Care Home: Jewish Care

What the care home does well Ealon House (7b Mapesbury Road) is very well managed and staff as well as people using the service spoke positive about the manager and deputy manager. Comments made by the expert; "The management appears to be pleasant and satisfactory". "The service had greatly benefited from the manager`s input...and she has organised an effective team of staff". One person using the service commented, "She (manager) is always listening to what I have to say". The home has a very enthusiastic staff team supporting people using the service with mental health and age related problems. People using the service are consulted regularly regarding the care and support received and a range of suitable activities is provided. The home has changed the medication procedures, which is judged of excellent standard. The procedures ensures that people using the service are protected and medication is administered safely. Service users care plans have been updated and are of very good standard and residents` involvement is evident throughout. The home is providing a wide range of activities and has 25 different activities for people using the service to choose from. Activities are facilitated by an activity cocoordinator and participation is clearly recorded. The home is providing kosher food, and is inspected by the London Beth Din Kashrut Society to ensure food is kosher and is prepared according to Jewish Law. We found excellent quality assurance procedures, ensuring people using the service receive excellent care and support. People using the service made comments: "I like it here". "The home supports my needs very well". "I receive very caring support from Jewish Care". "The meals are nice and it is clean and tidy here." Comments made by staff were similarly positive. "We work well as a team and get great support from the manager and deputy manager". "People using the service have a choice in their meals and are offered activities to keep them interested at all times". "The medication policy is brilliant". What has improved since the last inspection? The home has improved their quality rating from two to three stars and people using the service experience excellent outcomes. All of the requirements, which we have made during our previous key inspection in November 2007 have been met. The home has changed the procedure for monitoring peoples finances and the manager has received training in the audit of financial records. This ensures peoples finances are monitored, recorded and stored safely. The fridge to store medication is locked and temperature is monitored daily, to ensure safe storage and administration of medication. Maintenance works such as replacement of missing tiles, shower curtains and toilet role dispensers in the downstairs bathroom and the broken WC on the second floor have been resolved or repaired and people using the service can use the bathroom and toilet safely. The manager has applied to the Care Quality Commission (CQC) for registration, but due to issues outside her control had to re-apply. What the care home could do better: We have made four requirements during this key inspection. The home must replace or repair the chair in the hallway which exposes filler on one of the arms. This ensures people using the service have comfortable furnishing available. The urine smell in the ground floor toilet must be investigated and resolved, ensuring people can enjoy a fresh environment. The manager must ensure all Criminal Records Bureau checks are available for inspection, this ensures staff is safe to work with vulnerable adults. The manager must continue to pursue her registration with the CQC, so people using the service can be confident in the management of the home. Key inspection report Care homes for adults (18-65 years) Name: Address: Jewish Care 7b Mapesbury Road London NW2 4HX     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: Andreas Schwarz     Date: 2 9 1 0 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 Adults (18-65 years) Page 2 of 34 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 Adults (18-65 years) 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 Adults (18-65 years) Page 3 of 34 Information about the care home Name of care home: Address: Jewish Care 7b Mapesbury Road London NW2 4HX 02084592569 02084594855 msavaris@jcare.org www.jewishcare.org Jewish Care care home 25 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 25 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 7b Mapesbury Road is a purpose built house with a very large well-maintained garden at the rear of the property. It is in a quiet residential road, but within walking distance of good public transport links and close to Kilburn High Road shopping centre. The home is run by Jewish Care and provides accommodation for 25 adults with mental health problems. All people using the service have good-sized single rooms and there are five flats with en-suite facilities. There is a large dining/lounge area on the ground floor that opens out to a beautifully maintained garden and two further lounges on the first and second floor, one of which is used as a smoking room. There is off-street parking at the front of the property. Information on fees and charges can be obtained Care Homes for Adults (18-65 years) Page 4 of 34 Over 65 0 25 Brief description of the care home from the manager on request. Care Homes for Adults (18-65 years) Page 5 of 34 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 Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection took place during late October 2009 and lasted 