Care Home: Jubilee Lodge

What the care home does well Jubilee Lodge is a holiday home for people with physical disabilities and also provides respite breaks for people with dementia and their carers. The atmosphere in the Centre is relaxed, happy and lively. The Centre accommodates a large number of guests with complex physical disabilities coming for a holiday each week and admissions are well planned and effectively managed. The pre-admission process includes good communication with prospective guests and their representatives and good liaison with health and social care professionals supported within a framework of policies and procedures to ensure clear, full and comprehensive information is obtained prior to agreeing the admission. Customer satisfaction is high with many returning year after year for a holiday. Comments received from a guest included `I love it here. This is the fifth time I`ve been`. `We have entertainment every night. It`s brilliant here`. A representative of a guest told us `the staff are always friendly, helpful and kind to us when we go in with our service user. We are offered coffee after our long journey and if we arrive early they do not mind`. There are a comprehensive range of activities, excursions and entertainment offered. Well trained drivers operate the specially adapted coaches used to take guests on excursions. Drivers are provided with risk assessments and key information about each individual guest ensuring they have full information in the event of an emergency. There is an established volunteer programme that recruits younger volunteers from the UK and overseas (i.e. medical students, nurse student placements, physiotherapists, gap year students) to support guests & providing them with an invaluable experience. The Centre provides respite three weeks per year for people with dementia and their carers. There is a wide range of equipment to meet the needs of people with disabilities. All food is cooked on site and meals are healthy with alternatives provided and choices accommodated. Packed lunches are organised daily for guests to take on excursions. The Centre is very well managed with a manager on site 24hours per day and good health and safety systems in place that are well adhered to. The premises are clean, comfortable and well organised. There is a comprehensive quality assurance system in place that ensures close consultation with guests with any issues raised used to improve practice. Staff are robustly recruited, well trained and well supervised. What has improved since the last inspection? Pre-assessment forms have been developed to ensure full information is obtained regarding potential guests needs prior to agreeing the admission. Care planning documentation had been further developed to provide specific detail on guests needs is obtained. The systems for managing administration of medicines had been reviewed to minimise the risk of error and any incidents occurring. Regular medication audits and spot checks are now made. Supervision is provided regularly for all staff. The recruitment procedures have been obtained to ensure all relevant checks are obtained prior to employment. What the care home could do better: Staff did not always respect guests privacy, sometimes entering their room without being invited to. The medicines administration records need more detail on the description label. The ventilation of the medicines storage is inadequate and temperatures sometimes exceed safe levels. The policies and procedures for administration of medicines need review to provide more detailed instruction for staff. The premises are in need of refurbishment. Damage was noted to one area of flooring and paintwork was damaged throughout. Some furniture also needed replacement. Fly screens needed to be fitted in the kitchen. There is limited accommodation for the four managers who share an office. Key inspection report Care homes for adults (18-65 years) Name: Address: Jubilee Lodge Grange Farm High Road Chigwell Essex IG7 6DP     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diana Green     Date: 1 1 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 Adults (18-65 years) Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 31 Information about the care home Name of care home: Address: Jubilee Lodge Grange Farm High Road Chigwell Essex IG7 6DP 02085012331 02085599583 strump@vitalise.org.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Vitalise care home 36 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia physical disability Additional conditions: People with dementia must not be accommodated at the same time as younger adults, those under the age of 65 years, who have a physical disability Persons of either sex, aged 18 years and over, who require care by reason of a physical disability (not to exceed 30 persons) Persons of either sex, aged 18 years and over, who require nursing care by reason of a physical disability (not to exceed 20 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 30 persons) Persons of either sex, aged 65 years and over, who require nursing care by reason of a physical disability (not to exceed 36 persons) The total number of service users accommodated must not exceed 36 persons Date of last inspection 0 36 Over 65 30 36 Care Homes for Adults (18-65 years) Page 4 of 31 Brief description of the care home Jubilee Lodge is a holiday home offering personal and nursing care to people with physical disabilities. It is situated in a semi rural location with good links via a private road, to bus routes and the London underground. The main shopping area, which also has places to eat and drink, is approximately one mile away. Jubilee Lodge is one of five similar holiday homes that are owned and run by Vitalise. Each home has a different focus to the type of holidays it offers. Jubilee Lodges focus is trips to London and Kent . There are various themed weeks throughout the year, and these are detailed in the yearly brochure. Jubilee