Care Home: Jobs Close

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What the care home does well A detailed assessment of needs is undertaken before agreement is reached for people to move in to Jobs Close. People are encouraged to visit and stay for the day and the home makes sure that people have the information they need to help them decide whether Jobs Close would be suitable for them. Systems in place for managing people`s individual health care needs are good. People told us "since I have come to live here my health has improved". People have the opportunity to take part in organised activities both in and out of the home. A range of activities are offered on a daily basis. This helps people occupy their time with activities which they find meaningful and enjoyable. People said that the "atmosphere is always friendly". People are offered a choice of meals on a daily basis, a variety of foods are served and fresh and seasonal vegetables are used. People commented that they liked the food. The environment is well maintained and people said that they like living there. There is a variety of communal areas available for people to spend their day. The Home was warm, clean and had a welcoming, homely atmosphere and people seemed to be at ease in their surroundings. People are encouraged to use various communal areas and not spend all day seated in one room. The staff team are friendly, knowledgeable and were observed interacting with people in a very positive manner. People said "senior care staff are all excellent"; "the manager is lovely, she is very clever, she knows what needs to be done, she knows what people want even if they don`t say and she is very tactful". Quality assurance systems ensure that the views of the people living in the Home are sought and action taken as necessary when issues are identified. Some of the positive comments received on the day of inspection include "I feel very lucky to be here, I have no worries everything is good", "I can`t think of anything that I would change, everything is good, I am happy here", "I have made good friends here". What has improved since the last inspection? During this inspection it was identified that some of the requirements and recommendations made during the last inspection of the Home have been addressed as follows:The Service User Guide has been reviewed and revised and now includes information regarding the fees and extra costs. Audits of medication and staff competence are carried out at weekly intervals. Errors are identified and recorded and appropriate action taken to try and reduce future errors. It was noted that errors in medication administration records were noted at this inspection. Handwritten Medication Administration Record Sheets are countersigned, to ensure their accuracy, and include where the instructions originated. A homely remedies policy has been implemented in conjunction with the pharmacy and GP. This enables minor ailments to be treated safely using remedies available in the Home. Care plans seen during this inspection were reviewed and updated on a regular basis. Some of the improvements made during the last twelve months as recorded in the Home`s Annual Quality Assurance Assessment document are:Dependent Residents are now going out more on day trips, We have replaced old central heating boilers in November last year. Flooring replaced in Activities Room and Hairdressing Salon used by residents. Increased staff numbers on daily shifts with NVQ2 qualifications. A skill for Care Induction training has been introduced. Deputy manager completed NVQ4 last year. All policies and procedures have been updated and implemented. What the care home could do better: Improvements are required to medication administration systems and practices. Records checked did not balance with medications available on a number of occasions during this inspection. The manager completes weekly audits of medication and these audits also identify errors in record keeping or medication administration. Staff rotas did not clearly detail the hours worked by all staff or include the manager`s hours. Changing duty rotas to show this information was a recommendation made at the last inspection of the Home. People should be weighed on a regular basis. When people are out of the Home/not able to be weighed on a particular day an alternative time should be put aside to complete this task. All staff should receive training and updates in mandatory areas such as fire, first aid, food hygiene, moving and handling and the protection of vulnerable adults. Resident`s financial records should be audited on a regular basis to ensure that funds available balance with records held. The Home should ensure that all people are aware of how to make formal complaints. Key inspection report Care homes for older people Name: Address: Jobs Close Lodge Road Knowle Solihull West Midlands B93 0HF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Deborah Shelton     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 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 35 Information about the care home Name of care home: Address: Jobs Close Lodge Road Knowle Solihull West Midlands B93 0HF 0156477349 01564774333 care@jobsclose.