Care Home: Ella & Ridley Jacobs House

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What the care home does well What has improved since the last inspection? At the last inspection, fourteen requirements were made. Thirteen were fully complied with and one was partly met. The home is commended for working hard to improve the service, which included the following: Where appropriate, all residents have a nutritional assessment when they are admitted to the home and they are weighed each month as part of monitoring their care. Health records have been improved to ensure that dental and optical checks are carried out on a regular basis. There is an appropriate risk assessment in place for a resident who selfmedicates to ensure they do so safely. All staff have received training on adult protection or are booked to go on this course in the near future, which is important to protect residents from abuse. The front reception area has been refurbished and creates a positive, attractive impression of the home and old curtains and bedspreads in the bedrooms have been replaced with matching ones that improve their appearance. The lighting in the upstairs corridor areas has been much improved for the safety of the residents. There had been unpleasant odours in some bedrooms, but these have been eradicated by better continence management and more appropriate floor covering. Staff files now include a signed contract of employment. The staff have regular supervision and complete a period of induction, to ensure that they are properly prepared for their roles as carers. There is also a comprehensive training programme to meet their training needs. An action plan was implemented in response to the views expressed by residents and relatives in a quality assurance audit that was conducted last year by Jewish Care. A fire safety risk assessment of the building was completed. All catering staff have current food hygiene certificates to safeguard the welfare of the residents and staff. What the care home could do better: Areas that need improvement have been identified in this report, for which requirements and recommendations have been made. At present, only residents who are funding their care privately have detailed contracts that show all the costs involved in their care. It is required that all residents must be given contracts that clearly outline the costs, terms and conditions of residence even if they are funded by local authorities. This ensures that everyone is aware about periods of notice for terminating the contract and what any additional costs are for. Residents` care plans must be reviewed at least monthly to take account of any changes in the person`s needs. Better hygiene is required in the kitchen, which must be kept clean at all times but must not be swept while food is being prepared. In addition, the shutter in the kitchen must be repaired, and all the requirements made in the report from the local environmental health officer (10 October 2006) must be complied with. Steps must be taken to ensure that the garden pond does not present a hazard to residents` or visitors` safety. All these issues must be addressed to protect the health and safety of residents, staff and visitors. A review of staffing levels must be carried out and there must be better deployment of staff to ensure that residents are fully supported, especially at meal times and other busy periods in the home. To fully inform potential service users about good practice, the home`s Statement of Purpose and Service User Guide should include the fact that end of life care can be provided in the home if requested by service users or their representatives. The complaints log should be signed off by the registered person who carries out monthly monitoring visits and complaints should be logged in a way that enables an audit to be carried out and makes it easy to check if complainants are satisfied with outcomes to their complaints. CARE HOMES FOR OLDER PEOPLE Ella & Ridley Jacobs House 19-25 Church Road Hendon London NW4 4EB Lead Inspector Tom McKervey Key Unannounced Inspection 9:00 29 & 30th October 2007 th 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 Ella & Ridley Jacobs House DS0000010428.V337001.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. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ella & Ridley Jacobs House Address 19-25 Church Road Hendon London NW4 4EB 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) 020 8203 5368 020 8201 5254 Jewish Care Miss Natasha Jane Carson Care Home 48 Category(ies) of Dementia - over 65 years of age (48), Old age, registration, with number not falling within any other category (48) of places Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 48 adults of either gender over the age of 65 years some of whom may have dementia. 8th May 2006 Date of last inspection Brief Description of the Service: Ella and Ridley Jacobs House, which is operated by Jewish Care, is registered to provide personal care for up to 48 older people some of whom have problems associated with dementia or confusion. The environment and lifestyle reflect the Jewish culture and way of life. The home is purpose built and is located in a busy suburban area known as The Burroughs near Hendon Town Hall. There is a small car park at the front of the home, which is very convenient for local shops. The home is easily accessible by public transport. The stated aims of the home are to meet the needs of 47 elderly frail Jewish service users and provide respite care for one person. People who live in the home, relatives and friends are invited to parties at Jewish festival times. There are two “friends committees” who regularly hold events and raise money