Care Home: Jack Gardner House

What the care home does well The management system of the home is excellent. The people who use the service and their relatives are consulted about the quality of the service. Care plans are regularly reviewed and the residents` needs are identified and met. The home is clean, tidy and comfortable for the residents to live in. All the residents are engaged with the activities provided at the home and outside the home. The home is good in promoting independence. The meals provided at the home are excellent. The residents can choose what and when to eat. What has improved since the last inspection? As requested at the last inspection, the manager has introduced a system for recording incidents and accidents. This has enabled the home to monitor, report and manage incidents and accidents. What the care home could do better: Even though the home has a detailed risk assessment, this has not enabled it to specify how the risks are to be managed. We recommend that the manager develops a risk assessment format which not only identify the risks but also gives guidance for the staff how to manage the risks. There is a need for the staff to treat the residents with respect and dignity and ensure their choice. Key inspection report Care homes for adults (18-65 years) Name: Address: Jack Gardner House 184-186 Golders Green Road Golders Green London NW11 9AG     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Teferi Degeneh     Date: 1 7 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Adults (18-65 years) Page 2 of 25 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 25 Information about the care home Name of care home: Address: Jack Gardner House 184-186 Golders Green Road Golders Green London NW11 9AG 02087310300 02087310301 nchristie@jcare.org www.jewishcare.org Jewish Care care home 15 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) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Date of last inspection Brief description of the care home Jack Gardener House is owned and operated as a residential home by Jewish Care, a voluntary organisation that provides health and social care for the Jewish community. The home is relatively newly purpose built and registered to provide a service to fifteen people with mental health problems. The home is not registered to provide nursing. This is a very nice, well-planned building. It is situated along the Golders Green Road and provides easy access to the shops and cafes and all of the social, cultural and religious and community health provision that is in that area. There are fifteen single rooms and all have full bathroom en-suite facilities. The statement of purpose states that the home has a strong Jewish tradition and culture that offers accommodation to young Jewish people aged between 20-50 years of age who are recovering from serious and enduring mental ill health and require a supportive and therapeutic environment. The stated objective is to deliver to residents Care Homes for Adults (18-65 years) Page 4 of 25 Over 65 0 15 Brief description of the care home a quality service where the resident is involved in the decision making and running of the home so as to achieve his/her full potential in the home and in the wider community. The fee range for the home range from £597.00 - £703.00 per week. More information about the home including a copy of the inspection reports can be requested from the manager. The inspection reports are also available on the CQC website. Care Homes for Adults (18-65 years) Page 5 of 25 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was an unannounced inspection. We arrived at the home at 9:30 am without informing the manager that we were visiting. Most residents and three care staff were present when we arrived. The manager came later on and stayed during most parts of the inspection. Before our visit to the home, we had received a self assessment document also known as the annual quality assurance assessment (AQAA) from the home. An AQAA is a form which we request from care homes every year to complete and send back to us. It gives care homes an opportunity to tell us how they are planning to improve the service. We looked at the AQAA as part of this inspection. The other activities we carried out on the day of this inspection 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 files and discussions with and Care Homes for Adults (18-65 years) Page 6 of 25 observation of people who use the service, care staff, visitors and the homes management. We have also considered all the other information that we have about the home. Care Homes for Adults (18-65 years) Page 7 of 25 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 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 Adults (18-65 years) Page 8 of 25 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 25 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. New residents are confident that the home has a good admission procedure. This has ensured that new residents are admitted to the home only if there are good services that can meet their needs. Evidence: We checked five residents files and talked to the manager. The manager said that new residents are admitted to the home following the completion of their assessments which would show whether or not their needs can be met by the home. The manager said that new residents are not admitted to the home if it is felt that their needs cannot be met by the available services. The AQAA confirms the admission procedure by stating that all new residents are invited to the home to have the feeling of what it is like to live at the home and to meet the existing residents. We spoke to four residents and all of them said they had visited the home before their admission. They also said that they like the home. Care Homes for Adults (18-65 years) Page 10 of 25 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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 care plan system has enabled the residents to identify and plan services that meet their needs. Evidence: All the five residents files we examined contained detailed care plans and risk assessments. It was clear from the files that the home works closely with relevant people to review the care plans. The residents have signed to confirm that they know about their care plans and they are given a copy of the plans. From discussions with the residents it was evident that they are involved in the reviews and are aware of their support needs. Each file we looked at has a risk assessment which is regularly