Inspection on 07/03/07 for Vi & John Rubens House

This inspection was carried out on 7th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Vi & John Rubens House 07/02/06

Vi & John Rubens House 25/08/05

Vi & John Rubens House 22/12/04

Vi & John Rubens House 03/08/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Vi & John Rubens House 39 Clarence Avenue Gants Hill Ilford Essex IG2 6JH Lead Inspector Ms Gwen Lording Key Unannounced Inspection 08:30 7th March 2007 X10015.doc Version 1.40 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 DS0000025964.V330722.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 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. DS0000025964.V330722.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Vi & John Rubens House Address 39 Clarence Avenue Gants Hill Ilford Essex IG2 6JH 0208 518 6599 0208 554 6402 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) Jewish Care Mrs Mary O`Rourke Care Home 121 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (105) of places DS0000025964.V330722.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2006 Brief Description of the Service: Vi and John Rubens House is owned and operated by Jewish Care Ltd. it is a care home registered to provide accommodation with personal care and nursing for up to 121 residents, of whom 16 have dementia type illnesses. All residents are over 65 years and of the Jewish faith. The home is purpose built and situated in a residential area of Gants Hill in the London Borough of Redbridge. The home is well served by public transport and close to shops and other amenities. The majority of the bedrooms are single and have en-suite facilities, some with showers. The home has a passenger lift to all floors. On the day of the inspection the range of fees for the home was between £652.00 and £764.00 per week. A copy of the Statement of Purpose and Service User Guide is made available to both the resident and the family. There is a copy of the guide in each bedroom, and at the main reception area. A copy of the most recent inspection report is available on request. DS0000025964.V330722.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by two inspectors, namely the lead inspector Gwen Lording and Sandra Parnell-Hopkinson. It started at 8.30am and took place over eight and a half hours. The registered manager and deputy manager were available throughout the visit to aid the inspection process. This was a key inspection visit in the inspection programme for 2006/2007. Discussion took place with the manager; deputy manager; heads of the respective units; administrative; catering and laundry staff, and several members of nursing and care staff. Nursing and care staff were asked about the care that residents receive, and were also observed carrying out their duties. The inspectors spoke to a number of residents and relatives. Where possible residents were asked to give their views on the service and their experience of living in the home. A tour of the premises, including the laundry and main kitchen, was undertaken and all areas were clean and tidy with no offensive odours. A random sample of residents’ files were case tracked, together with the examination of other staff and home records, including medication administration, staff rotas, training schedules, activity programmes, maintenance records, menus, complaints, fire safety, accident/ incident records and staff recruitment procedures and files. Information was also taken from a pre-inspection questionnaire, which was completed and returned by the manager. At the end of the visit the inspectors were able to feedback to the manager, deputy manager and respective heads of units. The inspectors would like to thank the staff and residents for their input and assistance during the inspection. What the service does well: Although Vi and John Rubens House is a large care home, there is a relaxed atmosphere on all units and residents appeared unhurried and are given sufficient time and support in their everyday activities. The home has an experienced manager who sets high standards for the home. She works with strong staff teams across the home that are committed to further improve the quality of care for people living in the home. DS0000025964.V330722.R01.S.doc Version 5.2 Page 6 The attitude and practice of the service and that of the staff teams promote opportunities for residents to remain independent, exercise choice and express their wishes and needs. 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 summary of this inspection report can be made available in other formats on request. DS0000025964.V330722.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000025964.V330722.