Care Home: Jubilee House

What the care home does well The staff work hard to ensure that service users` needs are appropriately assessed and that their care is planned to ensure that these needs are met, whilst encouraging and enabling service users to maintain their independence where possible. Service users spoken with expressed their satisfaction with their quality of life at the home. Comments received from service users included: "Its like home from home here", "I like it very much here" and "I feel very comfortable here, the staff are very caring". One visiting relative commented that:"I have nothing but praise for the care my mother receives at Jubilee House". All interactions observed between the management, staff and service users evidenced that the home has a close and caring staff team. One member of staff commented that "the best thing about working here is having a good working relationship with the staff and manager, the good environment, being friendly and caring for service users in the best way". As stated in the AQAA a holistic approach to care, taking into account people`s diversity and level of need either physical, social or spiritual. It has been a long term house policy, that service users that need a wheelchair in order to be transfered within the house, are always seated in a chair in the lounge or in a dining room chair in order to have their meals. These service users are taken to the dining room first, so their disability is not witnessed by other, more able service users. Further changes will be made as the need arises, based on individual assessments. Jubilee House prides it self in providing care to individual service users, to the highest standards based on a holistic approach and involving every member of the multi disciplinary team. What has improved since the last inspection? The ongoing maintenance, redecoration and refurbishment programme provides service users with a comfortable and homely environment in which to live. There were four requirements made at the last inspection, which had been met, and there are four requirements and three recommendations made at this inspection. At the moment there are three service users living in the home from a different culture or background. All staff have received equality and diversity training to ensure they have a good understanding of the diverse needs of each individual service user. The "Friends of Jubilee House" members have doubled in numbers, there is a very strong link in the community. What the care home could do better: Encourage all staff to complete NVQ training. Develop person centred care individualised approach to the care of the service users, which will be achieved by further training, better communication with both service users and families. To promote team work by introducing team building events. The environment could be improved by a number of maintenance jobs that need to be completed. The garden is in need of being cared for and maintained to enable service users access to the garden. Key inspection report Care homes for older people Name: Address: Jubilee House Pound Lane Godalming Surrey GU7 1BX     The quality rating for this care home is:   two star good 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: Vera Bulbeck     Date: 2 5 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Jubilee House Pound Lane Godalming Surrey GU7 1BX 01483420400 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: manager.jubileehouse@careuk.com www.careuk.com Care UK Community Partnerships Ltd care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 48 The registered person may provide the following category/ies of service only: Care home with nursing - N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia DE Mental Disorder, excluding learning disability or dementia Date of last inspection Brief description of the care home Jubilee House is a large care home providing nursing for 48 service users with dementia. Care UK Partnerships Ltd, a Corporate organisation is the Registered Provider. The home is divided into two units, one on each floor, both of which have access to enclosed gardens. The home is situated in a quiet road in the centre of Godalming town, with the high street shops and amenities immediately accessible. All bedrooms have an en-suite facility. Care Homes for Older People Page 4 of 30 Over 65 0 0 48 48 Brief description of the care home Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good 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 inspection of Jubilee House care home was an unannounced Key Inspection and was undertaken on 3rd and 25th June 2009. Following the previous Annual Service review on 12th June 2008 and the last key inspection was on the 13th June 2007 and the service was given four requirements at the time of the previous inspection, which have been met. Mrs Vera Bulbeck, Regulation Inspector carried out the inspection and the registered manager represented the service. The home had submitted the Annual Quality Assurance Assessment AQAA prior to the inspection, which was well written to inform the commission about the service and some details of the document have been added to the report. The inspector arrived at the service at 05:45 on 3rd June for one hour to check on a complaint that had been made to the Commission referring to six service users being got up at 5.30am this practice was not substantiated. 25th June arriving at 08:45am Care Homes for Older People Page 6 of 30 and the inspector was in the home for nine hours and 50 minutes to have a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CQC has received about the service since the last inspection. The inspector spent time talking and observing the staff members and individuals in order to gain their views and opinions about the service. The inspector also looked at how well the service was meeting standards and has in this report made judgments about the standard of the service. Documents sampled prior and during the inspection included the homes Annual Quality Assurance Assessment AQAA, care and person centred plans, risk assessments, medication procedures, staff files, training records, health and safety records and several of the organisations policies and procedures including the complaints and safeguarding procedures. One complaint has been received to the commission, which was anonymous and was investigated on 3rd June 2009 by the Commission. There are two outstanding safeguarding issues, these have been dealt with and need to be closed by the safeguarding team. From the evidence seen by the inspector and comments received, it is considered that the home continues to be able to provide a service that meets the needs of people who have diverse religious, racial or cultural needs. The final part of the inspection was spent giving feedback to the registered manager about the findings of the visit. The fees for the home are from £690.00 - £1.076.79 these fees do not include personal items. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? What they could do better: Encourage all staff to complete NVQ training. Develop person centred care individualised approach to the care of the service users, which will be achieved by further training, better communication with both service users and families. To Care Homes for Older People Page 8 of 30 promote team work by introducing team building events. The environment could be improved by a number of maintenance jobs that need to be completed. The garden is in need of being cared for and maintained to enable service users access to the garden. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Each service user is only admitted to the home following a comprehensive needs assessment to ensure that the home can meet the service users identified needs. The home offers intermediate care and service users are fully assessed before being admitted to the home. Evidence: The inspector was advised that, on the first enquiry from a prospective service user or their representative, the service user or their representative will be invited to visit the home. Following the initial visit to the home, and if the service user wishes to continue, the manager will visit the service user and carry out a pre admission assessment to ensure that the home can meet the service users needs and wishes. However social services carry out a pre assessment if they wish to send a person to the home for any length of time. Three care plans were sampled during this visit. In each case comprehensive pre Care Homes for Older People Page 11 of 30 Evidence: admission assessments had been carried out to ensure that the home could meet the service users identified needs. Data provided in the homes AQAA identifies the home is able to meet the needs of any service users with specific religious, racial or cultural needs. From the evidence seen and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. The home accepts people who require intermediate care, a full pre assessment is undertaken and the nursing team are able to ensure the persons needs will be met before entering the home. In the AQAA, to demonstrate what the home does well, the manager stated that the home delivers specialist care and that the maximum of the staff have been trained in dementia care or working towards it. All relatives are encouraged to visit the home and to personalise their relatives bedrooms with pictures and small items of furniture and personal effects i.e photographs, paintings, bedcovers etc. in order to minimise the impact of the change of environment. Family members are advised to treat the home as they would their parents own home and visit any time day or night. Care Homes for Older People Page 12 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Policies, procedures and practices are in place to ensure the safe administration of medication. Evidence: The home has a close care team and the staff demonstrated an in depth knowledge of each individual service users needs, abilities and preferences in how they wish their care to be delivered, resulting in all service users spoken to stating that they always receive the care and support they need. One service user commented I am very well looked after and another commented I have everything I need. The care plans sampled during this visit were based on pre-admission assessments and had been drawn up shortly after each service users admission to the home and included appropriate risk assessments. The care plans set out the actions, which need to be taken by care staff to meet the health, personal and social care needs of the service users. Care plans are reviewed on a monthly basis and daily notes are kept Care Homes for Older People Page 13 of 30 Evidence: that reflect the care given. These daily notes demonstrated that any changes or new concerns are promptly acted upon. It was noted that one service user spends most of his time in his room he also has his meals in his room. The manager stated he prefers to stay in his room. The inspector suggested the management discuss with the G.P to ensure the home is able to meet his health needs. The manager has said following the inspection that the service user has been seen by the G.P and will be followed up. Staff are now encouraging him to come out of his room and join in some of the activities. The information to the paper care plan is not being followed with the care plan that is on the computer. It was very difficult to read the computer version of the care plan as it was not in date order and appeared to be just information stored rather than reading as a plan of care. The lunchtime medication round was observed and the medication administration records, medication storage, policies and procedures were all sampled and found to be in order. The Pharmacist from the local pharmacy inspects Jubilee houses medication its procedures and protocols, including storage and documentation. During the tour of the home staff were observed to always knock before entering service users bedrooms and all interactions observed between staff and service users were seen to be caring and respectful. All service users spoken to stated that they felt their privacy was always respected. In the AQAA, to demonstrate what the home does well, the manager stated that the home promotes care plans, which are based on assessed needs and documented personal choices and preferences and needs are reviewed regularly as required. Relatives are invited to discuss the contents of the care plan and ask for their input. The home has a retained G.P who visits on a regular weekly basis. A consultant Psychiatrist visits weekly to meet with the service users and sometimes their relatives. the home also has good access to other specialist services. Health assessments are carried out by nursing staff who are experienced in assessing the needs of service users in the client group of the homes registration. The staff who administer medication are qualified nurses amd competent to under take the task. Care Homes for Older People Page 14 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The activities provided by the home need to be expanded so that activites can be more individualised for each service user. Contacts with