Care Home: Jasmine House

Similar services:

• St Vincents
• The Cotswold Home
• Winton House
• Rush Court
• Hillyfield Rest Home
• The Maypole Nursing Centre
• The Briars

What the care home does well Prospective residents and their representative are provided with sufficient information about the home to enable them to decide on its suitability to their needs. A thorough assessment process is undertaken prior to and during admission to try to ensure that the home will be able to meet the needs of the prospective resident. The needs of residents are recorded within detailed and individualised care plans to enable carers to meet them. The degree to which the home addresses the privacy and dignity of residents is mostly very good. Residents are provided with opportunities to take part in an appropriate range of activities and their cultural and spiritual needs are provided for. Visiting is not restricted and regular contact encouraged where possible. Residents are encouraged and supported to make choices and day-to-day decisions about their lives and are provided with an appropriate and varied diet which also provides for any special needs or dislikes. The home has appropriate systems for receiving and responding to any concerns or complaints and also for safeguarding residents from abuse. The majority of the home provides residents with a satisfactory,safe and wellmaintained environment. The home has appropriate numbers of care and nursing staff and staff deployment meets the needs of residents. Levels of NVQ attainment and mandatory training are mostly good and provide staff with the skills and knowledge to meet the needs of residents. The home`s recruitment systems help to safeguard residents from abuse and appropriate records of the process are maintained. The home is effectively run by a well qualified and experienced manager and a consistent senior team in order to meet the needs of residents. Where the home hold funds on behalf of residents, appropriate systems are in place to safeguard these funds. Systems are in place to safeguard and promote the health, safety and welfare of residents and staff. What has improved since the last inspection? Staff have received some in house training on communication and other aspects of working with residents who have dementia, and a distance learning training package on dementia is also being used. The tertiary mental health nurse has been involved in assessments where there is a diagnosis of dementia to support the process. Nursing staff have attended training on the new "Deprivation of Liberty" safeguards, and associated records have been introduced. Four of the care assistants are undertaking NVQ level 4 and will have greater involvement in care planning. Twenty care staff who have attained NVQ level 2 have gone on to commence level 3. A new full-time activities coordinator has been employed and resident involvement in activities has been improved, as has the range of activities offered. Some premises improvements have been made including the addition of some new windows, some redecoration, the provision of a staff photo board in response to residents` request and the commencement of a carpet replacement programme. The common induction standards have been introduced for all new staff, and a new supervision system has been introduced. What the care home could do better: some inconsistencies in medication recording need to be addressed. The manager should consider how best to address the dignity and possible health and safety issues associated with the provision of hairdressing and chiropody in communal areas. Consideration should be given to the replacement of the dining room roof in Jasmine wing, which has ongoing problems with leakage. The suitabilty of one of the proposed new bedrooms should be reviewed. Additional staff training is needed in some areas. The provider should ensure that required monthly monitoring visits take place regularly in future. Key inspection report Care homes for older people Name: Address: Jasmine House 16-22 Westcote Road Reading Berks RG302DE     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: Stephen Webb     Date: 0 3 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Jasmine House 16-22 Westcote Road Reading Berks RG302DE 01189590684 01189585458 jasminecare@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Jasmine Care Ltd care home 79 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 79. The registered person may provide the following category/ies of service only: Care home with nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia (DE) Old age, not falling within any other category (OP) Physical disability (PD) the maximum number of places 2. Date of last inspection Brief description of the care home Jasmine House is a care home with nursing, opened in September 2003 that is now registered for 79 residents. The home is two residential Edwardian semi - detached properties that were converted to a care home by previous owners. It is situated in a quiet road just off major road links to the centre of Reading and has easy access by public transport. Jasmine House is one of three homes owned by the company Jasmine Care Homes for Older People Page 4 of 30 Over 65 0 79 0 79 0 79 Brief description of the care home Care Ltd. The home provides care to older people and to some younger people who have serious illnesses that require nursing care. The current fees can be obtained from the homes manager. Care Homes for Older People Page 5 of 30 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: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This inspection included an unannounced site visit from 09:30am until 17.15pm on the 3rd of December 2009. This report also includes reference to documents completed and supplied by the home, and those examined during the course of the site visit. The report also draws from conversation with the manager. Residents also provided some verbal feedback and the inspector also observed the interactions between residents and staff at various points during the inspection. An Expert by Experience also took part in this inspection and spent about three hours talking with residents and observing care practice in the communal areas of the home. Her feedback has been incorporated where appropriate in the body of the report. The Care Homes for Older People Page 6 of 30 interactions observed were positive and staff were seen to respond promptly to the needs of individual residents. The inspector also examined the premises. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? Staff have received some in house training on communication and other aspects of working with residents who have dementia, and a distance learning training package on dementia is also being used. The tertiary mental health nurse has been involved in assessments where there is a diagnosis of dementia to support the process. Nursing staff have attended training on the new Deprivation of Liberty safeguards, and associated records have been introduced. Care Homes for Older People Page 8 of 30 Four of the care assistants are undertaking NVQ level 4 and will have greater involvement in care planning. Twenty care staff who have attained NVQ level 2 have gone on to commence level 3. A new full-time activities coordinator has been employed and resident involvement in activities has been improved, as has the range of activities offered. Some premises improvements have been made including the addition of some new windows, some redecoration, the provision of a staff photo board in response to residents request and the commencement of a carpet replacement programme. The common induction standards have been introduced for all new staff, and a new supervision system has been introduced. 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 9 of 30 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 10 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents and their representative are provided with sufficient information about the home to enable them to decide on its suitability to their needs. A thorough assessment process is undertaken prior to and during admission to enable the management to establish that the home will be able to meet the needs of the prospective resident. Evidence: The home has a combined Statement of Purpose and Service User Guide document, rather than two separate ones, and also has a brochure and an information leaflet for residents and relatives. The Service User Guide contains details about the home, its staff and the service provided and also provides information about the complaints procedure. The information leaflet and brochure contain some out of date information which should be corrected when the documents are next updated. The service user guide was undated. The manager clarified that it had last been reviewed in April 2009. Care Homes for Older People Page 11 of 30 Evidence: The document should be dated. The home undertakes a detailed pre-admission assessment to a set format and additional needs assessment and admission forms are later completed; which all inform the subsequent care plan. The assessment identifies some of the necessary information on the individual wishes and preferences of the resident to enable the subsequent care plan to address these. Care Homes for Older People Page 12 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical, health, and social care needs of residents are recorded within detailed and individualised care plans to enable carers to meet their needs. Healthcare needs are also identified and met effectively. The home has an appropriate medication management system in place though some inconsistencies in recording need to be addressed to ensure resident welfare in all cases. The degree to which the home addresses the privacy and dignity of residents should be improved in the areas identified, but is otherwise very good. Evidence: The home uses an established care planning and recording system which provides standard formats for addressing the range of care needs and risk assessments relating to the resident, as well as formats for ongoing care records, monitoring and review. The documents were completed in detail. Examination of a sample of care plans and associated records indicated the plans were individualised and included reference to some personal preferences, wishes and Care Homes for Older People Page 13 of 30 Evidence: choices, and to the physical, emotional and social aspects of the residents needs. The completion of a resident profile at admission supports this individualisation by providing information on life/employment history, positive and negative life experiences, significant family and friends, and hobbies and interests. The plans also identified how some of the identified needs were to be met, though this aspect could be expanded upon further in some areas. The records indicate that ongoing review of the care plans takes place. Staff may use a variety of communication methods with residents, where they are unable to communicate verbally. They have become familiar with each individuals method of communicating their wishes and needs, via facial expression, gesture, body language and in some cases through using communication books containing relevant images. In their interactions with residents, carers demonstrated a patient approach to communication. The manager stated that staff are encouraged to spend time with residents and this was observed to be the case during the inspection, where they were seen by both the inspector and Expert visitor to be sat talking with individuals and encouraging their engagement with activities. An appropriate range of risk assessments were also completed, covering areas including the risk of falls, skin breakdown, manual