no medications in use that are required to be stored in a fridge. Service Users confirmed that they are treated with respect and their dignity is upheld. The Inspector evidenced a good rapport between staff and Service Users. From previous discussion it has been evidenced that the staff are supportive and sensitive to the needs of a Service User who is dying. Every effort is made to ensure the Service Users comfort, and close contact is maintained with family and professional services. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 12 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) 12,13,14,15 Service Users spoken with confirmed they were happy with the lifestyle they had living at the home, were able to maintain contact with family and friends, and are able to exercise choice and control as far as is possible over their lives. The meals in the home are good offering both choice and variety and catering for special diets. EVIDENCE: All Service Users that the Inspector spoke with spoke well of the staff and the home, and about their different lifestyles within the home. Flexibility in routines was seen to suit individual needs. Activities are undertaken that suit the needs of the Service Users and the home employs two persons as Occupational Therapists, and these were seen at work at the time of the inspection visit. Visitors are always welcome to the home, and Service Users are encouraged to go out in the community and use the resources available to them. Service Users told the Inspector that they are taken out for example to the local supermarkets, garden centre, to the seafront and out on trips. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 13 All Service Users spoken with commented that they enjoyed the food at the home. The meals seen provided on the second day of the inspection visit, were well presented and looked appetising. A tea party tea had been prepared for the second day of the inspection visit, including three types of sandwiches, sausage rolls, pork pies, trifle, biscuits, with beer wine and squash to drink. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 14 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) 16,18 Service Users know their complaints will be listened to and acted on. Arrangements for protecting Service Users are satisfactory, and staff indicated that they have knowledge and understanding of Adult Protection issues. EVIDENCE: The home has a policy and procedures in place for the handling of complaints. The complaints book was seen, and showed that three complaints had been recorded together with the action taken to address the issues raised since the last inspection visit. It was evidenced from talking with staff that they were aware of the policies and procedures in place in relation to Adult Protection, and were able to talk through what action they would take should an issue of concern be raised. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 15 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) 19,20,21,22,23,24,25,26 The standard of the environment within the home is good providing Service Users with a pleasant and homely place to live. Service Users bedrooms suit their needs and lifestyles. The home was clean, pleasant and mainly hygienic at this inspection visit. EVIDENCE: It was seen during the accompanied tour of the home that Service Users live in a safe, well-maintained environment including access to indoor and outdoor communal facilities. The Inspector enjoyed for a short while one of the enclosed safe garden areas whilst sitting and talking with two Service Users. Service Users have access to sufficient toilets and washing facilities, and it was seen that facilities provided included assisted baths, and raised toilet seats.
The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 16 Many of the bedrooms seen are individual and personalised, containing a wide range of personal possessions. Most of the bedrooms and corridors on one unit have been recently re-painted. The home was clean, mainly hygienic and warm at the time of the inspection visit. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 17 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) 27,29,30 Staff morale is good resulting in a workforce that works positively with Service Users to improve their whole quality of life. Staff are multi-skilled ensuring good quality care and support. Service Users are protected by the homes thorough recruitment procedures. The arrangements for induction of staff are good with the staff demonstrating a clear understanding of their roles. EVIDENCE: The staff rota for the home was seen, and showed that sufficient staff were on duty at all times to meet the needs of the current group of Service Users. Discussion took place in relation to the need for the home to maintain staffing levels and cover staff for sickness and annual leave, because occasionaly at these times it is known that the home may not be sufficiently staffed. The Registered Manager said that she was currently taking action to address this issue, and on the second day of the inspection visit she said that two staff had approached her requesting extra hours, and that these had been granted. Three staff files were seen, and these contained all documentation that would support that a thorough recruitment system was in place, including application form, references, CRB checks, copy proof of identity etc. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 18 Completed induction folders were seen for three staff members, and the Registered Manager reported that the induction programme in use complied with the requirements of TOPPS. The Registered Manager stated in the Pre-inspection Questionnaire that currently approximately 50 of the care staff has achieved NVQ Level 2, and staff spoken with confirmed that they had either completed the NVQ Level 2, were undertaking NVQ or were waiting to start the course. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 19 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) 31,32,33,35,37,38 The Registered Manager is supported well by the senior staff in providing clear leadership throughout the home with all staff demonstrating an awareness of their roles and responsibilities. Staff are appropriately supervised and the Service Users benefit from a well run home. Service Users financial interests are safeguarded, and the systems for Service User consultation are good with a variety of evidence that indicates that Service Users views are sought. The health, safety and welfare of Service Users and staff are promoted and protected. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 20 EVIDENCE: Discussions with Service Users and staff indicated that management provides a positive open and inclusive atmosphere. The Welfare Officer told the Inspector about changes that had been made to the amount of money held in the home on behalf of Service Users. The Inspector provided information in relation to an appropriate form of bank account that would meet the National Minimum Standards and Regulations. The Welfare Officer looked into this, and was going to visit the Bank to discuss the necessary arrangements to be made. There is a system in place at the home for the regular supervision of all staff with written records kept. The Fire Log Book was seen, and all regular weekly and monthly monitoring checks are recorded together with regular fire drills being undertaken. The accident book records were also viewed. Members of staff told the Inspector about undertaking in-house training in relation to Health & Safety, Moving & Handling, First Aid and Dementia. Maintenance certification information was taken from the Pre Inspection Questionnaire and would indicate that the home currently has all relevant certification. The fire extinguishers at the home were being checked on the second day of the inspection visit. The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 21 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 3 x 3 x 3 3 The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 22 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 7 8 Regulation 15 17(1)(a) Schedule 3 (n) Requirement Reviews to appropriately record changes as necessary Maintain accurate and up to date record of incidence of pressure sores and of treatment provided to the Service Users Timescale for action 19/07/05 19/07/05 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 35 Good Practice Recommendations Change to an appropriate banking account that meets the Standards and Regulations in relation to the banking of Service Users monies The Hockeredge & Jasmine Centre H56-H05 S23573 The Hockeredge Jasmine Centre 180705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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