Care Home: Clara Nehab House

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What the care home does well There is a good management system which ensures that services that meet the people`s needs are provided. The staff and the residents are confident that their concerns are listened to and investigated. The residents are engaged by the excellent activities organised and provided by the home. The residents` cultural, dietary, spiritual and health care needs are met by the provisions made available by the home.The residents are consulted about the quality of the services and the facilities.The staff are trained and are committed to their job to ensure that the needs of the residents are met. What has improved since the last inspection? There were no requirements at the last inspection. What the care home could do better: Even though the services and facilities of the home are good, there is a need for the home to ensure that care plans and risk assessments are completed for all residents. This ensures that the residents` needs are identified and met. It is also important that the home regularly checks the administration and recording of medication so that the residents are given correct medication on time. The home needs to put an action in place to manage falls. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Clara Nehab House 13-19 Leeside Crescent Golders Green London NW11 0DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Teferi Degeneh     Date: 2 9 0 4 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Clara Nehab House 13-19 Leeside Crescent Golders Green London NW11 0DA 02084552286 02084552120 david@lightburn99.freeserve.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Leo Baeck Housing Association Limited care home 25 Number of places (if applicable): Under 65 Over 65 25 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Clara Nehab House is registered to provide care for twenty-five older people. The Leo Baeck Housing Association operates the home. The accommodation is provided on three floors in twenty-five single en suite bedrooms. The lounge/dining room and an additional lounge is on the ground floor. The home is located in a residential area with shops and access to public transport close by. The original aim of the home was to provide care for people who had suffered Nazi oppression. Service users admitted to the home more recently may not have had that direct experience but choose to live there because the background ethos is relevant to their personal experience as the home maintains practices that meet the needs of service users from a Jewish Care Homes for Older People Page 4 of 26 Brief description of the care home background. The fees are £755 a week. This report is available through the CQC internet. Copies may also be obtained from the provider of this service. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was unannounced inspection which meant that the home did not know in advance that we were visiting. The inspection took approximately seven hours starting at 9 am and finishing at 4 pm.The manager and care manager were present throughout the inspection. The inspection activity undertaken included a tour of the building, the examination of the residents files including care records, the examination of health and safety records, the viewing of staff rotas and discussions with and observation of the people who use the service, care staff and the homes management. Two relatives who were visiting the residents were also spoken to. We also examined the homes annual quality assurance assessment (AQAA) which we requested and received from the home before Care Homes for Older People Page 6 of 26 the day of the inspection. The AQAA is a self assessment which the home is required to complete. It gives the home an opportunity to tell us what they are doing and planning to do to improve services. We have also looked at and considered all the information we have received from the home as part of our judgment of this inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents can be confident that their admission to the home is based on the outcome of their assessment and the ability of the home to meet their needs. Evidence: Five residents files were examined. All these files contained evidence of assessments completed by the home. It was also clear from discussions with the manager that the home receives, wherever possible, assessments of the residents from health professionals. From discussions with two relatives and a number of residents we confirmed that the residents have visited the home before admission. Many of the residents who completed a survey form we sent them said that they heard about the home through their friends, relatives or social workers. A number of the residents spoken to confirmed that they have lived at the home for many years and that they are happy with the services and facilities.The manager informed us that the home admits residents only if it believes that it can meet their needs. The manager said that Care Homes for Older People Page 10 of 26 Evidence: there were occasions when the home was not able to accept residents because of their needs not being able to be met by the home. Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Despite there being good systems of risk assessment and care plan reviews at the home, there is room for improvement so that all residents have up to date assessments and care plans. The medication administration and recording systems also need to be improved so that the risk to the residents is eliminated. Evidence: The five residents files we saw contained detailed risk assessments which identify risks to the residents and how to manage them. There are also care plans which are updated by the staff every month. The home keeps daily records of significant events in each residents file. The files of two new residents, who have been at the home for about two months, have assessments but no care plans. The manager informed us that the home was in the process of developing care plans for these people. We were concerned by the length of the time it has taken the home to complete care plans for these two residnets. The manager reassured us that he will go through their assessment and invite the relatives of the people to develop and review care plans for the people. Care Homes for Older People Page 12 of 26 Evidence: From obserations and discussions with the residents it was evident that they are comfortable at the home. Eleven residents were seen taking active part in an activity in the lounge. From discussions with the residents and relatives it is clear that the residents are supported to exercise. The residents are also seen by health professionals. Records in the files showed that a general practitioner (GP) comes to the home every week. The manager said that the GP has