Lodge has twenty-six single rooms and five double rooms all have en-suite facilities. All guest areas are on the ground floor of the building, with staff accommodation on the first floor. Jubilee Lodge has ample parking facilities to the front of the building. The grounds encircle the home. There are formal gardens with ornamental ponds and a wild flower garden with a large pond. The home also overlooks the adjoining Riding for the Disabled training ring. It has its own coaches and mini buses to transport the service users on the trips. The fees range from £545.00 to £975.00 weekly during the summer and £1100.00 at Christmas. Care Homes for Adults (18-65 years) Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means that people who use this service experience excellent quality outcomes. This unannounced inspection took place on 11th June 2009. An expert by experience attended the service for part of the inspection. Experts by experience have experience of disability either as someone with a disability or as a carer for someone with a disability and receive training from the Commission. The expert by experience met with a number of guests on an individual basis to obtain their views on the service. Their findings have been included in this report. All of the Key National Minimum Standards (NMS) for Younger Adults, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). Care Homes for Adults (18-65 years) Page 6 of 31 The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are being met for people using the service. This was completed by the registered provider and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to staff, guests and the manager, deputy manager and head of care. Surveys were sent to service users and their representatives, health and social care professionals and staff. The management were welcoming and helpful throughout the inspection. Care Homes for Adults (18-65 years) Page 7 of 31 What the care home does well: What has improved since the last inspection? What they could do better: Staff did not always respect guests privacy, sometimes entering their room without being invited to. The medicines administration records need more detail on the description label. The ventilation of the medicines storage is inadequate and temperatures sometimes exceed safe levels. The policies and procedures for Care Homes for Adults (18-65 years) Page 8 of 31 administration of medicines need review to provide more detailed instruction for staff. The premises are in need of refurbishment. Damage was noted to one area of flooring and paintwork was damaged throughout. Some furniture also needed replacement. Fly screens needed to be fitted in the kitchen. There is limited accommodation for the four managers who share an office. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 31 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People planning to take a holiday at Jubilee Lodge can expect to have full information about the service and to have a full assessment prior to their admission. Evidence: The home had a statement of purpose and service user guide that were comprehensive and were combined documents. A copy was provided during the site visit and had been recently reviewed. Copies were also observed held in each residents room for their information. The home provided holiday breaks for people with a disability and is registered to provide nursing care. The home also provided planned breaks for people with dementia and their carers. The admission process was discussed with the manager. Approximately 50 of residents were self funding with the remainder funded through the local authority. Guests come from all areas of the UK including the local area. Bookings are made through the reservations centre in Cumbria who arrange for no more that 20 residents who have nursing needs to be booked into the Centre each week. This enables the appropriate staffing levels to be provided. Care Homes for Adults (18-65 years) Page 11 of 31 Evidence: Pre-admission assessments are undertaken via the telephone and information on care needs obtained to determine if they can be met at Jubilee Lodge. Guests are required to have a medical certificate and patient summary confirming their diagnosis, care requirements and medication to be completed by their doctor prior to their arrival at the Centre. For guests funded through the local authority a copy of their care management assessment was also obtained. The assessment documentation for four residents was viewed during the visit to the service. All included a guest assessment /action required on arrival form that was used as a prompt to confirm the information on the pre-assessment, undertake various risk assessments (waterlow/wound assessment, moving and handling, excursions, passenger restraints) and initiate care plans for individual needs. Evidence of consent to the information and agreement to the care plans was seen in all four records viewed. The expert by experience met with seven guests. All confirmed they had received sufficient information and said they had been to Jubilee Lodge before so knew what to expect. One person said they found it more difficult to book this year as more paperwork was needed. Care Homes for Adults (18-65 years) Page 12 of 31 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People taking a holiday break at Jubilee Lodge can expect to have their care needs met by robust care planning and to be fully supported to make independent decisions about their lives. Evidence: The arrangements for care planning were discussed with the manager, deputy manager and head of care. Four care files were viewed during the visit to the service. Each guest had a file that included full information of their care needs together with care plans for bowel care, social, spiritual and psychological needs. Each guest had a dependency assessment undertaken based on three levels of need. Level one included minimal assistance, for example hair brushing, assistance with