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Job`s Close Residential Home for the Elderly care home 35 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 35 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: Old age, not falling within any other category (OP) 35 Date of last inspection Brief description of the care home Job s Close, which was established on the 1st July 1957, is an extended and adapted Edwardian House built in 1904. The Home, which is adjacent to and overlooks a park, has very attractive gardens with ample car parking facilities.The Home provides permanent placements for up to 33 frail older people over the age of 65 whose care needs can be met within a residential setting. Additionally one room is designated for respite/short stay placements. The Service Users receive accommodation, full board, 24-hour care, supervision and personal care as required. Of the 34 single bedrooms, Care Homes for Older People Page 4 of 35 Over 65 35 0 Brief description of the care home 33 have en-suite facilities. Daily routine is organised on a group living basis although the Home is flexible in meeting individual needs and preferences. Communal facilities include two large lounges, one of which is used as a library, a dining room and a separate sun lounge/dining room/activities room. There is a hairdressing salon and two smaller lounges in the annex building. There are two passenger lifts and a stair lift.The fees at the home were not published in the homes Service User Guide but the manager advised that hairdressing and chiropody are additional charges. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection visit and was unannounced. This means that the Home were not aware that we were going to visit. This visit took place on Tuesday 19 January 2010 between the hours of 9.25am and 7.45pm. The inspection process concentrates on how well the service performs against the outcomes for the key national minimum standards and how the people living there experience the service. Before the inspection we looked at all the information we have about this service such as previous inspection reports, information about concerns, complaints or allegations and notifiable incidents. This helps us to see how well the service has performed in the past and how it has improved. An Annual Quality Assurance Assessment (AQAA) was completed by the manager to a good standard. This document gives information on how the Home thinks it is performing, changes made during the last twelve months, Care Homes for Older People Page 6 of 35 how it can improve and statistical information about staffing and residents. During the key inspection we used a range of methods to gather evidence about how well the service meets the needs of those people who use it. Time was spent sitting with people in the lounge watching to see how they were cared for and how they spent their day. Surveys were sent out to people living in the Home and six were returned. Any comments made in these surveys are included in the main body of this report. Face to face discussions were also held with people who use the service, staff and the management team on the day of inspection. Information gathered was used to find out about the care people receive. We also looked at the environment and facilities and checked records such as care plans and risk assessments. Three people living in the Home were identified for case tracking. This involves reading their care plans, risk assessments, daily records and other relevant information. Evidence of care provided is matched to outcomes for the people using the service; this helps us to see whether the service meets individual needs. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? During this inspection it was identified that some of the requirements and recommendations made during the last inspection of the Home have been addressed as follows:The Service User Guide has been reviewed and revised and now includes information regarding the fees and extra costs. Audits of medication and staff competence are carried out at weekly intervals. Errors are identified and recorded and appropriate action taken to try and reduce future errors. It was noted that errors in medication administration records were noted at this inspection. Handwritten Medication Administration Record Sheets are countersigned, to ensure Care Homes for Older People Page 8 of 35 their accuracy, and include where the instructions originated. A homely remedies policy has been implemented in conjunction with the pharmacy and GP. This enables minor ailments to be treated safely using remedies available in the Home. Care plans seen during this inspection were reviewed and updated on a regular basis. Some of the improvements made during the last twelve months as recorded in the Homes Annual Quality Assurance Assessment document are:Dependent Residents are now going out more on day trips, We have replaced old central heating boilers in November last year. Flooring replaced in Activities Room and Hairdressing Salon used by residents. Increased staff numbers on daily shifts with NVQ2 qualifications. A skill for Care Induction training has been introduced. Deputy manager completed NVQ4 last year. All policies and procedures have been updated and implemented. 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 Care Homes for Older People Page 9 of 35 order line 0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Pre-admission assessment processes help to ensure that the Home have the information needed to be able to meet peoples needs. People have the opportunity to visit the Home before they move in, to access the facilities available. Evidence: The care file of the last person to move into the Home was seen and a discussion was held with the manager to find out the processes for admission. We were told that when an enquiry is received about moving in to Jobs Close, people are sent an application form and a copy of the Service Users Guide. This can be made available in large print or any other format if required. The Service Users Guide gives people information about the services and facilities available and gives an idea of what daily life at the Home would