been coming to the home for the last fifteen years and that they know the residents very well. From discussions with the manager and some residents it was clear that the residents are seen by health professional in their rooms privately. Observations indicated that the staff knock on the doors before entering bedrooms. The manager infromed us that the residents have access to a district nurse, a physiotherapist, chiropodist, dentist and an optician. We observed a team meeting in which the manager reminded the staff to make sure to care for the residents oral hygiene. From the AQAA, the files and discussions with the manager it was evident that each esident has their own GP. The residents medication is prescribed by their GP and delivered to the home in blister packs. Most of the residents have their medication administered to them by the staff. A few residents who self administer their medication have been risk assessed. Medication is kept in locked cabinets in a room. The staff who administer medication have attended training. We assessed mediication and the medication administration record sheets. We noted that a medicine, which was prescribed to be given once a week for some residents, had not been signed by the staff to confirm that it was adminsitered on a Tuesday. We checked the tablets and found out that they have been given but we could not confirm whether or not they were administered to the residents as prescribed since there was no recorded evidence. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities and the food provided by the home are excellent. The peoples cultural, dietary and individual needs are met by by the excellent opportunities the home provides. Evidence: The home has a fulltime entertainment and activities organiser. On the day of the inspection eleven residents were seen participating in activities provided in the lounge. The residents said they enjoy and look forward to the activities. From the activities programme and discussions with the staff and residents it was confirmed that the activities are varied and reflect the needs of the residents. The residents said that the activities included games, art and culture therapies, cinemas, yoga classes, exercise groups, scrabble club, concerts, trips to different places of interest, reminiscence classes, one to one interaction and shopping experiences. From records and discussions with the manager we learnt that some people come to the home to conduct weekly religious services. Children from local schools also come to the home to sing for the residents. Many residents we spoke to said that they are visited by their relatives or friends. On Care Homes for Older People Page 14 of 26 Evidence: the day of the inspection two relatives were seen coming to the home. These relatives told us that they regularly visit the residents. They said that they can see the residents in private in their bedrooms and that they are happy with the way the staff welcomed them. A resident said they have a telephone in their room which they use to contact their relatives. It was evident from observations and discussions with the residents that the residents are able to access all parts of the communal areas. There is a passenger lift and stairlift for the residents with a mobility difficulty. A resident was seen going out and returning independently from the local shops. The manager said that the residents are registered on the electoral roll and have been able to vote either by post or in person. A service user told us that they can go to bed and get up at a time of their choice. There is a lockable safe in each of the rooms even though most of the residents do not use them. The manager said personal allowances are given to the home and the residents are supported to obtain extra items such as toiletries or services such as hairdressing. The receipts and records of the residents money are kept by the home. There is an eight week rotating menu. The home has two chefs who are supported by a general assistant. The chef we spoke to told as that they have worked at the home for over ten years. The manager confirmed that the residents are consulted about the meals and each resident can expect to get what they want. The dietary needs and food preferences of the residents are identified in the files we checked. About fifty percent of the resident who completed and returned the survey questionnaires said that they always liked the meals while a third of them said they usually liked the meals. Most of the residents we spoke to said they were satisfied with the meals. One resident said the meals could be improved. The lunch served on the day of the inspection reflected the menu of the day. The meals were freshly prepared and care staff were present to support the residents who needed help with their meals. The lounge, which is also used as a dining room, was well decorated to reflect a special occasion on the day. The meals were varied and nutritious. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can be confident that their concerns can be listened to and dealt with to their satisfaction. The residents can be sure that they are protected from abuse by the homes policies, procedures and practices. Evidence: The AQAA states that the home makes people aware of the complaints procedure and keeps records of complaints. A number of the residents spoken to confirmed that they know how to complain if they have a concern. The relatives spoken to also said that they talk to the staff or the manager if they have a complaint. The home has a complaints policy a copy of which is displayed on the wall by the main entrance. The manager said all complaints are taken seriously and dealt with. The complaints book showed that there have no recorded complaints since the December 2007. The manager confirmed that the home has obtained the local authoritys safeguarding Adults policies and procedures. He also said that the staff have attended training on safeguarding. Evidence of staff training on adult protection was available in staff files. Two care staff who were interviewed individually were able to explain the action they need to take to make sure that the residents are safeguarded from abuse. They confirmed that they have read and understand the homes policies and procedures on safeguarding and whistle blowing. Care Homes for Older People Page 16 of 26 Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The facilities and the equipment of the home are good. These have enabled the residents to live in a safe and comfortable environment. Evidence: The home was clean, bright and tidy. The corridors are wide and have facilities for the residents. There are domestic staff to clean and rooms and to ensure that the facilities and equipment are maintained. The visitors spoken to said they have always found the home clean and tidy. A visitor said the home is spotless. A sample of bedrooms seen were all large and well furnished and personalised with pictures and personal items. As mentioned above one resident we takled to has a private telephone line which they use to talk to friends and relatives. The home is located in a quiet residential area. There is a space for car parking for the staff and visitors at the front and there is a well looked after garden at the back of the building. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use the service can be confident that their needs can be met by the homes robust staff recruitment, training, and deployment practices. Evidence: The residents we spoke to told us that the staff are good and they treat them with respect and dignity. Observations showed that the staff provide care in a way that meets the residents needs. Two staff members were seen talking to and helping residents during an activity programme in the lounge. It was noticed that the staff were skillful in communicating with the residents and in giving them time and support each person needed. We randomly chose and checked five staff files. All these files contained evidence of written references, criminal record bureau (CRB) checks, contracts, application forms and certificates of training. The manager confirmed that the home has a recruitment procedure which requires that jobs are advertised and staff are selected through interviews. The home has a policy on equal opportunities. We spoke to two members of staff individually. Both the staff were able to demonstrate their good knowledge and skill of supporting older people in a care home setting. The rota, which was checked, showed that there are four care staff, a care manager, activities coordinator, and the registered manager during the day. There are also other Care Homes for Older People Page 19 of 26 Evidence: members of staff such as a cook, a kitchen assistant, a handyperson and a cleaner. The night shift is covered by two waking night staff. The manager said that a group of people come to the home as volunteers to support the residents. The home has a training programme and discussions with the manager and the AQAA showed that a number of staff have achieved a care qualification equivalent to the national vocational qualification (NVQ) level 2. From conversation with some staff and the manager it was evident that some staff have embarked on a training programme to achieve a similar care qualification. We observed a staff meeting which was attended by eleven people. In this meeting the manager discussed various issues about management and care. We noticed that the staff were able share information and contribute to the smooth running of the home. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good management and quality assurance systems to ensure that the residents views are listened to and quality services and facilities are provided to meet individual needs. Despite the efforts the home is taking to manage falls, the residents health and safety are not fully guaranteed. Evidence: The manager has been at the home for the last seven years. He said he has been a senior manager of the organisation before taking up this post. The manager is responsible for the overall management of the home. A care manager supports the manager. The care manager is responsible for assessments, care plans and the care management. Both the registered manager and the care manager have a long experience of managing care homes. The staff and residents spoke positively about them. There is an administrator who keeps records and accounts such as petty cash or money that is used on a daily basis. As mentioned earlier the home does not manage the residents finances. Care Homes for Older People Page 21 of 26 Evidence: The home has a system of quality assurance. This includes a formal quality assurance questionnaire which is distributed to the residents, relatives, staff and visitors of the home. A sample of the last feedback was seen and this showed that the people were able to give their views about the services and the facilities. For example, a relative wrote: I am very happy with the care and attention given to my [relative] since [they were] admitted to the home last year. Another person commented that the lift was unsatisfactory. The manager said that a quality group which comprises residents, families, volunteers and the staff has been set up to examine the outcome of the feedback and make recommendations as to how to address issues and make improvement. There is also a house committee which regularly meets to discuss issues of common concern to the residents and make recommendations. As mentioned above the home has a handy person. The manager said the handy person ensures the maintenance of the facilities and equipment. The manager confirmed in the AQAA that all electrical equipment and other facilities are either checked or serviced to ensure that they are safe to be used. Records of maintenance and certificates of safety are kept by the handy person. The residents files showed that risk assessments and care plans have been completed and reviewed for most of the residents. We checked the incident and accident records and found out that there have been twenty six recorded incidents from January 2009 up to the date of the inspection. Most of these incidents involved falls of some residents. Discussions with the manager showed that action is being taken to manage the residents falls. During the tour of the premises we noted that the home uses break glasses in fire exit doors. The manager said this was to stop some people [staff] from leaving the home through fire doors. We were concerned whether this was appropriate and if the staff knew how to break the glass in case of fire. We asked the manager to consult the local fire officers about this. After consulting the local fire officers, the manager sent as an email confirming that the use of such a device is perfectly acceptable on doors. The manager also confirmed that he has included the use of this device in the homes fire risk assessment and will immediately instruct all staff what to do in a fire emergency case. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 Care plans must be completed and reviewed for all the residents. This will ensure that the residents needs are identified and met by the home. 30/06/2009 2 9 13 There must be audit of medication administration and recording. This ensures that the right medication is given to the residents at the right time time. 31/05/2009 3 38 13 Action must be taken to reduce, eliminate and manage falls effectively. This will reduce risks to the residents and ensures that they are safe in the home. 31/05/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of Care Homes for Older People Page 24 of 26 improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!