to ensure that the residents have the best possible care. There is also a small group of volunteers who visit and manage a trolley shop for the service users. The home uses the Jewish Care quality assurance process to monitor the care of residents and the support and development of staff, by arranging visits by lay assessors and undertaking questionnaires that seek the views of everyone involved in the service. The home comprises of six floors. On the ground floor, there is a front and a rear lounge, each with a dining area. Also located on the ground floor is, the kitchen a synagogue, staff office, (which is also a medical examination room), and an activities area/meeting room. All bedrooms are upstairs and they are accessed by passenger lifts. The current range of fees in the home is £450 to £706 per week depending on the individual needs of the residents. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days and was completed in thirteen hours and twenty minutes. The visit was part of the Commission’s inspection programme to check compliance with the key standards and to look at how the home was progressing in meeting requirements from the last inspection, which took place in May 2006. I was assisted by my inspector colleague, Daniel Lim on the first day, and by Sue Mitchell, my regulation manager from the Commission for Social Care Inspection, on the second day. The registered manager of the home was present throughout the inspection and we also met two senior managers from Jewish Care, all of whom offered every assistance with the inspection. Before this inspection, the manager sent me an AQAA, (Annual Quality Assurance Audit), which is a self-assessment of how the home meets the National Minimum Standards. Against each standard, the manager is asked to provide evidence about what the home does well, what they could do better, how they have improved in the last 12 months and what their plans are for improvement. The manager is commended for providing such comprehensive information in her submission, which is also referred to in appropriate sections of this report The inspection process included visiting all areas of the home, reading residents’ case files and other records, and discussing with them about their experiences of living in the home. Several staff were also interviewed about their work and how they were supported, and their records were examined. Questionnaires from the Commission were also used to seek residents and relatives’ views about the service. These were returned to me shortly after the inspection and are referred to throughout this report. During the two days, we observed how the staff interacted with the residents when providing care and support. . What the service does well: The manager and her staff were able to demonstrate a good understanding of the residents’ needs. People who live in the home and their families value the ethos of the home, particularly within the context of their religious and cultural backgrounds. The home has its own synagogue, which the local community is welcome to attend. This provides an excellent opportunity for residents to meet and associate with many people from outside the home, who have similar backgrounds. There is good information available about the service to help people decide if the home can meet their needs. In the past year, the service has been Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 6 extended to include end of life care when this was requested by the residents and their relatives. Ella and Ridley Jacob House presents as very homely and welcoming to visitors and although there was a busy atmosphere, the interaction between staff, residents and visitors was very relaxed and friendly. The home has strong links with the local Jewish community, as evidenced by the number of volunteers who visit and support the residents. There are good security and health and safety systems in place to safeguard the people who live in the home and their visitors from harm. The residents are consulted in various ways about their care; for example, by meetings, “food forums” and annual audits of their views by Jewish Care. The home is well maintained and there is an ongoing programme of improvement to the furnishings and décor. There is a high level of satisfaction with the food and the activities that are provided, which include holistic therapies and reminiscence sessions. What has improved since the last inspection? At the last inspection, fourteen requirements were made. Thirteen were fully complied with and one was partly met. The home is commended for working hard to improve the service, which included the following: Where appropriate, all residents have a nutritional assessment when they are admitted to the home and they are weighed each month as part of monitoring their care. Health records have been improved to ensure that dental and optical checks are carried out on a regular basis. There is an appropriate risk assessment in place for a resident who selfmedicates to ensure they do so safely. All staff have received training on adult protection or are booked to go on this course in the near future, which is important to protect residents from abuse. The front reception area has been refurbished and creates a positive, attractive impression of the home and old curtains and bedspreads in the bedrooms have been replaced with matching ones that improve their appearance. The lighting in the upstairs corridor areas has been much improved for the safety of the residents. There had been unpleasant odours in some bedrooms, but these have been eradicated by better continence management and more appropriate floor covering. Staff files now include a signed contract of employment. The staff have regular supervision and complete a period of induction, to ensure that they are properly prepared for their roles as carers. There is also a comprehensive training programme to meet their training needs. An action plan was implemented in response to the views expressed by residents and relatives in a quality assurance audit that was conducted last year by Jewish Care. A fire safety risk assessment of the building was completed. All catering staff have current food hygiene certificates to safeguard the welfare of the residents and staff. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 7 What they could do better: Areas that need improvement have been identified in this report, for which requirements and recommendations have been made. At present, only residents who are funding their care privately have detailed contracts that show all the costs involved in their care. It is required that all residents must be given contracts that clearly outline the costs, terms and conditions of residence even if they are funded by local authorities. This ensures that everyone is aware about periods of notice for terminating the contract and what any additional costs are for. Residents’ care plans must be reviewed at least monthly to take account of any changes in the person’s needs. Better hygiene is required in the kitchen, which must be kept clean at all times but must not be swept while food is being prepared. In addition, the shutter in the kitchen must be repaired, and all the requirements made in the report from the local environmental health officer (10 October 2006) must be complied with. Steps must be taken to ensure that the garden pond does not present a hazard to residents’ or visitors’ safety. All these issues must be addressed to protect the health and safety of residents, staff and visitors. A review of staffing levels must be carried out and there must be better deployment of staff to ensure that residents are fully supported, especially at meal times and other busy periods in the home. To fully inform potential service users about good practice, the home’s Statement of Purpose and Service User Guide should include the fact that end of life care can be provided in the home if requested by service users or their representatives. The complaints log should be signed off by the registered person who carries out monthly monitoring visits and complaints should be logged in a way that enables an audit to be carried out and makes it easy to check if complainants are satisfied with outcomes to their complaints. 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. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 8 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 Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 9 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): 1, 2 & 3 (Standard 6 does not apply). People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service, looking at residents’ case files and receiving comments from relatives. There is good information available about the service to help people decide if the home can meet their needs, but the information could be improved by stating that end of life care can also be provided if appropriate to peoples’ wishes. Potential service users can be confident that their needs will be properly assessed to ensure that the home can meet their needs. Self-funding residents have contracts that inform them about fees and terms and conditions of the service. However, residents whose care is funded by local authorities, do not have such contracts, which could prevent them from being aware of what is covered by their top-up contributions to the cost of care. EVIDENCE: Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 10 We looked at the information for residents that the home provides, which was available in all the bedrooms. This included the home’s “Statement of Purpose” and “Service User Guide”. The information was written in a clear style, and gave a good picture of the type of service provided. I was informed that in the past year, terminal care had been provided for two people at theirs’ and relatives’ wishes, rather than going into hospital for terminal care. The Statement of Purpose and Service User Guide should be updated to state that end of life care can be provided if people wish this. Most of the comments from relatives were very positive about the home, some of which were in the form of written questionnaires from the Commission, for example; “ The home provides a caring environment where my father is safe, well cared for physically and socially. Most importantly, he is happy, all of which, is a great worry lifted from my shoulders. I cannot praise them enough”. Another relative stated, “ The care home looks after my mother’s needs well in all respects”. However, there were some reservations expressed by relatives about staffing levels not being sufficient to meet the needs of residents who have dementia. This issue is addressed under the Staffing standards in this report. We looked at several residents’ case notes, which included an assessment prepared by the Jewish Care social work team before the person was admitted. These were comprehensive and addressed all the person’s needs. There are two types of service contracts; one from the local authority where it funds the placement, and a separate one from Jewish Care for people who fund their own care privately. Samples of these two types of contracts were looked at in detail. The local authority contracts, although comprehensive, refer primarily to the fees they pay for the service the home provides. People who are funded by the local authorities do not have a separate “terms and conditions of residence