be like. Either the manager or the deputy undertakes a pre-admission assessment at the persons current address. The pre-admission assessment is completed to help decide Care Homes for Older People Page 12 of 35 Evidence: whether staff at the Home would be able to care for the person and meet all of their needs. We were told that people are given a copy of the Homes brochure and told where they can get a copy of the last inspection report of the Home. People can then make an informed choice as to whether they think Jobs Close is the right Home for them. People are invited to visit for the day and stay on a trial basis of four to six weeks. This helps them decide whether they would like to move in to the Home permanently and also helps staff find out further information about the persons needs, mobility, likes and dislikes. Care plans are developed when the person first moves into the Home and then further developed during the trial stay. In all files reviewed, pre-admission assessment paperwork was available. This demonstrates that an assessment of needs and abilities had been undertaken in order to help the Home decide whether they would be able to care for the person. The assessment covered a range of areas such as personal care, oral hygiene, eating, toileting, foot care, mobility and long term health problems amongst other things. Preadmission assessments were detailed and would provide staff with sufficient information to be able to decide if they could meet the needs of the individual being admitted. Information obtained was then used to form initial plans of care which guide staff how to care for an individual in a way in which they prefer. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans cover the support required by the people living at the home and are revised as individuals circumstances change. People living in this home have their healthcare needs met. There are some concerns around the medication process that could impact on the residents health and welfare. Evidence: We were told that everyone who lives at this Home has a care file. We looked at three peoples care files and other information such as medication records and information about meals and activities amongst other things. This process is called case tracking. Each of the care files seen contained an assessment undertaken before admission to the Home. This shows that the Home have found out about the person to ensure that they would be able to meet their needs. Care plans are developed when the person moves in to the Home. They record all of Care Homes for Older People Page 14 of 35 Evidence: the information needed by staff to enable them to care for the person each day. Information about peoples health and personal care needs are recorded along with details of what the person is able to do independently, what support is required from staff and what equipment is needed in order to meet their needs. Preferred routines and likes and dislikes are also recorded. In the files seen people had signed a document to say that they have read and are in agreement with care plans and various risk assessments in place. This shows that people are involved in planning their own care which can then be met in a way in which they prefer. Care plans recorded detailed information about peoples daily living needs. They clearly identified the number of staff needed to assist with certain tasks, equipment needed and peoples preferences and abilities. For example one personal hygiene care plan records that two carers are needed to assist with personal hygiene, the person has no preference to male or female staff to provide support with personal care and prefers baths rather than showers. It notes that two carers are needed to support the person in getting in and out of the bath. Peoples strengths and weaknesses are recorded. This helps staff to promote independence and offer assistance only when needed. For example strengths such as orientated, independent, mobile with frame, expresses her wishes, socialises, attends a church service in the Home, expresses choice, maintains individual routine were recorded in one file, and weaknesses such as not confident with stairs, occasionally incontinent of urine, unsteady on feet, needs support of one carer and at times uses a wheelchair were noted. Care plans were reviewed and updated on a regular basis. The views of the person and their representative (family member) were recorded on an annual review. This demonstrates that people are given the opportunity to discuss their care and be involved in the ongoing planning of care. Care files also contained a personal profile which records information about likes and dislikes and abilities such as enjoys gentle exercise, watches activities, loves going on outings, loves watching wildlife. Records were available to demonstrate that people are weighed regularly, this is important as weight loss or gain could be caused by an underlying health problem. Two of the people being case tracked had not been weighed since 20 November 2009. Both of these peoples weight was unstable, going up and down on a monthly basis. Care Homes for Older People Page 15 of 35 Evidence: The manager confirmed, and we saw that people were being weighed on the day of inspection. Risk assessments regarding the risk of falling, developing a pressure area or nutritional risk had been completed in each file seen. These identify the risk to the person and record the action that staff should take to reduce the risk. All risk assessments had been regularly reviewed. Assessments highlighting the needs and abilities of people regarding mobility were completed. These show the equipment and number of staff needed to help people stand, walk, and