10 hours. The inspector was accompanied by an expert by experience for three hours. The manager Mrs Anthea Jones and deputy manager Ms Maria Savaris were available throughout this key inspection. We have received 24 service users surveys, six staff surveys and one health care professional survey prior and shortly after this key inspection. We have included information of the surveys in this report. The home has returned a completed Annual Quality Assurance Assessment (AQAA) form within the given timescale. The AQAA was filled out to excellent standard and provided us with valuable information about the home and service provided. The expert spoke to 13 people using the service and the lead inspector spoke to five people using the service. We interviewed two support workers and spoke to a Community Psychiatry Nurse (CPN), who is visiting the home regularly. We observed staff working with people using the service and were invited to sample lunch by people using the service and manager. We would like to take this opportunity thanking everybody involved and make this Care Homes for Adults (18-65 years) Page 6 of 34 inspection a very pleasant experience. Care Homes for Adults (18-65 years) Page 7 of 34 What the care home does well: What has improved since the last inspection? What they could do better: We have made four requirements during this key inspection. Care Homes for Adults (18-65 years) Page 8 of 34 The home must replace or repair the chair in the hallway which exposes filler on one of the arms. This ensures people using the service have comfortable furnishing available. The urine smell in the ground floor toilet must be investigated and resolved, ensuring people can enjoy a fresh environment. The manager must ensure all Criminal Records Bureau checks are available for inspection, this ensures staff is safe to work with vulnerable adults. The manager must continue to pursue her registration with the CQC, so people using the service can be confident in the management of the home. 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 Adults (18-65 years) Page 9 of 34 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 34 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. We assessed National Minimum Standards 2 during this inspection. All new people using the service receive a comprehensive needs assessment before admission. This is carried out by staff with skill and sensitivity. The service is highly efficient in obtaining a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission. Evidence: We have looked at five assessments of people being admitted to 7b Mapesbury Road. Three of the people have been admitted to the home in the last twelve months. The assessments viewed are very detailed and holistic. The manager is undertaken the assessments. Part of the homes referral process is that the home requests the prospective persons Care Plan Approach (CPA) report, risk assessments, psychiatrist assessments and any other relevant documents. A mental health and physical health assessment form has to be completed by the referrer as part of the assessment documentation required by the home. The home monitors that all the required Care Homes for Adults (18-65 years) Page 11 of 34 Evidence: information is provided by the referrer and the manager informed us that she would contact the referrer in case further documentation is required. Following the assessment of the referral documents the management team decides the suitability of the prospective person and a trial visit is arranged. The planned visits consist of day visits and overnight stays. Once the person is commencing the tenancy the allocated key worker is meeting with the person and a costed care plan is designed together with the service user. We spoke to three people using the service, who informed us that they have been involved in they assessment process and met with their key worker to decide and agree a care plan. Following a three month settling in period a CPA meeting is arranged to discuss the stay and agree on the care plan. We noted that one of the people living in Mapesbury Road does not speak English as his first language; and his assessment has been translated into the preferred language of the person. Care Homes for Adults (18-65 years) Page 12 of 34 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. 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. We assessed National Minimum Standards 6, 7 and 9 during this inspection. The service involves individuals in the planning of care that affects their lifestyle and quality of life. The care plans are person centred and are agreed with the individual. The care plan includes a comprehensive risk assessment, which is regularly reviewed. The service has a can do attitude and risks are managed positively to help people using the service lead the life they want. People using the service make their own informed decisions and have the right to take risks in their daily lives. Evidence: We have assessed five care plans, care plans are judged of very good standard and provide detailed information about the person. All people using the service have an allocated key worker. Key workers are responsible for the care planning process. This involves of meeting regularly with their key client, arranging of CPA meetings, review of care plans (3-monthly), etc. People using the service spoken to informed us that they are involved in the care planning process, which was confirmed by all surveys we Care Homes for Adults (18-65 years) Page 13 of 34 Evidence: have received prior and during this inspection. Care plans are based on information obtained