Inspection on 16/05/05 for The Jacob Centre

This inspection was carried out on 16th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Jacob Centre 09/06/08

The Jacob Centre 21/06/06

The Jacob Centre 09/11/05

The Jacob Centre 26/01/05

The Jacob Centre 08/09/04

Similar services:

Claremont House

Sun Court Nursing Home

Bramley Avenue (73)

15 Bramble Close

Dolphin Court

Fen Road

Wakes Hall

165 Putnoe Lane

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 The Jacob Centre High Wych Road Sawbridgeworth Hertfordshire CM21 OHH Lead Inspector Claire Farrier Unannounced 16 & 24 May 2005 10:00 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. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Jacob Centre Address High Wych Road Sawbridgeworth Hertfordshire CM21 OHH 01279 600201 01279 721297 rita.mccarthy@capio.co.uk Capio Healthcare UK Ltd 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) Rita McCarthy Care Home with Nursing 60 Category(ies) of PD Physical Disability 60 registration, with number PD(E) Physical Disability 60 of places TI Terminally ill 60 TI(E) Terminally ill 60 The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 26 January 2005 Brief Description of the Service: The Jacob Centre is a care home with nursing, providing accommodation and care for sixty adults with a physical disability or terminal illness. Specialist services are provided for people who have survived a traumatic brain injury or spinal injury, including tracheotomy care and respiratory ventilator support, and for people with complex neurological conditions. It is owned by Capio Healthcare UK, which is a private company. The home was opened in April 2004 and consists of a two-storey pupose built building. It is situated in a complex of Capio services that includes a private hospital, The Rivers, and another home, The Gardens. The home is located in a rural setting on the outskirts of Sawbridgeworth, not far from the outskirts of Harlow. There is a shop for the service users in the home, and a pub that also serves food across the road from the Capio complex. Other community amenities, including shops, banks, cafes and leisure facilities, can only be accessed by use of the homes transport. All the bedrooms are single with en-suite facilities. There is a passenger lift. The home has a patio garden accessed from the first floor dining room. The home is fully accessible for service users. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of the inspection year and took place over one day, with a further visit in order to discuss some of the observations with the manager. Two inspectors visited the home, and the majority of time was spent observing and talking to residents and staff. Some time was also spent in the offices looking at records and care plans. The inspectors spoke to eight residents and eight members of staff during the inspection, and several relatives and visitors gave their comments during the inspection and contacted the inspector following the inspection. This was generally a positive inspection, and the majority of the standards were met or partially met. The home is continuing to make improvements. No new requirements were made, but requirements were repeated from the previous inspection report on care plans, the involvement of residents, medication and food hygiene. Enforcement action may be considered if the requirements on medication and food hygiene are not met within the new timescales provided. What the service does well: The Jacob Centre is a care home with nursing care, and provides a specialised service for people who have survived a traumatic brain injury or spinal injury, including tracheotomy care and respiratory ventilator support, and for people with neurological conditions. The clinical managers on each floor are experienced in neuro care, and Northwick Park Neuro Rehab Unit provide a specialist outreach service to the home. The home has its own physiotherapy gym and a team of physiotherapists. The home is well equipped with a variety of hoists and environmental controls, and many residents have their own individually designed seating systems. Most of the residents and visitors spoken to said that the staff provide good personal and nursing care. One visitor said that her friend is very well cared for, and the staff take good notice of every detail. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: The home has moved on considerably from the impression it gave during the first inspection of being a clinical environment focussed on nursing needs and not on the holistic needs of the residents. The design of the building and the complex and intensive service that is provided mean that it continues to be a challenge to create an atmosphere that is totally centred on the residents. Some improvements have been made, as detailed above, but there is room for more positive changes. The involvement of the residents in writing and reviewing their own care plans is central to this, and the manager plans to introduce a new format that will place the resident at the centre of the care planning process. The National Minimum Standards recommend that homes for younger adults should be arranged so that small groups of no more than ten people share a staff group, dining area and other communal facilities. The Jacob Centre is arranged on two floors, with groups of 25 and 35 residents. This enables the staff to be organised to meet the variety and complexity of the residents’ medical needs, but it inhibits the creation of smaller, more homely groups to meet their social needs. Several discrepancies were found in the recording of medication on the ground floor, and a system of regular and thorough audit of the home’s medication must be put in place. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 7 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 Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 8 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 The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 9 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) 2 A comprehensive assessment is carried out of the needs of each resident. This ensures that the home has sufficient information on the residents’ needs and access to appropriate services to enable the needs to be met. EVIDENCE: The customer service manager carries out assessments of prospective residents. The assessments have a clinical format, with a check list for personal care, eating and drinking, elimination, sleeping, breathing, communication, mobilising, body temperature, working and playing, safe environment, expressing sexuality, and dying, with brief details for each heading. The assessment provides basic information for the care plans, which also follow a clinical model (see Standard 6). The assessments meet the minimum standard, but there is very little information on quality of life issues, and no emphasis on education and suitable occupational activities. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 10 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, 8, 9 and 10 There has been no change in the format of care plans. They follow a nursing model, and provide good details of the personal and nursing care needed, but no information on quality of life. There is no evidence that the residents are involved in writing and agreeing their care plans. This style of care plan enables the staff to provide a good quality of care, but it does not offer a person centred plan that ensures that the wishes and decisions of the residents are included. EVIDENCE: The care plans of seven residents were examined. The manager has drawn up a new format for care plans that includes goals based on the residents’ assessments and daily recording for each care plan goal, but this has not yet been put in place. There has been no change in the format of the care plans that were seen. They provide reasonable details on meeting each person’s personal and health care needs, with clearly written goals. The care plans are not holistic and do not give equally detailed information on the quality of life, including goals for independence skills, education, community involvement and leisure activities. There is a separate sheet for therapy goals, and in one case this included the goal “to maintain the quality of life”. However the only action to meet this was to “ask her if she wants to go and visit the activities organiser”. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 11 There was no evidence that this had happened, and no information on her interests or how to improve her quality of life. Monthly reviews of the care plan goals are recorded by a staff signature, but there is no comment made for the review and no information on the progress being made towards each goal. Only one of the care plans that were seen was signed by the resident. Apart from the signature, no evidence was seen in the care plans or from talking to residents of their involvement in drawing up their care plans or of setting their own goals. In some care plans it was recorded that “The resident was consulted and asked about their likes and dislikes”, but the residents spoken to were not aware of the goals and procedures written in their care plans. Residents meetings and relatives meetings are now taking place. As a result of an issue brought up by a resident, a portable ramp was provided to go over the lip in the door from the dining room to the patio. Key pads have been fitted to the doors of the nursing offices on both floors, where the care plans are stored, to ensure that they are stored securely. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 12 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) 11, 12, 13, 14, 15, 16 and 17 A great deal of progress has been made in providing a varied programme of activities in the home, including facilities for residents to practice independence skills. This ensures that service users are involved in the planning of their individual and group activities. The food provided is variable, but generally provides a nutritious diet. Improvements are being made to the way that menus are planned to ensure that residents receive their choice of meals. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 13 EVIDENCE: The activities organiser carried out a survey of all service users concerning their interests and wishes for social activities. A full programme of activities has been drawn up as a result, with a variety of group and individual activities, and talks and entertainments. Time has also been allocated for educational and independence skills, massage, make-up and manicures. A very varied daily activity programme is now in place, including films, newspapers, computer skills, poetry, life skills and exercise classes. Relatives are encouraged to be involved in providing activities, and the mother of one resident leads a weekly book-reading group. The activities organiser provides individually tailored activities for some residents, for example providing a keyboard and an individual music programme for one person who had been a professional musician, and sitting with a blind person who enjoyed films, to explain the action to him. Outings are organised jointly for service users of The Jacob Centre and The Gardens, using two minibuses, including hydrotherapy, pub lunches and horse drawn carriage riding, in small groups and individually. There are no kitchen facilities in the home and all catering is provided by contract from The Rivers Hospital, which is part of the Capio complex. The residents spoken to said that the quality of the food is variable. The meal served at lunchtime looked and smelled appetising. It included fresh vegetables and a choice of dessert or fruit. However one resident had chosen fish, but was given a pork chop that she could not eat. The comment book in the dining room had several examples of unsuitable meals being provided, or not sufficient food being provided. It also included comments of some very good meals. The chef attends residents and relatives meetings. Residents choose their meals on the previous day, but the residents spoken to did not know what meal they were having for lunch. The home now employs catering assistants, who are currently getting to know the residents and their individual needs. They will discuss the menu choices with each resident, and ensure that suitable meals are served to them. A new format for ordering food highlights individual choices, and requires the kitchen to notify the home if these are not available. It also provides clear information on special needs such as soft diets, which should ensure that unsuitable meals are not provided. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 14 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, 20 and 21 The staff provide good quality personal care and nursing care. Many residents and visitors commented that the staff are very caring, but some feel some insecurity due to recent changes in staff. The procedures for storing, administering and recording medication are generally satisfactory, but recording must again be improved in order to enable an accurate audit to be carried out. Enforcement action may be considered if the issues are not addressed. EVIDENCE: The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 15 The home provides care for service users with a high level of need, including PEG feeding and tracheotomy care. There are four trained nurses on duty in the home at all times, including the night, and the clinical managers on each floor are experienced in neuro care. The home has a physiotherapy gym and a team of physiotherapists. The aim of physiotherapy is not for intensive rehabilitation, but to maintain flexibility and mobility and prevent further deterioration. Northwick Park Neuro Rehab Unit provide a specialist outreach service to the home. The neuro rehab consultant spends one day a week in the home, the speech and language therapist three days a week, and occupational therapy is available for those with an assessed need. The GP visits the home every day. The home has recently recruited a dietician for ten hours a week, and she was spoken to during the inspection. She was currently carrying out dietary assessments, and consulting all the service users individually about their likes and dislikes. All healthcare needs were seen to be appropriately recorded, with detailed procedures for the care required. Most of the residents and visitors spoken to said that the staff provide good personal and nursing care. One visitor said that her friend is very well cared for, and the staff take good notice of every detail. However there has been a lot of change in staff on the ground floor, and several residents and relatives feel a certain lack of confidence that their needs were being met, especially those with specific nursing needs. The evidence seen in the care plans shows that all the care needed is provided, but the current reliance on agency staff means that there is a lack of consistency (see Standard 33). One resident said that the care staff do too much for her, and don’t allow her to do things for herself (see Standards 6 and 7). Medication is stored and administered separately for each floor, and is administered by a trained nurse. The storage and recording of medication on the first floor was satisfactory. On the ground floor the controlled drugs are stored and recorded properly, but there was some evidence of inconsistent and poor practice for the general medication. 1. Some gaps in recording were seen on MAR (medicines administration record) charts, and the recording of when a package of medication was started was not clearly recorded on either the MAR chart or the package, which means that there is no clear audit trail to show that the medication has been taken. A form is filed with each resident’s MAR chart for recording the reason for gaps on the MAR chart. In some cases this was completed, and in some cases it was not. 2. There was no clear procedure for recording medications coming into the home. In some cases they are recorded on the MAR chart, but in several cases the stocks held did not tally with what was recorded. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 16 3. The reason for giving each dose of PRN (when required) medication was not recorded on the MAR charts. It was reported that it was recorded in the daily recording in the resident’s care plan. However when one example, for a PRN medication administered on 8th May, was tracked, it was not possible to verify this because the daily sheets had already been archived and were not in the care plan. Errors and omissions are less likely if the reason for PRN medications is recorded on the MAR chart at the time they are administered. 