get into bed amongst other things. Detailed information was recorded. Daily records are made three times per day, staff write a comment for each shift during the day and night. Records seen detailed information about general health, meals, continence and daily life, care needs and abilities. These daily records provided enough information to be able to monitor peoples ongoing health and wellbeing. Records and discussions with people who live at the Home demonstrate that people have access to external professionals such as dentists, opticians, chiropodists and GPs as necessary to ensure health and wellbeing is monitored. As a reminder to staff, medical and dental appointments were recorded on the whiteboard in the medication room. People commented on our surveys that they always receive the care and support that they need and on the day of inspection they said I see the GP when I need, I have recently had a chest infection and just finished my antibiotics and I am feeling much better, since I have come to live here my health has improved, I can now walk around which I didnt used to do. People spoke positively about life at Jobs Close. Medication systems and storage was reviewed. Medication was appropriately stored in a locked room where the lockable trolley, cupboards and a fridge were located. Controlled drugs and the record book were checked and found to be correct. Excess medication is stored appropriately in a different location. We were told that there is not a large amount of excess medication available. Key custody practices were satisfactory and safe. Copies of prescriptions were available and we were told they are used to check against medication received into the Home to ensure that the correct medication is received. The medication and records of the people being case tracked were reviewed and Care Homes for Older People Page 16 of 35 Evidence: errors were identified. One aspirin, a furosemide tablet and a senna tablet had been removed from a blister pack but had not been signed on records to show that they had been given to the person. Other records show that medication had been signed as given when it was available in the blister pack. A quantity of lactulose had not been recorded on the administration records as being carried forward from the previous month, therefore the amount of lactulose recorded as available in the Home was incorrect. The manager confirmed that only staff trained in medication administration gives out medication; this includes the manager, deputy or senior staff on duty. Medication audits take place every week. The manager audits to ensure that records are being completed correctly and that the balance of stock is the same as records held. Medication audit records seen for 7 and 8 January 2010 show that the manager has identified issues regarding the administration of a tablet. On this occasion, out of the 8 records checked by the manager, 5 were incorrect. The manager had also identified errors on other occasions and had written comments on the audit records requesting a meeting of senior staff. The minutes of senior staff meetings evidence that medication management has been discussed at these meetings. The manager also told us that medication management is discussed at staff supervision and further training is provided for staff as needed. Some of the issues identified at the last inspection of the Home remain outstanding. The Home have not as yet developed a protocol to instruct staff when to give as required medication. This will ensure that residents receive the correct medication at the correct times for the relevant symptoms. It was also identified previously that there were unexplained gaps in the Medication Administration Record Sheets. Records checked on this occasion still identified unexplained gaps in records. It was required at the last inspection that any handwritten Medication Administration Record Sheets should be countersigned, to ensure their accuracy. Handwritten records checked on this occasion had been countersigned, although it was noted that one had been signed twice by the same person. Further work is required to medication systems and practices to safeguard the health and welfare of the people living at this home. During this inspection people were observed to be cared for in a respectful manner. Staff were seen to have a good relationship with people and were attentive to their needs. People said that staff always knock on bedroom doors before they enter and were patient, kind and caring. People were dressed appropriately for the time of year. Peoples hair was neatly brushed and ladies were wearing makeup and nail varnish as Care Homes for Older People Page 17 of 35 Evidence: they wished. Personal care was carried out in private. Care Homes for Older People Page 18 of 35 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. People are encouraged to lead active lives and were occupied and stimulated. People have choice and control over their daily lives. Meals are nutritious and well balanced. Evidence: We spent some of our time completing paperwork in the small dining room. During the morning people walked into the dining room to have their mid morning drink and snack. People wandered freely around the building and appeared to be at ease in their surroundings. The atmosphere at Jobs Close was relaxed and friendly. Ladies sat at dining tables chatting amongst each other. People who did not go to the dining room for the mid morning drink came in later and asked staff to make them a drink. Drinks were freely available and made upon request. Staff chatted to people as they went about their daily duties. Before lunch a lady who lives at the Home played the piano, she said that