during the initial assessment. Staff told us that with the assessment information they would draw up a basic care plan with people using the service. This care plan is than reviewed and up dated continuously to include any changing needs. For example one person who has developed Dementia since living in 7b Mapesbury Road, information has been updated and reviews have been arranged with the persons social worker. We viewed one care plan, which was provided in English and a second language. The manager and staff explained to us that this is due to the person speaking very poor English. Review meetings showed us that the home invites a translator to the review meetings. Risks due to challenging behaviour is clearly recorded in care plans and guidance in how to minimise the risks is provided. People using the service told us that they are able to make decisions about their lives, what they want to do, eat, where they want to go, etc. Regular monthly residents meetings gives people using the service a chance to voice their feelings about the home, food and care provided. The home encourages people using the service to access independent advocacy services and also provide in-house advocacy support. We observed staff interacting with service users, which was judged of being professional and staff encouraged people to make decisions on their own. People using the service manage their own finances. The home keeps money in the homes safe, which can be accessed by the manager and deputy manager. We audited three accounts, which were all found in order. Income and expenditure was clearly recorded. We spoke to service users and asked them if they are happy, that the home is safekeeping their money. All people spoken to confirmed that they are happy with these arrangements. The expert noted in her report, that she had the impressions when talking to people using the service, that they have choice and control over their own lives. The home has updated and reviewed risk assessments. All files viewed have a mental health risk assessments in place. People using the service have environmental risk assessments such as smoking in their room, fire, etc. As well as person specific risk assessments such as community access, self harm, falls assessment in place. Risk assessments are drawn up and reviewed together with the person. The manager demonstrated very good knowledge of risk assessment processes. The home has undertaken dependency assessments on all people using the service, evidence shows that since 2007 people became less dependent around their personal care, but have received at the same time more individualised one to one support from staff. A new missing persons form has been introduced, which indicates the persons vulnerability. The manager told us that this makes it easier for staff to know at which point to contact the police. Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: Care Homes for Adults (18-65 years) Page 15 of 34 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. We assessed National Minimum Standards 12, 13, 15, 16 and 17 during this inspection. The service has a strong commitment to enable people who use services to develop their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. People who use the service have the opportunity to develop and maintain important personal and family relationships. People who use services are involved in meaningful daytime activities of their own choice and according to their individual interests and capability. Meals are well balanced and highly nutritional and cater for cultural and dietary needs of the people who use services. Evidence: People using the service take part in various activities. One person told us that he is Care Homes for Adults (18-65 years) Page 16 of 34 Evidence: attending college for piano lessons, another person told us that he is taking part in a gardening project in Battersea Park. The home has an activity coordinator who arranges planned activities such as Bingo, current affairs, various table top activities, etc. Another person has won a poetry and piano competitions. Another person has published poetry relating to 7b Mapesbury Road. People using the service have access to 18 different leisure groups, which happen inside and outside the home. The leisure groups range from educational activities such arts and crafts to leisure activities such as theatre, cinema, etc. People using the service can access a computer with Internet access. One service user told us that he is regularly playing the piano for other residents. This was observed during a birthday celebration in the afternoon of this key inspection. People using the service told the expert that they go to the hairdresser, other people told us in the surveys that they go to cafes and restaurants. People using the service can access Brondsbury Synagogue for worship and local school children visit the home during Purim. One person told us that volunteers from the local synagogue visit the home for manicures and chats. People using the service told us that they have been voting during the European Election this summer. Rotas viewed demonstrated sufficient staffing during weekends and weekdays. The home has employed staff from various background. We observed one member of staff communicating with a service user in his first language which is not English. The home encourages people using the service to make and maintain relations. One person we spoke to regularly calls his brother in Israel, another person is visited regularly by his brother. People using the service told us that they can invite friends to celebrate festivals and