Care Home: Jansondean Nursing Home

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What the care home does well During the inspection all staff were helpful and courteous. The administrator was helpful and able to evidence well organised files particularly those relating to health and safety service certificates, and staff personnel files. Information was easily accessible and to hand when it was requested. There is generally a happy atmosphere in this home. All the residents and their friends and relatives that we spoke to said they were happy with the care and support provided to residents at Janosdean. The food is of a good standard and residents said they like it. There was evidence that recruitment checks were undertaken prior to employment to ensure staff are safe to work in the home. What has improved since the last inspection? It is evident that money has been invested in the building, with the new extension completed and ongoing upgrading of individual bedroom areas. New furniture has been purchased along with curtains and soft furnishings providing great improvements in the communal and individual bedroom areas. Work is still underway in the grounds of the building although the internal work has been completed. The kitchen has been relocated and some new equipment has been installed. The kitchen is now located adjacent to the dining area hence food can be served more directly to residents. The kitchen was awarded a 3 star rating by the Environmental Health Officer at their last inspection of the home. Staff and residents files are in good order with information much easier to find as it is set out in a logical order with appropriate dividers and sections. What the care home could do better: The following areas were identified as a result of this inspection that requires improvement: Standard 3 It is recommended that a pre admission needs assessment should be carried out before placement begins as it will help ensure that potential residents are appropriately placed at Jansondean. Standard 5 We recommend the Manager ensures that before each admission of a potential resident a needs assessment is carried out and a comprehensive information pack is provided. This will help potential residents and their families decide if Jansondean is an appropriate placement where their assessed needs can be met. Standard 7 It is required that the Manager ensures that the process of the review of care plans is revised so that when a review is carried out, each care plan objective is considered, recording progress that has been made since the last review and recording the signatures of all the parties involved in the review. Standard 10 It is required that the Manager draws up a structured induction package preferably linked with the TOPPS standards and one that is timetabled over a specific period. Documented evidence that shows how this process has been carried out must be made available for inspection. Standard 16 It is required that the Manager revises the complaints process to ensure that the time taken to process the complaint is recorded together with the outcome and the resolution with the complainant. A written record should be maintained and signed and dated by all the parties involved. Standard 18 The Manager should ensure that all staff receive POVA training from an external trainer preferably the L.B.Bromley and certificated evidence held on files. This is a recommendation. Standard 19 We recommend that the urgent repairs that are needed to some of the window frames on the top floor and the need for all those rooms to be redecorated is taken while there are no residents living in the top floor accommodation. Standard 19 It is required that the Manager ensures that those bathrooms and sluice rooms identified at the inspection are refurbished. The floors must be properly sealed so as to avoid the potential for infection. The rooms must be redecorated and retiled in some cases and in the case of one of the bathrooms the stained old bath must be replaced. Standard 26 The laundry area is well laid out but there is not an impermeable floor. Many of the floor tiles were cracked, loose and broken presenting a considerable risk to the staff operating in this area and also providing an ideal environment for germs and infection to flourish. It is essential that the whole floor is completely renewed to the expected standards and this is a requirement. Standard 27 It is required that the Manager ensures that all new staff are properly inducted, trained and supervised to the expected standards and that they only work together with experienced staff. Standard 28 The Manager must ensure that all care staff who do not hold an NVQ qualification (excluding the Manager and RGNs) are enrolled for NVQ training as soon as possible. Failure to meet this requirement and the timeframe in which it is set may result in enforcement action being taken. Standard 30 It is a requirement that the Manager ensures that all staff be asked to review the key policies and procedures for the home, be given opportunities to discuss them and to sign to say they have read and understood them. Standard 36 It is required that individual supervision is held regularly and as prescribed in this report and that detailed supervision records for all staff at Jansondean are maintained and kept on site with copies provided to the staff themselves. Standard 36 We recommend that all staff providing staff supervision should receive training on staff supervision so as to ensure that supervision and staff appraisals are carried out consistently and effectively. Key inspection report Care homes for older people Name: Address: Jansondean Nursing Home 56 Oakwood Avenue Beckenham Kent BR3 6PJ     The quality rating for this care home is:   one star adequate 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: David Halliwell     Date: 1 1 0 5 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 37 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 37 Information about the care home Name of care home: Address: Jansondean Nursing Home 56 Oakwood Avenue Beckenham Kent BR3 6PJ 02086507810 02083258008 jansondean@btinternet.