Care Home: Jubilee House

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What the care home does well What has improved since the last inspection? They have taken action to meet the requirements and recommendations made following the last inspection. They have checks in place to ensure staff are completing the medication records accurately, and they have purchased a new lockable fridge, to store drugs in. The manager has completed their Registered Managers qualification. What the care home could do better: The home`s staffing levels are the same throughout the day, although if an emergency occurs they will borrow staff from the sheltered housing side. This ensures physical care needs are met, however the normal staffing levels do not give flexibility, and fully support social needs. Especially for those residents unable to, or do not want to join in with group activities. Where residents are refusing, or not taking sufficient diet and fluids, staff must keep detailed records; to give them a good idea of how much is being consumed. Where concerns are identified, they can then seek professional advice. CARE HOMES FOR OLDER PEOPLE Jubilee House Seckford Almshouses Seckford Street Woodbridge Suffolk IP12 4NB Lead Inspector Jill Clarke Unannounced Inspection 6th November 2007 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Jubilee House Address Seckford Almshouses Seckford Street Woodbridge Suffolk IP12 4NB 01394 382399 01394 387449 tania@seckford-foundation.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Seckford Foundation Mrs Tania Elizabeth Collins Care Home 19 Category(ies) of Old age, not falling within any other category registration, with number (19) of places Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate up to two people, aged 50 and over, who require respite care and accommodation. 17th November 2006 Date of last inspection Brief Description of the Service: Jubilee House is run by the Seckford Foundation and registered to provide care for 19 older people. The home is able to offer respite (short break) care for up to 2 people between the age of 50 to 64 years. Access to Jubilee House is through the new Very Sheltered Housing complex. Once inside, visitors are directed to the front door of the home, which enables staff to monitor access. Residents living in Jubilee House can use the small shop, hairdresser and chapel located in the housing complex. The home is within walking distance of Woodbridge town centre, which has a range of facilities on offer. These include a swimming pool, library, restaurants, public houseS, Post Office, a range of shops, rail and bus links. The accommodation consists of 19 single bedrooms located on 2 floors. All have en-suite toilet and wash hand basin, 4 also have showers. There are 2 assisted bathrooms and a shower room. Communal rooms include a dining room, 2 lounges and 3 toilets. Residents can access all parts of the home by ramp, stairs or passenger lift. Outside, there is a selection of patio areas and gardens, and parking spaces are available at the front of the home/housing complex. Fees range from £341 to £512 per week, which includes accommodation, meals and care. Mrs Tania Collins manages the home. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, undertaken over 6½ hours, which focused on the core standards relating to older people. We also assessed the outcomes for the people living at the home against the key Lines of Regulatory Assessment (KLORA). The report has been written using accumulated evidence gathered prior to, during the inspection, and contact made following the inspection. Commission for Social Care Inspection (CSCI) surveys were sent to the home in October. This gave an opportunity for people using, working in, and associated with the service, to give their views on how they think the home is run. At the time of writing this report 3 resident, 2 relative/visitor, 2 staff, had been returned. Comments from which have been included in this report. Prior to the inspection, the agency was asked to complete an Annual Quality Assurance Assessment (AQAA). This provides the CSCI with information on how the home is meeting/exceeding the National Minimum Standards, and any planned work for the next 12 months. Comments from which have also been included in this report. The Registered Manager was available throughout the inspection, to answer any questions and provide records to support work undertaken at the home. A tour of the building took in all the communal rooms, dining room and a sample of 2 bedrooms. Records viewed included, care plans, staff recruitment and training records, menus, staff rotas, complaints policy and medication records. Time was also spent talking (2 in the privacy of their rooms) with residents, gaining general feedback and observing the day’s routines. People living at the home prefer to be described as residents, rather than service users, therefore this report reflects their wishes. What the service does well: Jubilee House offers a comfortable, homely environment, which is kept well maintained. All people moving into the home will have their needs assessed, given information on the facilities, and invited to visit. This supports prospective residents in identifying if the home will be able to meet their needs. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 6 Staff work well as a team, and are committed to proving a quality service. They receive training to support them to have the skills and knowledge to care for the residents. Residents spoken with, and information given in CSCI surveys showed that they are happy with the standard of care, and liked the staff. Comments included “very good – look after you well” and “food is good”. Relatives comments included Jubilee House ‘provides good all-round care and support in pleasant surroundings’ and they ‘keep the home clean and give support and re-assurance’. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5. (The home does not offer intermediate care, therefore standard 6 was not assessed). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to have their needs assessed, invited to look around the home and be given enough information, to support them in deciding if the home offers the level of service they are looking for. EVIDENCE: All of the residents surveyed said that they had received enough information about the home, before they decided to move in. One resident, who had lived in the area for many years, commented that they ‘had always heard good reports of Jubilee House’. They also said that they knew of the ‘Almshouses’, a Very Sheltered Housing complex, which links onto Jubilee House. Often tenants, who wish to move into residential care, move into Jubilee House, as they have got to know the residents and staff well though joint social events. In their AQAA, the home states that ‘prospective service users are invited to come and look around the home’, and are given an ‘information pack’ which Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 9 includes a copy of the home’s Statement of Purpose and Residents Guide. The information pack also contains information on how much it costs to stay at the home, and what is included in the fees. Staff complete a pre-assessment for all residents (normally undertaken in the person’s own home) which also, where applicable supports information obtained from Adult Social Care assessments. The home (AQAA) says this supports them in identifying any ‘specialist equipment’ so it can be put in place in readiness for the person’s arrival. Once the pre-assessment has been carried out, and the home has confirmed that they are able to offer the level of care required, the prospective resident is asked to confirm when they want to move in. They will also be asked to complete a ‘Contract of Occupancy’, before arriving. Where the placement is social care funded, the prospective resident will be given information on how much they will be required to pay towards the fees. Information on how ‘Social Services will assist with funding’ is included in the information pack. Time spent talking with a resident who had only just been admitted for ‘respite’ care, confirmed that they had looked around before moving in, and that they had settled in. Their care records showed that a pre-assessment had been undertaken, and the reasons why they needed the care and support. The resident said they had stayed previously (for short-term care) in another home, and therefore was able to compare the 2 homes. Their experience in the first home had led them to “quite honestly” not to be “looking forward” to staying in a home again. However, their first impressions were “very good – staff look after you well – that’s the important bit”. Relatives surveyed said that the home was ‘always’ or ‘usually’ able to meet their friends/relatives needs, which reflected the comments made by the new resident. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be fully consulted, to ensure that information held in their care plans, reflects their preferences on how they wish to be looked after, and the level of assistance they require. EVIDENCE: During the inspection 3 residents care were tracked, which involved looking at their care plans, medication records, and spending time with the residents to hear (where able) their views on the level of service provided. Care plans looked at held a good level of information, showing work undertaken to monitor residents physical (personal care, nutrition, pressure areas, continence), safety (manual handling, falls and environmental risk assessments) and social interests and spiritual fulfilment. However, for 1 resident, who was very frail, although their monthly nutritional chart was being completed, there was no accurate record of their daily intake of food and drink. The information given on the daily records, gave no clear Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 11 information, with comments such as ‘not eaten much today’, ‘refused any nourishment’, and ‘has refused all fluids and meds’, to how much they had taken. We were concerned, that without this detailed information, there was no evidence that the resident was being given sufficient fluids and nourishment. Records showed that their family and the Community Nurse visited regularly. Discussions with staff showed that the resident was receiving end of life care, although not documented in the care plan. Time spent with the resident and their relative showed that the resident was comfortable and enjoying sips of fluids, between sleeping. Once our concerns had been brought to the attention of the manager, they acted quickly, and said they would ensure all diet and fluids taken are recorded, and the amount monitored. The day following the inspection they contacted us to confirm that this was now happening. They also said the GP had visited, and that they felt the resident was receiving sufficient fluids. The way the information had been written in the care plans, showed that staff had consulted with residents. This ensured the information given in the care plan portrayed their preferences and wishes, on how they wanted to be looked after. There was clear guidance for staff on how much residents were able to do for themselves, and how much help staff should offer to give. This supports residents to retain their independence, and feel in control of their lives. Information was being reviewed