birthdays. People using the service can contact their family, by using the computer. The manager told us that some people using the service have attended computer classes. The home has a relative forum, which is open to everyone. Visits and phone calls are recorded in peoples care folders. All people using the service are issued with a front door and bedroom key and depending on their risk assessment can go out independently or with staff support. We observed people accessing all areas in the home and picking up their unopened mail from the office. People using the service can choose to be on their own or with others. People using the service told us that they can do things independently, but have limitations if it infringes on others. The manager told us that the home has an open door policy and people using the service can choose where and when to go out. Deprivation of Liberty assessments have been undertaken by the local authority and none of the people using the service are detained under the Mental Health Act. Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: Meals are nutritious and varied. The home employs a contractor to provide cooked meals. All meals are Kosher and are monitored by the London Beth Din Kashrut Society. People using the service have at least two meal choices and three hot meals are provided daily. People using the service informed us that the quality of food has improved since kitchen staff has changed. The chef is meeting people using the service every two weeks to discuss menus and meal choices. The home has recently prepared a new menu together with people using the service. We were invited to sample lunch, which was nicely prepared and tasted very good. The home has a complaints book, which allows people using the service to raise their dissatisfaction about meals anonymously. We have received 24 surveys from people using the service, 12 of these surveys commented on the food in 7b Mapesbury Road. Seven people rated the food as good and five people told us that the food could be improved. This was confirmed by the people who spoke to the expert. We recommend that the home follows this up and discusses the menu with people using the service to find out why people are dissatisfied and how the meals can be improved. Care Homes for Adults (18-65 years) Page 18 of 34 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. We assessed National Minimum Standards 18, 19 and 20 during this inspection. Personal health care needs including specialist health, nursing and dietary requirements are clearly recorded in each persons plan. Personal support is responsive to the varied and individual needs and preferences of the people who use services. People who use services have access to health care and remedial services. The home has an efficient medication policy supported by excellent procedures and practice guidance, which staff understand and follow. People who use services are given the support they need to manage their medication. Evidence: All of the five care plans we viewed had detailed support guidance for people using the service in place. People living in 7b Mapesbury Road require different levels of support, this ranges from prompting to have a shave to supporting the person having a wash. People using the service told us that the home has no restrictions on times when to get up or go to bed. Staff has good understanding of peoples cultural background, part of the induction new staff receive, is to learn about peoples culture in Mapesbury Road. The home has a medibath, which can be used for frailer people Care Homes for Adults (18-65 years) Page 19 of 34 Evidence: using the service. A lift enables people using the with mobility problems to access all areas in the home. The home deals with peoples medical problems pro-actively. Staff told us that people using the service are encouraged to refer themselves to health care professionals if records indicates a change in their condition. All people using the service have an allocated Community Psychiatric Nurse (CPN) and regular CPA meetings are undertaken with health care professionals, care staff and people using the service. All people using the service have a designated key worker and co-key worker. All people using the service are registered with a local GP surgery and visits to health care professionals is documented very well. For example one person had 3 GP visits, 4 hospital outpatients appointments, 3 mental health appointments and two multi disciplinary team appointments documented for the past month. The records showed details of outcomes, actions and any future appointments. People using the service have access to community support services such chiropody, dentist, opticians, etc. The home provides in-house services by trained therapists such as movement and mobility, private chiropody, mobile optician, dentist, art therapy, etc. If a person refuses health care appointments the home records this in the persons care folder and a new more suitable appointment is arranged for the person. A survey received from a CPN visiting the home regularly stated, The service is well run and caters for the needs of the residents, staff have good relationships with people using the service and act on my advice. The CPN visited the home and provided depot injections to people using the service in room 1 which is also used as an office. By mistake we entered the room, this could have been avoided if a sign would have been displayed informing people that medical examination are currently undertaken in the room. The deputy manager showed us the homes medication procedure. It was