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Sage Care Homes Limited Name of registered manager (if applicable) Mrs Susan Ann Clarke Type of registration: Number of places registered: care home 32 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 accommodated is: 32 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Jansondean is a large, detached, older building, situated in a pleasant residential area of Beckenham. It is near to local facilities and shops, and is close to a main road, bus routes and train stations. Parking is to the front of the building. The Providers (Sage Care Homes) have several other homes for the care of older people at different locations around the country. Care Homes for Older People Page 4 of 37 Over 65 32 0 2 1 0 5 2 0 0 9 Brief description of the care home Accommodation is provided on 4 floors (lower ground, ground, first and second), and a passenger lift facilitates access to all floors. A new build extension was completed at the end of 2007, and this has extended the lounge/dining room on the lower ground floor, which leads out into a large garden. Disabled access has been provided into the garden. Extensive refurbishment of individual bedrooms, to incorporate en suite facilities and develop all single bedroom accomadation continues . Fees range between £605.00 for Local Authority beds ,The Primary Care Trust fees are £750, private fees are £ 670.00 per week Care Homes for Older People Page 5 of 37 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: one star adequate 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: The star quality rating for this service is adequate. This means that people who use these services experience adequate quality outcomes. This was an unannounced inspection visit of the services being provided at Jansondean. The Inspection covered the key standards and involved a tour of the home, a review of all the homes records and formal interviews with 3 staff, the Manager and 9 residents. No enforcement activity has occurred since the last inspection in May 2009. As a result of this inspection 9 requirements and 5 recommendations have been made. 3 of the areas of this inspection were raised as requirements at the last inspection and have been repeated again at this inspection. Enforcement action may be taken on these requirements if the new timescales are not met. Care Homes for Older People Page 6 of 37 People who use the services at Jansondean said they like to be called residents. We found the residents and staff most helpful and they are to be thanked for the assistance that they gave him over the course of this inspection visit. At the time of this inspection there were 26 people in residence at Jansondean. The fee for a placement at this home ranges from £605 to £735 per week depending on the persons level of needs. The homes Registration Certificate with the Commission was seen displayed appropriately in the main office. Care Homes for Older People Page 7 of 37 What the care home does well: What has improved since the last inspection? What they could do better: The following areas were identified as a result of this inspection that requires improvement: Standard 3 It is recommended that a pre admission needs assessment should be carried out before placement begins as it will help ensure that potential residents are appropriately placed at Jansondean. Standard 5 We recommend the Manager ensures that before each admission of a potential resident a needs assessment is carried out and a comprehensive information pack is provided. This will help potential residents and their families decide if Jansondean is an appropriate placement where their assessed needs can be met. Standard 7 It is required that the Manager ensures that the process of the review of care plans is revised so that when a review is carried out, each care plan objective is considered, recording progress that has been made since the last review and recording the signatures of all the parties involved in the review. Standard 10 It is required that the Manager draws up a structured induction package preferably linked with the TOPPS standards and one that is timetabled over a specific Care Homes for Older People Page 8 of 37 period. Documented evidence that shows how this process has been carried out must be made available for inspection. Standard 16 It is required that the Manager revises the complaints process to ensure that the time taken to process the complaint is recorded together with the outcome and the resolution with the complainant. A written record should be maintained and signed and dated by all the parties involved. Standard 18 The Manager should ensure that all staff receive POVA training from an external trainer preferably the L.B.Bromley and certificated evidence held on files. This is a recommendation. Standard 19 We recommend that the urgent repairs that are needed to some of the window frames on the top floor and the need for all those rooms to be redecorated is taken while there are no residents living in the top floor accommodation. Standard 19 It is required that the Manager ensures that those bathrooms and sluice rooms identified at the inspection are refurbished. The floors must be properly sealed so as to avoid the potential for infection. The rooms must be redecorated and retiled in some cases and in the case of one of the bathrooms the stained old bath must be replaced. Standard 26 The laundry area is well laid out but there is not an impermeable floor. Many of the floor tiles were cracked, loose and broken presenting a considerable risk to the staff operating in this area and also providing an ideal environment for germs and infection to flourish. It is essential that the whole floor is completely renewed to the expected standards and this is a requirement. Standard 27 It is required that the Manager ensures that all new staff are properly inducted, trained and supervised to the expected standards and that they only work together with experienced staff. Standard 28 The Manager must ensure that all care staff who do not