monthly by staff, or earlier if required. Letters and notes from reviews showed that relatives were invited to a 6 monthly joint review with the resident and staff. During the review they looked at the level of care and support being given, and enable those present to raise any issues. Time spent talking to a resident on the level of support they received, reflected the information written in their care plan. Residents surveyed all said that they received the medical support they needed. The home said they are working towards setting up regular ‘medical reviews’ with resident’s GPs. They are also introducing ‘Doctors appointment by attending the surgery’, and gave information on the new purpose built surgery in Woodbridge. Where required, records showed that advice had been sought from health professionals. Arrangements were also in place to ensure all residents were invited to have their eyesight tested annually, by a visiting optician. Residents and a relative spoken with praised the level of support and care given by the “friendly staff. Since the last inspection, a copy of residents manual handling assessments are kept in the bedrooms, to ensure staff are fully aware of any support required, including any mobility equipment, such as handling belts or hoists. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 12 During the inspection, staff were observed to address residents politely, using their preferred first name, or surname. Residents said that staff ensured their privacy and dignity was maintained when receiving personal care. Records seen for 1 resident showed that staff had acted quickly, in calling paramedics to ensure the resident received required treatment as soon as possible. Also on returning to the home, they acted as their advocate following up concerns over their discharge arrangements, and ensuring that they were sent required medication. The home uses a commercial monitoring dosage system to dispense medication, which is supplied from the local pharmacist every 28 days. The last inspection confirmed that the home has a good working relationship with the Pharmacist who carries out audits at the home, to ensure medication is being stored correctly. Medication is held securely in a locked medication trolley with restricted key access. Training records showed that staff had received training in the dispensing of medication, and how to complete residents Medical Administration Records (MAR) correctly. The home has systems in place for recording all medication received into the home, and returned to the pharmacist if no longer required. Since the last inspection, to address a recommendation made, the home has purchased a new lockable ‘drugs’ fridge. The temperature of the fridge, and the room where medication is stored, is being checked daily, to ensure drugs are stored at the correct temperature. Medication held by the home for the residents whose care was being tracked, was checked against the information given on the MAR chart, which was correct. The home has safe systems in place to store and dispense controlled medication. Records seen and information given in the AQAA, confirms that the manager, carries out a ‘twice-weekly medication audit’, to monitor staff practice. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect to be offered nutritious home cooked meals, and be invited to join in with group activities. However, if people prefer more one to one social interaction, and stimulating activities throughout the day, this cannot be assured. EVIDENCE: Residents surveyed were asked if the home arranges activities that they can take part in, 1 replied ‘always’, and 2 ‘sometimes’ (1 person said they were unable due to their physical disability). During the inspection, there had been an opportunity for residents to go out in the mini bus, to visit local amenities. This was followed by a flower arranging session in the dining room, which 3 residents joined in with. The activities organiser arranges social events for both the residents from Jubilee House, and tenants living at the sheltered accommodation. The list of activities displayed for the 4th to the 12th November, showed what was taking place (including Coffee morning and Bingo, Afternoon Tea, Fun Quiz). The locations of the activities are shared between the 2 sites, which enables residents and tenants to mix. The AQAA confirms that there is an ‘activities Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 14 programme in place, according to the activities requested’. However, there was no further information as to how people were asked their choices. Time spent with a new resident identified that they “don’t get bored”, as they had their television which was “very good”. Other residents were also watching TV in their room. Information on social interactions given in 1 care plan, stated that the resident ‘prefers to spend time in own room watching TV – does come down for meals’. Staff were busy throughout the inspection, which did not leave time for 1 to 1 activities. The home benefits from having their own chapel, where residents can attend regular services. There is also a hairdresser and shop on site, opening times of which are displayed on the notice board. Under forthcoming events for December residents are informed there will be a carol service (12th) and Christmas luncheon (18th). The information board also gave the menu choices for the week, an example for the lunchtime menu was ‘Sausage Meat Pie & Mash & Vegetables, or Prawn Cocktail, Jacket Potato and Salad’, followed by ‘Rice pudding or Mixed fruit Jelly & Cream’. The AQAA informs us that ‘residents have a choice of menu on the day’. Residents surveyed were asked if they liked the meals, 1 