Care Home: James House

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What the care home does well The home is comfortable and well maintained. There is a programme of redecoration and refurbishment. The environment is kept to an excellent standard. The home is competently managed and administered for the benefit of people who use the service. The records we viewed were very well organized. Quality Assurance in the home is good with people consulted and there being a thorough audit of the National Minimum Standards by Abbeyfiled Society. What has improved since the last inspection? The records relating to care planning had improved since the last inspection; a new care plan format has been introduced, this covers all areas of care, and the views of people and their relatives are incorporated into the care plan. People are asked to identify the areas of care they need support with as well as areas where they wish to maintain independence. Changes have been made to the staff team, mainly with the appointment of a team leader to oversee care. A houseworker has been appointed, prior to this care staff undertook house work duties. The continual cycle of redecoration and refurbishment is evident with improvements to the environment. What the care home could do better: We did not make any statutory requirements as part of this inspection. We made one good practice recommendation for the home to look at making communal toilet/bathing facilities more personal. Key inspection report Care homes for older people Name: Address: James House James House 2 Sandy Lodge Way Northwood Middx HA6 2AJ     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: Susan Woolnough-Singh     Date: 0 4 0 3 2 0 1 0 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 Older People Page 2 of 28 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 Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 28 Information about the care home Name of care home: Address: James House James House 2 Sandy Lodge Way Northwood Middx HA6 2AJ 01923823122 01923823122 m.veereen@abbeyfield.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): The Abbeyfield Society Name of registered manager (if applicable) Maggie Veeren Type of registration: Number of places registered: care home 12 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accomodated is 12 The registered person may provide the following category of service, Care Home only, Code PC, to service users of the following gender, either, whose primary need on admission to the home are within the following cetegories, Old Age, not falling within any other category, Code OP Date of last inspection Brief description of the care home 0 Over 65 12 Care Homes for Older People Page 4 of 28 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This Key Inspection of James House took place on 3rd March 2010 and 12th March 2010. The first day of the inspection was announced as we planned to meet with the Registered Manager. The second day of the inspection was unannounced. The duration of the inspection over the two days was approximately six hours. We assessed the key National Minimum Standards for Older People during this inspection. We sent out surveys to people who use the service and staff. Information and the views of these surveys are contained in the body of this report. The Registered Manager completed an Annual Quality Assurance Assessment. This document sets out how the National Minimum Standards for older People are being met, how the home has improved and gives basic statistical information on the service. This document, in part, was used to to assess some of the standards. Care Homes for Older People Page 5 of 28 We met with the Registered Manager to discuss the management of the home, and we met privately with three people who use the service to ascertain their views. We toured the building and sampled records relating to staff, care of people living in the home, quality assurance and health and safety. Care Homes for Older People Page 6 of 28 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 Older People Page 7 of 28 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 8 of 28 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information is available for prospective residents and their families in the Statement of Purpose and Service Users Guide. People only move into James House once they have had their care needs assessed. Evidence: Prior to people moving into the home people will have their care needs assessed. An assessment form is used for this purpose, and from the assessment the care plan will be developed. The (AQAA) informs us that a visit to the home forms part of the assessment process. At the time of the inspection people living at the home were self funding. As part of the inspection process we looked in detail at the care records of three people who live at the home. We were able to see that care needs had been assessed and that people had been consulted on the level of support they felt they would like. Care Homes for Older People Page 9 of 28 Evidence: This was recorded as part of the care plan. Care Homes for Older People Page 10 of 28 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information and records with regard to the support and care people require for daily living is very good. This includes consultation with people who live at the home and relatives. There are procedures and practices in place for the safe storage and administration of medication. The staff team are looking at ways to ensure that end