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive assessments are being undertaken for all residents prior to them moving into the home. Care plans are drawn up from the information in this assessment, ensuring that the needs of the residents are identified, understood and met. The Statement of Purpose and service user guide provide residents and their relatives/ representatives with information about the home. However, consideration must be given to providing the service user guide in alternative formats that are more accessible and easily understood by all current and prospective residents. The home does not offer intermediate care. DS0000025964.V330722.R01.S.doc Version 5.2 Page 9 EVIDENCE: Individual records are kept for each resident and a number of files were examined across all units of the home. All records inspected had assessment information recorded and the information had been used to continue assessment following admission to the home, and develop written care plans. The inspectors were satisfied that a full assessment of need is undertaken prior to residents moving into the home, and that the manager would not admit a new resident unless she was sure that the assessed needs of the individual could be met. Prospective residents and their relatives/ representatives are provided with information about the home and there is always the opportunity to visit the home prior to making any decision to move in. The Statement of Purpose and Service User Guide are both comprehensive documents, which are regularly updated to reflect any changes in the service. However, it is strongly recommended that consideration be given to providing the Service User Guide in alternative formats that are more easily understood and accessible to those residents with specialist needs such as dementia and sensory disabilities e.g. blindness. This document could be developed in a part pictorial format, on audiotape or a DVD format. The Care Homes Regulations 2001 have been amended with effect from the 1st September 2006, for new residents, and for existing residents with effect from the 1st October 2006, so that more comprehensive information is to be included in the service users’ guide. Details of information to be included are contained within the amended regulations. Therefore, the service user guide must be reviewed and amended by the stated timescales. The manager was also provided with a copy of the Commission’s ‘Policy and Guidance on Provision of Fees Information by Care Homes’. DS0000025964.V330722.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 & 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ health, personal and social care needs are set out in individual care plans. However, care plans require further development to ensure that they provide staff with up to date information about residents care, to ensure that care needs are being understood and met on a daily basis. All residents could be assured that at the time of their death, staff would treat them and their family with care, sensitivity and respect. EVIDENCE: General It was not evident that residents and/or their relatives are involved in the drawing up and reviewing of their care plan, and this was discussed with the manager and head of unit who will be addressing this issue to ensure as much involvement as is possible. DS0000025964.V330722.R01.S.doc Version 5.2 Page 11 The development of specific night care plans for each resident was discussed with the manager and heads of units. For example, identifying specific choices around the time a resident wishes to go to bed; have their night light turned off; low light left on all night; number of pillows; and choice of night time drink. This will assist in co-ordinating the care for each resident throughout the 24-hour period. Nutritional screening is undertaken on admission but on a more frequent basis if the health needs of the resident indicate this. All residents are weighed monthly and any increase/decrease in weight is monitored. Appropriate action is taken if necessary with the involvement of the GP, nutritionist or dietician. An audit was undertaken for the handling and recording of medicines within the home and a random sample of Medication Administration Record (MAR) charts were examined. Discussions with staff and the review of medication records show that staff are following policies and procedures, so as to ensure that residents are safeguarded with regard to medication. Medication audits are undertaken on a regular basis. Care plans contained some information on ‘End of Life’ wishes but this was very limited. The home is involved in the ‘End of Life’ project being developed by the London Borough of Redbridge, which includes work on the Liverpool Care Pathway (LCP) for the Dying Patient. The manager has expressed an interest in implementing the (LCP) for the Dying Patient across the service. This transfers the hospice model of care into other settings and has been used effectively in care homes. A presentation on this model is scheduled to be presented to staff in late March. However, from discussions with the manager and staff, and the lead inspector’s experience and knowledge of the home, it is apparent that staff deal with a person’s dying and death in a sensitive and understanding manner, both for the individual and relatives. Staff talked about and were observed to treat residents in a respectful and sensitive manner. They were seen to be very gentle when undertaking moving and handling tasks and offered explanation and reassurance throughout the activity. Nursing Unit Individual care plans were available for each resident and the care of five residents was case tracked, and their care plans and related documentation inspected. The home is still in various stages of the implementation of a new care planning system. However, care plans require further development to ensure that they provide staff with up to date information about residents care, to ensure that care needs are being understood and met on a daily basis. Care plans were generally detailed, with monthly reviews being undertaken, but care plans were not always being updated to reflect changing needs. Risk DS0000025964.V330722.R01.S.doc Version 5.2 Page 12 assessments are being routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention; and are being reviewed on a regular basis. The documentation/ health records relating to wound management; catheter care; diabetes; management of infection, and the most recently admitted residents were examined. Care plans for wound management were good, and advice and input had been sought from the tissue viability nurse. The care plans of two residents with an isolated infection were examined. There were no care plans relating specifically to control of infection, which should have included eradication protocols and reference to Universal Precautions in relation to effective infection control. However, in all cases entries had been made in the individuals daily progress notes, reporting on these specific care needs, and staff were able to give a good verbal account of residents needs in this area. Records indicated that residents are seen by other health professionals such as tissue viability nurse; dietician; speech and language therapist; optical, dental and chiropody services. Monitoring charts such as fluid intake/ output; turning regimes and blood sugar monitoring, were up to date and being adequately maintained. Several residents were asked about the care they receive in the home. Comments included:” I have everything I need” Another said: “I have no complaints, staff are kind and they look after me”. Residential Unit Individual care plans were available for each resident and the care of four residents was case tracked, and their care plans and related documentation inspected. Care plans were generally detailed, with monthly reviews being undertaken, and care plans being updated to reflect changing needs Risk assessments are being routinely undertaken on admission around nutrition, manual handling, continence, risk of falls and pressure sore prevention; and are being reviewed on a regular basis. The documentation/ health records relating to wound management; catheter care; colostomy care; diabetes; and the most recently admitted resident were examined. Care plans for wound management were good, and advice and input had been sought from the district nurse. The care plan of a resident who had recently been admitted from another Jewish Care home was examined. There was no evidence that any work had been undertaken with this resident in terms of the transition from one home to another. Nor was there any evidence of a short-term care plan in relation to orientating and settling the resident into DS0000025964.V330722.R01.S.doc Version 5.2 Page 13 the new environment. However, from discussions with staff it was clear that staff from both homes had worked with this resident to enable the transition from one home to another to be as least disruptive as possible. The care plans of two residents with diabetes indicated the frequency of blood sugar monitoring and urine testing. In both cases the recording of this monitoring was not in line with the frequency as directed in the individual care plan. Records indicated that residents are seen by other health professionals such as district nurse; chiropody, dental and optical services. Dementia Unit The files of 5 residents were inspected. All had a comprehensive assessment from which had been produced a comprehensive care plan. Care Plans are regularly reviewed on a monthly basis, or more frequently if necessary, and had been updated to reflect changing needs and current objectives for health and personal care. However, where a resident has “challenging” behaviour the manager must ensure that the care plan shows the required strategies necessary for staff to implement to minimise such behaviours. It would also be beneficial for there to be a night care plan and a continence care plan in place for each resident. This will assist in co-ordinating the care for each resident throughout the 24 hour period. Residents are encouraged to remain as independent as is possible, and where able, residents are being assisted in undertaking personal and oral hygiene on a daily basis. This can be very time consuming for the care workers and those residents living with dementia, which is why it is essential that there is always sufficient staff time allocated to this. This is a fact that is appreciated by the manager and her senior team. Staff must continue to be aware of the importance of listening to what the resident is saying, and getting to know the meaning of words and phrases used by an individual resident. This information will also help in the further development of the life histories. Staff did ensure that residents had any aids they needed such as hearing aids, glasses and dentures. As with the production of menus in pictorial format, so the manager may wish to give consideration to producing daily living tasks in a pictorial format, as this may assist in the continued independence of the person living with dementia. Wound care management is good and where necessary comprehensive care plans are in place. Advice is sought from the tissue viability nurse whenever necessary. All residents are registered with a GP, and also have the services of an optician, dentist and chiropodist. Residents are never sent to hospital or to attend appointments outside of the home without being accompanied. Wherever possible family and friends are DS0000025964.V330722.R01.S.doc Version 5.2 Page 14 encouraged to support these appointments, but where this is not possible then a member of staff will accompany the resident. In discussions with the head of unit and the team