she plays most days and enjoys playing. People in the room enjoyed the music. There are a number of communal areas for people to spend their time, including two large lounges, two small quiet lounges, a conservatory, used to complete activities and two dining rooms. There were televisions in both large lounges, although people Care Homes for Older People Page 19 of 35 Evidence: were not watching the television during the morning or early afternoon. In one lounge there is a hearing loop. This helps those with hearing difficulties listen to the television without having to have the sound turned up too loud. A notice board displays details of planned activities for the month. It was noted that people had visited to sing the day before our inspection and that there is a clothing sale on 25 January. It also detailed the activities taking place on the day (bingo at 3.15pm). People are encouraged to go into the dining room to have their meals, drinks and snacks and on the day people appeared happy to do this. An activity organiser is employed, who works for twenty one hours over four days a week. This person is responsible for organising and completing daily activities each morning and afternoon. Records are kept to show what activities have been provided and who has joined in. The records for the three people case tracked were reviewed. There were no records for one of the people being case tracked. One person had attended eight activities during December, such as choir concert, cocktail party, bible reading, Christmas lunch and the other person had attended five activities, for example film afternoon, choir practice, cocktail party, guides choir, Lloyds Xmas sale. A quick review of other records show activities such as bingo, guess the word, fish and chip supper, quiz also take place regularly. People living at Jobs Close were asked for their views of the activities. One person said that the activity organiser asks if you want to join in but never pressurises you. You can if you want, she is very clever, she talks to you and shows an interest and before you know it, you have told her something and she gets you doing things that you used to do, We go out in the gardens in the summer which is nice. The gardens are lovely I like to watch the birds, there are activities but you can join in if you want and not if you dont, I was encouraged to play the piano again and I play every day. Sometimes people come and listen; one lady likes to have a sing song. I either play in the morning or the evening as I fancy, We had some singers in yesterday and they played the piano they were really good. The activity organiser arranges all of that, I have started to do things again since I have been here, I wake up on the days that I know she (the activity organiser) is in and I feel happy, she is lovely, always smiling, You can sit in the lounge or you can sit in here, you can go where you want. People spoken to were happy with the activities on offer. No concerns were raised on the day of inspection or in the seven satisfaction surveys received. The Homes Annual Quality Assurance Assessment (AQAA) records that there are no rigid rules or routines in the home which would infringe on the liberty or choice of Care Homes for Older People Page 20 of 35 Evidence: residents. Varied activities are available under the supervision of an Activities Coordinator Records show that peoples religious needs are identified and that a Catholic and Church of England service is held in the Home every week. We were told that currently there are no other religious or cultural needs to be met. We were also told that some people go out to local churches with family members, trustees from the Home, or members of local church. The Home has an open visiting policy and people can visit at any time but are asked not to visit too late at night unless absolutely necessary. Visitors were seen being offered a drink by staff and were made welcome. Kitchens are available for visitors to make themselves a drink if they wish. We were told that relationships with friends and family are encouraged and visitors are invited to events at the Home such as Christmas parties, coffee morning, strawberry teas and bring and buy sales. Residents meetings are held and sometimes people ask if their relatives can attend these meetings. People are encouraged to go out into the local community if they are able. We were told that people go out alone, with staff, family, local church people or, committee members. Representatives from the local community are also invited to come in to the Home. A local school, church, working mens club have all been in to the Home and sang/held carol concerts. We spoke to people about the meals served and looked at menus and food choice records. We noted that people are offered a choice of two main meals or a sandwich at lunchtime. There is a four weekly rotational menu offering a varied choice of meals. People are able to eat their meals in their bedroom or dining rooms as they wish. We were told that the food is good there is a choice of two things, there is always plenty of things to eat, The food is good, it is excellent really. There is a choice of porridge or cornflakes and then a cooked breakfast. If they know you want a cooked breakfast but you fancy a lie in bed they do the breakfast and keep it to one side for you. You dont miss out on anything, There is a vast choice of food, if you cant find anything you like thats your own fault. All people spoken to were happy with the lifestyle at the Home including the meals and activities on offer. Care Homes for Older People Page 21 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that their concerns are being listened to and acted