of life care is dealt with according to wishes and all the necessary support is given. Evidence: We looked at the care plans of three people who use the service. A new care plan format has been introduced since the last inspection. The care plan is written in good detail and there is a section where the person using the service is asked to identify areas where help is needed and also areas where independence should be encouraged. On the care plan is also a section for relatives to make comments if they wish. We could see that care plans had been reviewed and dated. Care Homes for Older People Page 11 of 28 Evidence: The care plans had been reviewed and covered social and heath care needs. The care plans are presented in a clear manner, care needs and guidelines are stated. The care plan contains information on personal care including continence care, dietary needs, medical and daily heath care needs such as foot care. Financial guidelines and wishes are included. A full range of risk assessments are available as part of the care plan. We saw that these included mobility, going out independently, and self-administration of medication and tissue viability. Care is assessed and identified under a number of headings. Physical and psychological well being, personal care, mobility, nutritional needs and social contacts and activities. We could see a clear record of visits, and appointments with health care professionals. People are registered with a local General Practice and some people receive a service from District Nurses and McMillan Nurses. Risk assessments had been completed for personal safety such as Moving and Handling, and a personal fire evacuation plan had been prepared. Assessments for the purpose of monitoring health were seen, these include mobility,falls, tissue viability,infection control, hydration,and nutrition. We looked at the medication storage area. A monitored dosage system is used for the administration of medication, this is supplied and provided by a local Pharmacy. We also looked at the procedures in place for controlled medication. The storage area for medication and the medication administration record were found to be in order. Staff who administer medication have the training to do so. We were informed by the Registered Manager that she is responsible for auditing the practice of medication administration, and that medication administration records are double checked by senior staff as part of the afternoon/evening shift duty. The Annual Quality Assurance Assessment (AQAA) informs us that improving end of life care has been identified for further improvement. Some of the staff at James House have already attended End of Life Care training, this training has been provided by a local Hospice. Training for staff who have not yet attended is booked for May 2010. The training focuses on palliative care and support and communication. We were able to see that these arrangements are included in the care plan as preferred priorities of care. This is discussed as part of the care planning process, and wishes are recorded. Sometimes relatives are asked for information. We were informed that sometimes people do not wish to discuss this part of the care plan and that this is Care Homes for Older People Page 12 of 28 Evidence: respected. Care Homes for Older People Page 13 of 28 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the home are able to make decisions on how they spend their day in the home. Activities and outings are provided for those who wish to participate. People are able to retain links with family and friends. A chef is employed to provide a choice of meals in pleasant surroundings. Evidence: We sent out satisfaction surveys to people who use the service. These surveys ask people to rate their care by responding to a statements. People are also asked to comment of the home and areas that could be improved. We received eight completed surveys. People responded positively when asked about quality of care with regard to food, care and support and medical arrangements. The additional comments made were that James House is friendly, caring, and the food is good. One person commented that they are happy and content. When asked about improvements, one person said the hot water could be improved and a shower fitted. We spoke with three people who live at James House. Overall people confirmed that the food is good and activities and outings are arranged and staff are friendly. One Care Homes for Older People Page 14 of 28 Evidence: comment was made that some outings had been canceled due to poor weather. The activities schedule is completed on a weekly basis for each day and is displayed in the lounge. The schedule comprises of exercise, sing a long, group games such as group crossword and clergy visits for prayer and communion. Outings from the home and some activities have been planned until November 2010. These include trips to local cafes and garden centre, trips to Windsor and Safari Park and special lunches at James House such as the family buffet lunch. The (AQAA) informed us that activities are picked after consultation with residents. The (AQAA) informers us that friends and families may visit the home freely and there is no restriction on visiting. A new chef had been appointed to the home and people commented that they were happy with the meals provided. The dining room had been redecorated since the last inspection and new curtains fitted. On both days of the inspection we noted that the dining room looked pleasant with