family and friends are encouraged. Meals are well-balanced and varied with individual choices and preferences catered for. However, food being left in the trolley for the service users being fed by staff needs to be kept warm. Evidence: The manager stated the routines of daily living are arranged to suit individual service userss preferences and choices. This was confirmed by service users and a relative spoken with. The activity programme was sampled at this visit, activities provided included a range of arts and crafts, jig saw puzzles and multi table games. The activity programme is very limited and needs to be expanded to enable service users to be interested and want to be involved. Records detailing service users involved and attended, were found to be not dated therefore it was difficult to know, which service users were using the facilities. Several trips had been arranged one was a boat trip on the Guildford Canal, another was a trip to Selsey on a hired coach. The home has its own vehicle/car and staff are able to take two service users to Godalming, visiting Secrets garden centre and have afternoon tea. Care Homes for Older People Page 15 of 30 Evidence: Menus sampled showed that the home offers a varied and well-balanced menu, which is changed every three months. A dietician is involved and service users are able to choose from an alternative if they do not want the dish that is on the menu on the day. The lunchtime meal was taking place during this visit, the food was well presented, the atmosphere in the dining room was pleasant and relaxed and there were ample staff available to offer help and assistance as needed. The menu is four weekly and is displayed on the notice board in the dining area. One service user commented that the food served could be better presented. This information was fed back to the manager and chef. It was also noted that the food left in the trolley after serving lunch did not have the lids put back on the dishes while the food was being stored, therefore the food was getting cold. There were six service users who needed to be fed in their bedrooms by staff, two were being fed and four service users were waiting. The inspector sampled the mashed potato and found the food cold. There were still four service users to be fed at this time. This was discussed with the chef who went to warm the food up. The home has excellent facilities in their seperate gardens but not used by the service users. The garden needed attention and areas needed to be made safe, for example the fish ponds needed to be made safe from service users falling into the ponds. And some walls and fences needed to be increased in height so that service users can use the garden safely. Grass and flower beds need to be maintained. On the day of inspection it was a very hot day and all the doors were locked. The manager stated that he intends to make one patio area of the garden into a cafe with a machine serving drinks, where service users and relatives can sit have tea or coffee. The inspector spoke with three relatives on the day of the site visit and they all expressed their satisfaction with the home and one relative said I do not think one could get better care anywhere else. Two service users commented that they like the staff, and one service user said some of the staff are lovely.The observation by the inspector on staff involvement with service users was respectful and caring. when speaking to one service user he informed the inspector that every day he goes to the betting shop with a carer and puts a bet on. In the AQAA, to demonstrate what the home does well, the manager stated that service users enjoy discussing current events for example the Presidential Election and celebrating special events and other important ocassions such as birthdays, wedding anniversaries etc: Entertainment provided internally as well as organising trips to various places service users choose to go. The home provides a varied menu to suit all cultural and dietary needs. There are regular meetings of the Friends of Jubilee House to discuss social events and fund raising for trips and in house Care Homes for Older People Page 16 of 30 Evidence: activities that they will support. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a simple, clear and accessible complaints procedure, which includes timescales for the process. Policies and procedures are in place to protect service users from potential harm or abuse. All staff have completed the vulnerable adults procedure training. Evidence: The home has a complaints procedure in place that is available to all service users and their relatives and is also included in the service users guide. One complainant has contacted the Commission with information regarding a complaint, which was investigated by the Commission on 3rd June and found to be unsubstaniated. The manager stated no complaints had been received since he took over management in May 2009, however several staff had received poison pen letters, which had been referred to the police. The commission did not receive any notifaction regarding the incident. Two referrals were made to the safeguarding team, which are on going. However the manager stated the investigation has closed and been dealt with therefore the safeguarding referrals need to be closed, and the manager would contact the safeguarding team for a closure. Service users spoken to confirmed they knew who they would speak to if they were not happy, with one service user adding that: the staff are very helpful. The manager stated that all service users have said that they Care Homes for Older People Page 18 of 30 Evidence: felt safe in the home. There is a whistle blowing policy in place and the home has a copy of the latest Surrey Multi-Agency Procedure for the Protection of Vulnerable Adults. Training in safeguarding adults is included in the homes staff induction and all staff confirmed that they had received the training and were aware of the procedures to follow. In the AQAA, to demonstrate what the home does well it states they encourage discussion of issues before they become complaints. Structured complaints procedure is well publicised. The home has a good relationship with the local Social Care Team. The inspector spoke with a number of service users who were extremelly complimentary about the home and one service user stated she felt very safe and another commenting I feel very happy and safe here. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The location and layout of the home and gardens are suitable for their stated purpose. An ongoing maintenance and redecoration programme provides the service users with pleasant and homely surroundings in which to live. However some areas of the environment could be greatly improved. Evidence: Service users spoken with expressed their satisfaction with the accommodation provided at the home, and two relatives stated they were very satisfied with the home. One relative was very complementary about the home and said they had looked at several homes before choosing Jubilee House and Jubilee House was far better than others they had viewed. There are two floors and each floor has its own facilities including several small lounges for service users to use, these areas can be used to entertain their relatives or friends. The manager stated he intends to open a cafe on the top floor, which has a large terrace area and could be a very nice area for service users to sit weather permitting. However it needs to be made safe with fences raised to ensure service users will not fall over the top and the garden area needs attention. On the day of the site visit it was a very hot day and all the garden doors were locked. The home was toured during this visit. The maintenance and redecoration programme for the home was seen to be ongoing. The laundry facilities with washing machines Care Homes for Older People Page 20 of 30 Evidence: and tumble dryers are suitable for the needs of the service users. However the general layout of the laundry is far from satisfactory for the persons working in there. There is not sufficient room and when laundry is left by the staff it causes some problem for staff to manoeuvre. These facilities need to be reviewed as the laundry is a Health and safety hazard. There are several areas in the home which need attention, this was discussed with the manager at the time of the tour, also during feedback at the end of the inspection. Several bedrooms had large holes in the wall from door handles banging into the wall. There was an odour in a number of bedrooms particuarly the en-suites, which could be the floor covering needs replacing. Some toilets had an odour this again could be the floor covering needs replacing. One en- suite needed the hazard strip on the floor secured, it was a health and safety hazard. Curtains needed to be hanging appropriately some were hanging off the rails. The door handle on one bedroom door needs attention, the inspector found it a problem to get out of the room, in fact the relative spoken to in the bedroom said he himself had been stuck in the room and could not get out on one occassion. Several toilets and bathrooms were without a shade and some shades were missing from service users bedrooms. All the toilet and bathrooms were found to be locked and the manager stated this was so that service users could not turn the water on and leave it running. The inspector suggested this practice be reviewed and if necessary to change the taps, this is the service users home and they should have access. In one of the bathrooms the hairdressing basin has been installed and since having a new parker bath it would be impossible to wash a service users hair if in a wheelchair as the area is to small. The manager stated the basin is to be moved to a more suitable area. Since the site visit the manager has said that any service user who is going to have their hair styled by the hairdresser is now bathed on the morning and their hair is washed before the hairdresser arrives. This practice needs to be reviewed as this should only be a temporary arrangement. The manager also informed the inspector that he plans to change some of the bathrooms/shower rooms to storage areas. This must be thouroughly checked to ensure the home will be meeting the required standards. Several bedrooms had broken furniture for example several chest of drawers were found broken. When the inspector was reading the homes surveys from relatives one survey stated that their relatives chest of drawers had been broken for over a year. The gardens could be a very nice feature of the home, however this area needs to be maintained and made safe for service users to use including making the fish ponds safe, so that service users cannot fall into the water. All service users have their own en suite bedroom, comprising of toilet, basin and shower. It is Jubilee Houses policy that no service user will share a bedroom unless Care Homes for Older People Page 21 of 30 Evidence: they are in a partnership/couple and wish to do so. Some service users have a telephone in their own room. For those that do not there is a service users phone in one of the small lounge areas, the call can be transferred to a area where they can talk in private. Staff address service users by their preferred named. In the AQAA, to demonstrate what the home does well, the manager states the home is well maintained, a maintenence programme is in place, malodour has been controlled due to replaced flooring and an air purifier and better trained domestic staff. The home is constantly being refurbished and ongoing painting and maintence is implemented. The home has purchased new furniture in the lounges and dining areas and that the flooring has been replaced in the corridors, lounges and dining areas. Plans for improvement to continue decorating service users bedrooms as they become empty and to involve service users planting summer flowers in the garden so the home would be able to join in the local community garden competition. The home was found to be warm and bright with a homely atmosphere. Care Homes for Older People Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The numbers and skill mix of the staff meets service users needs. The home has a comprehensive staff recruitment and training programme which incorporates all areas needed to ensure, as far as reasonably possible, that service users are in safe hands at all times. Evidence: The staff rota evidenced that staff are provided in sufficient numbers to meet the needs of the service users at the home. The 12 hour shift is covered by one RGN and four care workers on each floor, and the night staff consists of one RGN and two waking care workers on a 12 hour shift. There is a person on call for any emergencies. Four staff hold a National Vocational Qualification (NVQ) level 2 and above in care. During this visit the files of two recently recruited members of staff and one member of staff who had been employed for some time were sampled. All files were seen to contain proof of identity, two references, a completed application form and enhanced Criminal Record Bureau (CRB) and Protection of Vulnerable Adult (POVA) list checks had been obtained. Staff