jewelry, level two included assistance with a shower or from a care assistant and level three included assistance with hoisting etc.and confirmed from the care file viewed. On admission guests are grouped in line with their dependency needs enabling the process to be speeded up and thereby reducing the wait for assessment. All care plans were monitored and reviewed during their stay. Daily records were completed in each case Care Homes for Adults (18-65 years) Page 13 of 31 Evidence: and showed evidence of discussion with the guest, showing they were involved in making decisions concerning their care. The AQAA informed us that at the end of a stay, guests are requested to complete a customer satisfaction survey which showed a high level of satisfaction. During the visit to the service one resident told us I love it here. Ive been here four times. This is my fifth. Jubilee Lodge had a comprehensive risk management strategy in place. Individual risks were assessed and minimised as far as possible without restricting individuals independence. Risk assessments were seen for individual risks, for example for waterlow, wound care, moving and handling, service user on excursion and use of passenger restraint were evident on each of the files seen. Additional risk assessments were also seen for self medication, challenging behaviour, use of bed rails, tea and coffee making, nutritional need and hygiene. This demonstrated that residents were enabled to take risks as part of a independent life style. Care Homes for Adults (18-65 years) Page 14 of 31 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People staying at Jubilee Lodge can expect to experience a full programme of activities, excursions and entertainment supported by well trained staff and volunteers and to have well balanced and nutritious diet with choices accommodated. Evidence: Education and personal opportunities are not applicable as the aim of Jubilee Lodge is to provide holiday and respite stays for guests and their carers. A wide variety of outings, activities and entertainment are arranged and seen from the programme displayed in the Centre. Daily excursion on offer included trips to historical places of interest (e.g.Colchester, Cambridge, Rochester or Canterbury) or to London (e.g. London Eye, Greenwich, Tate Modern or Covent Garden). Visits are arranged to local shopping centres such as Blue Water and theatre trips also arranged. During the visit to the Centre guests were preparing to go on a theatre trip to London and were Care Homes for Adults (18-65 years) Page 15 of 31 Evidence: clearly excited by the opportunity offered. All the residents spoken with during the visit to the Centre said they were happy with the outings arranged and felt adequately supported. In addition to student nurse placements the Centre is supported by a large number of volunteers from the UK and overseas who have been successfully recruited from a wide range of backgrounds and are employed to support guests and accompany them on excursions. The Centre has three accessible vehicles and a minibus that are appropriately fitted for wheelchair access, enabling guests to go on the numerous outings that are arranged during their stay. Since the previous key inspection the home has attained free wireless internet, a Nintendo Wii, flat screen tv and a range of game and accessories. The Centre has its own licensed bar that is open each evening and enables guests to socialise with each other and engage in conversation with staff. Regular karaoke sessions are arranged for guests. A guest told us we have entertainment every night. Its brilliant here. The statement of purpose included the Centres visiting arrangements. The visiting times were fairly relaxed, i.e. 10:30am to 12 midnight and we were informed these could be more flexible. Few guests lives locally, most lived some distance away and visitors tended to visit with them when they arrived or at the end of their stay. The nature of the Centre as a holiday home provided opportunities for guests to meet and make friends with others with different disabilities. Several of the guests spoken with said they had met previously when on holiday and had looked forward to meeting their friends again. The daily routines were centred around the various excursions that were arranged for guests during their stay. A discussion with guests during the visit to the service confirmed that they were enabled a choice of taking part in the various outings or activities arranged and were able to spend time in their rooms, in the lounges or outside as they chose. One guest told I can do pretty much what I want to. From observation and the records viewed it was evident that residents were enabled a choice in what clothes they wore, how they wore their hair, wearing makeup etc. The statement of purpose informed us that privacy and dignity of service users is paramount within the Centre and Employees and volunteers do no enter rooms before knocking and being invited in. However the expert by experience witnessed a staff member knocking and entering a guests room without being invited in. The guest maintained that this did happen at times. Several other guests did however, state that they were treated with respect. The records confirmed that guests had a nutritional assessment on admission to ensure their nutritional needs were met. Daily records confirmed that their nutritional intake was monitored during their stay and supplements provided as needed. Menus Care Homes for Adults (18-65 years) Page 16 of 31 Evidence: were displayed on each of the tables in the dining room. The lunchtime meal was observed and comprised a choice of curry or fish and chips which guests ate together with staff and volunteers in the main dining room. Those spoken with said they enjoyed their meal and confirmed that the food was always good. Residents told us that they could have drinks and snacks during the evening and at night if they wished. The kitchen was viewed and was