evident that a lot of work and effort has been put into this procedure since the last key inspection. The deputy manager is responsible for the recording, ordering and monitoring of the medication in the home. Medication Administration Sheets (MARS) are of good standard and had no gaps, all relevant information such as the prescriber, known allergies, dose and route of the medication are recorded. The homes medication administration procedure requires two carers to administer. All staff have attended medication administration training by Boots The Chemist in April 2008 and ongoing training is provided to ensure staff are competent in handling medication. The home does not store any controlled drugs. Medicines such as insulin and eye drops are kept in a fridge, the home checks the fridge temperature regularly to ensure medicines are stored correctly. Three people using are able to self administer, detailed Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: risk assessments and monitoring systems are in place. The home has re-written the medication policy, which is now specific to the service, and based on guidance of the Royal Pharmaceutical Society (RPS). The deputy manager monitors medication records monthly and the dispensing chemist audits medication quarterly. Care Homes for Adults (18-65 years) Page 21 of 34 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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. We assessed National Minimum Standards 22 and 23 during this inspection. The home has an open culture that allows people using the service to express their views, and concerns in a safe and understanding environment. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. Evidence: The home has a detailed complaints procedure in place, which is available in English and Spanish, to ensure all people can access and understand the procedure. The procedure is displayed on the noticeboard in the hallway. The home has received eleven complaints since the last key inspection. All complaints have been recorded and dealt with by the manager within 28 days. The majority of complaints have been responded within three working days. Jewish Care has designed a leaflet Your view counts, which enables people using the service to raise concerns anonymously with the Chief Executive. People using the service meet regularly with the chef to complain or compliment about the meals provided and are able to make suggestions of future menus. A notice on the notice board in the hallway informs people using the service, that they can contact the Care Quality Commission (CQC) with any complaints and concerns.The home informs the CQC of any incidences which are reportable. The home did not make a Protection of Vulnerable Adults referral since the last Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: inspection. Staff has received Protection of Vulnerable Adults training and detailed adult protection policies are in place. The home has obtained Protection of Vulnerable Adults guidelines from funding boroughs. The manager informed us that the home has a whistle blowing, violence and aggression policy, etc. in place. The manager told us that all staff have had Criminal Records Bureau checks, this was confirmed by two of the staff we have spoken to during this inspection. One of the people told us, that he feels safe at 7b Mapesbury Road. The CQC Provider Relationships Lead met with Jewish Care on 17/09/2009 and made the following statement. All people using Jewish Care services had been assessed against the Deprivation of Liberty safeguards. Existing measures were found to be appropriate, and no referrals made. The expert informed us that she could not find any evidence of harassment and discrimination during this inspection. Care Homes for Adults (18-65 years) Page 23 of 34 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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. We assessed National Minimum Standards 24, 26, 29 and 30 during this inspection. The home provides a physical environment that meets the specific needs of the people who live there. The home is comfortable, and has a programme to improve the decoration, fixtures and fittings. Occasionally there is slippage of timescales and maintenance tends to be reactive rather than proactive. The home is well lit, clean and tidy and generally smells fresh. The management has a good infection control policy; and seek advice from external specialists. Evidence: The home provided the following information in their AQAA: 7b Mapesbury is a 25 bedded residential care home. It is normally a home for life and whilst we have provided respite care in the past, it is usually used for permanent placements. Twenty people have their own room with a personal door key, a lockable drawer, a sink, an arm chair, lamp, and all amenities as specified by CQC. There are also four selfcontained flats with a kitchen, en suite bathroom and living room. People are encouraged to bring furniture and personal belongings with them at all times. Communal areas include a large dining area, laundry room, and kitchenette for residents use, a separate lounge on the first floor, and a garden and patio. The premises reflect the style and preferences of the residents and also reflects their Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: Jewish faith and customs, e.g. pictures, ornaments, cultural calendars. It is light and airy and newly decorated. New furniture and tableware has been purchased. 