contract” with the home. Residents who are self funding however, have a contract that details the fees and gives details about any additional charges for items that are not covered by the fees. It also itemises the services and the facilities provided by the home. These documents were also clear about house ”rules” and gave examples of when a person may be asked to leave the home. The two types of contract were discussed with the manager and she was advised that all residents must have clear terms and conditions of residence contracts even if they are funded by local authorities. This would make all residents and their relatives aware of the specific services being offered and what top-up funding they might need to contribute for things not covered by the fees. (The contract for self-funding residents could be adapted for local authority funded residents.) Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 11 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): All these standards were assessed. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including looking at residents’ records, interviews and observing staff providing support. The health, personal and social needs of residents are recorded in individual care plans and these needs are generally being met. However, the care plans need to be reviewed more regularly to take account of any changes in the person’s needs. Medication is stored and administered safely, which ensures that residents are protected from harm. Staff treat residents with dignity and respect and they can be confident that at the end of their lives, they will be treated with care and sensitivity. EVIDENCE: I sampled four care plans at random. Each resident had individual care plans based on the “Roper, Tierney, Logan” model which provides a holistic assessment of individual needs. These include memory loss, nutrition, physical and emotional aspects. Where residents had specific needs, for example Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 12 dementia, the care plans addressed these. The care plans however, were not all being reviewed on a monthly basis, which is necessary to monitor any changes in the resident’s health. In some cases, I saw dated entries that just stated; “continue with the care plan”, which indicated that they were not being properly updated. I advised the manager to address this matter. The staff office doubles as an examination room, which the G.P and district nurse use to see and treat the residents. The case notes included good records of health care assessments including nutritional and pressure care assessments. Any risks identified were documented and appropriate actions were put in place, for example, pressure care pads and mattresses were provided for people at risk of developing pressure ulcers. Appointments with chiropodists, opticians and dentists were well documented and there were records showing that residents had their weight checked regularly. I observed that staff used hoists appropriately for moving residents safely who had mobility problems. The medication charts were examined. These indicated that medication had been administered as prescribed. The temperature records of the fridge and the room where medication was stored had been recorded daily and were satisfactory. Residents confirmed that they are given their daily medication. The case records of a resident who administers her own medication, contains an appropriate risk assessment, which was signed by the person’s G.P and the resident. During the two days of inspection, some twenty residents and twelve relatives were spoken to by the inspectors. All those spoken to, said they were well cared for by dedicated staff. They also appreciated being contacted when residents had been seen by the doctor. These were some of the comments from residents; “The staff are very nice, they treat me with respect and help me to have a bath when I want”. “It’s very nice here, the food is very good and the staff care about me”. “Highly satisfied and I’m happy to be here”. Examples of comments from relatives who were spoken to; “ The care is excellent, the staff can’t do enough for my mum”. Several relatives also sent the following written comments that were complimentary; “All the staff treat my mother in a kind and caring way and encourage her to participate in any activities and outings”. “Every effort is made to meet the individual needs of the residents, both physically, cultural and socially”. “Care is generally good and considerate. The food is good and freshly prepared”. In response to the question-“what do you feel the home does well?” a relative stated; “Everything; I think they are wonderful and always keep in touch. I am very grateful my dad has a place there”. It needs to be borne in mind however, that many of the comments received, also referred to concerns about the perceived shortage of staff. Volunteers, who spend significant time with the residents were also spoken to. They stated that the standard of care in the home was very good. Residents who were spoken to said that the staff treated them with dignity and respect, especially when supporting them with personal care needs. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 13 I observed staff supporting some residents to eat at meal times. This was generally done well and the member of staff spoke to the resident while supporting them. However, in one instance I reported to the manager that an agency staff was not appropriately supporting a resident to eat. She dealt with this immediately by contacting the agency and this person will not be accepted back to work at the home. The wishes of residents and/or their representatives regarding their funeral arrangements are documented. Recently, two residents had received terminal care at theirs’ and relatives’ wishes, and died at the home, rather than going into hospital for terminal care. I saw letters of appreciation and thanks from relatives of deceased residents for the care they had received in the home. In her AQAA, the manager stated that she intends to further develop end of life care to meet residents and relatives’ wishes. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 14 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): All these standards were assessed. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including interviews with residents and staff, observation and looking at records. The residents enjoy a lifestyle that meets their expectations and satisfies their social, cultural and religious needs. Contact with friends and relatives and the wider community is positively encouraged and residents are supported to exercise choice and to influence the running of the home as far as possible. The food in the home is wholesome and nutritious and meets the residents’ cultural needs. EVIDENCE: When people are admitted to the home, their life histories, interests, likes and dislikes are recorded and their activities are largely matched to their identified needs. The majority of the residents are Orthodox Jews, for whom their culture and religion is of great importance. Therefore, there is an emphasis on observing these important dates in the Jewish calendar. There is a synagogue in the Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 15 home, which the local Jewish population also attend, thereby ensuring the prominence of the home in the community. There are two “friends committees” that hold fund-raising events and there is a group of volunteers who visit the residents and man the reception desk for periods. The manager informed me that the activities organiser had gone on maternity leave, but a replacement had been appointed and was due to start work in the next few weeks. From discussions with residents and relatives, it was apparent that they missed some of the activities they had enjoyed previously. However, social activities that were still being provided, included bingo, outside entertainers and visits from local schools and other community groups. A small lounge has been set aside as a reminiscence room and is furnished with sensory equipment to provide a tranquil environment for relaxation or stimulation. A dramatherapist provides weekly sessions and a holistic therapist whom I met, provides sessions for groups and also for individuals, particularly those with dementia. These sessions include yoga, massage and reflexology, all of which are tailored to the individual’s needs. I observed the therapist in a “touch therapy” session with a person with dementia and it was apparent that the resident was deriving great benefit from this. Residents’ and committee meetings are held, which ensures that residents are able to actively take part in the running of the home. The residents spoken to said they were able to choose the activities they want to join or opt out of. Some people told me they prefer to do their own thing and go out a lot to the local shops and amenities. However, some relatives commented that more activities could be provided, particularly at weekends. During the two days of inspection there were many visitors to the home and the atmosphere, although very busy, was relaxed and friendly with much laughter and conversation between visitors, residents and staff. Residents can see their relatives in their rooms or in the lounges. The manager informed me that there is a quarterly relatives meeting and a monthly newsletter is produced to inform everyone about events in the home. The food is provided by a catering company called Eurest, which has a contract with other Jewish Care homes for cleaning and catering. The menus showed that meals were well balanced, appropriate for the season, and reflected the ethnic preferences of residents. Fresh fruit was available, and I was told that the residents can have hot or cold drinks at any time. The majority of residents spoken to were satisfied with the Kosher diet and “food forums” are attended by the head chef to obtain regular feedback from the residents about the food. Residents interviewed, indicated that they were satisfied with their meals. Food hygiene training had been provided for staff and was documented in staff records. During meal times, tablecloths and condiments were put on the dining tables, and there was a relaxed and pleasant environment for residents to enjoy their meals. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 16 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): 16 & 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including interviews with residents, relatives and staff and examining complaints records. Complaints and concerns are taken seriously and the majority of residents and their representatives have confidence that concerns are properly investigated and responded to. The logging of complaints could be improved by crossreferencing the file so that outcomes for the complainant are clear. The staff are aware of, and are trained in the subject of abuse, so residents can be confident that their best interests are protected. EVIDENCE: The home has a robust complaints procedure, and complaints that were recorded in the files were noted to have been responded to within the agreed timescales. According to the AQAA document, Jewish Care has a quality assurance manager who is involved when a serious complaint is made. It is strongly recommended that the manager keeps a log of the complaints received by cross referencing them to the file so that