handling support and nutrition; and these were subject to regular review. Where appropriate the use of bed rails is also risk assessed. A multi-disciplinary healthcare record is also maintained together with notes from GP visits and nurses notes. It was noted that in several cases where the risk of skin breakdown had been assessed as high, in each case the residents skin integrity was being successfully maintained. Two residents have specialist dietary needs and the home is supported in meeting these by dietician and nutritionist advice and staff training. The home uses the Gold Standard Framework for end-of-life care to produce a detailed care plan around these issues and some staff have also received training on the Liverpool Care Pathway end-of-life care. The home uses a monitored dosage system to manage medication on behalf of residents, none of whom were able to manage this for themselves at the time of inspection. The manager indicated that a resident who wished to do so, could manage their own medication subject to risk assessment if they were able, and one residents who comes for periodic respite care does this. Medication is only administered by the nursing staff in the home. The records include individual medication and allergy Care Homes for Older People Page 14 of 30 Evidence: profiles and the home has a homely remedies protocol to cover non-prescribed overthe-counter medication. The medication system provides an audit trail for the medication, as the quantities received are recorded within the medication administration record (MAR) sheets as well as the actual administration. Any disposals are also recorded. The home has a system of positive entries for the nonadminmistration of as required medication but this was seen to be applied inconsistently in some cases, making stock control more difficult. Also in one of the MAR sheet folders a significant number of gaps were observed in administration records. In some cases this was reported to have been due to the non-delivery of supplies by the pharmacy, but there was no record of this within the administration record sheets. The manager must investigate these errors and ensure that appropriate steps are taken to prevent recurrence. Consideration should be given to a system of checks at handover to ensure that the administration records are monitored to pick up any errors in timely fashion. A recent inspection of the homes medication management system and records by the Primary Care Trust in September 2009 found no significant issues. Staff were observed to treat individual residents with dignity and demonstrated a calm and patient approach. Care plans record individuals preferred mode of address and any cultural or individual wishes and preferences. Feedback from residents to the inspector and the visitingExpert by Experience who supported this inspection, confirmed that residents felt that their dignity and privacy were respected and that staff were very kind. The visitor observed that various residents had had their nails and make-up done, and that attention had been given to individual residents clothing. The visiting hairdresser was also working in the home during the inspection. All of these provide evidence of support for residents dignity. However, two aspects of care practice appeared to potentially contradict this. It was observed that the visiting hairdresser undertook her task in the communal dining room with various residents and staff coming and going. There is also a potential food hygiene issue here as the room is used for resident dining. On the day hairdressing took place right up until just before lunchtime. The visting expert also noted this concern. The manager explained that there was no dedicated hairdressing room, which is unusual in a home of this size. Consideration should be given to how the dignity and hygiene aspects of hairdressing in the home could be better addressed. The manager also clarified that the visiting chiropodist attended to residents needs in the communal areas. She stated that this was by residents choice as it avoided them having to return to their room for treatment. However, this is an aspect of personal/healthcare, and as such, should be provided in private. There are also potential health and safety and dignity issues, for both the patient and any other residents sat nearby, which should be considered. Care Homes for Older People Page 15 of 30 Evidence: Residents privacy is supported by the majority of bedrooms being single occupancy and sharing in larger rooms only being by mutual agreement. Appropriate locks are also provided to toilets and bathrooms. Records are maintained appropriately and personal care undertakne behind closed doors, with the exception of the issues identified above. Care Homes for Older People Page 16 of 30 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are provided with opportunities to take part in an appropriate range of activities and their cultural and spiritual needs are provided for. Visiting is not restricted and regular contact encouraged where possible. Residents are encouraged and supported to make choices and day-to-day decisions about their lives and are provided with an appropriate and varied diet which also provides for any special needs or dislikes. Evidence: The home has a new full-time activities coordinator who has established a new activities programme and quickly developed a positive relationship with the residents. This was observed on the day of inspection by the inspector and the expert visitor and confirmed by the residents themselves. The activities coordinator demonstrated good knowledge about the individual interests and needs of residents. Care plans include a record of the activities in which a resident has taken part and the residents profile completed at admission may provide information on any particular interests or hobbies. There