updated. The risk assessment format requires the staff to categorise each area as high, medium or low risk. While such a system allows the staff to measure the risks and provide appropriate support, it does not clearly indicate how each risk is managed. We discussed this with the manager who said she would review the system to specify the Care Homes for Adults (18-65 years) Page 11 of 25 Evidence: management of risks. Each of the residents we spoke to said that they have the keys for the front door and bedrooms. They said they can independently travel to places of interest. They have also opportunities and facilities to make light snacks. The residents we spoke to said they can get up or go to bed at the time of their choice. They they are happy with the way things are set up to aallow them to be free to make snacks, watch television or do what they want when they want it. Observations indicated that the staff are there to prompt and encourage the residents to be independent. Care Homes for Adults (18-65 years) Page 12 of 25 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 residents have good opportunities to engage and develop skills for independent living in the community. The meals provided at the home are excellent and the residents needs are met. Evidence: From discussions with the manager and the people who use the service it was clear that there are a range of social and therapeutic activities for the residents. The four residents we spoke to said they do activities such as working as volunteers or attending vocational training. All the residents we talked to said they are engaged and do not feel bored at the home. A computer with access to the internet is provided for the residents to use in a quiet room. The manager said the residents are supported to use the computer. From discussions with the manager it was evident that many of residents have their own television in their bedrooms. There is also a television in a lounge which all the residents have access to. As we mentioned above the residents Care Homes for Adults (18-65 years) Page 13 of 25 Evidence: have keys for the front door and their bedrooms. Records and conversations with the residents indicated that the residents are visited by their friends and families. Two visitors were at the home during the inspection. Both visitors said there are no time restrictions and they can visit the home and speak to the residents. They said they come to the home regularly and they are happy about the services and the way the home is managed. They said the staff are polite. Care Homes for Adults (18-65 years) Page 14 of 25 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. There are good systems to ensure that the health and personal care needs of the people who use the service are met. Evidence: Observations and discussions with the residents indicated that the personal and healthcare of the residents were on the whole, well managed. Residents living in the home have access to healthcare services in the local community. It was evident from discussions and case records that the healthcare needs of the residents are monitored and appropriate intervention taken. Case records showed that the residents have appointments with psychologists, psychiatrists, community psychiatric nurses, dentists and general practitioners. The staff we talked to demonstrated a caring attitude towards the residents. However, as we mentioned earlier a few residents are not happy with the way some staff talk to them. As we said earlier the manager is aware of this issue and is addressing it. we will also make a recommendation below under Staffing. All the residents in the home are able to do their personal care independently. The staff we interviewed have skills and knowledge of ensuring the residents respect and Care Homes for Adults (18-65 years) Page 15 of 25 Evidence: dignity while supporting them. The care plans of the resident are detailed and up-todate. We mentioned earlier in this report that the residents have front door and bedroom keys and are able to sleep or get out of bed without time restrictions. We have also mentioned that the residents can make light snacks at the time of their choice. Each resident has a key worker who closely works with them. The home has successfully supported two residents to gain skills for independent living and move to live in the community. We checked the administration of medication. The home has the required policy and procedure. Medication is stored in a locked cupboard in an office. The medication administration record sheets (MARS) and the medicines we checked were all in order. The manager informed us that medicines are administered by the staff who have appropriate training and experience. Some of the residents take their own medication by themselves. There is written evidence in the files that assessments have been completed to confirm that these residents are able to take their own medication. In addition to this the staff regularly monitor to ensure that the residents take their medication. Care Homes for Adults (18-65 years) Page 16 of 25 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 are confident their concerns are listened to and resolved by the home. The homes safeguarding and care assessment processes make the residents feel safe in the home. Evidence: There have been two recorded complaints since the last inspection. Both complaints have been investigated but withdrawn by the complainants. The home has a complaints procedure. The residents we spoke to said they know they can talk to the manager or the staff if they have a concern. The AQAA confirms that all complaints by the residents or their families are taken seriously and responded to within the time scale given in the homes complaints procedure. A discussion with the manager and an examination of the AQAA confirm that all staff have attended training on safeguarding. Our interview of the staff showed to us that they have knowledge and skills to safeguard people in a care home. There are policies on safeguarding and whistle blowing. We have noted in the care plans that the home has arranged and completed a mental capacity assessment for a number of the people who use the service. Care Homes for Adults (18-65 years) Page 17 of 25 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. There are good facilities for the residents to feel that they live in a safe and comfortable home. Evidence: The home was clean, hygienic and tidy during the inspection. We checked the kitchen which we found to be in good order. The kitchen temperatures were