Care Home: Jaffray Nursing Home

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What the care home does well Each person has a care plan so that staff know how to help the people living there to meet their needs and keep them safe. Staff are good at helping people do the things they want to do. People go out often in the community and to places they like going to. People go on holiday every year with staff if they want to. They go to places that they would enjoy and have a good break. The home is well decorated and maintained so it is a comfortable place to live in. Staff have training so that they know how to meet the needs of individual`s. There is equipment that is in good order to help people be moved safely. Staff have an induction when they first start working there so they have the skills and know how to help the people living there. What has improved since the last inspection? Outcomes for people who live at the home had improved since the last inspection. At the last inspection some outcomes were adequate and now are good. People`s risk assessments had been reviewed and updated so that they do not say something different to the care plan to make sure people get the care they need. Care plans about how to meet people`s health needs were better so that people get the care they need to stay healthy. Information provided to people who live at the home includes pictures so it is easier to understand. People go out more in the local community and enjoy the activities they do. Oxygen is stored at the home that some people need to use. It is written down how and when staff should use this so they know how to help the people living there to be well. Staff have regular formal recorded supervision with their manager so that they are fully supported in their role. The quality assurance process is better and includes the views of the people who live there. What the care home could do better: Staffing vacancies must be recruited to so to make sure that staff know the people living there and how to meet their needs.The service users guide should state the fees charged to live there so that prospective service users can make a choice as to whether or not they want to live there. There should be care plans for all needs of individual`s so that staff know how to support them. Pressure sore risk assessments should be updated regularly so that action is taken to reduce the risk of them getting a pressure sore. Where people are at risk of becoming dehydrated staff should make sure they write down how much the person drinks to make sure they are well. All staff should know about the Mental Capacity Act 2005 and what it means for the people living there. All records of belongings should be regularly updated so it is easier to track if a person`s belongings should go missing. Individual fire risk assessments that state how each person is to be supported if there is a fire should be in place so staff know what support each person needs. CARE HOME ADULTS 18-65 Jaffray Nursing Home 19 - 31 Jaffray Crescent Erdington Birmingham West Midlands B24 8EG Lead Inspector Sarah Bennett Key Unannounced Inspection 30th May 2008 09:20 Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jaffray Nursing Home Address 19 - 31 Jaffray Crescent Erdington Birmingham West Midlands B24 8EG 0121 382 1383 0121 382 9278 jaffraycaresociety@btinternet.com 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) Jaffray Care Society Sukhwinder Thandi Care Home 18 Category(ies) of Learning disability (18), Physical disability (18) registration, with number of places Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 18 persons with a learning disability and physical disability. That the home can continue to accommodate four named services who are over 65. That Jaffray Nursing Home apply for variation on behalf of future service users who reach the age of 65. That details regarding how the specific care and social needs of people over the age of 65 will be met must be included in the service users plan. Date of last inspection Brief Description of the Service: Jaffray Nursing Home comprises of four bungalows and each bungalow accommodates 4 - 5 people up to a total of 18 people who have a learning disability, physical disability and additional nursing needs. All bungalows are well maintained internally and externally. There is parking to the side of the property plus a pleasant garden with seating to the rear. All the bungalows have level access throughout and are fully accessible to people without full mobility. Each bungalow has a dining room and lounge area and one has a conservatory. All bedrooms are single with a wash hand basin and call bell system. There is a separate toilet and bathroom, which are fully adapted and suitable for people with mobility problems where assistance is required. They also have a range of hoists for people with mobility problems and pressure relieving equipment for people who are at risk of developing pressure sores. A copy of the service user guide is available in each bungalow, which provides information about the facilities. The range of fees was not stated in the service users guide and these should be included. The information in the statement of terms and conditions stated, “Fees will be reviewed with social services from time to time as determined by the proprietor. The people living there pay for their own holiday and expenses and the company pay for staff. People pay up to 50 of the mobility part of their Disability Living Allowance towards the cost of the vehicle.” The last inspection report was available in the home for visitors who wish to read it. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was carried out over one day; the home did not know we were going to visit. This was the homes key inspection for the inspection year 2008 to 2009. The focus of inspections we, the commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home and an Annual Quality Assurance Assessment (AQAA) completed by the manager. Four people who live in the home were case tracked this involves establishing individuals experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Some of the people who live at the home were not able to tell us their views because of their communication needs. Time was spent observing care practices, interaction and support from staff. The Registered Manager was not on duty, the Nursing Support Manager assisted with the inspection. The staff on duty were spoken to. A tour of the premises took place. Care, staff and health and safety records were looked at. Staff and the people living there completed our surveys ‘Have your say’ about the home. Their views are included throughout this report. There were sixteen people living there and there were two vacancies, one in two of the four bungalows. What the service does well: Each person has a care plan so that staff know how to help the people living there to meet their needs and keep them safe. Staff are good at helping people do the things they want to do. People go out often in the community and to places they like going to. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 6 People go on holiday every year with staff if they want to. They go to places that they would enjoy and have a good break. The home is well decorated and maintained so it is a comfortable place to live in. Staff have training so that they know how to meet the needs of individual’s. There is equipment that is in good order to help people be moved safely. Staff have an induction when they first start working there so they have the skills and know how to help the people living there. What has improved since the last inspection? What they could do better: Staffing vacancies must be recruited to so to make sure that staff know the people living there and how to meet their needs. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 7 The service users guide should state the fees charged to live there so that prospective service users can make a choice as to whether or not they want to live there. There should be care plans for all needs of individual’s so that staff know how to support them. Pressure sore risk assessments should be updated regularly so that action is taken to reduce the risk of them getting a pressure sore. Where people are at risk of becoming dehydrated staff should make sure they write down how much the person drinks to make sure they are well. All staff should know about the Mental Capacity Act 2005 and what it means for the people living there. All records of belongings should be regularly updated so it is easier to track if a person’s belongings should go missing. Individual fire risk assessments that state how each person is to be supported if there is a fire should be in place so staff know what support each person needs. 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. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users have most of the information they need so they can make a choice about whether or not they want to live there. Before people move into the home their needs are assessed to ensure they can be met and they have an opportunity to visit to see what it is like. EVIDENCE: The service users guide was produced using pictures making it easier to understand. It was updated in January this year so that the information is relevant for prospective service users to know what the home provides to make a choice as to whether or not they want to live there. The fees charged to live there was not included in the service users guide but there was details about this in the statement of terms and conditions. These should be included in the service users guide to give prospective service users all the information they need. The statement of purpose included the relevant and required information so that prospective service users have the information they need about the home. One person’s records were looked at who had been recently admitted to the home. Their records included an assessment of their needs. This was Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 10 completed before they were admitted to ensure their needs could be met at the home. The AQAA stated during initial consultation stages prospective service users and their representatives are welcome to visit to meet others, staff and look at the environment. People who wish to take up residency are supported well in the resettlement period and the initial assessment period also, where all parties involved communicate well all the needs of the person. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff have most of the information they need so they know how to support individual’s to meet their needs and make choices about their day-to-day lives. EVIDENCE: Records of four of the people living there were looked at. These included an individual care plan that included pictures making it easier to understand. Care plans detailed how staff are to support individuals to meet their needs and achieve their goals. Care plans reflected the cultural background of the individual and how staff are to support the person to continue to practise their religious and cultural background. Records for one person stated that they had nosebleeds but there was not a care plan stating how staff are to support the person with these. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 12 Care plans had been reviewed regularly and updated where necessary to reflect changes to the person’s needs, likes and dislikes. Care plans cross referenced with guidelines and recommendations made by professionals so that staff had all the information they needed together to know how to support the person. Staff said in the survey “We are given up to date information about the needs of people living there not only in the care plan but also through daily communication and during staff meetings.” “Every person has a well written and easy to understand care plan. Their needs have been well assessed, well evaluated and plans are functional.” “ All needs are well prioritised and in an orderly manner. The care plans are accessible to all carers.” “ Changes in care plans are implemented as required. All staff are informed of any change or new information. Staff are encouraged to get involved in care plans.” The AQAA stated each person has a six monthly care review, which includes the person, all relevant professionals and family so all are involved in decisions being made about that individuals care