attractive fresh table linen and flowers. Care Homes for Older People Page 15 of 28 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People in the home have access to a Complaints Procedure and people know how to make a complaint. The home has policies and procedures and guidelines in place to safeguard people from abuse. Evidence: The home has a Complaints Procedure, this is displayed in the home and contained in the Statement of Purpose. We looked at the complaints policy and recording system. The form used for recording complaints is good and the Registered Manager informed us that the procedure for making complaints is discussed at residents meetings. We looked at the record of complaints and concerns raised by people living in the home. We were able to see that these had been dealt with immediately, monitored and rectified. Information on Advocacy Organizations is displayed in the home. A Safeguarding of Vulnerable Adults procedure is available developed by Abbeyfiled Society for their Care Homes. Information in the (AQAA) informs us that the London Borough of Hillingdon Safeguarding of Vulnerable Adults Procedure is available. Care Homes for Older People Page 16 of 28 Evidence: Staff receive training as part of their induction and further training on protection and recognizing signs of abuse. The questionnaires received, completed by people who live at the home indicated that they all knew how to make a complaint. Care Homes for Older People Page 17 of 28 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in the hone benefit from a very well maintained and homey environment. People have clean and comfortable bedrooms and are able to arrange their bedrooms to suit their needs, and bring in personal possessions. Evidence: We were able to tour the building and meet with three people in their bedrooms. The communal areas of the home are very homely and well maintained and decorated. There is a fake flame fire in the lounge with an attractive fire place. New armchairs had been purchase for the lounge and new curtains for the lounge and dining room. A new carpet had been fitted in the hall. The bedrooms seen were nicely decorated, looked comfortable and people had personalized them with their own belongings and to suit their mobility needs. Improvements are being planned for the future. The outside of the home, namely the exterior walls have been identified as needing decorating and the (AQAA) informs us that This will commence spring/summer 2010. The kitchen is also going to be refurbished. We noted on observation that the kitchen looked clean and functional, but there was a lack of space for food preparation and the kitchen would benefit from Care Homes for Older People Page 18 of 28 Evidence: updating. The (AQAA) informed us that a recent Environmental Health Inspection Report had given the home an excellent rating. A Maintenance Person and Gardener are employed at the home and this is evident in the high standard of the environment. We ere able to see that the winter garden was tidy and attractive. The home has identified room for improvement with regard to parking arrangements at the front of the home. Overall, the environment of the home is being kept to an excellent standard. We would however, recommend that the communal bathrooms and toilets be looked at to make these rooms more personal The home was seen to be very clean and tidy through out. Care Homes for Older People Page 19 of 28 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff levels in the home are satisfactory and staff are able to offer care and support to people. Staff who are employed to work in the home receive the training required to enable them to work in a care setting with older people. There is a very good level of National Vocational Training for staff. A recruitment procedure is in place and recruitment practice ensures that people are checked to make sure that they are suitable to work in a care setting. Evidence: We were informed by the Registered Manager that changes had been made to the staff team structure and staff duty rota since the last key inspection. The home adheres to the Abbeyfield Society recruitment process and is supported by Human Resources. We were informed that recruitment and the paperwork associated with recruitment is now being instigated from the home. Advertising for care staff to work in the home takes place locally. A Team Leader has been appointed with the main responsibility of monitoring care to people who use the service. A Houseworker has also been recruited and works weekdays between 10am and 13.00. Prior to this the care staff undertook domestic duties. The staff rota has changed with morning Care Homes for Older People Page 20 of 28 Evidence: shifts between 7.30 and 14.30 and afternoon/evening shifts between 14.00 and 21.00. Prior to this some staff worked split shifts. Overnight one waking night staff is on duty with one care staff sleeping in. Two care staff are on duty in the morning and afternoon evening with the support of a senior care worker. On both days of the inspection we noticed that there was a calm atmosphere and people where attended to as required. We looked at the staff records of two new members of staff. We looked in detail at recruitment records and also at training records. The required documents were in place for the two staff recently recruited to the staff team. We were able to see the application form, references, and Criminal Records Bureau and Protection of Vulnerable Adults check. The new employees identity had been