is a standing programme of planned activities throughout the week but it is acknowledged that it can be difficult to engage some residents in activities, and individuals may choose whether or not to take part. The activities coordinator spends a lot of her time with individual residents providing one-to-one contact and trying to Care Homes for Older People Page 17 of 30 Evidence: establish any activities which might be of interest, and has developed individual social activity care plans for residents, which also help to identify ways for care staff to engage with residents. She has also spoken with relatives where appropriate to obtain information about past interest and history. The home has a mobile snoezelen unit which provides a variety of sensory stimuli to promote relaxation, which can be beneficial for some residents, and also has a specially designed sensory garden. The activities coordinator obtains reminiscence equipment from Reading museum and library service and also collects relevant items herself. The dignity of residents is addressed through such areas as manicures and hair care and the expert visitor also commented favourably on the attention given to maintaining residents appearance and dignity. The communication books used, may also assist the dignity of those residents unable to communicate verbally. Residents orientation is also aided by the provision of their names and pictures on bedroom doors. Any cultural and spiritual needs identified are provided for by the home. Spiritual needs can be addressed via visiting representatives from relevant local faiths, and appropriate services and communion are provided within the home. This was confirmed by some of the residents. At the time of inspection none of the residents go out to local places of worship though this can be arranged if desired. One respite residents first language is not English and a number of the staff are able to converse with them in their mother tongue. The home does not have set visiting times and encourages relatives to visit at any time. One relative was seen to visit her mother during the inspection and assisted her at lunch. There were a number of thank-you cards posted on the notice boards, expressing the gratitude of relatives, for the care provided by the staff. Although few outings are possible the home does bring in a variety of outside entertainers and an exercise leader as well as a small animal handling service, which is popular. Photographs of residents enjoying various events and activities were available and residents confirmed to the expert visitor they enjoyed the activities and entertainment provided. One resident has their own computer in their bedroom. The home provides for residents to make choices in their day-to-day lives and staff were seen to encourage this. Residents have choice around clothing, meals, activities participation, where they wish to spend their time, etc. and their wishes for their care after death are sought and recorded. One resident has their main meal in the evening by their preference. Residents are provided with an appropriate and varied diet, prepared using mainly Care Homes for Older People Page 18 of 30 Evidence: fresh ingredients, by the catering staff. The chef meets with new residents to establish any menu preferences or dislikes and these are recorded. The menu lists one main meal but residents have the option of other alternatives if they do not like the meal. Choices were seen to be available and to be actively offered by staff during the lunchtime meal, which was tasty and well presented. Specialist dietary needs are met including pureed food, diabetic and vegetarian diets etc. and the chef demonstrated her awareness of the importance of presentation and textural variety when liquidising elements of residents meals. The kitchen was recently awarded five stars following a health and safety inspection. Care Homes for Older People Page 19 of 30 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. The home has an appropriate system for receiving and responding to any concerns or complaints and has responded appropriately where issues have arisen. The home has appropriate systems in place to safeguard residents from abuse. Evidence: The home has an appropriate complaints procedure and the complaints log contained records of two complaints in the previous twelve monnths, both of which had been appropriately addressed and resolved. Although residents said they were not aware of how to complain, all of those asked also indicated they had not felt the need to do so and felt they were well cared for. The complaints procedure is posted in reception and is sumarised in the Service User Guide given to each resident or their relatives on or around admission. The home also has a visitors feedback booklet which includes a form on which to note any concerns or complaints. The booklets were available in the reception of both wings of the home. The home has an appropriate procedure for safeguarding residents from abuse. One safeguarding issue had arisen in the previous year relating to the inter-relationship between two residents. The manager had referred the concerns appropriately and the necessary steps were taken to meet the needs of both parties. All of the care and nursing staff had received recent safeguarding training to maintain their awareness and knowledge of current practice. Care Homes for Older People Page 20 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The majority of the home provides residents with a satisfactory,safe and wellmaintained environment, though some issues remain, as identified in this report. General standards of hygiene were observed to be good. Evidence: The home is divided into two wings, the original building forming the Jasmine wing and the Hawthorn wing providing care for residents with dementia, in the more recently converted next door