leader they demonstrated an awareness that some behaviours in residents living with dementia, such as refusing food, quiet rocking, or really challenging behaviour, could be due to an individual experiencing pain, or other discomforts. Therefore, they were very well aware of the need to exclude this when trying to understand what residents were trying to express through their behaviour. Staff were observed to knock on a bedroom door before entering, and obviously had a good knowledge and understanding of the needs of residents with regards to what they preferred to be called. Staff were seen to treat residents with respect, understanding and kindness. During discussions with some staff it was very evident that they enjoyed working with people living with dementia, although some said that this could also be very stressful. DS0000025964.V330722.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given the opportunity to take part in a variety of activities both within the home and in the community. The lifestyle in the home matches the preferences of residents with regard to their social and recreational interests and needs. The home is able to meet the cultural and religious needs of people from the Jewish faith. Visiting times are flexible and people are made to feel welcome in the home so that residents are able to maintain contact with their family and friends as they wish. EVIDENCE: General The home exclusively admits people from the Jewish faith. However, the home and Jewish Care as an organisation has a workforce from diverse cultures and backgrounds. As part of the induction programme, all staff learns about the Jewish culture and way of life. A number of volunteers from the Jewish DS0000025964.V330722.R01.S.doc Version 5.2 Page 16 community are employed in the home and provide a valuable contribution to life in the home and the experiences of the people living there. The home employs a full time social care co-ordinator and she is viewed as a valued member of the staff team. There is a general programme of planned activities for all residents and regular visits by professional entertainers. There are a variety of large group activities, which are usually held in the main lounge/ dining room. Other small group activities take place in the variety of small lounges/ quiet rooms. The care co-ordinator takes into account the needs, preferences, expectations and capabilities of all residents by arranging activities suited to individual’s interests. There is a social club held twice a week in the evenings, which is popular with residents, and includes alcoholic/ non-alcoholic drinks; card games and films. Twice a year the home holds a popular “Lyons Tea House” event. Staff dress up in waitress uniforms and the dining room is transformed with signs etc., replicating this traditional and wellknown venue. The choice of those residents not to be involved in some or any activities is respected. A more recent initiative has been to produce a monthly newsletter. One resident commented: “I like the newsletter, it’s a good idea as it tells me what ‘s happening in the home this month”. Another resident showed the inspector a poem she had written which had been printed in the newsletter. Other items included photographs of the recent Purim Party. Two computers with Internet access have been purchased for the use of all residents. Individuals are supported and encouraged to maintain contact with their families and friends through the use of email and other interactive facilities. The inspectors observed members of staff allowing time for residents to express their wishes and supporting individuals to make choices in their everyday lives, for example choosing a type of drink, where to sit, or if they wished to join in the planned activities. Relatives/ friends are encouraged to visit the home and there are no restrictions on when people can visit. Visiting can be undertaken in any of the communal areas, or in the privacy of the resident’s own room. The serving of the lunchtime meal was observed on both the residential and nursing unit, and provided residents with an appealing, varied and nutritious meal. Staff was seen to offer assistance where necessary and this was done discreetly and individually. Pureed meals were presented in an attractive and appealing manner and residents who required assistance were not hurried. All catering is contracted to an external catering company. A kosher kitchen is maintained and Jewish Care employ a peripatetic Jewish chef who visits the care homes on a rotational basis to advise on all food issues. The inspectors were able to meet with the catering manager and visit the main kitchen. The kitchen area was inspected and this was found to be clean with foods being stored and labelled appropriately. Kitchen staff were aware of the dietary DS0000025964.V330722.R01.S.doc Version 5.2 Page 17 needs of all of the residents and work closely with the manager and heads of unit. Dementia Unit The inspectors were able to talk to two visitors, one a friend and the other a relative, during the visit. Both were very satisfied with the care being delivered on this unit and spoke very highly of the staff. One said “My wife used to be here but died recently, but I have come back to visit a friend. The staff are wonderful and nothing is ever too much trouble.” Another said, “my mother has settled well and I enjoy my visits to her.” Due to the mental capacity of the residents it was not possible for the inspector to