hold an NVQ qualification (excluding the Manager and RGNs) are enrolled for NVQ training as soon as possible. Failure to meet this requirement and the timeframe in which it is set may result in enforcement action being taken. Standard 30 It is a requirement that the Manager ensures that all staff be asked to review the key policies and procedures for the home, be given opportunities to discuss them and to sign to say they have read and understood them. Standard 36 It is required that individual supervision is held regularly and as prescribed in this report and that detailed supervision records for all staff at Jansondean are maintained and kept on site with copies provided to the staff themselves. Standard 36 We recommend that all staff providing staff supervision should receive training on staff supervision so as to ensure that supervision and staff appraisals are carried out consistently and effectively. Care Homes for Older People Page 9 of 37 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 10 of 37 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 11 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 3 & 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents have a needs assessment carried out once they have moved into this home. Evidence: Standard 3 We looked at 6 of the residents files at this inspection and found that most of the referring authorities had provided a needs assessment for the people they had referred to Jansondean. A needs assessment completed by the staff was seen on each of the files. However no pre admission assessment had been carried out on the files we inspected. This is Care Homes for Older People Page 12 of 37 Evidence: recommended since it will help ensure that potential residents are appropriately placed at Jansondean. The needs assessments that we saw had been carried out after the residents had moved into the home. The assessment format being used is thorough and comprehensive in its coverage of a residents needs. This helps to ensure that residents needs are understood and care plans can made to ensure their assessed needs can be met. A risk assessment was seen on all of the residents files that identifies any risks which might affect the resident. Preventative actions had been identified and integrated into the care plan objectives. The completion of the needs assessment format on the files inspected was good with some information provided on all the areas mentioned. Standard 5 We were unable to find records relating to trial visits or visits made to the home by families of prospective residents in the care plans we viewed. There was little evidence relating to what other information had been provided before the potential residents admission. All of this information and a pre admission needs assessment would be beneficial in ensuring that the home is able to meet the residents needs and that they had sampled the service prior to any permanent decision on placement being made. If this were located in the care plan it would provide staff with some initial information on which to provide care. We strongly recommend the Manager ensures that before each admission of a potential resident a needs assessment is carried out and a comprehensive information pack is provided. This will help potential residents and their families decide if Jansondean is an appropriate placement and whether their assessed needs can be met. Standard 6 We did not inspect this standard given that the Registered Manager said that no intermediate care is provided so Standard 6 is not appropriate and has not therefore been assessed. Care Homes for Older People Page 13 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users may be assured that their health and social care needs will be set out in an individual care plan and that their health needs will be met. The policies and procedures for the administration of medication should help protect them. Residents in the home feel that they are treated with dignity and respect. Evidence: Standard 7 6 residents files were inspected at this inspection and on all those files there was a care plan. All of the care plans look to have been reviewed monthly and had been signed off by staff. However there was no evidence to show that the individual care plan objectives in these care plans had been specifically considered with comment written down on the progress (or not) made in achieving the stated objectives. Where the resident is able, their signature or that of their families or representatives should also be on the care plans and the reviews of care plans. This is to evidence that they or their families or representatives have been central to the Care Homes for Older People Page 14 of 37 Evidence: process and that their views, wishes and preferences have been taken into account. The Manager told us that should the needs of any resident change then there would be a review of the assessment and of their care plan. It is required that the Manager ensures that the process of the review of care plans is revised so that when a review is carried out, each care plan objective is considered, recording progress that has been made since the last review and recording the signatures of all the parties involved in the review. Care plan information included all the key information details for the resident including the name and address of their relatives and next of kin; information about their GPs; the date of the residents admission to the home; the appropriate details of the referring agencies which placed the residents; a record of all the medicines administered and any other relevant information to the provision of care for the resident concerned. The Manager should ensure that a photograph of the resident is placed at the front of each of the residents files. This should assist anybody reading the file (and especially agency staff) to easily recognise the person concerned. Standard 8 We were advised that there are three residents in the home who have pressures sores. We were told that the Tissue Viability nurse is involved with those residents who have pressure sores. The care plans