house. The buildings are linked at ground and first floor but operate as separate entities with their own staffing, lounge and dining rooms on a day-to-day basis, though residents can mix where this is their wish. The majority of the home is pleasantly decorated and homely, with the original building retaining various period features while the Hawthorne wing was refurbished and designed along more modern lines to meet current standards, including the provision of twenty one bedrooms with en-suite showers and toilets. Each wing has separate lounge and dining space and its own bathroom and toilet facilities. The home has two laundry facilities equipped with appropriate machines to meet the homes needs, and standards of hygiene observed about the home were good. Bedding and clothes washing is separated between the two facilities to enhance infection control. The homes central kitchen located in the Jasmine wing, supplies meals to the whole Care Homes for Older People Page 21 of 30 Evidence: home. The kitchen is well equipped with catering facilities and received a five star hygiene award at a recent health and safety inspection. The dining room in the Jasmine wing has a polycarbonate type roof and though this provides lots of light, evidence suggests ongoing problems with leakage at various times, apparently most recently earlier in the week of the inspection. It would be prudent to consider a more suitable and permanent roofing in this area. The majority of bedrooms are pleasantly decorated, light and in some cases considerably exceed minimum size standards, and some overlook the attractive gardens. However, two of the old double bedrooms have been divided to create four single bedrooms, with varying degrees of success. One of these new single bedrooms appears to be beneath the required minimum dimensions in terms of usable space having a narrow corridor leading to the usable area. The room would be unsuitable for anyone requiring mobility aids or significant assistance such as hoisting. The room is also not as well lit as other bedrooms, having been left with a very small window when the division was made. The other three new singles created by division are adequate. In the Jasmine wing two new single en-suite bedrooms are also being created from old sluice/bathroom areas. Again in one case the resulting room shape may be potentially awkward in terms of siting the required furniture. Whether it will meet the size and usability standards should be carefully checked, given that a potential occupant may require nursing care. Given the current lack of a dedicated hairdressing room, it might be prudent to consider where such a facility could be located to address the current dignity and health and safety issues of using the dining room, while maintaining the social elements of a specialist room. This was also raised by the expert visitor as a potential issue. Four modern adjustable hospital beds have been purchased and there are plans to purchase more of these to further upgrade provision. The home has purchased its own pressure relief mattresses etc. and has various hoists and stand-aids available to assist residents. Ramps had been provided at changes of level to enable residents to more about the home more easily. The homeliness and personalisation of residents bedrooms was notable with good evidence of residents own personal belongings having been brought in. This was also observed by the expert visitor who assisted with the inspection. Care Homes for Older People Page 22 of 30 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. The home has an appropriate complement of care and nursing staff and staff deployment meets the needs of residents. Levels of NVQ attainment and mandatory training are good and provide staff with the skills and knowledge to meet the needs of residents, though additional training is needed in some areas. The homes recruitment systems help to safeguard residents from abuse and appropriate records of the process are maintained. Evidence: The manager stated that the regular staffing for Hawthorn wing was two RGNs and seven carers in the mornings, one/two RGNs and six carers in the afternoon and evening and one RGN and three carers at night on waking duty. The Jasmine wing staffing was stated as two RGNs and six carers in the morning, one RGN and four carers in the afternoons and evenings and one RGN and two carers at night on waking duty. These levels appear to meet the current needs of residents. No one complained of having to wait extended periods for support and all were complimentary about the support and care from the staff. The expert visitor observed positive relationships and warmth between staff and residents and expressed no concern about staffing levels. Staff were seen to be attentive and to respond promptly to the needs of individual residents; as well as being patient and spending the time necessary to understand the communication of residents who were unable to communicate Care Homes for Older People Page 23 of 30 Evidence: verbally. The manager reported a stable staff team with relatively low levels of staff turnover with only ten staff having left over the previous twelve months. Levels of NVQ attainment were good with over 50 of care staff having attained at least NVQ level 2 or equivalent and others currently undertaking their NVQ. Examination of a sample of recruitment records indicated an appropriate system of pre-appointment checks was in place and the required evidence was on file. To date the CRB checks have been updated on a five-yearly basis, but the manager indicated that all would be re-done in January 2010. Good practice guidance indicates it would be appropriate to establish a more regular cycle of re-checking than in the past. The recent training records were only available on an individual staff basis though the manager had previously kept an overall