replied ‘always’ and 2 ‘usually’. The lunch routines were relaxed, with many of the residents taking themselves to the dining room, and admiring the handiwork of the flower arranging class. Residents enjoyed the social interaction, 1 resident who had previously visited another home, said they enjoyed the fact that “residents here are very good to talk to – and you sit around a table to have your meal”, they went onto say that the meals at Jubilee House were “far superior”. Residents are given a choice where they eat their meals, breakfast time, 3 people prefer to be served their breakfast in their rooms, whilst the other residents prefer to go down to the dining room. Drinks were freely available during the day, at set times, or on request. The Cook had come fourth in the ‘Care Cook of The Year 2007’, and was looking to enter again next year. Information held in care plans evidenced how staff support residents to retain autonomy, by being able to choose how they wish to be cared for. For example ‘likes to be woken up at about 6.30 and does not require a cup of tea in the morning – but likes hot orange’. There was also information on preferred night routines, what drinks they would like, and if they wanted staff to check on them. Residents can receive their visitors at any time, which was happening during the inspection. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can expect any concerns to be listened too, and appropriate action taken by staff, who are committed to safeguarding their interests. EVIDENCE: Residents are given a copy of the home’s complaint procedure in their information pack, and it is also displayed within the home. Since the last inspection the home has amended their policy, so people are aware that the CSCI is not a complaints agency. However, although the contact numbers of the CSCI were previously displayed, the current policy on display did not. Once brought to the attention of the manager, they said they would add the details on. All the residents surveyed said that they knew who to talk to if they were not happy with the service, and if they wanted to make a complaint. Comments included, ‘the manager asks us to speak to her if there is anything we are anxious about’. Information supplied by the home showed that they had received 6 complaints during the last 12 months, 1 of which resulted in a safeguarding referral being made. The CSCI was kept fully updated on the outcome of the investigation, and subsequent action taken. Prior to the inspection, whilst looking at the action taken by the home, we identified areas of the home’s procedures and polices that needed to be reviewed. This concerned the delay in making a safeguarding referral Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 16 (although the home had taken appropriate steps to safeguard the resident’s welfare), and the need for further training for staff. Following the outcome of the investigation, it was also suggested by the Social Worker, that the home reviews their staffs disciplinary policy, to give more detailed information on what is viewed as ‘Gross Misconduct’. Information supplied in the AQAA, and discussions during the inspection, confirmed that the home has/was taking appropriate action to deal with all the issues raised. They confirmed all staff ‘have attended abuse training’. In the light of the safeguarding referral, they have also arranged further ‘in-house’ training during November, to supplement the annual training “using the Action on Abuse DVD”. Staff will also be given different scenarios to discuss, to make it more relevant to their working environment, and client group. Staff surveyed confirmed that they knew what action to take if anyone raised concerns about the home. Residents spoken with during the inspection felt comfortable to raise any concerns with staff, but also wanted to stress that they were happy and had “no complaints”. Because staff can work across both sites, all staff have been issued with a photographic identity card. Contractors working in the home, are also given a ‘Visitors’ pass, to reassure residents who the stranger walking around the home is. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use this service can expect to live in a clean, safe, homely and comfortable environment, which is well maintained and can be easily accessed. EVIDENCE: Access to the home is via a doorbell system whereby a member of staff speaks through an intercom prior to opening the door. Once in the home visitors turn left to go to the sheltered housing complex, and right to the front door of Jubilee House. Access is again via ringing the doorbell and informing staff who you are via the intercom. The Day Centre, which operates from Jubilee House, has its own entrance and facilities, therefore does not impinge on the residents living in the home. The complex (residential and sheltered housing) as part of their security system, have CCTV cameras fitted, which also does not impinge on the residents privacy. The staff is looking to use the Day Centre facilities at weekends for ‘luncheons’. They are also going to ‘promote the use of its whirlpool bath, for Jubilee House residents to use if they wish. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 18 Bedrooms are all single occupancy, and have en-suite facilities. Time spent visiting 2 residents in their bedrooms, confirmed that the room met their needs, and they were well furnished. Residents are encouraged to personalise their rooms, and bring in their own belongings taking into account the size of the rooms. Bedroom doors are lockable and residents are offered their own key, to their door and lockable drawer. All areas of the home visited during the inspection were well maintained and clean, which reflected feedback in the residents’ surveys who all said that the home was ‘always’ kept clean and fresh. The AQAA states during the last 12 months ‘many rooms/areas, have been furnished with new carpets and curtains’. The home has 2 spacious bathrooms with assisted baths, and a shower/wet room. The communal toilets are located close to the dining room and lounge areas. As stated in the last report, the home has individual thermostats fitted to hot water outlets, which are checked regularly by staff to ensure there are no faults in the system. In the sluice area which was clean, tidy and free from unpleasant odours, a green liquid, which looked like soap had been poured into a disposable drinking cup. Although the room can be locked, the cup was not sealed, or labelled, therefore staff would not know any relevant health and safety information. When fed back to the manager, they said staff use the cup to fill the washing up bottles in the kitchen, and they would get a funnel, which would stop the incidence of liquid being left in the cup. There are 2 lounge areas, with comfortable chairs, settees and fireplaces, completed with mock flame fires, enhancing the homely atmosphere. There is a telesensory machine for partially sighted residents. The dining room tables displayed the results of the residents flower arranging class. Telephones are located through the home for staff use, which they can also be used to transfer incoming calls. Assurances were given during the last inspection that if a resident wanted to make a call, they could use the home’s mobile phone. Corridors are wide with grab rails and well-lit areas. The lift is easily accessible with a call bell inside. All radiators have safety covers on. Residents were seen to freely move around the home, using the passenger lift, or stairs if they preferred. As stated earlier in this report, the home benefits from having a Chapel, hairdressers and a small shop on site. Many of the residents who have small patio areas leading off their bedrooms, have planted flowerpots and erected bird tables, as points of interest and Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 19 colour. Although not viewed during this inspection, the AQAA informed the CSCI that since the last inspection they have ‘new outdoor seating areas, accessible by all service user’, and they have ‘refurbished’ the Summerhouse. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People using the service can expect to be cared for by trained, skilled staff in sufficient numbers to support their physical needs. However residents cannot be assured that the current staffing levels will meet their social needs. EVIDENCE: The current staffing level for the home is 2 carers covering each shift, with additional support being given by the manager, if able, during peak times. The staffing level is very much reliant on the majority of the residents being more able, and requiring minimal support. Information supplied on the AQAA (completed 12 October 2007), showed that that no residents required the help of 2 carers. By the time of the inspection, this had changed, with 1 resident requiring the assistance of 2 carers. When help was required during lunchtime, this resulted for a short period, having no care staff in the dining room. During this time 1 resident who required support to get up from their chair, a member of the housekeeping staff asked them to wait until the carer got back. However, they did not want to, and was getting another resident to assist, who themselves were a little unsteady. At that point the manager returned and gave the required assistance. Residents asked through the surveys if staff were available when they needed them, all replied ‘always’, with 1 resident saying ‘at times a shortage of staff Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 21 upsets the routine, but this cannot be helped’. However staff, asked if they felt there was enough staff to meet the individual needs of all the people who used the service, replied ‘ sometimes’. Comments included that staff work a straight 7¾ hour shift, with no official break. When they do try and get a drink/something to eat, as there ‘is not enough on duty’ they are required to answer the call bell. The manager confirmed that this was what was stated in their contract, which staff had signed. To try and give more flexibility, staff are trained to work in both the residential and sheltered housing side, so when required, are able to give extra support. If this is not available, they will try and cover with agency staff. However, staff say although this happens, as the people do not know the residents and their routines so well, they need to be supported by the regular staff. During the evening, and weekends, 2 staff will be responsible for bathing, assisting people to bed, assisting with supper, giving out medication, answering the phone, door intercom and updating care plans. From feedback given from staff, and observation, staff are managing the care needs of people, through their commitment and drive. They see this as an area that the home does well ‘It looks after and assists the residents well and their well-being always comes first – any problems are quickly and efficiently dealt with, in house first, but quickly asking for more help where needed’. However, other feedback identified that there was not enough time to spend individually with residents, to support their social needs. For example in the evening when a resident is being assisted with their bath, this would leave 1 member of staff for the other 18 residents. Where staff vacancies occur, the manager confirmed that they are actively looking to recruit, and