we viewed were in a standard typed format, they included activities of daily living. As we have already stated it was evident in the care plans that not all of the care needs had been updated. There was little other information to indicate what staff were doing about these presenting problems. All of these need to be individually managed by staff and may require specialist input from psychiatric services. The staff need to have a clear consistent approach when delivering care and this needs to be identified in the care plan. Risk assessments were in place to cover manual handling, skin integrity, falls and oral hygiene. It was apparent that when high risks were identified the routine re evaluation continued regularly. The Manager informed us that all the residents have access to and are seen by a GP from the local area in Beckenham. The Manager also told us that all residents have access to appropriate health care professionals. The optician visits every 6 months; the dentist also visits once every 6 months and the chiropodist also visits on regular basis every 3 months. Standard 9 We saw the agencies policies and procedures manual and this file included an appropriate medication policy for the unit. The Manager told us that only the RGNs Care Homes for Older People Page 15 of 37 Evidence: and the Manager administer the medicines to the residents at Jansondean. The Manager said that none of the current residents self medicate. Appropriate records (MAR sheets) were seen to have been completed properly for the period and for the administration of medicines to residents. Medications are via the MDS system. They were safely stored in a clinical room which was very tidy. The records were well completed. Charts had photographs for identification purposes and this should help staff to be sure that they are administering medication to the correct person. Those medications received into the home were recorded. A check carried out by us together with the RGN on duty for medicines remaining in the stores against the recorded levels proved correct and no errors were found in the system. The storage of medicines was seen to be completely appropriate including refrigerated cupboards where necessary. Standard 10 We spoke with 8 of the residents at Jansondean about the quality of the care they receive to meet their needs. Although the presence of dementia for the residents in varying degrees of progression did make this rather difficult in some cases we were impressed with the positive remarks made by residents about the care and support that they receive from staff. We were also impressed by the commitment of the staff, formally interviewed by us, to maintaining the dignity and privacy of the residents wherever possible. All the residents receive personal and nursing care and are helped with washing and bathing, dressing and toileting. All residents have their own laundry baskets operated by the care staff and their laundry is washed in a systematic way so as to ensure they are able to wear their own clothes. We were told by the Manager that there is a staff induction programme which all new staff are expected to work through. We were shown these documents however there was little evidence seen by us that new staff have actually received this training via a properly structured induction package. It is therefore required that the Manager draws up a structured induction package that is timetabled over a specific period. The documentation must be provided that shows exactly what staff have covered and should be signed off and dated by both the staff and their supervisor. Induction should Care Homes for Older People Page 16 of 37 Evidence: cover all the core standards (preferably linked in with the TOPPS standards), the policies and procedures of the home, the roles and responsibilities of the new staff as key workers working with the residents. Care Homes for Older People Page 17 of 37 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. Standards 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are likely to find that the lifestyle they experience at Jansondean matches their expectations and their preferences and satisfies their social, cultural, religious and recreational interests. Residents are encouraged to maintain contacts with their friends and families and are helped to exercise choice and control in their lives wherever possible. The meals and food provided to residents is well balanced, healthy and varied. Evidence: Standard 12 The Manager told us that since the last inspection a new member of staff has been employed who organises the activities programme for the residents. We were told about the homes programme of entertainment and events, which are provided for the residents. Care Homes for Older People Page 18 of 37 Evidence: The Manager informed us that the residents religious and cultural needs are assessed as a part of their initial assessment and placement at Jansondean. Evidence of this was seen in part on the residents files and specifically in their needs assessments. The Manager told us that both an Anglican and a Catholic Minister attends the home on a regular basis for the residents. Standard 13 We were told by the Manager and the staff that there are no specific visiting hours and that as long as a resident wishes to see a relative then visitors are welcome at most times of the day. A record of visitors was seen and there is a room as well as the residents own bedrooms where relatives, families and friends can be seen in private if they wish. We spoke to 4 relatives of 4 different residents who said that they are able to visit when ever they wish and that there are no restrictions placed on their visiting their relatives. They told us, we come in at all times unannounced and we are always welcomed. The staff here are very kind to the residents. Standard 14 This standard explores issues relating to: managing financial affairs, advocacy, respecting of the right to personal possessions, and enabling access to information kept concerning a resident. The Manager told us that none of the current residents are able to