upon. The Home has appropriate policies and procedures to help safeguard people. Evidence: We have not received any complaints about this service since our last inspection. We were told that the Home has not received any formal complaints recently. There is a complaint log book which is used to record grumbles and formal complaints if any are received. A few grumbles had been recorded and the action taken to address any issues raised had also been recorded. From information recorded it appeared that staff had taken appropriate action and addressed issues to everyones satisfaction. Two people who responded to our satisfaction survey reported that they did not know how to make a formal complaint. People spoken to on the day of inspection knew how to make a complaint and said If I had any complaints I would speak to the manager and she would sort it out for me, I feel that if I told them anything they take it seriously and sort out the problem for you. There have been no issues regarding the protection of vulnerable adults who live in this Home since last inspection. We were told, and records confirmed that, a majority of staff have completed adult protection training. New staff employed have watched a training DVD regarding adult protection and they will be booked on the next training course. Care Homes for Older People Page 22 of 35 Evidence: Recruitment practices safeguard residents from the employment of unsuitable people and financial practices safeguard residents financial interests The Annual Quality Assurance Assessment (AQAA) reports that policies and procedures regarding adult protection and whistle blowing are available at the Home. These were not reviewed at this inspection. Care Homes for Older People Page 23 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers the people living there attractive and comfortable surroundings, in a well maintained, relaxing and welcoming environment, which are clean and free of offensive odour. Evidence: Jobs Close is not a purpose built Care Home but has been adapted to meet the needs of those that live there. The Home is an Edwardian building located in a residential area overlooking parkland at the rear. Parking is available to the front of the building. The Home is close to shops, churches, public houses and transport links. The Home has two large and two small communal lounges where people can choose to spend their day. Lounges were bright with large windows letting in lots of natural daylight. All were clean and well decorated. Period features gave some rooms a charming, homely feel. People appeared to be comfortable in the lounges, and were seen chatting and reading newspapers. There are also comfortable seats in corridors if people wish to sit in a quiet area. There are two dining rooms where meals are eaten. All areas seen were comfortably furnished. The conservatory is used as the activity room and this and the dining rooms overlook the well maintained gardens and the park at the rear of the garden. Five people were seen in the activity room during the afternoon playing bingo and chatting. One person said that they like to watch the wildlife from the conservatory and Care Homes for Older People Page 24 of 35 Evidence: commented that the gardens were always lovely. Two people who responded to our survey commented that the Home is comfortable, warm and clean and rooms are always clean and comfortable. One person spoken to during the inspection said its like living in a first class hotel, home from home. A passenger lift gives access to all floors of the Home; a stair lift is also available and is used in emergencies if the lift were to be out of order. This helps to ensure that people are always able to access all areas of the Home. There is a hairdressing salon with special hairdressing sinks and other equipment. We were told that currently three different hairdressers visit the Home each week, therefore people have a choice. Bedrooms seen had all been personalised with pictures and other personal possessions. All bedrooms have en-suite toilet and all but four have a shower. Bedrooms were clean and hygienic and no unpleasant odours were noted. Lockable space is provided in each room to enable people to secure personal belongings if they wish. Bedroom doors are also lockable and people are able to have a key to their room if they wish. There are two sluice rooms both have a sluice sink and bed pan washer. These are used to hygienically clean and sterilise commodes. Disposable gloves and aprons are readily available and their correct use helps to ensure infection control standards are met. The laundry was clean and well organised. There are two washing and two drying machines. Soiled laundry is transported and washed in red bags. This reduces the amount of times soiled laundry has to be handled and therefore reduces the risk of cross infection. All equipment in the laundry was in good working order. Laundry staff are available for five and a half hours each day Monday to Friday. Care staff would be responsible for completing laundry duties at all other times. The kitchen was clean and hygienic. An environmental health officer had visited the Home two weeks before our inspection and reported that the Home had achieved a good standard in the kitchen. We briefly checked food temperature and kitchen cleaning records and these were in good order and up to date. The cook was knowledgeable about peoples individual preferences and confirmed that every day there is a choice of white or brown bread for sandwiches, fresh vegetables are used as much as possible and any special dietary needs are catered for. Care Homes for Older People Page 25 of 35 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. There