4. One resident had a prescription for PRN paracetamol, but there was no supply of paracetamol for her. There was no record that this had been noted when the last dose was given, and a new supply requested. It was reported that if she needed paracetamol before a new supply was delivered, a request would immediately be made to the GP for an urgent prescription, but she would then have to wait in pain for the prescription to be written and supplied. 5. For one medication (frusemide) there was a discrepancy of twelve tablets between the number in the bottle and the number recorded as taken, with no explanation for the missing tablets. These discrepancies would be discovered and rectified more readily if regular and thorough audits of the medication were carried out, especially at the current time when there are frequent changes in the staff on the ground floor. It was reported that a complete audit is not practicable due to the complexity of the medications, but this is not a satisfactory explanation. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 17 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) 22 and 23 Residents are protected by the home’s policies for complaints and protection from abuse, but some do not feel confident that their concerns are listened to. EVIDENCE: The residents and visitors spoken to are aware of the complaints policy. One relative had made a complaint about some of the procedures for providing care, and changes were made as a result. Some of the residents felt that their views and concerns made no difference. The complaints record showed that all complaints are dealt with effectively, and that changes have been made as a result. The uncertainty may be due in part to the insecurities from the current staffing problems (see Personal and Healthcare Support), but is also an indication that consultation and communication with residents needs further improvement (see Standard 7). All the staff have had training in the prevention of abuse. The staff spoken to were aware of the home’s procedures and of the whistle blowing policy. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 18 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) 24, 28, 29 and 30 The home provides a comfortable and well maintained environment for the residents, and the staff maintain a good standard of cleanliness and hygiene. The style, scale and facilities of the building continue to give the impression of a clinic rather than a home, and this would be improved if the home was organised to provide for groups of not more than ten residents to share a staff group and communal facilities. The gardens need to be properly tended, in order to provide a pleasant environment for the residents. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 19 EVIDENCE: The home is new and purpose built, but in style and scale gives the impression of a clinic rather than a home. Some attempts have been made to address this with pictures on the walls and displays of photographs of activities and outings. Some of the residents have made their bedrooms more homely and individual, reflecting their personality and sense of humour, and one had a humourous notice on his door. The home is registered for sixty service users. The ground floor has 25 single bedrooms, two lounges and one dining room. 11 rooms have an en-suite shower and there are three assisted bathrooms. The first floor has 35 single bedrooms, two lounges, one of which has been designated as a sensory room and the other as a cinema, and two dining rooms. 14 rooms have an en-suite shower and there are four assisted bathrooms. The home is well equipped with a variety of hoists and environmental controls, and many residents have their own individually designed seating systems. Staff are allocated to work either on the ground floor or the first floor, and there is no indication in the design or the management of the home that there are any separate units on either floor. The home has lounges and dining rooms on both floors, and areas for the residents to sit in the hallways. There is a garden at the rear, accessed from the ground floor dining room, with a patio, lawns and flowerbeds, and flowerbeds at the front of the home. All the flowerbeds were overgrown with weeds and looked neglected and unattractive. It was reported that the gardens had not been maintained because their upkeep was omitted from the home’s maintenance contract, and that this has now been rectified. The home appeared to be clean and hygienic, and despite the early start there were no offensive odours. All laundry is taken to either The Rivers or The Gardens. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 20 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) 33 and 35 The home is staffed with employees who are experienced and competent to care for younger adults with physical disabilities. The current staff shortages have affected both staff morale and the confidence felt by the residents, but new permanent staff were being recruited. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work. EVIDENCE: Some of the residents and relatives on the ground floor expressed concerns about the shortages of staff. The staffing rotas showed that staffing levels are being maintained, of both care staff and qualified nursing staff. However there has been a fairly high turnover of staff recently on the ground floor, and there are currently several vacancies. The permanent staff team is complemented by agency staff, and new permanent staff are being recruited. It was evident from talking to several members of the care staff that morale is currently low on the ground floor, and that this affects the confidence in their abilities felt by the residents. The manager was holding staff meetings to address their concerns. The staff team on the first floor was more stable, and the residents there did not express the same concerns. Several of them said that they are well cared for, and praised the staff. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 21 Several new or fairly new members of staff were spoken to, and all were enthusiastic about their work and felt well supported by their colleagues and the management. The home has a comprehensive training programme and the induction programme includes a balance of shadowing more experienced workers and formal training. Each new care assistant has a mentor from the existing staff. This ensures new staff are familiar with the home and the needs of service users. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 22 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) 42 The home has policies and procedures in place to protect the health and safety of the residents and staff. A requirement has been repeated to ensure that the food trolleys are clean, and enforcement action may be considered unless satisfactory action is taken to address this. EVIDENCE: Appropriate records are maintained for health and safety and the management of the home. No fire drills have taken place since the last inspection, but a new monitoring form is in place that records everyone who attends the drill and any actions needed. The heated food trolleys in the ground floor dining room were clean on the surface, but burnt on food was seen inside the compartments, as in both previous inspections. The trolleys showed a temperature of between 91ºC and 93ºC, and it was reported that due to the high temperature the food residue was not a hazard for food hygiene. However there was no evidence that this advice had been provided by a health and hygiene professional. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 23 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 x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x 2 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Jacob Centre Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 24 YES 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 6 Regulation 15(2)(a) Requirement Care plans must be made available to the residents. (PREVIOUS TIMESCALE OF 31/03/05 NOT MET) Residents must be consulted and involved in decisions on how their care needs are met. Evidence of this involvement, according to the abilities of each service user, should be recorded. (PREVIOUS TIMESCALE OF 31/03/05 NOT MET) All medication must be administered and recorded in accordance with the Royal Pharmaceutical Society guidelines. In particular: 1. The date of opening must be written on all containers of medication, in order to enable an accurate audit to be carried out. 2. Any gaps on MAR charts must have a recorded reason for nonadministration. 3. The reason for administering each dose of PRN medication must be clearly recorded. 4. An adequate supply of all prescribed medications must be kept in the home. 5. A system of regular and Timescale for action 30 September 2005 30 September 2005 2. 6&7 12(2) & (3) 3. 20 13(2) 31 JULY 2005 The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 25 4. 42 13(3) 13(4)(c) 16(2)(j) thorough audits must be put in place to ensure that discrepancies in the recording of medication are investigated and corrected without delay. (PREVIOUS TIMESCALE OF 28/02/05 NOT MET. ENFORCEMENT ACTION MAY BE CONSIDERED IF THIS REQUIREMENT IS NOT MET WITHIN THE REVISED TIMESCALE.) The heated food trolleys were again seen to be dirty. The registered person must ensure that appropriate procedures are implemented concerning the maintenance of food hygiene. (PREVIOUS TIMESCALE OF 28/03/05 NOT MET. ENFORCEMENT ACTION MAY BE CONSIDERED IF THIS REQUIREMENT IS NOT MET WITHIN THE REVISED TIMESCALE.) It was reported that there is no risk to ffod hygiene due to the high tempterature maintained in the food trolleys. However there was no evidence that this was professional guidance. 31 JULY 2005 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 24 28 Good Practice Recommendations The organisation of the home should provide for groups of not more than ten service users to share a staff group and communal facilities. The flower beds at the front and back of the home were overgrown with weeds. It was reported that this was due to an error in the maintenance contract which has now I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 26 The Jacob Centre been put right. The gardens should be kept tidy and looked after, to provide a pleasant environment for the residensts. The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City AL7 3BQ 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 The Jacob Centre I52 s60010 Jacob Centre v228854 160505 stage 4.doc Version 1.30 Page 28 - 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. 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