spoken to stated they had not received a copy of the General Social Care Council (GSCC) code of conduct and practice document. The manager confirmed he would ensure all staff are supplied with a copy. Staff induction is in line with the new, mandatory Skills for Care common induction standards and the inspector was advised that staff are supervised until they have completed their Care Homes for Older People Page 23 of 30 Evidence: induction. Staff are booked on additional training and updates as the courses become available. Twenty eight staff have completed the Induction training Skills for Care. The home operates on using bank staff and the manager stated this works very well amongst the staff, the staff cover for each other during sickness and holidays. All staff receive regular supervision. The staff training plan is comprehensive and full details of all training are recorded. This plan is kept up to date by the administrator who was on holiday on the day of the site visit, therefore the document was not available at the time of the visit, for future visits by the Commission it would be appropriate to ensure a copy is printed from the computer on a regular basis. Several service users commented that they were happy in the home and one service user commented my carer treats me very well she is like a daughter to me. Two relatives spoken with stated they thought the staff were well trained and very caring. In the AQAA, to demonstrate what the home does well, the manager stated that staff who have completed NVQ training has received an enhanced pay rate to encourage other staff to do the training. In the section what the home could do better it states, the staff need to be continually motivated to complete NVQ qualifications and all staff are encouraged to take ownership of their own training needs and identify what training they require. Care Homes for Older People Page 24 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from the clear management approach at the home providing an open, positive and inclusive atmosphere. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the service users and relatives. Policies and procedures are in place to protect service users financial interests. All policies, procedures and practices are in place to ensure, so far as is reasonably practicable, the health safety and welfare of service users and staff. Evidence: The manager completed the Registered Managers Award three years ago. The management style of the manager is inclusive and the service users will benefit from the ethos, leadership and clear management approach of the home. The home has an effective quality assurance and monitoring system in place that is based on seeking the views of the service users and their relatives. The inspector was advised that the home carries out yearly service users and relative surveys, correlates the responses and then formulate an action plan to address any issues that are raised. Policies and procedures are in place to protect service users financial interests. The manager Care Homes for Older People Page 25 of 30 Evidence: stated that the administrator for the home handles the financial affairs for service users, which were seen to be well documented. A number of relatives manage their own family members finances. Health and safety monitoring check sheets were sampled and found to be generally well-maintained and up to date. Some were in the process of being up dated, visits had been booked for example the testing for Legionella was due on 20/02/08 and had been booked to follow up on 20/06/09 but not completed to date. All staff have received the required safe working practice training and updates. Staff were observed to be following appropriate health and safety practices as they went about their work. There are regular monthly Regulation 26 visits undertaken. The home indiciates regular staff meetings, service users meetings need to be undertaken. The Fire Risk Assessment for the home needs to be undertaken and the inspector suggested that management contact the fire officer for advice, there were many gaps in the recording of the fire alarm test, it was difficult to establish the records as there were three fire files and these need to be in some order, old records need to be archived. In the AQAA, to demonstrate what the home does well, the home provides a good, safe, secure and individualised care for the service users using a person centred approach whilst offering a wide range of stimulating activities both internally and externally to cater for the individual or group activity. The home has good local community support from the church, outside agencies and local businesses in the area. There are strong links with outside agencies who are more than willing to provide additional training such as cathether care, venepuncture, wound care, continence care and medication training. These are but a few of the training courses provided by the professional health care team. The home also has very strong links with the community and the Friends of Jubillee House members. Jubilee House is registered as a care home for forty eight people of either gender within the categories of dementia. The home is situated within walking distance of Godalming town centre. The registered provider is Care UK Community Partnerships Limited and the responsible person is very much involved with the smooth operation of the home. The home provides nursing, residential care and respite care. All the bedrooms are single occupancy with ensuite facilities. There are a number of communal areas, which are spacious, well decorated and maintained. Care Homes for Older People Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 Garden to be maintained and made safe for service users to use. 31/12/2009 In order to ensure that service users have access to their garden and it is safe. 2 19 13 Holes in the walls to be plastered and general maintenance work to be undertaken. In order that the service users home is well maintained. 3 21 13 Malodour to be addressed. In order to ensure that services home is clean and hygenic 4 26 13 The layout of the laundry to be reviewed. In order to ensure safe practices for staff. 31/12/2009 31/12/2009 31/12/2009 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 12 15 38 Activities need to be expanded. Food needs to be kept warm. To seek the advice of the fire officer in order to ensure that the fire risk assessment of the home is reviewed. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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. 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