control and manage their own affairs; this is usually done by relatives. We noted advertisements for local advocacy services in the front hallway of the home, where residents and their relatives often pass. Permission is given to residents who wish to bring in items of furniture or other familiar items when entering the home; the only proviso is that these items be safe from the point of view of fire and soundness. Standard 15 A 4 week rolling menu is provided and the Manager draws that this up after consultation with the residents who are asked what they would like to eat. Any special dietary requirements are also taken into account and provision is made in the menu plan. We were shown the menu plan and the daily menus by the Chef and these menus provide a wide and healthy range of food for the residents. We were able to speak to the residents about the food. All the residents who were asked by us said that they like the food on offer to them and they confirmed that they do have a choice. One resident to whom we spoke is a vegetarian and she said she really enjoys the vegetarian options she is offered at Jansondean. The Chef told us that every day residents are asked for their choice from the 2 meal Care Homes for Older People Page 19 of 37 Evidence: options. Care staff were seen to provide assistance to the residents when this was necessary and staff were seen to ask the residents before they offered any help to them. Meal times were seen to be unhurried and any resident who chose to eat in their bedrooms was enabled to do so. The Manager said that at the Environmental Health Officers last visit the home was awarded a 3 star rating. We reviewed the report and saw that where any improvements were required, they had been completed. The Manager informed us that where appropriate a nutritional assessment is undertaken as a part of the residents needs assessments and any special needs are catered for in the menu planning. Care Homes for Older People Page 20 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standard 16 & 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users can be confident that the home will deal with complaints appropriately; information about the complaints procedure is readily available to all who may wish to express an opinion about the service. Service users can be assured that the processes in the home will protect them from potential abuse by staff or others. Evidence: Standard 16 The Manager showed us the complaints policy and procedure for Jansondean. This policy covers all the essential areas required for a complaints policy including a staged process with timescales and contacts for other agencies including the CQC to contact in the event of dissatisfaction with the internal process of investigation. The Manager maintains a record of the complaints book and we saw this. Only 1 complaint had been recorded since the last inspection, however there was no recording of the outcome or how the complaint had been resolved with the complainant. It is required that the Manager revises the complaints process to ensure that the time taken to process the complaint is recorded together with the outcome and the resolution with the complainant. A written record should be maintained and signed and dated by all the parties involved. Care Homes for Older People Page 21 of 37 Evidence: Standard 18 Staff were interviewed about the action they would take if there was suspected abuse and how they might action whistle blowing. Staff said that they had received training on protection of vulnerable adults. This topic had also been covered during the induction period. All staff had a good knowledge of what action they should take in abuse or circumstances where whistle blowing is appropriate, and knew the importance of reporting this on in a timely manner. Of the 6 staff that we case tracked only on 2 of the staff files could we find evidence that they had received POVA training. The new training matrix however shows that most of the staff group received training in March 2010. The Manager should ensure that all staff receive POVA training from an external trainer preferably the L.B.Bromley and that certificated evidence is held on the staff training files. This is a recommendation that should help ensure that all staff recognise the signs of abuse and what action is required where necessary. This will help to ensure the protection and safety of the residents. Residents said they would raise concerns with staff or members of their families. Care Homes for Older People Page 22 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The house is safe and reasonably well maintained. It is clean but some specified refurbishment and repairs are needed to ensure that it is hygienic and the potential for infection is reduced. The laundry areas and the sluice rooms have not been maintained to the expected standards. Bedrooms are safe and comfortable, meeting each individuals needs with all basic amenities provided. Evidence: Standard 19 Together with the Manager we undertook a tour of the premises. At the time of the inspection the lift was out of action and the Manager said that this might have lead to residents on the top floor being somewhat isolated. The Manager told us that the residents who were on the top floor had been moved to rooms either on the ground or first floors. The Manager said that this has provided an opportunity for the top floor of the home to be refurbished and redecorated. We would recommend that this opportunity is taken as we saw urgent repairs are needed to some of the window frames on the top floor and all the rooms need redecoration. Care Homes for Older People Page 23 of 37 Evidence: The general condition of the home and the facilities is good; communal areas and bedrooms are kept clean and odour-free. The Manager and staff provide a homely touch through supplementary decoration, ornaments, flower decorations and pictures hanging on all the walls. The home has a wide range of bathrooms and toilets and sluice rooms some of which have been upgraded and others that are desperately need upgrading. It is therefore