clean and well organised. Food stocks were plentiful and there were appropriate systems in place to ensure food was stored appropriately and the kitchen was kept clean. We were informed that the Centre had achieved the Heartbeat Award from the local environmental health department. This confirmed the provision of healthy food in a smoke free environment with good standards of food hygiene. Packed lunches were prepared on site for guests to take with them on their excursions. Care Homes for Adults (18-65 years) Page 17 of 31 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People staying at Jubilee Lodge can expect to have their health and personal care needs met by skilled and well trained staff and to protected by robust medication systems and practices. Evidence: Guests individual care plans viewed were person centred and included specific detail of the individuals care needs. These were supported by additional protocols /procedures for specific health issues, for example swallowing difficulties, seizures and backed up by staff training on these issues. This ensured staff had appropriate guidance to enable them to meet individual guests needs and were skilled to provide the care. The AQAA informed us that the Centre have introduced a system of group support for guests whereby they are grouped according to their assessed level of dependency and a team of trained staff and volunteers are allocated to assist them with their personal care needs. This appeared to work well. One guest told us Staff cant do enough for you. Always available when you want them and nothing is too much trouble. When asked does the care home give the support or care to your relative that you expect or agreed? a relative told us always. No problems x is always happy to go back. Care Homes for Adults (18-65 years) Page 18 of 31 Evidence: From discussion with staff, the manager and an inspection of records it was evident that residents had access to a GP if needed during their stay. We were informed that the home sought advice from other professionals as needed. For example advice was sought from a pharmacist to ensure that there were safe systems in place for administration of medicines, this was particularly relevant in ensuring medicines were handled safely when guests were on excursions. Advice had also been sought from a tissue viability nurse to ensure that appropriate standards were in place for the prevention and treatment of wounds. One relative told us sometimes they have had to call in a doctor and they have always let me know and I have no complaints over care. X always looks so well when x comes home. The medication systems for the home were discussed with the head of care. Arrangements were complex due to the volume and quick turnover of guests staying at the Centre. Systems had therefore been reviewed since the previous key inspection to minimise the risk of errors. Guests were requested to bring in their medication in monitored dosage systems, unless self medicating and dosset boxes were not accepted. There was a medication policy and procedures for staff guidance. However this needed further development to provide clear procedures for staff. A list of staff initials and signatures was maintained to enable appropriate follow in the event of an adverse incident occurring. All medication was administered by qualified nurses unless a guest was self medicating (as part of a risk assessment). Guests brought their own medication with them together with a medical certificate from their GP. A list of homely remedies was agreed annually by the GP attached to the home. Medication was stored in the clinical room in a lockable trolley that was secured to the wall. A Controlled Drugs (CD) cupboard was also provided for storage of CD drugs and was bolted to the wall as required. There were systems in place to monitor and record room temperatures remained within safe recommended levels (maximum 25 degrees Centigrade). However the records showed that there were times when temperatures exceeded 25 degrees centigrade. There was no outside wall on which to fit an air conditioning unit and a fan was therefore used to cool the room. This needed close monitoring as it was not wholly effective in reducing the room temperature. A drug refrigerator was also available for storage of items requiring cool temperature storage and systems were in place to monitor the temperature. Systems were in place to ensure that medication received and disposed of was appropriately checked. Each Saturday on changeover day medication was checked out for guests at the end of their stay and checked in for new guests. Records were signed by a registered nurse and countersigned by another person. This was confirmed from the records viewed during the visit to the service. Evidence of audits and spot checks undertaken were also seen together with action taken to address any issues identified. The medicines administration records and supplies were inspected for Care Homes for Adults (18-65 years) Page 19 of 31 Evidence: two guests. The instruction on the MAR sheets did not include the full detail of the prescription. Records of administration were however were completed accurately and in full and all medicines were available as prescribed. Care Homes for Adults (18-65 years) Page 20 of 31 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People staying at Jubilee Lodge can expect to have their concerns and complaints listened to and acted upon and to be protected by robust safeguarding policies and procedures. Evidence: Jubilee Lodge had a complaints policy and procedure that included timescales for a response and met regulatory requirements. The AQAA informed us that a welcome meeting was arranged for guests on the day of their arrival when the complaints procedure was explained to them and they were provided with a copy. The procedure was included in the statement of purpose and service users guide of which a copy was held in each guests room. A suggestion box was