are appropriate numbers of staff on duty to meet peoples needs. Satisfactory recruitment practice protects residents from the employment of unsuitable people. The importance of training is recognised however, Some staff require updates in mandatory and other training. Evidence: There were thirty two people living at Jobs Close on the day of inspection. A copy of the duty rota for the week of 17 January 2010 was taken for review. The number of staff on duty on the day of inspection was in line with the information recorded on the duty rota. Records show that five staff work every morning, four every afternoon and three at night. In addition to this the manager and/or deputy work Monday to Friday. The hours that the manager works is not recorded on the duty rota. It is therefore difficult to confirm from documentary evidence that sufficient management hours are provided. Discussions with people living at Jobs Close and duty rotas indicated that staffing levels were adequate for the needs of the people living there. People commented that Staff are lovely, helpful; there is a bell you can ring if you need help. Staff are all kind and come quickly to help out, all of the staff are kind, they take an interest in Care Homes for Older People Page 26 of 35 Evidence: you, there are some I prefer more than others but I like them all, they pop their head around the door at night to make sure you are alright which is really reassuring, they (staff) are very patient, kind, always knock on your door before they come in, they (staff) seem to have a sense of when something is not right with you and they ask you if everything is ok. Not sure how they do it but they always know. They make you feel that you are the most important person in the world to them. Two people who responded to our survey said all carers very helpful, staff are always available if needed. In addition to care staff, ancillary staff such as laundry, domestic and catering staff work seven days per week. All areas of the Home were clean, people commented they clean your room, take your washing away in the morning and it is back at tea time, the cleaning and laundry service is excellent, second to none, couldnt fault it. The manager and the information received on the AQAA evidenced that there has been eleven staff employed since the last inspection of the Home. The manager said that two part time staff have been employed to cover a full time vacancy on some occasions and this accounts for the high number of new recruits. The personnel files of the new staff were reviewed. It was noted that all employee files contained two written references, copies of application forms, medical questionnaires, contracts and other information to ensure that appropriate staff are employed at the Home. All records were in good order and information was easy to follow. Protection of Vulnerable Adults (POVA) and Criminal Records Bureau (CRB) checks have been completed with the vettings and barrings scheme. One CRB is outstanding but this member of staff works in the kitchen with existing staff. The AQAA records that 17 of the 19 care staff employed have obtained a national vocational qualification in care at level two. Providing staff with appropriate training helps to ensure that the workforce has the knowledge and skills to meet the needs of those under their care. A training matrix has been developed which records mandatory training undertaken by staff. Records show that some staff require update training and new staff need to undertake the training course. Some staff complete an in house video training course whilst waiting to attend the certified training course. Various training courses such as fire, first aid awareness, food hygiene, health and safety, moving and handling and adult abuse awareness training is booked between February and June 2010 and we were told that a large number of staff will be Care Homes for Older People Page 27 of 35 Evidence: undertaking this training. The managers monthly audit also identifies staff training needs and the manager is therefore able to book training as appropriate to ensure that staff have the necessary training updates. Only one of the eleven staff recently employed does not already have a national vocational qualification (NVQ) in care. This staff member is currently undertaking the skills for care induction and has completed paperwork to start NVQ level 2 training. Induction records for the newly employed staff member were not seen on this occasion. We were told that all staff undertake in house induction training. Care Homes for Older People Page 28 of 35 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 manager has appropriate qualifications and experience in order to be in charge of this Home. Quality assurance systems ensure that all services operate in the best interests of the people living there. Health and safety systems and practices protect all people including staff at the home. Evidence: The Manager has worked at the Home for approximately 3 years and has the relevant qualifications and experience to manage a Residential Care Home. The managers qualifications include a National Vocational Qualification at level four, the Registered Managers Award and a BET qualification in Dementia. A deputy and senior carers are in place to support the manager and lines of accountability in the Home are clear and understood by all. The Director and Trustee of the charity are involved at the Home and visit regularly to support the manager if required. Care Homes for Older People Page 29 of 35 Evidence: We discussed the methods used to obtain the views of people living and working in the Home. We were told that residents meetings take place approximately