have meaningful conversations with them. However, from observation and some conversations it was apparent that for most of the time the residents appeared to be in a state of well-being. Staff were observed to interact very well with the residents and it was obvious that staff were very well aware of the needs of the individual people. During the inspection drinks were freely give to residents, together with biscuits. The inspector was able to observe lunch being served and staff were seen to be given assistance, where necessary, in a kind and encouraging way. However, it was not evident that residents had actually made the choice of meal but the inspector was satisfied that staff really knew the likes and dislikes of the individual resident and the meal was chosen accordingly. This was discussed with the manager and the head of unit and they will take this on board to ensure that systems are put into place to enable residents to make choices at the actual time of the meal. There is a small milk kitchen and fridge on this unit, and snacks are available for residents at all times. However, more thought should be given to the nutritional quality of the snacks and drinks to ensure that those residents who wander and will not sit at meals continue to receive an adequate diet. The staff were also very aware of the importance of providing “finger” foods where residents are experiencing difficulty in using cutlery. There is a general programme of activities available in the main lounge/dining area of the home for all residents, and these include sing-along, board games, bingo, drawing, quizzes and visiting entertainers. On the day of the inspection there was an entertainer in the main dining room, and several of the residents from the dementia unit were taken down. It was very apparent that they enjoyed the singing and some were even dancing with care staff. There are daily activities on the dementia care unit, but because of the very short concentration span of people living with dementia it would be more beneficial if activity resources are made available at all times so that residents can dip in and dip out as they wish. Again the further development of life histories will also be beneficial in one to one activities. The home now has a small DS0000025964.V330722.R01.S.doc Version 5.2 Page 18 snoozelum room and this is proving to be of benefit to some of the residents living with dementia. Staff do give great consideration and time to the retention of an individual’s daily living skills, and the task of assisting a resident living with dementia in washing and dressing can be very time consuming. Some residents may like to dust, help clear the tables, and fold napkins and are encouraged to do this. The head of unit ensures that staff are given the time to sit and talk to residents on a small group or individual basis, and the further development of the life histories will help in this area. The inspector was able to observe that residents felt able to speak or to interact with members of staff, and that staff did not ignore them. As this home is for people of the Jewish faith, all of the relevant festivals are celebrated and these include the birthdays of residents. It was apparent from observation and talking to some residents and staff, that residents can choose when to get up and go to bed. Contact with family and friends, and the local community, are encouraged and periodic residents/relatives meetings are held. It was obvious during the inspection that the manager and her staff are very aware that this is the home of the residents and they are trying to make this as appealing as is possible. The manager and staff were also very aware of the need to minimise any reduction in the freedom of residents to walk about the home, and realistic risk assessments are in place that balances safety with the individual’s right to be as free and in charge of their actions as possible. The manager also ensures that the rights of all residents are recognised and addressed and balances the needs of all with the needs of individuals. DS0000025964.V330722.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and staff make every effort to sort out any problems or concerns and makes sure that residents and their relatives feel confident that their complaints and concerns will be listened to and acted upon. However, all complaints, including verbal expressions of concern or dissatisfaction must be routinely recorded so it is clear that any concerns or dissatisfactions have been acted upon and resolved. Staff working in the home have received training in adult protection/ abuse awareness to ensure that there is a proper response to any suspicion or allegation of abuse. EVIDENCE: The complaint log was examined and this recorded the number of complaints/ concerns, action taken and the outcome for the complainant. In discussion with the manager and inspection of the complaint record maintained, it was evident that only formal written, or serious complaints are being logged. The Inspector discussed as to what constituted a “complaint” to be logged. This must include verbal complaints via telephone or face to face, and expressions of concern or dissatisfaction with any aspect of the service. The manager must ensure that staff routinely record all complaints, including verbal expressions of concern or dissatisfaction, so it is clear that such concerns have been acted upon and DS0000025964.V330722.R01.S.doc Version 5.2 Page 20 resolved. Those residents spoken to were aware of how to complain and to whom. In discussions with the manager, staff and from viewing training records it was evident that staff have received training in protection of vulnerable adults. This topic is also included in the induction programme for all new staff. There is a written policy and procedure for dealing with allegations of abuse and whistle blowing. The outcome for any adult protection referral is managed well and the registered manager works co-operatively with the Commission and the local authority to address all matters. DS0000025964.V330722.