spreadsheet to maintain an overview and supplied an up-to-date spreadsheet immediately following the inspection, to complete the training records for the previous three years. The manager agreed to maintain the overall spreadsheet as an ongoing document. The home accesses training from Reading and Wokingham training departments. The records supplied indicated that staff had received the majority of mandatory training, though additional staff need to attend training on the Mental Capacity Act and associated legislation. One of the deputy managers is an accredited manual handling trainer and is thus able to provide training when required on this aspect of care. The homes mental health nurse provides workshops on mental health to carers over a five week programme. A number of staff have also attended training on working with dementia, though additional staff should attend dementia care training. Care Homes for Older People Page 24 of 30 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is effectively run by a well qualified and experienced manager and a consistent senior team in order to meet the needs of residents. Aspects of the quality assurance and monitoring of the home require improvement, in order to maximise their consistency and effectiveness; though the manager herself, undertakes a cycle of audits and quality surveys to monitor the quality of the care provided. Where the home hold funds on behalf of residents, appropriate systems are in place to safeguard these funds. Systems are in place to safeguard and promote the health, safety and welfare of residents and staff. Evidence: The manager is appropriately qualified and experienced to manage the home, and does so with an appropriate team of other senior staff. There is a deputy manager who takes responsibility for each of the two wings. The manager is an RGN Care Homes for Older People Page 25 of 30 Evidence: (Registered General Nurse) and has also obtained her Registered Managers Award. She also has a Teaching and Assessing in Clinical Practice, certificate and has been the man gager for six years at Jasmine House and two years elsewhere prior to that. She has attended a range of training courses to update and maintain her knowledge of current practice. The home undertakes an annual quality assurance survey of residents and relatives, but as yet does not survey care managers or other external professionals. The most recent survey was undertaken in April 2009. A summary report is produced and posted on the homes notice board. In addition, the manager undertakes quarterly audits of catering, housekeeping and nursing care to monitor ongoing standards in these areas. The manager explained that the results of these audits/surveys are used to assist with future planning, and though no separate annual development plan is produced, identified aims or issues are noted within the homes AQAA. The home should be subject to monthly monitoring visits by or on behalf of the provider, but over the past twelve months, these have not always taken place as required. Based on the reports available for inspection there was an eight month gap in these visits between October 2008 and May 2009. The provider is legally required to ensure that this monitoring takes place on a monthly basis in accordance with Regulation 26. More recently, with the delegation of this role to the part time tertiary mental health manager, the regularity of visits has improved with only one visit having been missed since June 2009. The reports are now being completed to the format provided by CQC and include appropriate detail including feedback from residents, visitors and staff. The home only holds sums of money on behalf of about six residents, and any significant expenditure is receipted and the receipts filed should they be required at a later date. In other cases the resident or their relatives are individually billed for expenditure such as hairdressing. Examination of a sample of health and safety-related service certification indicated that servicing has taken place with the required frequency. Fire safety training was provided to all but twelve of the staff in October/November and is to be scheduled for the remaining staff. Fire drills are held approximately six-monthly and weekly fire alarm testing also takes place. The Fire Risk Assessment for the home was originally prepared in 2004 and has been reviewed annually. Following fire officer advice this will, in future, be amended on the basis of any relevant changes or faults. Care Homes for Older People Page 26 of 30 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 27 of 30 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 30 18 The manager must ensure that all staff receive appropriate training on the Mental Capacity Act. To ensure they understand its implications for the rights and dignity of residents. 16/03/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 The manager should investigate and address the identified recording errors and inconsistencies, in order to maintain accurate records of medication and and an effective audit trail. The manager should review the identified issues with regard to addressing the dignity/privacy of residents in the course of receiving personal care, in order to ensure that residents are afforded the maximum dignity and privacy. The manager/provider should consider how to address the identified potential health and safety issues associated with hairdressing and chiropody being provided in communal areas. 2 10 3 26 Care Homes for Older People Page 28 of 30 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 4 33 The provider should ensure that the required monthly monitoring visits take place in accordance with Regulation 26 in the future. Care Homes for Older People Page 29 of 30 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). 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