also provided in the reception area of the Centre to enable guests to put forward any comments or suggestions for improvement. A customer satisfaction survey was also provided to guests at the end of their stay. The record of complaints was seen and confirmed that all complaints were appropriately investigated in line with the services procedures. Two guests who completed surveys confirmed they knew who to speak to if they were unhappy and knew how to make a complaint. The Home had a safeguarding policy and procedures and a whistle blowing policy in place to ensure residents were safeguarded from abuse.The records viewed during the site visit confirmed that staff received training on abuse during their induction, through NVQ training and regular updated training was also provided. The home had Care Homes for Adults (18-65 years) Page 21 of 31 Evidence: copies of the Essex Safeguarding procedures available for staff guidance to be used in the event of an allegation being made. There had been three safeguarding allegations made since the previous key inspection, one of which was not accepted as a safeguarding issue and the other two had been investigated in line with procedures and appropriate action taken. Compared with the large number of people who stay at Jubilee Lodge (approximately 1450 per year) there are relatively few complaints or safeguarding issues raised which indicates the high level of satisfaction from guests. The systems for supporting residents with their finances were discussed with the manager. Some guests prefer to manage their own finances and a lockable facility is provided in their rooms which also have door locks. For those guests who wish to be supported, cash is distributed to individuals for outings or other expenditure and records are maintained with receipts held. Care Homes for Adults (18-65 years) Page 22 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who stay at Jubilee Lodge can expect to stay in clean and well maintained premises that meet their individual needs. However the standard of decor and furnishings does not enhance the appearance of their holiday home. Evidence: A tour of the premises was undertaken during the site visit. The guest accommodation is provided on one level and is accessible to wheelchair users with wide corridors and grab rails throughout. There are thirty one rooms with en suite facilities of which two are twin rooms. Assisted baths and a wet room/shower room is provided. The AQAA informed us that planned maintenance and decoration is carried out each year during the month of January and the records confirmed the premises were well maintained. Rooms were seen to be clean and adequately furnished. Some residents individual rooms were seen with their agreement. However the paintwork and general decor particularly in some of the guests rooms seen was shabby and in need of refurbishment. Fire safety equipment was available in each of the units and records confirmed that it was appropriately maintained and that fire safety practices were in place to meet the requirements of the local fire service. The Centre had grab rails throughout and aids and equipment in residents rooms, ensuites and bathrooms to meet their individual needs. We were informed that there Care Homes for Adults (18-65 years) Page 23 of 31 Evidence: were ten profiling beds to aid positioning and nursing treatment and that more were being purchased as funds allowed. Store cupboards were seen to be well equipped with banana boards, sliding sheets and support belts to aid mobility and support safe moving and handling staff practices. Call systems were available in all individual, communal rooms and bathrooms for guests to call for assistance. The home was clean and odour free. One guest told us your room is cleaned thoroughly every day. Residents also told us their beds were made daily during the morning. There were infection control policies and procedures for staff guidance and personal protective clothing (gloves, aprons and alginate bags) and hand washing facilities (liquid soap, paper towels and foot operated pedal bins) were provided to minimise the risk of infection. The laundry room was large with separate entries/exits for clean and dirty laundry. There were two washing machines (one in working order) that had the capacity to carry out sluice cycles (wash at minimum 65 degrees for not less that 10minutes) and two tumble driers. The laundry was equipped with an iron and ironing board but there was no rotary iron available to ensure sheets, bed covers, curtains could be easily ironed. Net curtains in guests rooms were observed to be very creased which detracted from the overall decor. Linen viewed was observed to be clean and well laundered. Care Homes for Adults (18-65 years) Page 24 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People staying at Jubilee Lodge can expect to be cared for by well trained and well supervised staff who have been robustly recruited and are employed in sufficient numbers. Evidence: The AQAA informed us that the staff team endeavour to provide a holiday atmosphere at the Centre and well supported and supervised long and short term vounteers complement the staffing numbers and assist with social interaction and activities as well as some physical elements of care. Staff appeared skilled and experienced and motivated in their work. Several volunteers were spoken with and were clearly enjoying the time spent with guests playing games and talking with them. One volunteer told us they had received training and felt well supported and said I am really enjoying the experience. All staff were observed to treat residents with respect and to listen and engage in conversation with them. One relative told us I would like to thank the staff for the care and the kindness they have always shown. Several residents said that staff appeared to had more paperwork than previously which meant they were less attentive. The home employed 19 care staff. We were informed that