Inspection on 21/06/06 for The Jacob Centre

This inspection was carried out on 21st June 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Jacob Centre 09/06/08

The Jacob Centre 09/11/05

The Jacob Centre 16/05/05

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 Herts CM21 0HH Lead Inspector Claire Farrier Key Unannounced Inspection 21st June 2006 10:00 The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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 Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Jacob Centre Address High Wych Road Sawbridgeworth Herts CM21 0HH 01279 600201 01279 603866 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Capio Healthcare UK Ltd Rita McCarthy Care Home 60 Category(ies) of Physical disability (60), Physical disability over registration, with number 65 years of age (60), Terminally ill (60), of places Terminally ill over 65 years of age (60) The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th November 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 purpose 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 ground floor dining room and decking areas outside the ground floor lounges. The home is fully accessible for service users. The Statement of Purpose and Service Users Guide provide information about the home for referring professionals and prospective clients. The current charges range from £945 to £3600 per week. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two inspectors over one day and including preparation time a total of 21 hours was allocated to it. The majority of time was spent talking to residents and staff, and discussions were held with the home’s manager. Some time was also spent in the office looking at records, care plans, risk assessments, complaints, and staff files, and the inspectors made a tour of the premises. The staff and residents were very welcoming. The improvements seen during the last inspection have been maintained, and the home provides a good quality of care. What the service does well: What has improved since the last inspection? The quality of food has improved, and most residents said that they enjoy the food provided by the home. The CSCI pharmacist inspector visited the home following the last inspection, and made several requirements concerning the administration, recording and storage of medication. Action has been taken to meet these requirements, but further action is needed to ensure that controlled medications are administered safely. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 6 Training for the staff is taken very seriously in the home. The training available has increased and improved, and there is an ethos among both staff and management of valuing training. All the members of staff who were spoken to were enthusiastic about their work and felt well supported by their colleagues and the management. They said that the training is very good, and provides them with the specialised information and skills that they need. 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 Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 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 the following standard(s): 1, 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people who use this service have sufficient information available about the home in order to make an informed decision about whether they would like to use the service for respite care. The assessment and admission procedure provides good information for the staff so that they can meet the needs of the residents. EVIDENCE: The files of four residents were seen, and all contained good information, so that the staff are able to provide a good quality of care and meet each person’s needs. Comprehensive assessments are carried out before each person is admitted to the home. The staff spoken to confirmed that they have sufficient information to meet the residents’ needs, and the residents said that the staff are competent to meet their needs. The staff have access to a good training programme that includes training on specific conditions, including an understanding of neurology and epilepsy, and specialised techniques including tracheostomy care and PEG tube feeding. The home endeavours to meet any ethical or cultural needs. One resident is a Muslim who uses Arabic words. There is a chart on the wall of their room and in the care plan with appropriate Arabic words to aid communication, Halal meals are available for them. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 9 The home is registered to provide palliative care, and they accept residents who are in the final stages of their illness. Some prospective palliative care residents have not been accepted either because their condition was not stable or because they were at a very late stage of their illness. However, inevitably the condition of those accepted may change in the one or two weeks between the assessment and admission, and some die within a few weeks or days of their admission. The compliments book contains several letters of appreciation for the care provided to these residents, and for the support provided for their families. The home has a positive atmosphere. The contracts have been revised, and two residents who returned questionnaires for this inspection commented that they have both received and signed the contracts. One who was admitted recently said that sufficient information was provided to help with the choice of a home. They had also found the CSCI reports useful, and in their opinion the home is better than the reports suggest. Another resident said that they had not been provided with useful information when they were admitted soon after the home first opened, but that better information was available to new residents now. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 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 the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A new format has been introduced for care plans that places the residents at the centre of the care planning process. The care plans provide detailed information on the residents personal and healthcare needs. Residents and family members spoken to confirmed that they are fully involved in writing their care plans. Appropriate risk assessments are in place, but in some cases they are not sufficiently specific. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care plans of four residents were examined. A new format has been introduced that aims to get residents and their families more involved, and to record their likes and their views. Personal care needs are recorded from the resident’s perspective. Two residents and their partners who took part in the inspection both said that they were involved in writing their care plans, and that their comments were included in the care plans. However one care plan records that the person would like to have physical therapy and massage, but this wish is not addressed. The format includes regular reviews, which provide an opportunity for the residents to also monitor and record their views on the progress of their care plans. Some appropriate risk assessments were seen in the care plans. They identify the risk and refer to a care plan for management of the risk. However some attention should be given to ensuring that risk assessments are completed when a risk is identified. One resident with limited mobility does not have a risk assessment for falls, and two people were identified as a high or very high risk for falls, but there is no care plan to address this risk. One person has a risk assessment for restraint. This is a general risk assessment, and does not identify the person’s individual risks and the measures needed to manage those risks. The residents spoken to said that they are able to make decisions about their lives in the home, and the staff encourage and support them when needed. There are regular residents’ meetings, although one resident would like them to be more frequent. They can choose whether to look after their own money or to give it to the home for safekeeping. There are appropriate and secure procedures in place for managing their cash, with a comprehensive and clear system of recording. In some cases their family or a solicitor has responsibility for their money. Several residents have been awarded compensation for traumatic brain injury. A spot check was made on the cash for one of these. The solicitor sends a regular monthly amount of spending money to the home, and all expenditure is recorded with the receipts. The resident has spent money on hairdressing, chiropody, tuck shop, toiletries, and on a new blind for their room. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents spoken to said that they enjoy the activities available in the home. The quality of food has improved, and most residents said that they enjoy the food provided by the home. The menus offer a balanced and nutritious diet. Relatives play an integral part in the care of the residents and their lives in the home. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 13 EVIDENCE: Most of the residents spoken to take part in activities in the home, and said that they enjoy them. One of the therapy assistants is activities co-ordinator, and twelve members of the care staff have recently completed training in providing activities. There is a list of activities arranged for each day on the notice board on each floor. There are up to four activities each day, and on the day of the inspection these were newspaper reading and a sensory group. Staff spoken to said that they were also planning some activities in the garden. The residents spoken to said that the outings are particularly good. There have been recent trips to Hatfield forest and a local quiz night, and the following week there would be a canal trip. One resident does not often join in activities, as they are worried that there will not be sufficient staff to take them back to their room. There is no evidence that this fear is based on fact, but the staff should ensure that they encourage and reassure all residents so that they are enabled to take part in their choice of activities. The home has residents covering a wide range of ages and physical abilities, but the activities on offer seem to be appropriate for them, including quizzes and computer activities, craft activities and games. There is a monthly interdenominational church service. None of the residents currently attend college or regular activities outside of the home, but this has been arranged where appropriate in the past. Relatives are encouraged to visit the home whenever they wish, and many visit every day and are very involved with the care and planning for the residents. The relatives who were spoken to during the inspection said that the staff provide very good care and they are very happy with the home. Relatives and residents praised the staff and said that they provide a good quality of care and have a good relationship with the residents. 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 meals are served in the ground floor dining room first, then in each of the two first floor dining rooms. The food appeared to be attractively presented, and most residents said that the quality of food provided is good. One person said that the food is “lovely”. Another said that there is a large choice, and the chef will always cook something else, such as an omelette, if requested. However other residents said that the food has improved, but there is no attempt to cater for individuals, and there is no alternative to the meal offered each day. These views seem to be contradictory, and the staff should ensure that all residents are offered alternatives if they do not like the meal that is provided for them. The atmosphere in the dining room was sociable, and the staff assisted the residents who needed help. They talked to the residents while they were helping them, and treated them with patience and respect. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 14 Some of the residents have a fridge in their room and keep some drinks and snacks for themselves. Halal meals are provided for a Muslim resident, and one family bring Indian food for their relative, which is labelled and stored in the freezer. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff continue to provide good quality personal care and nursing care, including palliative care, and many residents and visitors commented that the staff are very caring. Therapies must be provided in private in order to protect the privacy and dignity of the residents. Action has been taken to meet the requirements made in the pharmacist inspection report concerning medication, but further action is needed to ensure that controlled medications are administered safely. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 16 EVIDENCE: 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. Equipment available for the residents includes environmental control units and specialised communication aids. Northwick Park Neuro Rehab Unit provides a specialist outreach service to the home. The rehabilitation consultant spends one day a week in the home, and there is regular input from occupational therapists and speech and language therapists. It was reported that psychology input is available when it is needed. The GP visits the home every day. All healthcare needs were seen to be appropriately recorded, with detailed procedures for the care required. Generally good recording was seen for the treatment and monitoring of pressure sores, but the care plan for one resident contained a body map that indicated a pressure sore, but there was no further information and no plan for treating it. The home is registered to provide palliative care, and they accept residents who are in the final stages of their illness (See Choice of Home). There have been 15 deaths in the home since the last inspection, some of which have been very shortly after admission. An inquest was carried out into one unexpected death. The conclusion was that appropriate care and support was provided by the home, and exactly what happened was unknown. The compliments book contains several letters of appreciation for the care provided to these residents, and for the support provided for their families. The home has a positive atmosphere, and no indication was seen that the care given to palliative care residents in any way affects the others. The care plans seen provide comprehensive details of each resident’s personal care needs, written by the resident or from their point of view (see Standard 6). Staff are allocated according to each person’s assessed need of 1:1, 1:2 or 1:3 staff:resident ratio. The rotas seen showed that there are sufficient staff to meet the residents’ assessed needs. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 17 Most of the residents and visitors spoken to said that the staff provide good personal and nursing care. One person described it as “First class care”, and another said, “I can’t speak highly enough of the home, the staff excellent and there is lots of therapy.” One questionnaire returned by a resident following the inspection stated, “Nursing liaison with home Doctor is good…. Very caring and careful. I feel however that there is too little liaison with Neurologists…. I am not certain they monitor (my condition).” Another commented, ”Standards of care at Capio are almost always completely excellent. Always receive care and support needed. Medical support always received.” The relative of one resident who is on a PEG feed aid that most staff are very good at following the correct procedures, and the equipment is kept very clean. They occasionally have to remind agency staff to follow the correct procedures. The visiting dietician regularly checks and monitors this person’s programme. The door to the therapy gym was open throughout the time that the inspectors were in the home, with the result that residents having therapy could easily be observed by other residents and any visitors to the home. This has also been observed on previous occasions, and this lack of attention to privacy detracts from what is otherwise a very good provision of care that meets each person’s individual needs. The CSCI pharmacist inspector visited the home on 9.12.05. Records of the administration of medicines were inspected for all current service users and with the exception of a few minor deficiencies were acceptable for those service users on the first floor. Records of the administration of medicines made for service users on the ground floor carried an unacceptable number of gaps in the records with no indication of whether medication had been administered or not. Inspection of corresponding nursing care notes did not explain any reason for omission of medication. Six requirements were made concerning the storage, recording and administration of medication. Following this report a medication technician has been appointed to carry out regular audits of the medication, making sure that the stocks are controlled and the medication administered and recorded is reconciled. All nursing staff are undertaking training in administration of medication at Oaklands College, and the nurses spoken to were positive about the training and said that it is very useful. The medication policies have been updated as required by the pharmacist inspector. One of the senior nurses is a “named link person” linking with the Health Protection Agency, and in charge of infection control in the home. Some discrepancies were found on this occasion in the recording of medication on both floors, but the procedures that are now in place should ensure that these are rectified. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 18 The most serious discrepancy was in the recording of controlled medication on the ground floor. For one Temazepam prescription the register stated that there was a stock of 21, but there were only 20 in the box. The same person had another prescription for a different dosage of Temazepam; there was one extra of these. It therefore seems that there was some confusion between the different dosages of a controlled medication, and measures must be taken to ensure that this does not recur. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents are encouraged and enabled to make their views and concerns known. Policies and procedures are in place to ensure that service users are protected from abuse and neglect. EVIDENCE: The residents who returned questionnaires for the inspection are aware of the complaints policy, and said that they can always speak to someone if they are not happy. Three complaints were made to the Commission following the last inspection. The manager investigated and responded to them appropriately. Two were upheld in part, and one was not upheld. A further concern was raised by a relative, and it was reported that the issues “have all been sorted”. The complaints record showed that all complaints are dealt with effectively, and that changes have been made as a result. Capio Healthcare has appropriate policies on adult protection and whistle blowing. The staff spoken to showed good knowledge and understanding of these policies, and all have had training in the prevention of abuse. An allegation of abuse was made against a care worker. The proper procedures were followed, and Social Services were satisfied with the manager’s actions and investigations. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 20 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 the following standard(s): 24, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. EVIDENCE: The home is new and purpose built. The ethos and atmosphere of the home have improved, but in style and scale it continues to give the impression of a clinic rather than a home. The home is registered for sixty service users. 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 Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 21 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 raised flower beds, and flower beds at the front of the home. New pathways have been laid around the garden, and several residents and visitors commented that they can now go out and enjoy the gardens more easily. Sturdy gazebos have been erected on the patio to provide shade, and some residents had their lunch in the garden. New decking areas have been installed outside both ground floor lounges that are easily accessible for wheelchairs. There is still a small lip in the doorway from the dining room to the patio, but staff and visitors reported that this does not prevent access for the residents. A portable ramp is available if it is needed. Two residents had a problem with their beds, that there was a gap between the mattress and the footboard. The manager checked this during the inspection, and discovered that there is a lever under the beds that can adjust the length of the base. All beds will now be checked to ensure that they are safe, but in the meantime there has been a risk of discomfort or injury to residents if the beds are not adjusted properly. The home appeared to be clean and hygienic, and there were no offensive odours. Several residents and visitors commented on the high standard of cleanliness in the home. One resident who returned a questionnaire commented, “This is the best aspect of The Jacob – the housekeeping is excellent and the bedroom is spotless.” The home has neither a kitchen nor a laundry; these facilities are provided by The Rivers hospital. One senior nurse is now a named link person with the Health Protection Agency, with responsibility for infection control in the home. There is an efficient system for maintenance of the building. Any fault found, such as a light bulb that needs changing, loose door handles or a blocked toilet, is recorded in the porter’s book in reception. The porters who work in the home effect most repairs on the same day that they are reported. Maintenance engineers from The Rivers carry out any more serious repairs. One of these tasks, the replacement of tiles and a leaking pipe in the male staff toilet, was completed the day after it was reported. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 22 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is staffed with employees who are experienced and competent to care for younger adults with physical disabilities. The staff spoken to are confident of their knowledge of the needs of the residents and feel well supported in their work. There is a thorough recruitment procedure in place that ensures that the staff recruited are fit to work with vulnerable people. EVIDENCE: The staffing rotas seen showed that there are sufficient staff to meet the residents’ assessed needs. There are four trained nurses on duty in the home at all times, including the night, and care staff are allocated according to each person’s assessed need of 1:1, 1:2 or 1:3 staff:resident ratio. There are six or seven care workers on each shift. The staffing levels and skill mix are regularly reviewed to ensure that they are appropriate for the needs of the current residents. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 23 All the members of staff who were spoken to were enthusiastic about their work and feel well supported by their colleagues and the management. They said that the training is very good, and provides them with the specialised information and skills that they need. There is a system for regular supervision and appraisal for all the staff. The home has a comprehensive training programme that includes all mandatory health and safety training, and essential skills. All staff also have training in neuro skills and twelve members of the care staff have recently completed training in providing activities. One of the administration staff has responsibility for co-ordinating the training for both The Jacob Centre and The Gardens, and for monitoring the training completed and when updates are due. A recent audit and review of the training programme showed an improvement in the numbers of staff who have completed induction training and neuro skills training. Training is taken very seriously in the home. The training available has increased and improved, and there is an ethos among both staff and management of valuing training. 