required that the Manager ensures that those bathrooms and sluice rooms identified at the inspection together with the Manager are refurbished so that the floors are properly sealed so as to avoid the potential for infection, the rooms redecorated and retiled in some cases and in the case of one of the bathrooms the stained old bath be replaced. Hot water temperatures are checked on a regular basis so that over a period of one month all the hot water outlets are temperature checked. Records of these checks were seen by us and all the checks showed that hot water temperatures are within the safe and prescribed limits. There is an extensive and secure back garden leading from a relatively new dining room and lounge extension built at the rear of the house. Standard 26 The home was found at this inspection to be clean and free from offensive odours. We toured the unit together with the Registered Manager and inspected all areas of the home. Most of the 23 residents bedrooms were seen and were found to be clean and tidy and all the residents spoken to by us said that their bedrooms are decorated and furnished as they would wish. The Manager showed us the homes an infection control procedure, which seems to be effective. We were told that the home has a contract with a company that deals with clinical. The laundry area is well laid out but there is not an impermeable floor. Many of the floor tiles were cracked, loose and broken presenting a considerable risk to the staff operating in this area and also providing an ideal environment for germs and infection to flourish. It is essential that the whole floor is completely renewed to the expected standards and this is a requirement. Laundry is not taken through the kitchen and cooking areas of the home. Care Homes for Older People Page 24 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users may be assured that they are in safe hands however they cannot be assured at present that there are sufficient numbers of staff with the necessary level of skills, training and experience to fully meet their needs. Evidence: Standard 27 The Manager provided us with a staffing rota for Jansondean. The rota shows exactly who is working for the week. We were informed that there are usually 2 RGNs on duty and 5 care staff on duty as well as the Manager who is on duty during the day. At night we were told that there are 2 care staff on duty. The rota provided supported this statement. Given that the number of residents currently living at Jansondean the staff: resident ratio mix seems adequate to meet the needs of the residents. However inspection of 7 of the staffing files including a number of new staff did not re assure us that the home has yet achieved the level of staff with the appropriate skills and experience that is really required properly to deal with the complex needs of the residents. This was raised at the last inspection and a requirement was made to this Care Homes for Older People Page 25 of 37 Evidence: effect. While we recognise that there has been some improvement in the staff numbers being provided on duty we are still concerned with the level of skill and experience that some of the staff group hold. A number of the new staff are students and are working at Jansondean whilst also studying for their NVQ level 2 and 3 qualifications. It was clear from the interviews we had with them that some of the new staff have difficulty understanding the language. We recognise that these staff are committed to their work as care workers. Also that they are studying to achieve their NVQ qualifications. They do not however at present hold sufficient qualifications, skills and experience to be working unsupervised in these roles. It is required that the Manager ensures that new staff are properly inducted, trained, supervised and that they only work together with experienced staff until they have achieved this. The home also has kitchen and domestic staff who we met over the course of this inspection. The Manager told us that wherever possible the home does not use agency staff. Standard 28 According to the rota we were shown for the home there are 25 staff who are employed to work at Jansondean. We inspected 7 of the staffing files; 2 of these staff are qualified RGNs and 1 member of staff holds the NVQ level 3 although there was no certificated evidence available to support this claim. 3 of the other staff files we inspected showed us that these new staff are also students working to achieve their NVQ qualifications at levels 2 and 3. As we have already stated there are concerns about the number of staff who hold sufficient and appropriate qualifications, a requirement has been made under the Standard 27. The Manager must ensure that all care staff who do not hold an NVQ qualification (excluding the Manager and RGNs) are enrolled for NVQ training as soon as possible. Failure to meet this requirement and the timeframe in which it is set may result in enforcement action being taken. Standard 29 Jansondean does have a recruitment procedure that was inspected and the appropriate stages of the process had been implemented in the 7 staff files that we inspected. Applicants were seen to have been interviewed, application forms completed, two written references gained, enhanced Criminal Record Bureau (CRB) checks undertaken and documentation regarding all these parts of the recruitment Care Homes for Older People Page 26 of 37 Evidence: process are held on staffing files in the main office. We saw evidence that this process is being properly implemented. All of the 7 staff files inspected showed that their CRBs had been carried out between 2008 - 2010. We did not find evidence that appropriate induction training had been implemented and a requirement has been made to this end earlier in this report. Contracts with staff were seen on the staffing files. Standard 30 The Manager informed us that since the last inspection in May 2009 3 new members of staff have joined the staff team. We inspected all 3 of their files as a part of the 7 staff files inspected. We have commented on the induction process