eight staff had an NVQ level 2 qualification and two had a level 3 qualification which meets the recommended Care Homes for Adults (18-65 years) Page 25 of 31 Evidence: standard for 50 of care staff to have an NVQ level 2 qualification. In addition eight care staff were undertaking NVQ level 2, one was undertaking level 3 and one was undertaking level 4. In addition to the manager, deputy manager and head of care there were two registered nurses and seven care staff on duty. These were supported by a number of volunteers. Ancillary staff comprised an administrator, laundry, kitchen and domestic staff, a maintenance person, a part-time gardener and drivers. Residents appeared well cared for and were well supervised during the visit to the Centre. From discussion with the manager and observation it was evident that regular meetings were held and handover sessions provided to ensure staff were appropriately supported and were kept up to date with residents changing needs. The manager explained the recruitment process. The recruitment records for two recently recruited staff and two volunteers were viewed. All included evidence that the required checks had been undertaken prior to appointment (two satisfactory references, CRB Disclosures, evidence of identification etc.). The computerised record of training was seen and confirmed that since the previous key inspection training had been provided in fire safety, manual handling, food safety, health and safety, safeguarding adults, equality and diversity, infection control, first aid, feeding and swallowing, makaton training, the Mental Capacity Act and dementia care. The training records for two care staff were viewed and confirmed that both had undertaken manual handling, fire safety, first aid, dementia awareness, customer care and feeding and swallowing and safeguarding adults training. The arrangements for staff supervision were discussed with the manager. Staff had fifteen minute handover sessions between shifts with 10 minutes for volunteers staff and observation of practice was also undertaken. Regular one to one supervision sessions were arranged but were not always recorded. Weekly staff meetings were held and confirmed from the records viewed. Care Homes for Adults (18-65 years) Page 26 of 31 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who stay at Jubilee Lodge can expect to stay in an exceptionally well managed service with good health and safety standards that protect guests and staff. Evidence: The management arrangements were discussed with the registered manager. He had managed the home for a number of years having been employed at the home since 1982. He had achieved a Diploma in Management Studies (DMS) and a Masters Degree in Human Resources and from discussion it was evident that regular, updated training had been undertaken. The manager was supported by a deputy manager who was responsible for training and development, a clinical services manager/head of care and an assistant manager who was responsible for volunteers and entertainment. Throughout the visit to the Centre it was evident that the manager operated an open door policy and was very available to support staff, volunteers and guests. The AQAA was completed in detail. Information provided was very comprehensive and was supported by evidence during the visit to the service. The AQAA informed us that Jubilee Lodge had used the Practical Quality Assurance Assessment for Smaller Care Homes for Adults (18-65 years) Page 27 of 31 Evidence: Businesses (PQASSO) since 2007 which aimed to promote quality issues within the Centre. Quality was promoted through suggestion boxes, customer satisfaction surveys, the complaints procedure and individual consultation with guests. The results of surveys were used to develop an action plan and inform the annual plan to improve the service. provided to guests. Audits were undertaken in key areas (for example care plans, medication, environment etc. showing that care practice was monitored and appropriate action taken as relevant. Meetings were held for staff, residents and health and safety and issues discussed and appropriate action taken. Records held on behalf of residents were kept up to date and were stored safely in secure facilities. Records viewed at this inspection included: the statement of purpose, service user guide, assessments/care plans, medication records, complaints, staff meetings, staff recruitment and training records, maintenance records and fire safety records. The home had health and safety policies and procedures that were regularly reviewed. The records confirmed that staff had attended relevant health and safety training. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment fire alarms and emergency lighting etc.). All accidents, injuries and incidents were well-recorded and appropriate action taken. Care Homes for Adults (18-65 years) Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 29 of 31 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 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 16 To ensure guests privacy and dignity is respected staff and volunteers should be reminded to ensure they do not enter a guests room without being invited in. To ensure residents dignity, dinner plates should be large enough to ensure gravy does not spill over. To minimise the risk of error instructions on the medicine administration sheets should mirror the instruction on the prescription. Policies and procedures for administration of medicines should be further developed to provide detailed guidance for staff. A planned programme of refurbishment should be developed to improve the decor of the Centre. A rotary iron should be provided to enable linen to be easily ironed. Regular individual supervisions sessions held should be recorded. 2 3 17 20 4 20 5 6 7 24 30 36 Care Homes for Adults (18-65 years) Page 30 of 31 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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