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20,22, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall atmosphere in the home is very welcoming and all areas of the home are clean, comfortable and provide residents with a safe and wellmaintained environment. EVIDENCE: General A tour of the premises was undertaken by the inspectors at the start of the visit accompanied by the deputy manager, and some areas were visited again later during the day. All areas of the home were found to be well lit, clean, pleasant and hygienic with no offensive odours. Some bedrooms were seen either by invitation of the resident, whilst others were seen because the doors were open or being cleaned. All of the bedrooms seen were very personalised DS0000025964.V330722.R01.S.doc Version 5.2 Page 22 and representative of the occupant’s interests. There is a call alarm system fitted to each bedroom, and is located within easy reach of each residents bed. Specialist equipment such as hoists and handrails were evident, and any other equipment would be provided to enable a resident to maintain independence. Whilst the standard of the décor, furnishings and fittings is generally being maintained to a good standard, some of the carpets in the communal areas need deep cleaning or replacing; wallpaper on the first floor corridor is peeling badly, and there are tiles missing from one of the bathrooms on the third floor. The refurbishment and re-decoration programme for the home must be progressed to ensure that all parts of the home are well maintained. The laundry area was visited and this was found to be clean, with soiled articles, clothing and foul linen being appropriately stored, pending washing. Laundry staff were aware of health and safety regulations with regard to handling and storage of chemicals. Personal Protective Equipment (PPE) such as clothing, gloves, masks and goggles were available and in use. Hand washing facilities are prominently sited and staff were observed to be practising an adequate standard of hand hygiene. Dementia Unit A tour of the unit was undertaken by the inspector and all areas were found to be well lit, clean, pleasant and hygienic with no offensive odours. All of the bedrooms are single with en suite toilets, and have been fitted with an emergency alarm, which is situated within easy reach of each resident’s bed. There is a mixture of suitable baths and showers, which gives a resident choice. All of the toilets were equipped with toilet paper, towels and soap, and hot water was plentiful. The manager and staff are proactive around infection control and staff have undertaken training in this important area. Residents were able to walk around the home freely without being told to “sit down” by care staff. The manager and the head of unit are in consultations with the organisation’s Dementia Care Co-ordinator around suitable signage and décor for this unit. Improvements have already been implemented such as names and photographs on bedroom doors to make these more recognisable to residents with dementia. Pictures and other types of wall hangings in this unit should be more in keeping with the memories of residents, that is pictures of the local areas as they used to be. This should also include memorabilia of the east end of London since many of the current residents spent their childhoods and adolescent years in.. DS0000025964.V330722.R01.S.doc Version 5.2 Page 23 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels are satisfactory and residents benefit from a committed staff team who have the skills, training and competence to meet the individual assessed needs of residents. The procedures for the recruitment of staff are robust and provide safeguards for the protection of residents. EVIDENCE: Staff rotas were inspected and the staffing level and skill mix of qualified nurses and care staff was sufficient to meet the assessed nursing and personal care needs of residents. Care workers were being effectively deployed to ensure that residents’ choosing, or needing to remain in their bedrooms were being cared for appropriately. Vi and John Rubens House has a relatively stable workforce and effective team working was observed and evidenced throughout the inspection. Staff interacted well, both with each other and the residents. In August 2006 the registered providers, Jewish Care implemented a 12 hour shift pattern for all staff. This transition has clearly been easier for some staff than others. However, the manager reports that staff have adapted to the new DS0000025964.V330722.R01.S.doc Version 5.2 Page 24 shift patterns and Jewish Care undertake regular audits of the impact of its implementation on the staff, residents and the overall service. From talking to staff and inspecting training records it was evident that nurses and care staff have undertaken a wide variety of training, and that such training is then put into practice