earlier in this report and a requirement has been made. At this inspection the Manager showed us a new training matrix that contains all the information about the staff group identifying what training they have received and when. This should now provide a useful tool for the Manager that identifies what training staff have received and when. This will help the Manager identify future staff training needs and give a complete picture at a glance. The Manager informed us that there is an overall training and development plan and that all staff received essential training updates in. Certificated evidence was provided that confirmed staff had completed training in the following areas: Manual handling Fire awareness Infection control Ist aid awareness Essential care elements POVA Medication. We asked the Manager how she ensures that staff are aware of the homes polices and procedures and how they are kept up to date with this and any changes or revisions that are made. The Manager told us that staff cover this in induction however they are not discussed in supervision and staff are not currently asked to sign with a date to say they have read them. It is therefore a requirement that all staff be asked to review the key policies and procedures for the home. It is suggested that they have a discussion in their supervision sessions over a period of time and are then asked to sign to say that for each individual key policy and procedure that they have read and understood them and have had the chance to discuss them with their supervisor. This should help benefit residents in that the staff will know and understand the homes policies and procedures. Care Homes for Older People Page 27 of 37 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Standards 31, 35, 36 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is run by a person who is fit to be in charge and is able to discharge their responsibilities. The Managers approach to monetary issues at the home ensures the protection of services users financial interests thus providing protection especially to those who cannot manage their own affairs any longer. Supervision practices need development and improvement. Evidence: Standard 31 Ms Clarke took up post in September 2008 and is currently working 32 hours a week in her role as Manager. She has experience in this type of work previously managing a similar facility in Bromley. She is a Registered General Nurse Care Homes for Older People Page 28 of 37 Evidence: and holds the Diploma in Management Studies; she has since the last inspection become a registered manager with the Commission. The Manager told us that she has 11 years of management experience in social and healthcare services. Standard 33 We did not inspect this standard at this inspection. Standard 35 The Manager told us that generally Jansondean does not look after residents monies directly. However a small financial float is kept for residents so that if a resident does need something to be purchased the Manager or staff may make the purchase. For this reason we inspected the records, 2 staff signatures are gained with all transactions as well as that of the resident. Everything was found to be in order. This all means that residents financial interests are in order. Standard 36 Inspection of the staff supervision records, discussion with 4 members of staff and the Manager shows that staff do not receive t he appropriate frequency of individual supervision. Equally the areas bought up in current staff supervision are not adequate to ensure that staff are being appropriately supervised. Care staff should receive formal supervision at least once every 4 - 6 weeks and informal supervision more often, sometimes on a daily basis. Supervision records should be made and copies held on file and provided to staff for their information. Inspection of the supervision records at this inspection showed that supervision sessions are very brief and they did not contain sufficient detail where discussions had been had with key working staff about the work they are doing with residents in meeting their care plan objectives. Staff interviewed were rather vague about their supervision sessions and what they discussed in them. Supervision sessions should include the monitoring and review of work objectives, the training needs required by the staff member in order to carry out their work and any other issues that have arisen in supervision. Both the member of staff and the supervisor should sign off these records. It is required that supervision is held regularly and is as prescribed above and that detailed supervision records for all staff at Jansondean are maintained and kept on site. By doing so it should improve the quality of supervision and support offered to staff and the quality of care delivered to tenants. We spoke with the Manager about supervision practices and confirmed that supervision sessions held with staff should include the monitoring and review of all Care Homes for Older People Page 29 of 37 Evidence: aspects of care practices, the philosophy of care in the home and also career and training development needs. Areas of discussion should also cover the monitoring and review of any individual work with residents care plans objectives. The supervision record should detail any agreements made, revised work objectives and key areas of discussion. We recommend that all staff providing staff supervision should receive training on staff supervision so as to ensure that supervision and staff appraisals are carried out consistently and effectively. Standard 38 The policies and procedures manual includes polices on health and safety, risk assessment, moving and handling and fire risk awareness. A fire risk assessment had been carried out on 28th April 2010. This covers all the necessary areas and the Manager has ensured that all staff are aware of this assessment and their responsibilities associated with it. Certificates were also checked and seen by us for the following services that are installed in the home, certificates which state that these systems have been checked by appropriate professionals since the last inspection and found to be satisfactory and fit for purpose. 