7B employs a separate cleaning company to take care of the premises and laundry, Eurest. The building is kept clean and free from odor at all times. There is a weekly written audit carried out by the House Keeper which lists the cleaning schedules in detail. This in turn is audited by the Eurest Manager and also the Eurest Service Manager. Copies are kept on file. There are also checklists in bathrooms and kitchens for the cleaners to sign. The Eurest Manager on site keeps records and controls for control of infection, food hygiene and COSHH procedures along with safety data sheets. All Eurest staff receive appropriate training along with Jewish Care staff, records are kept in personnel files. We took a tour of the premises, and assessed cleaning records during this inspection, which confirms the comments made by the home in the AQAA. People using the service spoken to confirmed that they like the home and are happy with their rooms. This was confirmed by the expert used during this inspection. Generally, it was my impression that the Service Users were satisfied with their quality of life as their overall demeanor did not reflect any serious dissatisfaction. The expert commented on the odour in one of the downstairs toilet, which had a strong smell of urine and one of the armchairs in the hallway which had a significant hole in the arm exposing the stuffing. The home informed the Providers Relation Lead and the Lead Inspector, that 7b Mapesbury Road is planning to relocate to a new site within the next 18 months. The registered manager told us that consultation has started and a service user has been elected by the residents as their representative. Care Homes for Adults (18-65 years) Page 25 of 34 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. We assessed National Minim Standards 32, 34, 35 and 36 during this inspection. Management prioritise training and facilitate staff members to undertake external qualifications beyond the basic requirements. The content of the induction and probationary periods are very robust, detailed and service specific. The service only confirms permanent employment when satisfied that competence and progress has been shown to be satisfactory against their high standards. Evidence: The staffing rota told us that three care staff, two managers and one administrator are working during the morning; three care workers are on shift during the afternoon and one waking night and one sleep over staff during the night. We spoke to two members of staff, who told us that they are happy with the numbers on staff on duty and enjoy working with the team at 7b Mapesbury Road. Over the past two years the staff team at the home has gradually been replaced and relations between people using the service, staff and management has improved. Comments made by staff in surveys received Staff have good interaction and team work. I enjoy my work with the management and staff. The Provider Relationship Lead made the following findings in regards to recruitment Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: during a meeting with Jewish Care on 17/09/2009. Jewish Care have a Sponsorship Licence (Tier 2) from the Home Office to issue work permits. They received an A grade in a recent Home Office audit of their practice. We viewed four staffing folders during this inspection. We noted that one folder did not contain a valid CRB check. We discussed this with the manager, who told us that the CRB check has been misplaced. We spoke to the member of staff who told us that he has provided documentation and completed his CRB form and has received a CRB check. All other documents viewed were of good standard and relevant documentation was on file. The home informed us in their AQAA, that all new staff have to attend a 5-day external induction course in line with the Skills for Care workforce strategy targets within 3 months of starting employment. We viewed training records of two newly appointed staff and spoke to two members of staff, which confirmed this. Staff are offered and have access to a comprehensive training programme. Training recorded which staff have attended over the past twelve months included Adult Protection, Fire Safety, Food Hygiene, Medication, Mental Capacity Act, Deprivation of Liberty, Jewish Way of Life, quality assurance, sexuality training, etc. The home provides refresher training to staff annually. Jewish Care has achieved the Investors in People Award, this award is given to organisations who have good staff development and training procedures in place. We viewed training records and staff development plans in all of the four staffing files we assessed. One staff member told us. I really enjoy the training, which is offered to me. A service user told us. They (staff) really know what they are doing. We looked at supervision records of four staff. All staff have received a minimum of six supervisions per year, the majority of staff have received eight or nine supervisions since November 2008. Staff working with Jewish Care for over a year have received an appraisal on their anniversary. Staff confirmed in surveys, that they feel valued and supported by the management in 7B. Care Homes for Adults (18-65 years) Page 27 of 34 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. 