within the home to the benefit of residents. Records showed that staff had undertaken training in essential areas such as fire safety, manual handling, protection of vulnerable adults and first aid. All nursing and care staff have undertaken training in dementia awareness and this had been extended to include administrative, ancillary and activities staff. Other staff training undertaken has included, loss and bereavement; administration of medicine; and working with challenging behaviour. The manager has just completed a course run by Bradford University in Dementia Mapping, and the deputy manager has recently commenced training for the Registered Managers Award (RMA). The pre-inspection questionnaire completed by the manager states that 74 of care staff are qualified to NVQ level 2 or above. A random sample of the personnel files of the five most recently recruited staff were examined. These were found to be in good order with necessary references, Criminal Records Bureau (CRB) disclosures, and application forms duly completed. It was evident that the recruitment procedures are robust and in accordance with the Care Homes Regulations. DS0000025964.V330722.R01.S.doc Version 5.2 Page 25 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 32, 33, 35, 36, 37 & 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The manager of the home is a well qualified and experienced person and residents benefit as the home is run in their best interests. Monitoring visits are undertaken regularly by the responsible individual to monitor and report on the quality of the service being provided in the home. Staff are appropriately supervised and the health, safety and welfare of service users and staff are promoted and protected. DS0000025964.V330722.R01.S.doc Version 5.2 Page 26 EVIDENCE: The registered manager has been in post since 1995 and is well qualified and experienced to manage the home. She is ably supported in clinical issues by the deputy manager, who is an experienced and suitable qualified nurse who manages/ advices on the nursing elements of the service; and two assistant heads of home that report to the manager on issues relating to the dementia and residential units of the home. All staff spoken to throughout the visit, both care and departmental staff, spoke very positively about how well supported they felt by the manager, her deputy and respective heads of home. Staff receive regular 1:1 supervision, direct observation of care practices, annual appraisals and regular staff group meetings. Mrs O’Rourke has an open and inclusive style of management and staff feel valued. She is very resident focused and works continuously to improve services and provide an increased quality of life for residents with the support of strong staff teams and in partnership with the families of residents and professionals. All staff work as a team and in such a large home the manager and her staff are to be commended for this. The home benefits from the quality assurance procedures adopted by the registered organisation, Jewish Care. Regulation 26 visits are undertaken by the responsible individual to monitor and report on the quality of the service being provided in the home, and a copy of the report is sent to the Commission. is sent to the Commission. Currently the manager does not act as an appointed agent for any resident. Residents financial affairs are managed by their relatives/ representatives. The home has responsibility for the personal allowances of several residents. There is a computerised financial system in place, which is managed by the home’s administrator. Through discussion with the administrator and records inspected, there was evidence to show that residents financial interests are safeguarded. Secure facilities are provided for the safekeeping of valuables held on behalf of residents. The maintenance records such as those for lift, gas, electrics, water and fire safety were inspected and found to be in good order. Insurance certificates where required were in place and up to date. DS0000025964.V330722.R01.S.doc Version 5.2 Page 27 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 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 Standard No Score 16 2 17 X 18 3 2 2 X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 3 3 DS0000025964.V330722.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO 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 OP7 OP8 Regulation 12 & 15 Requirement The registered manager must ensure that care plans provide staff with up to date information about residents care, to ensure that care needs are being understood and met on a daily basis. The registered manager must ensure that staff routinely record all complaints, including verbal expressions of concern or dissatisfaction, so it is clear that such concerns have been acted upon and resolved. The registered persons must ensure that the refurbishment programme for the home is progressed to ensure that all parts of the home are well maintained. Timescale for action 30/04/07 2. OP16 22 07/03/07 3. OP19 16 & 23 31/05/07 DS0000025964.V330722.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 OP1 Good Practice Recommendations Consideration must be given to providing the service users guide in an alternative format that is more accessible and easily understood by all current and prospective residents. DS0000025964.V330722.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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