an audit trail can be kept of complaints logged and the outcomes. It would also be helpful to have a section on whether the complainant was satisfied with the outcome and any action needed if this was not so. Complaints are kept in files in date order. Some were recorded on the home’s complaints form. It was noted that there was a section on the form that Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 17 required the complaint to be signed off by the Responsible Individual, (R.I.). These had not been done. It is recommended that the RI signs complaints off on their monthly visits to check that they have all been dealt with satisfactorily. Other complaints were in the form of e mails/ letters/ notes from relatives wishing to either complain or raise concerns with the manager about a range of issues for her to address. Some of these had been copied to head office staff and their responses to these complaints were also in the file. One relative has some ongoing issues with the organisation / manager regarding the care of their relative. There was a comprehensive record of these concerns and the responses, from both the manager and head office. It was evident that both the organisation and the manager took each issue raised seriously and made every attempt to resolve the concerns. Meetings had also been held with the complainant to try to resolve the issues raised. A complaint was made to the Commission for Social Care Inspection by a relative of a resident who had lived at the home and had died some time ago. This had been recorded and investigated at the time, but the complainant had recently contacted the Commission and stated that they were not satisfied with how the matter had been dealt with. This complaint was forwarded to the manager to respond to, and at the time of the inspection, the manager was intending to arrange a meeting with the complainant as part of her further investigation. Over the two days of the inspection, many residents and relatives were interviewed and all expressed a high level of satisfaction with the service and said they were confident that any concerns would be addressed promptly. The home has its own and the local authority’s adult protection policy and procedure. Staff who were interviewed, said they had received training about abuse issues and I was satisfied that they would be able to recognise and respond appropriately to any concerns in this area. The staff training records showed that all had been already trained or were booked on an adult protection course in the next few weeks. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 18 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): 19, 20, 21, 22, 23, 24 & 26 People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including visiting all areas of the home. The residents live in a home that is generally well maintained, clean and smells fresh. However, the environment and hygiene in the kitchen must be improved to protect the health and safety of the residents and staff. Residents are able to bring personal possessions with them into the home and they have comfortable and pleasant bedrooms. There are sufficient, wellequipped facilities provided for the residents’ comfort. EVIDENCE: The home is purpose built over six floors, including the ground floor. Since the last inspection, the reception area has been refurbished and presents an attractive entrance to the home. Visitors to the home have to gain entry by Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 19 ringing the bell and be admitted by the receptionist. Exit is effected by a key pad which protects the more vulnerable residents from wandering out of the home. My colleague and I visited all areas of the home, including several bedrooms on each floor. There is easy access to an attractive garden at the rear of the property. The pond in the garden was full of water at the time of the inspection, which could be a safety hazard to either residents or their visitors (who may include children). This was brought to the attention of the manager and the maintenance person and since the inspection, I have been informed that action has been taken to make the pond safe. There are two large lounges and two smaller ones. One room is used as a synagogue and another has been converted into a reminiscence room. There are two separate dining areas and a central kitchen on the ground floor. Residents’ and visitors’ toilets and the laundry are also located on the ground floor. The upper floors are bedroom and bathroom areas, accessible by two lifts. Each floor has suitable bathing facilities with hoists and adaptable baths for people with mobility difficulties. The lounges were well decorated and the furniture was of a good standard with footstools provided in many instances. The AQAA states that residents were involved in selecting new furniture for the lounges and reception area. The bedrooms were bright and airy and there was evidence of personal possessions, including family photographs and other mementoes. There were many new beds, which the manager said had been funded from a donation to the home. Some of the beds had integral rails to safeguard residents from falling out. Risk assessments had been carried out on the bed rails and consent was obtained for their use. I noted that since the last inspection there have been several improvements including, much brighter lighting in the bedroom corridors. Several bedrooms had been redecorated and new matching curtains and bed linen has been provided. With new flooring in some bedrooms, improved continence management and Ozone units, the bedroom areas smelt pleasant and were very clean and tidy. The laundry was well equipped and appeared well organised. A