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. We looked at National Minimum Standards 37,39 and 42 during this inspection. The manager has the required qualification and experience, is highly competent to run the home and meets its stated aims and objectives. The manager has sound knowledge of both strategic and financial planning. The manager is able to describe a clear vision of the home based on the organisations values and corporate priorities. The AQAA contains excellent information that is fully supported by appropriate evidence. All the working practices in the home are safe and there are clear trends indicating a steady reduction in the number of preventable accidents, evidenced by good monitoring and record keeping systems. Evidence: The Head of Home (who started in January 2007) has over 10 years of experience as a registered manager working in the mental health field. She has National Vocational Qualification in Care Level 4, a Registered Managers Award and is a qualified assessor in care. She is undertaking numerous training as part of personal development e.g. Care Homes for Adults (18-65 years) Page 28 of 34 Evidence: ILM5 in Management, OFI course in training to become a qualified manual handling trainer. The manager told us in the AQAA, that she has applied to be registered with the Commission for Social Care Inspection (CSCI), but there has been some delay in the application being processed. The manager informed us that the registration is still in process. People using the service and staff gave very positive feedback about the manager and I could see during this inspection that records, care plans, etc. have been updated. The management team comprises of the manager and deputy manager, it was evident through observations that the team is working very well and the home is managed very well. The expert had similar observations. Overall it was felt that the service had greatly benefited from the managers input now that she has been in post for some three years and appeared to have organised an effective team of staff. The home has a range of quality assurance measures in place; records of these are kept in individual files. We have viewed a business development plan, which addresses maintenance, people using the service, staffing, etc. The manager is undertaking monthly site visits and Health and Safety audits. The organisation has a good track record of undertaking regular provider visits and is forwarding copies of these records to the CQC. The annual development plan has been updated. Service users surveys are available in foreign languages if required. The manager is assessing the overall performance of the service monthly, data for this is collected from different sources to have a broad overview. In addition to this monthly data such as incidences, starters, admissions, etc is collected to make plans for the future, regarding staff vacancies, voids, etc. People using the service have taken part in surveys during the summer and data of these surveys is available on the noticeboard for people using the service, staff and visitors. People using the service meet every two weeks to discuss activities, staffing issues, maintenance issues and other issues relating to the quality of care provided. In addition to this people using the service have regular meetings to discuss menus and make suggestions to the meals provided. Medication and Health and Safety is monitored monthly by the deputy manager. The staff team meets every month to discuss issues relating to the service provided to people using the service. The AQAA contains excellent information that is fully supported by appropriate evidence. It includes a high level of understanding about the importance of equality and diversity and a wide range of evidence showing how they have listened to people using the service. The data section of the AQAA is accurately and fully completed and supports evidence in the self-assessment section. We looked at a range of Health and Safety certificates, which were all found to be of good standard and within the recommended timescales. This confirmed the information provided by the home in the AQAA. Regular fire drills are undertaken and Care Homes for Adults (18-65 years) Page 29 of 34 Evidence: the fire system as well as the fire equipment is checked and serviced regularly. The homes kitchen and environment has been assessed by the Environmental Health Department and was issued with a four star rating. Care Homes for Adults (18-65 years) Page 30 of 34 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 Adults (18-65 years) Page 31 of 34 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 29 23 The responsible person must 01/01/2010 remove or repair the broken armchair in the hallway. This ensures, that people using the service have safe and comfortable furniture to use. 2 30 23 The responsible person must 01/01/2010 investigate and eliminate the strong urine smell in one of the downstairs toilets. This ensures people using the service live in a clean and odour free environment. 3 34 19 The responsible person must 01/01/2010 ensure that all employees have an up to date CRB check on file. This ensures that people using the service are protected from unsuitable staff. Care Homes for Adults (18-65 years) Page 32 of 34 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 4 37 8 The manager must continue to pursue her registration with the Care Quality Commission. This ensures that people using the service are confident in the management of the home. 01/02/2010 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 17 We recommend that the home follows up the issues raised in the report and the surveys provided to the CQC and discusses the menu with people using the service to find out why people are dissatisfied and how the meals can be improved. The home should ensure that doors of rooms have signs informing people if not accessible due to medical examinations. 2 19 Care Homes for Adults (18-65 years) Page 33 of 34 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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