checked. Documentation pertaining to health checks and contracts could be seen on file. We looked at the training records, a copy of the training matrix was given. The majority of staff staff had attended mandatory health and safety courses such as moving and handling, medication, first aid and health and safety. Further dates for mandatory training had been booked. Staff had attended safeguarding adults training. New staff attend an Induction Course which covers skills for care induction induction training. The (AQAA) informs us that four staff have National Vocational Training (NVQ) Level 3, six staff have NVQ Level 2 with three staff commencing NVQ training. One Senior care worker has commenced NVQ Level 4. Supervision contracts, supervision records and appraisal records were on the two files examined. As a point of improvement the home has identified the need to include people who live in the home with the recruitment of staff. Five care staff returned surveys sent out to them by Care Quality Commission. Staff were asked to responded to questions on information, support, training and staffing. Overall staff responded positively although on person indicated that there were only enough staff on duty to meet peoples individual needs sometimes. Staff who responded also made comments with regard to what the home does well and what could be improved. Staff commented that peoples needs are catered for and Care Homes for Older People Page 21 of 28 Evidence: there is a homely environment, it was indicated that people like working at the home and team work is good. Improvements were sighted as more activities for people who are not able to occupy themselves and more staff to work in the home. Care Homes for Older People Page 22 of 28 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Registered Manager was able to demonstrate that she is administering the home in the best interests of people who use the service. Effective quality control and monitoring systems are in place to to ensure that the views of people are sought and areas for improvement can be identified. Systems are in place to manage peoples personal allowance effectively. Training is in place to enable staff to work safely. A safe environment is kept for people who use the service. Evidence: The Registered Manager has now registered with the Care Quality Commission, at the time of the last key inspection she was due apply for registration. The Registered Manager was a Deputy Manager at the home prior to being appointed as Manager. Care Homes for Older People Page 23 of 28 Evidence: We were able to see that the Registered Manager is very organized and has good administration skills. All of the files and records seen were in good order and information was easily accessible. She was able to demonstrate throughout the inspection that she is aware of the National Minimum Standards and is proactive in monitoring and aims to improve the quality of the service. The The Registered Manager has attended training in Handling investigations, Supervision, Protection of Vulnerable Adults, Care planning, Equality and diversity, and Fire Safety, First Aid , End of life care, Dementia , Mental capacity act , the deprivation of liberty safeguards. The manager has NVQ 3 in Care. A quality assurance consultation survey had been completed with people who use the service in 2009. The results of this survey were on display in the lounge. Abbeyfied Society had carried out an audit of James House in 2009. The results of which were forwarded to CQC at the time of the inspection. We looked at the audit record which is a review of all the National Minimum Standards for Older People. Points for improvement have been identified in some areas. In conjunction with the audit an action plan has been drawn up with time scales. The Annual Quality Assurance Assessment informed us that the home does not act as agents or appointees for people living in the home. A record is kept of residents property and accounts, a number of people require help and support and staff may purchase items on their behalf for them, overall relatives take responsibility for this. The (AQAA) informs us that staff have access to the Abbeyfield Society health and safety good practice guide. We were also able to see from the (AQAA) that utilities and equipment had been serviced recently for instance gas, electricity and fire safety circuits. We sampled a small number of health and safety records. A full and detailed fire risk assessment had been completed for the home and fire drills involving people who use the service had taken place in December 2009 and January 2010. The London Fire and Emergency Planning Authority had carried out an inspection of the home in October 2009 with the result of there being no significant failure to comply. The Abbeyfied audit carried out in 2009 had identified areas where mandatory training for some staff in health and safety related courses needed to be improved. We could see from the training spreadsheet and information given to use that training had been booked for staff in 2010 in health and safety and moving and handling. Care Homes for Older People Page 24 of 28 Evidence: Care Homes for Older People Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 28 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 21 We recommend that the home looks at ways to personilise the bathrooms. Care Homes for Older People Page 27 of 28 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. 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