maintenance person works at the home for four days per week, which ensures that requests for minor repairs are dealt with promptly. The kitchen was also well equipped and properly demarcated to observe Kosher principles. However, on the first day of the inspection the inspector noted that the kitchen was being swept with a brush while lunch was being prepared. This compromises food hygiene and may result in food contamination. A requirement is made for the registered person to ensure that this is not done when food is being prepared. Some food debris was seen on the floor of the kitchen and under the cookers and cupboards. This was brought to the attention of the chef, who agreed that it would be kept clean at all times. Some areas of the kitchen were in a state of disrepair; (paint peeling off, a tile was missing and the shutter was damaged). These were discussed with the chef and catering manager and a requirement is made for repairs to be carried Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 20 out to areas identified. It was also noted that a report from the local environmental health officer (10 October 2006) identified similar deficiencies, not all of which had been responded to. A requirement is therefore made for all requirements made in that report to be complied with. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 21 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): All these standards were assessed. People who use this service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. At times, there are insufficient care staff available to meet residents’ needs, particularly at busy times of the day, but the residents can be confident that the staff are well trained and properly screened to protect their welfare and best interests. EVIDENCE: The staff shift pattern was changed to twelve-hour shifts in August 2006 to provide better continuity of care during the day. The duty rota was examined and staffing levels were discussed with the manager, residents and relatives. The rota indicated that in addition to the manager and her deputy and ancillary staff, there was normally at least 10 care staff during the morning shift, 9 care staff during the afternoon and 5 care staff on waking duty during the night shifts. Ancillary staff working at the home consist of kitchen and laundry staff, cleaners and a maintenance person. Although this is an improvement on the care staffing levels identified at the last inspection, relatives expressed a common concern that there were not enough staff to assist residents who needed support with personal care. On the first day of the inspection, I noted that there were only three care staff and a team leader in the rear lounge. I was informed that a staff had gone sick Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 22 at short notice that day. At lunchtime, I observed that three residents who needed staff support to eat, were waiting until someone was available to help. I also observed that these residents’ food was going cold, which could have been avoided if their meals had been served when they were ready to eat. It seemed that the residents’ lunchtime coincided with the administration of midday medicines and staffs’ breaks, which left few staff available at such a busy time. These problems could have been minimised by better organisation of the staffs’ duties. Staff who were interviewed, said that staffing levels were not always adequate and they did not always work as a team. They further indicated that they were dissatisfied about poor organisation of their breaks. I have asked the manager to address these issues. As stated elsewhere in this report, the residents and relatives who were interviewed indicated that the staff were respectful and caring, but expressed concern about the number of staff available to support highly dependent residents I am making a requirement for staff levels and organisation of duties to be reviewed and amended to meet residents’ needs at the busiest periods of the day. Staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities and the care to be provided to residents. The staff said that they were made aware at their induction, of the need to treat residents with respect and dignity regardless of their race, religion or sexual orientation. The home has a mission statement to this effect. Some staff informed the inspector that they had been subject to verbal abuse from certain residents and relatives. This was brought to the attention of the manager. To ensure that staff are able to deal appropriately with these issues, the organisation is advised to provide a procedure for staff about how to deal with such incidents. A staff training spreadsheet was available for inspection. The staffs’ training records indicated that they had been given training in the mandatory subjects, such as health & safety, moving & handling, care of residents with dementia. fire training and adult protection. Jewish Care sponsors adult literacy courses for staff whose first language is not English, to improve their writing skills. Other staff training includes dementia care and National Vocational Qualifications. A sample of three recruitment records showed that proper recruitment procedures (including obtaining of satisfactory CRB disclosures and two references) had been followed. This indicates that staff recruitment procedures are thorough and residents are protected. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 23 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): 31, 33, 36 & 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents and their representatives can be confident that the home is managed by an experienced and competent person. They are consulted about the service and their views are respected and acted upon. There are appropriate systems in place to safeguard the welfare, health and safety of residents, staff and visitors to the home. However, staff need to be protected from harassment and/or abuse from residents and/or visitors. EVIDENCE: Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 24 The manager is a qualified social worker and has been in post since May 2005, having previously worked for Jewish Care for some eight years. She is also registered with the Commission for Social Care Inspection. Throughout the inspection, the manager demonstrated a good knowledge of the home and the needs of the residents. she also showed a commitment to improving and maintaining a high quality service which was also evident in the AQAA she submitted to the Commission. The manager was open to the constructive comments given at the end of the inspection. Feedback from the majority of residents, relatives and staff was positive about the manager and how she managed the home. This is reflected in the many letters of appreciation and verbal and written comments from residents and their relatives. However, some relatives remained dissatisfied about how the manager responded to their complaints and some staff said she was sometimes not very sympathetic to their concerns. The inspectors pointed out these issues to the manager who agreed to respond in a sensitive manner. These issues will be reviewed at subsequent inspections. Jewish Care has a quality assurance system based on an ongoing programme of audits and questionnaires. I saw an action plan to address the issues identified in last year’s audit which had for example, led to one extra staff being employed on each shift. At the time of this inspection, the results of this year’s audit were being compiled. A senior manager from Jewish Care carries out an unannounced monthly visit to the home to monitor the service and sends a report of their findings to the Commission for Social Care Inspection. Resident and relative meetings and staff meetings are held regularly to inform and involve everyone as much as possible in the running of the home. The staff said that they had regular one-to-one supervision with their line managers. This was confirmed by evidence in their files. They also had a contract of employment. Some staff informed the inspectors that sometimes they are subject to harassment and verbal abuse from some residents and visitors. This was brought to the attention of the manager. A policy should be provided to ensure that staff know what to do when this type of behaviour occurs. As required, fire drills (including a night drill) and fire training had been carried out and documented. There were records of the fire alarms being tested weekly and monthly emergency lighting checks are being carried out. Safety inspection certificates for the portable appliances and other equipment used in the home were seen. These were up to date. Safety inspections had also been carried out on the gas installations, lift, hoists and the electrical installations. The fire risk assessment was just out of date but we were informed that an assessment had just been carried out and the new this was in the process of being completed. The home has a current certificate of insurance. Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 25 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 3 17 X 18 3 3 3 3 X 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X X X X 3 Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 26 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 OP2 Timescale for action 5(1) All residents must have clear 31/12/07 terms and conditions of residence contracts even if they are funded by local authorities. 15(2)(b)(c Residents care plans must be 30/11/07 ) reviewed at least monthly to take account of any changes in the person’s needs. 13(4)(c) 16(2)(g) 23(2((d) 13(4)(c) 16(2)(g) 23(2((d) The kitchen must be kept clean 13/11/07 at all times. All requirements made in the 13/12/07 report from the local environmental health officer (10 October 2006) must be complied with. The kitchen floor must not be 13/12/07 swept while food is being prepared. The shutter in the kitchen must 31/12/07 be repaired. A review of staffing levels and 31/12/07 how the staff are deployed must be carried out to ensure that residents’ are fully supported at DS0000010428.V337001.R01.S.doc Version 5.2 Page 27 Regulation Requirement 2. OP7 3. 4. OP15 OP15 5. OP15 13(4)(c) 16(2)(g) 23(2((d) 23(2)(b) 18(1)(a) 6. 7. OP19 OP27 Ella & Ridley Jacobs House 8. OP38 13(4) busy times of the day. This requirement is amended and restated from the last inspection. The previous timescale was 15/06/06. Steps must be taken to ensure 30/11/07 that the garden pond does not present a hazard to residents’ or visitors’ safety. 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 The Statement of Purpose and Service User Guide should be updated so that potential service users are aware that end of life care can be provided in the home if requested. The RI should sign complaints off on their monthly visits to check that they have all been dealt with satisfactorily. The manager should keep a log of the complaints received by cross-referencing them to the file so that an audit trail can be kept of complaints and the outcomes. A policy should be provided to ensure that staff know what to do when they are subjected to abusive behaviour from residents and/or visitors. 2. 3. 4. OP16 OP16 OP33 Ella & Ridley Jacobs House DS0000010428.V337001.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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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