31 of all eligible staff have completed NVQ qualifications at either level 2 or level 3. 17 members of staff completed the qualifications last year, and 21 are currently working towards them. There is a thorough recruitment procedure in place, that includes taking up references and CRB (Criminal Record Bureau) disclosures in order to ensure that the staff recruited are fit to work with vulnerable people. The staff files of two members of staff were inspected. They contained all the required information, including references, proof of identity and evidence of satisfactory CRB disclosures. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 24 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well run by a competent manager who leads a dedicated and enthusiastic staff group. The home has policies and procedures in place to protect the health and safety of the residents and staff. Requirements were made concerning the recording of fire drills and safe storage of equipment. EVIDENCE: The manager is a RMN (Registered Mental Nurse), and she has a diploma in management and NVQ assessors award. She had several years experience of management in care homes for people with mental health problems before being appointed to manage The Jacob centre when it opened. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 25 Separate residents and relatives forums take place on a quarterly basis, and issues raised are taken up and acted on. The Acting Managing Director of Capio Healthcare UK is frequently in the home, and he carries out monthly monitoring visits as required under regulation 26, during which residents are consulted. Internal audits are carried out, for example of accidents and incidents and training, and the results are given to Capio Healthcare UK and discussed in the home at senior management meetings. During the last inspection it was reported that a residents’ satisfaction survey has been drafted, but there is no evidence that this has distributed to the residents in order to asses their views. The home maintains appropriate records for the health and safety of the residents and staff in the home, and staff follow the home’s policies and procedures. Good procedures are in place for fire drills, and the residents’ room list has information on the evacuation method (walking, wheelchair, mattress) for each resident. However the residents’ list in the fire log book is not up to date. Regular fire drills take place, but there is no record of the names of staff who take part in each drill. The log book records “staff on site” or “re staff signing in book”. One health and safety concern was found during this inspection. The linen store, where laundry is taken from and returned to every day, is also a base for the porters. It has a door into the home, and a door leading to the outside. On the day of the inspection the door to the outside was wide open and the door into the home was unlocked. The inspector was able to enter the room and to remain there unobserved for five minutes, with easy access to the porters’ tools, paints and a kettle. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 3 3 X 2 X X 2 X The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA9 Regulation 13(4)(c) Requirement Some appropriate risk assessments are in place, but they do not provide adequate information on the management of risk, in particular for the risk from falls and for the risks of using restraint. Timescale for action 30/09/06 2. YA18 12(4)(a) Appropriate and adequate risk assessments must be put in place for all residents, and kept under review. The door to the therapy gym 30/09/06 was open throughout the time that the inspectors were in the home. Personal and health care, including therapy, must be provided in private. PREVIOUS TIMESCALE OF 31/12/05 NOT MET. The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 28 3. YA20 13(2) There was some confusion between the different dosages of a controlled medication. All medication, including and in particular controlled medication, must be administered and recorded in accordance with the Royal Pharmaceutical Society guidelines and the home’s policy and procedures. There was a gap between the mattress and footboard of some beds, and residents were at risk of discomfort or injury. Staff were unaware of how to adjust the bed bases. The registered person must ensure that all equipment provided in the home is used in accordance with its instructions, in order to safeguard residents from the risk of injury. The linen store, which is also a base for the porters, was unlocked, giving access to tools, paint and a kettle. All tools and equipment that may cause a risk to residents must be stored securely at all times. The names of staff taking part in fire drills must be recorded to ensure that every member of staff takes part in at least one fire drill a year. 30/09/06 4. YA29 13(4)(a) & (c) 31/08/06 5. YA42 13(4)(a) & (c) 30/08/06 6. YA42 23(4)(e) 30/09/06 The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 29 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 YA17 Good Practice Recommendations One resident said that alternatives are available if they do not want the meal provided, but others said that they are not offered alternatives. The staff should ensure that all residents are offered alternatives if they do not like the meal that is provided for them. The organisation of the home should provide for groups of not more than ten residents to share a staff group and communal facilities. A method should be implemented for a regular survey of the views of the residents that informs the home’s audits and quality assurance procedures. The residents’ room list has information on the evacuation method for each resident. However the residents’ list in the fire log book is not up to date. The information needed in case of a fire emergency should be kept up to date. 2. 3. 4. YA24 YA39 YA42 The Jacob Centre DS0000060010.V299366.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire 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. 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