Care Home: Jesmond

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What the care home does well People who live in the home are placed at the centre of its running. Their views are listened to and the service is developing to make sure achievable goals are set. People can be confident that support will be given to making sure independent living skills are maintained and developed. Jesmond has a welcoming, homely atmosphere where people can openly discuss any issues they may have. Staff are responsive to individual need. The service has the potential to become an excellent service. What has improved since the last inspection? Significant improvement has been made in making sure that assessments and care plans of people that live in the home reflect their individual needs. Regular reviews with the involvement of individuals makes sure that information held is current. Medications are kept securely and records show that they are handled safely. CARE HOME ADULTS 18-65 Jesmond 23 Jesmond Close Merton Mitcham Surrey CR4 1EQ Lead Inspector Janet Pitt Key Unannounced Inspection 21st and 29th May 2008 09:55 Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jesmond Address 23 Jesmond Close Merton Mitcham Surrey CR4 1EQ 020 8646 8319 F.P 020 8646 8319 sunil.kumar@mst-online.org.uk www.stepforward.org.uk Metropolitan Support Trust Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) vacant post Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 5 Date of last inspection Brief Description of the Service: Jesmond is a care home providing residential care and accommodation for five people with learning disabilities. The home is located close to shops, pubs and other amenities. It is a three-storey domestic style property. All accommodation is provided in single rooms. At the time of this inspection the manager reported that the weekly fees were £869.19 per week. Additional charges are made for some outings and holidays. People are made aware of the inspection report at the residents meeting. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good quality outcomes. One inspector undertook this unannounced inspection. Two site visits were made which lasted a total of four and a quarter hours. One of the site visits was made after 5pm, so we were able to meet with people that live in the home. A tour of the premises was undertaken and records relating to staff recruitment and training were examined. The manager provided a comprehensive Annual Quality Assurance Assessment (AQAA); information from this document has been used in this report. What the service does well: What has improved since the last inspection? What they could do better: Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 6 Only one requirement from the previous inspection had not been met. The carpet in the lounge needs replacing, as attempts to clean it have not been successful. The organisation responsible for the home need to make sure that bills they are responsible for are paid on time, to prevent interruption of services into Jesmond. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People have the opportunity to decide whether they want to live at Jesmond. Assessments and visits to the home are undertaken and they are fully involved in the process. Assessments identify the individual needs of each person. EVIDENCE: Each person is assessed prior to moving into Jesmond. Opportunities are provided for them to meet people who currently live in the home. Assessment from social workers and other agencies are used to inform this process. We saw in people’s records that personal care, health, social and cultural needs are identified. The AQAA indicates that people are able to stay overnight at Jesmond before making a decision on whether they want to move in permanently. The home has not had any new admissions since the previous inspection. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People can be confident that care plans are individualised and lead from their assessment of need. Support is given to enable individuals to make decisions about their lives. Training has been planned to make sure that staff have the appropriate skills to meet people’s needs. EVIDENCE: Examination of people’s plans demonstrated that they led from the initial assessment. Work is currently ongoing into the reviewing of plans to make them more ‘user friendly’. One member of staff showed us the new format for reviews. The format uses pictures and words and people are involved throughout the process to make sure that their views are known. The home’s AQAA indicates that there is a need for all staff to be trained in person centred planning, to make sure that people who live in the home are appropriately supported. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 10 Support is given to people who live in the home in areas such as housework, laundry and cooking skills. People who live in the home can take risks. Some of the people go shopping on their own or out for a walk. An individualised risk assessment is in place for these sorts of activities, giving an appropriate balance between safety and enabling people to lead fulfilled lives. The care provided in the home is starting to be wholly individualised. For example one person enjoys cooking and regularly plans, shops for ingredients and cooks a meal for everyone in the home. This has lead to other people who live in the home starting to cook on other evenings. Overall, the plans provide good detailed information on how a person chooses to live their life and is focused on developing and maintaining skills. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Activities in the home are based on people’s individual expectations. Support is given to enable people to lead fulfilling lives and do activities of their choice. Personal relationships are respected and staff are able to discuss socially acceptable behaviours. Mealtimes are relaxed and people are encouraged to be involved in the process, from buying the food to cooking a meal. EVIDENCE: People who live in the home are able to choose how they spend their day and plan activities they want to participate in. People have a range of interests and support is given for them to maintain them. People spoken with said they had enjoyed horse riding, discos, holidays, cooking classes, trips to the pub and gym. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 12 At the time of the site visit some people were working part time. People who live in the home are supported to have personal relationships and appropriate health guidance is available if needed. Staff assist people in making sure acceptable social boundaries are kept when mixing with persons of the opposite sex. People who live in the home are involved in the planning and preparation of meals. During the evening site visit one person was preparing the meal with the assistance of a member of staff. Healthy diets are encouraged; this was evidenced in records of key working sessions. People who live in the home chatted about when they were planning to see their family and friends. They also mentioned places they had enjoyed visiting on holiday and their plans for this year. The use of photographs of people on holiday or dressed for a special occasion in care records enables staff to discuss what has been happening and how the person feels about something that has happened. Staff reported that this helps them to develop their skills in making sure care plans are person centred. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Personal support is given when needed with hygiene needs. Individuals are able to make choices about what clothes they wear and staff will assist with these decisions if needed. Medications are administered and handled safely in the home. The home has indicated where improvement could be made in ageing, illness and dying. EVIDENCE: People who live in the home are able to carry out their own personal hygiene with the minimum of input by staff, as evidenced in the AQAA. The home’s AQAA also states: ‘[People] are able to make their own choices and are supported to plan their days in accordance with their needs and wishes.’ People who live in the home confirmed this. People seen on the days of the site visits were clean and tidy. We discussed with staff and the people that live in the home topics such as shopping for clothes and selecting outfits to wear for different occasions. The manager said that he encourages staff to be aware of the person’s actual age, rather than any diagnosis they have, so that clothing and accessory choices are age appropriate for the individual. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 14 None of the people that live in the home are currently self-medicating. Risk assessments have shown that at the present time people need further support in achieving this goal. The home’s AQAA states that they could improve medication handling in the home by: ‘develop[ing] an in depth risk management framework in order for a [person] to be able to manage their own medication.’ Medication administrations records are kept and the AQAA states that a monthly audit is made on medications to make sure that there are no discrepancies. People’s medications are reviewed by either the general practitioner or a psychiatrist. We noted that when people had received their medication, then the member of staff would sign the record to indicate that it had been given. On examination of care records it was noted that bereavement counselling is available for people if they need it. The AQAA indicates that more work is needed on addressing people’s own wishes for end of life care, ageing and death. The home states that it needs to ‘look at ways on how people can be engaged to express’ their views. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People can be confident that the will be safe from abuse and any concerns they may have will be listened to and acted upon. EVIDENCE: We have not received any concerns or complaints regarding the service. There has been one referral made to the Protection of Vulnerable Adults list. The incident occurred last year and involved a member of staff. Records at the home evidenced that the correct procedures were followed; to make sure that the people who live there were protected. Jesmond’s AQAA shows that they have not received any complaints, but are continuing to monitor communication between staff and people that live in the home in key worker sessions. Further training on Safeguarding Adults and the Mental Capacity Act is being planned for the forthcoming year. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People live in a home that is clean and tidy. Planned redecoration needs to be completed to make sure that individuals live in a maintained place. EVIDENCE: People live in a home that is safe and maintained. The AQAA states that people have their own keys to the front door and their room door. This was evident when individuals returned to Jesmond after their day’s activities. One person let us view their room and we saw that it was decorated and furnished according to their wishes. The lounge, kitchen and entrance hall have be re-painted in colours chosen by people that live in the home. Carpeting in the hall and stairs has been replaced, but the lounge carpet still needs renewing. The AQAA states that one of the aims for the next year is to make sure that outstanding maintenance issues are resolved, such as a new carpet for the lounge. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People are supported by staff who have been recruited safely and have received training to enable them to carry out their role. Supervision of staff makes sure that areas can be identified for further development of skills. EVIDENCE: Information held on staff has greatly improved since the previous inspection. Staff files examined evidenced that all necessary checks are made prior to a person commencing employment at Jesmond. A clear recruitment process was noted. Files contained application and candidate selection forms. References were in place and there was detail on the person’s previous employment history. Each file had a section on one-to-one supervision sessions, with a plan for the coming year. Training recently undertaken in areas such as First Aid, Food Hygiene and Protection of Adults was recorded. People who live in the home are supported by staff that plan individualised, person centred care and make sure that there is full involvement of the person. Support from the manager has empowered staff to ‘own’ the work they Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 18 carry out and continue to develop the service, to provide good outcomes for people who live in Jesmond. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 and 43 People who use this service receive good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People are supported by a manager that promotes individualised care. The organisation that owns the home needs to make sure that they support the manager to fulfil his role. Systems are in place to make sure that peoples views are known and can be acted upon. EVIDENCE: Pre inspection information was requested and returned within the stated timeframe. The AQAA clearly details areas the service thinks improvement could be achieved and how this will be actioned. One main area is the continuation of making sure that people who live in the home are consistently consulted and involved in the running of Jesmond. The manager has been proactive in encouraging staff to develop and maintain their skills and has welcomed new ways of working. An example of this is the Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 20 use of pictures in reviews. One member of staff said that the new way of undertaking care reviews had enabled them to be aware of the individual’s point of view and make sure that it was the person’s needs that are being recorded. No health and safety issues were identified at the time of the site visits. Risk assessments were in place for people who did not want their windows restricted. The organisation that runs the home needs to make sure that household bills are paid in a timely manner. On one of the site visits we found that a utility bill had not been paid and the utility company was planning to stop the service to the home. This must not happen, as the people that live in Jesmond are vulnerable. The issue was sorted out at the time of the site visit, but must not be allowed to occur again. Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 2 Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23(2) (b) Timescale for action People should live in a home that 30/09/08 is routinely refurbished as needed. The carpet in the lounge requires replacement, in order to make sure that the home is suitably maintained. (previous timescale of 30/09/07 not met) People need to be confident that 30/09/08 financial obligations of the home are met. The organisation that owns the home must put in place systems for ensuring that bills are paid. This will make sure that there are no interruptions of services into the home. Requirement 2. YA43 10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Jesmond DS0000027210.V361754.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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