programme. Several of the people living there are not able to communicate verbally because of their learning disability. Their records included a ‘communication passport’ that stated what the person likes, what they do when they like or want something, what they don’t like, what makes them angry or upset, what they do when they don’t like something and what they do when they are angry. This helps staff to understand what the person wants and needs so they can support them appropriately and avoid the person becoming frustrated as they can make their needs known. Meetings are held between staff and each of the people living there. This gives the person an opportunity to talk about what they would like to eat, what activities they want to do, how they can be more independent and their health needs. Some of the people living there do not have contact with their relatives. Staff have contacted advocacy agencies so that the person has someone independent to speak up for them if needed. Unfortunately, these services are not available unless the person needs this in a crisis situation. People living there responded in the surveys that they are able to make choices and decisions about their lives. They said: “ I like to have a cigarette every one hour. Sometimes I like to have it earlier before one hour elapses. I am assisted by staff to have a cigarette and have a time table for cigarette times.” “ The staff always support and guide me when making decisions.” Relatives said, “ The people living there are always given choices on everything ranging from what they would like to wear, and what they choose to eat through to day care activities.” Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 13 Records included individual risk assessments that stated how staff are to support the person to take risks whilst maintaining their independence as much as possible. These are reviewed regularly and updated if the person’s needs have changed. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living there experience a meaningful lifestyle. People are offered a varied and healthy diet so ensuring their well being. EVIDENCE: Records sampled showed that people take part in a range of activities inside and outside the home. People go out for meals, to parks, cinemas, shopping, watch TV and DVD’s, for drives in the country, swimming, to the zoo, to a local sensory room, go to pubs, listen to music, have aromatherapy and day trips to the coast and Blackpool. Records stated what things each person liked doing and their activity records showed that they had the opportunity to do these. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 15 One person who had recently moved to the home had been re-referred to the day centre they used to attend so they can keep in contact with their friends and do the things they did before they moved to the home. Records showed when people were offered the opportunity to do an activity but refused because they wanted to do something else or stay at home that day. Some people went out shopping during the day and others went for a walk to a local park with staff. Some people were doing jigsaws and playing games with staff. Others spent some time looking at magazines, which their records said they enjoyed doing. The AQAA stated all the people living at the home are actively involved in participating in daily leisure activities appropriate to their needs. Two additional drivers/ care support workers have joined the team and this has improved the day care activities tremendously. Public transport has already been used by some people and is working well. Some people had been away for a long weekend to a hotel the weekend before. Staff said that the people really enjoyed their holiday especially the evening discos and the food. Some people were observed looking at holiday brochures with staff. One person said that they would like to go to Butlins. Staff asked them if they would like to go abroad. They said that they did not like planes although had never been on one so they might like to go. Staff said it was their choice where they went. Staff said that they are planning to take one person away on holiday to Cheshire. The person was looking on the Internet with a member of staff in the office so they had some involvement in choosing where they went. Staff talked about taking one person on holiday to Scotland twice in the last year. The person is interested in cars, on one holiday they hired a Range Rover and on the other holiday they hired a Mercedes S class car, which the person really enjoyed being driven around Scotland in. Records sampled showed that the people living there are supported to keep in contact with their family and friends. This is through visits to the home, visits to family and friends supported by staff where needed and telephone calls. The AQAA stated and care plans sampled showed that daily routines reflect and promote independence, individual choice and freedom of movement. Food records sampled showed that people were offered a varied and healthy diet that reflected their likes and cultural background. Individuals’ diet included fresh fruit and vegetables and these were available in the home. Records showed that where people had refused food alternatives had been offered. Records detailed how much a person eaten so it was clear how much nutrition the person was receiving. Where the person had a poor appetite the Dietician was involved. Where necessary supplements had been prescribed for the Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 16 individual and records showed that these had been given to ensure the person was adequately nourished. Some people are fed through a PEG tube, which has been surgically inserted into the person following assessment and discussion with health professionals. This may be because they have had difficulty swallowing and are at risk of choking. It ensures that the person receives the nutrition they need but are not at risk of choking whilst eating. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20, 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are generally sufficient to ensure that the personal care and health needs of the people living there are met so ensuring their well being. EVIDENCE: The people living there were well dressed in good quality clothes that were of styles appropriate to the individual’s age, gender, cultural background and the activities they were doing. People had individual hairstyles and colours. Staff were observed supporting people who wanted a rest in the afternoon to do so, which gave them a change of position from sitting in their wheelchair or in one position in a chair. This helps to reduce pressure on their skin so minimising the risk of the person getting a pressure sore. Records included individual health action plans. This is a personal plan about what a person needs to be healthy and what healthcare services they need to Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 18 access. The plans were produced using pictures making them easier to understand. Records showed that where appropriate other health professionals were involved in their care to ensure their health needs were met. People had regular check ups with the dentist and optician to ensure their teeth and eyes were healthy. People had annual health checks with their GP to ensure that they were receiving the healthcare that they needed. The AQAA stated all the people living there are registered with the local GP, and further input from the Multi Disciplinary Team is available to all who require specialist input from other health professionals. All changing health care needs are followed up regularly with appropriate appointments and input via other health professionals. The AQAA stated that a Nursing Support Manager has been appointed. The qualified nurse team meet once per month and spend a high proportion of the meeting evaluating each person’s care needs. They communicate any changes, developments, and present a written report to the team about their individual areas. Staff expressed concerns about one person who had been refusing to eat. Their pressure care risk assessment (Waterlow) was last updated in December 2007 and stated that their appetite was average. This needs to be updated as the person’s needs have changed, which may put them at a greater risk of getting a pressure sore. A record is kept of how much one person drinks each day as they had been refusing to drink, which may put them at risk of dehydration. Fluid charts on one day stated they had drank only 550mls that day but their daily records stated that they “drank very well today.” On another day it stated that they had only drank 90mls but their daily records stated they had 200mls of drink for their supper. This indicates that staff were not recording accurately how much the person drank, which could impact on their well being. Some people are prescribed rectal diazepam to be given in an emergency when the person is having an epileptic seizure. The person’s psychiatrist and GP had been involved in developing the protocol that stated when, why and how much of this had been given to ensure it is given appropriately. One person was in hospital. Staff had been to visit them during the day and when they came back they told another person living there how the person was, as they were concerned about them. The rota ensured that staff who knew the person were supporting them at the hospital and they were covered by agency staff at the home. The medication was looked at in bungalow 19. The qualified nurses give the medication. At the front of each person’s Medication Administration Record (MAR) there was a photograph of the individual so that unfamiliar staff would Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 19 know who to give it to. There was also information about how the person likes to take their medication. Some people are prescribed as required (PRN) medication. Protocols were in place that stated when the person needed to take it and how much to ensure that it is effective and not given when the person does not need it. Boots supply the medication using the monitored dosage system in blister packs so it is easier for staff to know what medication to give to each person. Blister packs sampled had been taken out up to that day indicating that medication had been given as prescribed. Medication that needs to be stored in a cool temperature is stored in a separate fridge for medication. The temperature of the fridge is taken daily and records showed that these were within the recommended limits to ensure the medication is stored appropriately. Medication had been dated when it was opened so it can be audited and show that medication is given to individual’s as prescribed. Copies of prescriptions were kept to ensure that staff know what medication is prescribed for the person so that they can ensure that this is what is stated on their MAR. The AQAA stated audit systems are in place to manage medication monitoring and all medication is reviewed regularly. The audit file stated that the pharmacist had recently visited to undertake an audit, which went well and they were pleased with the systems in place. Sadly one person living there had recently died. The people living there had been informed of this and staff were supporting them in their loss. One member of staff was observed talking to a person living there about the person who died. They said that they would like a photograph of the person and staff said they would try to arrange this. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the views of the people living there are listened to and acted on. The people living there are protected from abuse, neglect and self-harm. EVIDENCE: The complaints procedure was produced using pictures making it easier for people to understand how to make a complaint. The home has not received any complaints in the last 12 months. We have not received any complaints about the service provided by the home in the last 12 months. The AQAA stated we have a clear and effective complaints procedure which includes the stages of the process and that people who live there know how and whom to complain. The home has recently introduced a concerns, complaints and compliments booklet so staff, relatives, visitors, advocates and the people living there are able to voice any issues and these are displayed for all. Staff said that the manager had received training in the Mental Capacity Act but they were not aware of plans for this to be cascaded to staff. All staff should be aware of this so they know what the implications of this legislation are for the people living there. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 21 The AQAA stated and staff training records sampled showed that all staff have regular training in adult protection and are aware of the procedure to be followed. This ensures that staff know how to safeguard the people living there from harm. Staff records sampled showed that before staff start working at the home a Criminal Records Bureau (CRB) check is completed to ensure they are ‘suitable’ to work with the people living there. Staff said, “ I had to wait for my CRB before being given a starting date.” Individual ‘s finance records were not looked at during this visit. However, reports of the senior manager on their monthly visits to the home stated, “ All people’s money was locked away and receipts of a few I sampled were correctly documented.” “Money fine, staff use finance systems well and budgets are well managed.” Records sampled included a list of the person’s belongings. All but one of these had been updated in the last few months. One had not been updated since October 2007. They should be updated regularly when people buy new things or dispose of any belongings. If something should go missing it would then be easier to track when the person last had it or when they bought it. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a homely, comfortable, safe and clean environment that meets their individual needs. EVIDENCE: Some new furniture had been provided in the lounge and dining room in bungalow 29, which was well decorated. In bungalow 31 new furniture had been provided in the lounge, conservatory and dining room. A new cooker had been provided in the kitchen. All the bungalows were well decorated ensuring that people live in a homely and comfortable home. Staff said and the AQAA stated that the home is well maintained ensuring a safe environment. Systems are in place where all decoration and refurbishment is carried out regularly. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 23 The office is in the garden between the bungalows so it is accessible to all of them. Space in the office is limited. Staff said that the office is being extended onto the patio and architects are involved in drawing up plans. The AQAA stated we intend to extend the existing office space and use this more effectively. The bedrooms were not looked at. At the last inspection these were found to be personalised and decorated in the way the individual had chosen. All the bungalows were clean and there were no offensive odours making it a pleasant place to live. Staff said, “The house usually gets cleaned daily.” Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for staffing the home, their support and development are sufficient to ensure that the needs of people living in the home are met. There is a robust recruitment system in place, which protects people from harm. EVIDENCE: The AQAA stated that 50 of staff have achieved NVQ level 2 or above in Care. Another five members of staff are working towards achieving this. This meets the standard to ensure staff have the skills and knowledge to meet the needs of the people living there. The AQAA stated that the Nursing Support Manager took up post in May 2007, supporting the qualified nurses in delivering care and good practice. The Nursing Support Manager said they had several vacancies for care staff but had adequate qualified staff in post. There is a full-time Team Leader (qualified nurse) in each bungalow. They have block bookings with some agency staff so that there is some continuity of care staff and they know the people living there. There are also bank staff that work there regularly and permanent staff Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 25 work some overtime hours to ensure continuity. Staff responded in the survey that there are usually enough staff. “Management always make sure that the homes are adequately covered within the pay budget.” “ The bank list to find workers at short notice is often a waste of my time. A more reliable list of available workers would be appreciated.” Minutes of staff meetings sampled in bungalow 19 showed that these were held regularly. Staff talked about how to meet the needs of the people living there, training, staff conduct and holidays, activities and birthday celebrations for people living there. Staff records sampled included the required recruitment records to ensure that ‘suitable’ people are employed to work with the people living there. The AQAA stated the recruitment procedure is robust and thorough. We need to look at ways of ensuring that the people living there are more actively supported to be involved in the recruitment process. Records sampled showed that when staff started working at the home they completed an induction. This was during their probationary period when their performance and progress was monitored to ensure they were suitable to do the job they were employed to do. Any further training and development needs were identified during this time to ensure they have the skills and knowledge to meet the needs of the people living there. Qualified staff records sampled showed that they were registered with the Nursing and Midwifery Council (NMC) who will ensure their practice is good. The AQAA stated all staff are inducted and are supernumerary for their first two weeks of duty. During this period any difficulties are identified and further support offered in the form of additional training, supervision and monitoring. Training records sampled showed staff had received training in adult protection and the prevention of abuse, fire safety, epilepsy, first aid, health and safety, food hygiene, moving & handling, medicines, infection control, diabetes and the Learning Disability Award Framework (LDAF). Staff said in the survey, “Management is very keen to ensure that staff have the maximum relevant training so that people’s needs are met effectively.” “All staff are given opportunity to improve their skills and knowledge to improve the standard of care as much as possible.” “ I was supported and given relevant information on induction. Supported by continuous training programmes yearly.” “ I found the information I was given in my induction very useful.” “Refresher training is undertaken every year to bring carers up to date with current requirements.” Staff receive regular supervision with their manager to ensure they are supported to do the job they are employed to do. Staff responded in the survey, “Any concerns I have are easily addressed with supervision from my managers. Supervision and support has always been readily available.” “Supervision and monitoring are routine aspects of my employment.” “Regular supervision where I can voice my concerns.” Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management arrangements ensure that the people living there benefit from a well run home. The people living there can be confident that their views underpin the self- monitoring, review and development of the home. The health, safety and welfare of the people living there is generally promoted and protected so ensuring their well being. EVIDENCE: The home has a manager who is registered with us. She meets regularly with other managers to discuss organisational policies and good practices. Since the last inspection the outcomes for people who live at the home had improved. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 27 The AQAA was sent to the Manager to be completed before the inspection was completed and returned within the set timescale. The AQAA stated the registered manager continues to update, develop and underpin her existing knowledge. Monthly management meetings take place where the needs of the people living there are discussed to ensure that they are being met. The AQAA stated that the senior management and human resources team are more accessible as they have moved to a building next door to the home. A representative of the provider visits the home monthly to ensure that it is meeting the needs of the people living there and is well run. Reports of these visits are written and were available. During these visits the needs of the people living there and staff are considered. The audit file showed that the manager had visited the home during the night to monitor care practices. Some shortfalls had been noted included records being completed before the time they should have been and some said that people were asleep but found they were awake. There was no record of what action was taken to improve. This should be recorded so it is clear that action is taken to secure improvement. The AQAA stated there is an effective quality assurance document in place, which is discussed at monthly senior and care management meetings. Policies and procedures are continually updated, replaced or developed at these meetings. There is an external auditor looking at risk assessment systems within the organisation and health and safety objectives. The AQAA stated the organisation has employed an external fire officer to complete a comprehensive fire risk assessment. The home has a maintenance team which ensure that regular servicing of boilers, legionella testing, maintaining a safe environment and security of the premises is undertaken, recorded and audited. Staff had fire safety training on the 15th May as well as some of the people living there so they also know how to minimise the risk of fire and what to do if there is a fire. Fire records showed that staff test the fire equipment regularly to make sure it is working. An engineer regularly services the fire equipment to ensure it is well maintained. Fire drills take place every six months to ensure that staff and the people living there know what to do if there is a fire. A fire risk assessment is in place that states how to minimise the risks of there being a fire. Individual fire risk assessments that state how each person is to be supported if there is a fire should be in place. The AQAA stated that an electrician completed the five yearly test of the electrical wiring in 2007 and stated that it was safe to use. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 28 Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 3 X 3 X X 2 X Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 30 No Are there any outstanding requirements from the last inspection? 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 YA33 Regulation 18 (1) (a) Requirement Staffing vacancies must be recruited to so to ensure that staff know the people living there and how to meet their needs. Timescale for action 31/10/08 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 YA1 Good Practice Recommendations The service users guide should state the fees charged to live there so that prospective service users have the information they need so they can make a choice as to whether or not they want to live there. Care plans should be in place for all needs of individual’s to ensure staff know how to support them. Pressure sore risk assessments should be updated regularly so that action is taken to reduce the risk of them getting a pressure sore. Where people are at risk of becoming dehydrated staff should accurately record their fluid intake to ensure they get the fluid they need to be well. All staff should be aware of the Mental Capacity Act 2005 and the implications it has for the people living there. DS0000024859.V366493.R01.S.doc Version 5.2 Page 31 2. 3. 4. 5. YA6 YA19 YA19 YA23 Jaffray Nursing Home 6. 7. 8. YA23 YA39 YA42 All records of belongings should be regularly updated so it is easier to track if a person’s belongings should go missing. There should be a record of what action was taken to improve following night audits. This will ensure that it is clear that action is taken to secure improvement. Individual fire risk assessments that state how each person is to be supported if there is a fire should be in place so staff know what support each person needs. Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. Extracts may not be used or reproduced without the express permission of CSCI Jaffray Nursing Home DS0000024859.V366493.R01.S.doc Version 5.2 Page 33 - 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. 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