recorded and the chef confirmed that there are no maintenance issues. The home is located on a main road and is accessible by public transport. The rooms are bright and spacious. The service users and visitors we spoke to were happy with the home. The home has good quality furniture. There are communal spaces for the residents to use for watching television, for having meals or for sitting and working, for example, on computers. The residents have also a laundry room which they are supported to use. The AQAA and the health and safety certificates showed that there are regular maintenance programmes and health and safety checks. Care Homes for Adults (18-65 years) Page 18 of 25 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 residents can be confident and feel safe with the homes good staff recruitment and training processes. However, the practice or attitude of the staff toward the residents can be improved in order for all the residents to have full confidence in them. Evidence: The AQAA confirms that except one member of staff all have a care national vocational qualification. The one member of staff who has yet to obtain a qualification has also embarked on training. A training programme we saw showed that there is an ongoing training arrangement for all staff. The list of training the home provides include: Introduction to Mental Health; Health Promotion; Jewish Festivals; Stress Management; Safeguarding; and many other relevant areas. It was clear from the staff records and conversations with the manager and staff that the care staff receive support and supervision from the manager. Our interviews with the staff and observations showed that the staff have skills and experience to support people with mental health problems in a care home. Most of the residents and all of the visitors we spoke to gave positive comments about the staff. For example, one visitor said: The staff are pleasant and friendly. A resident told us that the staff are good and they work hard to promote independence of the people who use the service. It has been mentioned above in this report that some residents are not happy the way they are Care Homes for Adults (18-65 years) Page 19 of 25 Evidence: treated by some staff. This has been relayed to the manager who confirmed that she has been aware of this issue and has been dealing with it. We ask the manager to ensure that all staff treat the residents with respect and dignity. We checked five staff files. All these files contained evidence of satisfactory criminal record bureau checks, written references from previous, job descriptions, and training certificates. The manager described the recruitment procedure which includes job advertisement, short listing of candidates and interviewing. The AQAA states that all new staff attend an induction programme for five days and are also required to receive training about the cultural needs and ways of life of the people who use the service. Care Homes for Adults (18-65 years) Page 20 of 25 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. There are excellent management arrangements for the residents to be listened to and to influence to make it a safe and comfortable place to live in. Evidence: The manager was present during most part of the inspection. We found the manager to be approachable, open and supportive to the staff and the residents. All the residents and staff we talked to spoke highly of the manager. From conversations and observations we found her to be experienced and knowledgeable in the management of care homes. As an experienced manager she also oversees the management of another care home where there is no registered manager. The manager told us that she has a care management qualification and she attends training to update herself with new care approaches and management techniques. The manager is supported by a service manager and senior care workers. The manager explained the quality assurance system of the home. She said each resident has a key worker who monitors their needs and care plan. The residents also have meetings in which they talk about issues of common concern. We looked at one Care Homes for Adults (18-65 years) Page 21 of 25 Evidence: of the minutes and found that the residents are free to talk on issues that concern them. The home also organises relatives meeting. The manager said the last relatives meeting was held on 1st September 2009. The main part of the quality assurance is the feedback that the home receives through the surveys it sends to the residents, families and professionals. The home collates the findings and writes a report which it discusses with the residents. The manager said this has helped the home to improve its services. Regular audits of the services and records are also undertaken to ensure that the residents receive safe and good quality service. At the last inspection we asked the manager to ensure that a clear incident reporting system is put in place to include clear information on actions taken. The home has now an incident reporting system and has also notified the Care Quality Commission about the incidents and accidents that needed reporting. The AQAA confirmed that health and safety checks have taken place. The manager confirmed that the home carried out a fire risk assessment as requested by the London Fire Officers on 23/01/2008. She also confirmed that fire drills and fire safety checks such as the fire alarms and emergency light are checked regularly. Certificates showed that the gas boiler was serviced on 27/04/2009 and all portable electrical appliances were tested on 05/02/2009. Care Homes for Adults (18-65 years) Page 22 of 25 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 Adults (18-65 years) Page 23 of 25 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 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 improving their service. No Refer to Standard Good Practice Recommendations 1 9 Risk assessments should be clear in identifying not only the risks but also how the risks are managed. The registered person should include in the risk assessment form information about by who, how and when an identified risk is to be managed. All staff employed to work at the home should treat the residents appropriately by ensuring their respect, dignity and choice at all times. This enables the residents to feel confident, valued and have equal opportunity in the home. 2 32 Care Homes for Adults (18-65 years) Page 24 of 25 Helpline: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. 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