although they can get a good response to their advert, they are not always suitable for the position. Potential staff are asked to complete an application form, and are interviewed by 2 senior members of staff. To ensure that the home is following safe recruitment procedures, the recruitment records for 2 staff employed since the last inspection were looked at,. Both files held information to validate the person’s name and address, and evidence a Criminal Bureau Record (CRB) clearance had been applied for/obtained. Their names had also been checked against the protection of vulnerable adults register. Written references had been obtained, and where applicable copies of relevant training certificates, to validate that they had undertaken the training given on their application form. With 1 of the staff, although there were gaps in their employment history written on the application form, they had submitted the required information on a separate sheet. However, the second application, also had gaps in the person’s employment history. As the person was on duty, the shortfall was sorted out during the inspection. The manager said the situation should not happen again, as they now have a new application form, which asks for a full Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 22 employment history. They will also have checks in place during interviews, to ensure the applicant has given all the required information, to support the home in validating the reason, why they have left any previous employment with vulnerable people. Staff asked (CSCI survey) if their induction covered everything they needed to know to get them started, 1 replied ‘very well’, and 1 said they felt it only ‘partly’ covered what they needed to know. Records looked at, showed staff had completed ‘Skills For Care Induction’ training. The AQAA also informed us that induction training was seen as an area they had improved on during the last 12 months, with ‘14 days’ now allocated for induction, and ‘3 supernumery days’, where staff will work alongside an experienced member of staff. The home also benefits from having a manual handling trainer working on site, to ensure staff receive manual handling training as part of their induction. Information supplied on the AQAA showed 8 out of the 12 care staff held a National Vocational Qualification (NVQ) level 2 or above. The home also said in their AQAA that they now have ‘a strategy in place to ensure all staff have equal access to all training’. Staff surveyed confirmed that they receive training relevant to their role, which keeps them updated on new ways of working, and helps them understand and meet the individual needs of the people they care for. They also felt that they received the right support, experience and knowledge to support the residents with their cultural and diversity need. Confirmation that they were able to do this was given in the relatives survey feedback. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can expect a well managed home, where staff are committed to providing a good level of care within a safe environment. EVIDENCE: The Registered Manager Mrs Tania Collins, has now successfully completed the Registered Managers Award and NVQ level 4 in Care. The manager is already looking at further training on being an “Expert Witness’. This will enable them to write ‘witness testimonies’ for staff undertaking their NVQ training, which will be used as evidence of their competence and knowledge. Due to the manager working regularly ‘on the floor’ (see staffing section of this report), enables them to give on-going support to staff, whilst monitoring staff practice. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 24 During this and previous inspections, we have always found the manager and staff to work well as a team, and arecommitted to providing a good level of care. Discussions with residents showed that they liked the staff who were “always helpful and polite”. We observed good interaction between staff and residents, by including residents in conversations and asking their opinions. The home states in their AQAA (under what they do well), that ‘service-users money is held, ensuring a rigid record of expenses are kept, and monies taken out are signed for correctly’. During the inspection we looked at 1 resident’s monies held for safe keeping in a lockable container. Finance sheets had been fully completed, keeping an on-going record of all deposits and expenditures (with receipts where applicable). Cash held for the person, agreed with the amount given on the finance sheet, which had been signed by the resident. Although the standard of record keeping was seen to be generally good, shortfalls were identified in the recording of a residents diet and obtaining a full employment history (see Health and Personal Care, and Staffing section of this report). Information supplied by the home in their AQAA, confirmed that policies and Procedures are being annually reviewed and updated as required. Training records showed that staff receive training to ensure the safety and welfare of the people living and working in the home. Servicing agreements are in place to ensure that equipment, used in transferring residents, and Fire Safety are kept in good working order. Records showed that this included weekly checks of the fire alarms systems, and monitoring of hot water supplies. Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 4 3 3 3 3 4 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x 2 3 Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Jubilee House DS0000067583.V354358.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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