1. Boiler & gas 2.06.2009 2. Electrical system check 26.11.2009 3. Lift, a full refurbishment is underway now 4. Fire alarms 22.01.2010 5. Emergency lighting system 2.03.2010 6. Fire fighting equipment 2.03.2010 7. Water check for legionella organisms 30.07.2009 8. Hoists and bath lifts 1.11.2009 9. Portable electrical equipment 22.4.2010 10. Nurse call system 23.07.2009 Records were seen and checked by us as satisfactory for: 1. Weekly fire alarm tests 2. Staff fire drills every 2 months 3. Fire extinguishers visually checked monthly 4. Fridge and freezer temperature checks 5. Accidents and incidents Care Homes for Older People Page 30 of 37 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Care plans and supporting documents need to fully reflect the care to be provided. The care plans are the basis on which staff deliver the care hence must be comprehensive. 30/09/2009 2 27 18 The manager must ensure that the skill mix and numbers of staff are sufficient to meet residents needs. Staff need to have sufficient time to provide care and complete required records under appropriate supervision levels . 30/09/2009 3 33 35 Quality assurance measures 30/09/2009 must include the views of all stakeholders. To ensure that there views are taken in to consideration in any future developments in the service. Care Homes for Older People Page 31 of 37 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 14 It is required that the 01/07/2010 Manager ensures that the process of the review of care plans is revised so that when a review is carried out, each care plan objective is considered, recording progress that has been made since the last review and recording the signatures of all the parties involved in the review. In order o meet the NMS. 2 10 18 It is required that the 01/07/2010 Manager draws up a structured induction package preferably linked with the TOPPS standards and one that is timetabled over a specific period. Documented evidence that shows how this process has been carried out must be made available for inspection. In order o meet the NMS. Care Homes for Older People Page 32 of 37 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 3 16 22 It is required that the Manager revises the complaints process to ensure that the time taken to process the complaint is recorded together with the outcome and the resolution with the complainant. A written record should be maintained and signed and dated by all the parties involved. In order to meet the NMS. 01/06/2010 4 19 16 It is required that the 01/09/2010 Manager ensures that those bathrooms and sluice rooms identified at the inspection are refurbished. The floors must be properly sealed so as to avoid the potential for infection. The rooms must be redecorated and retiled in some cases and in the case of one of the bathrooms the stained old bath must be replaced. In order to meet the NMS. 5 26 13 The laundry area is well laid out but there is not an impermeable floor. Many of the floor tiles were cracked, loose and broken presenting a considerable risk to the staff operating in this area and also providing an ideal 01/09/2010 Care Homes for Older People Page 33 of 37 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 environment for germs and infection to flourish. It is essential that the whole floor is completely renewed to the expected standards and this is a requirement. In order to meet the NMS. 6 27 18 It is required that the 01/06/2010 Manager ensures that all new staff are properly inducted, trained and supervised to the expected standards and that they only work together with experienced staff. In order to meet the NMS. 7 28 18 The Manager must ensure 01/01/2011 that all care staff who do not hold an NVQ qualification (excluding the Manager and RGNs) are enrolled for NVQ training as soon as possible. Failure to meet this requirement and the timeframe in which it is set may result in enforcement action being taken. In order to meet t he NMS. 8 30 24 It is a requirement that the Manager ensures that all staff be asked to review the key policies and procedures for the home, be given opportunities to discuss 01/08/2010 Care Homes for Older People Page 34 of 37 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 them and to sign to say they have read and understood them. In order to meet the NMS. 9 36 18 It is required that individual supervision is held regularly and as prescribed in this report and that detailed supervision records for all staff at Jansondean are maintained and kept on site with copies provided to the staff themselves. In order to meet the NMS. 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 01/07/2010 1 3 It is recommended that a pre admission needs assessment should be carried out before placement begins as it will help ensure that potential residents are appropriately placed at Jansondean. We recommend the Manager ensures that before each admission of a potential resident a needs assessment is carried out and a comprehensive information pack is provided. This will help potential residents and their families decide if Jansondean is an appropriate placement where their assessed needs can be met. The Manager should ensure that all staff receive POVA training from an external trainer preferably the L.B.Bromley and certificated evidence held on files. This is a recommendation. We recommend that the urgent repairs that are needed to some of the window frames on the top floor and the need Page 35 of 37 2 5 3 18 4 19 Care Homes for Older People 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 for all those rooms to be redecorated is taken while there are no residents living in the top floor accommodation. 5 36 We recommend that all staff providing staff supervision should receive training on staff supervision so as to ensure that supervision and staff appraisals are carried out consistently and effectively. Care Homes for Older People Page 36 of 37 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. 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