every three/four months. Minutes of these meetings were available for review. Two meetings were held in 2009 and three in 2008. Topics discussed include meals, activities, staff and general requests. Different topics are discussed at each meeting, for example security, heating, staff, activities and menus amongst other things. Residents made requests at these meetings such as replacing the stair carpet and only putting gravy boats on tables once all people are seated. Staff meetings are also held every three months and minutes are available. A separate meeting is held for care staff, seniors and night staff. Minutes of these meetings show that topics of discussion include the key worker system, confidentiality, mealtimes and staff meals amongst other things. Issues regarding individual residents are discussed as well as staff working practices. Holding these meetings helps to ensure that residents are able to have a say about life at the Home and staff are able to air their views about working in the Home and be informed about any changes that may be taking place. As well as holding regular meetings with staff and those living at the Home, satisfaction surveys are sent out annually. Surveys were seen for January 2010 and July 2009. Only one third of people responded to the January 2010 survey. Any issues raised were recorded along with the action taken to address these issues. This shows that people are able to have their say about the quality of service provided and enable the home to improve quality were necessary. Quality assurance systems in place are well developed and include a medication audit and Managers monthly audit. This audit checks areas such as medication, enquiry management, care documentation, pressure ulcer care/documentation and human resources. The audits for November and December 2009 were reviewed. Staff training needs were identified and confirmed that some staff require updates in mandatory training. The manager is therefore aware of the need to undertake training for some staff and we were told that training will be arranged. A discussion was held regarding residents spending money. It was noted that the Home holds small amounts of personal money for some people. People are able to manage their own finances if they wish or families look after money on their behalf. We looked at the records for two people to see how this was managed. Receipt or withdrawal of money is recorded in a separate book for each person. One set of records checked balanced with money available. The other person had 36p more available than records show. The manager confirmed that she would audit these Care Homes for Older People Page 30 of 35 Evidence: records and see where the discrepancy occurred. Receipts are available showing details of any money spent. Only a few people have money kept on their behalf. This was stored securely. Two members of staff sign record books to show all receipt and expenditure of funds. The manager confirmed that she will include audits of moneys on her regular monthly audit in future. A selection of health and safety and maintenance records were checked. These records are kept to demonstrate that equipment is safe and in good working order. A maintenance schedule records items that require servicing with dates. Records of weekly fire alarm tests, visual check of fire extinguishers, emergency lighting, electrical installation, lift servicing and fire system servicing were all up to date and in good order. A monthly health and safety checklist is also completed. This tick list is used to confirm that areas such as entrance, public rooms, toilets and bathrooms, general environment, workstations, office, laundry room, storage etc have been checked. There is also space to record addition comments/corrective action undertaken if issues are identified. Records were available to demonstrate that a member of the Board of Directors visits the Home regularly to review systems and practices. Records show that a check of the building and grounds was undertaken in July 09, resident records in August 09 and staff records in September 2009. Records seen did not demonstrate that discussions are held with the people who live at the Home on each occasion. Care Homes for Older People Page 31 of 35 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 32 of 35 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 9 13 There must be a protocol in place to instruct staff when to give as required medication. This will ensure that residents receive the correct medication at the correct times for the relevant symptoms 24/02/2010 2 9 13 There must not be unexplained gaps in the Medication Administration Record Sheets. This will safeguard the health and welfare of the people living at the home. 24/02/2010 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 7 Records should be available to demonstrate that people are weighed on a regular basis and action taken where an Care Homes for Older People Page 33 of 35 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 unexplained weight loss or gain is identified. This is important as weight loss or gain could be caused by an underlying health problem 2 3 4 27 35 38 Staff rotas should clearly detail the hours worked by all staff and include the managers hours Audits of residents spending money should take place to ensure that records balance with funds available. Records of Regulation 26 visits undertaken by a member of the Board of Directors should include details of conversations held with residents and with staff as part of this routine monitoring. Care Homes for Older People Page 34 of 35 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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