Care Home: Lady Sarah Cohen House

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What the care home does well The home is clean, modern and well equipped. The courtyard garden was attractive and seating had been provided. We noted that it was colourful and there were still flowers in bloom. Our expert by experience remarked that the facilities surpassed that of homes of comparable size that she had visited. The feedback from residents is that they were satisfied with their accommodation. The home has a varied and comprehensive programme of daily activities. These had been carefully tailored to suit the needs of the client group. Individual social care plans had been prepared for residents which reflected their interests and preferences. Staff are aware of the specific cultural and religious needs of residents and arrangements have been made to ensure that they are responded to. Effort had been made to obtain the views of residents and their representatives. There is regular consultation with them regarding the management of the home and care plans prepared. This ensures that the home is well managed and the care provided is appropriate. Residents and their relatives provided positive feedback on staff and described them as caring and respectful. Staff are on the whole, well trained and knowledgeable regarding their roles and responsibilities. The kitchen and catering arrangements were well managed. We also noted that the kitchen had been awarded a five star rating by the local environmental health department. The home had co operated fully with us and statutory agencies to ensure that residents are protected and concerns are promptly responded to. What has improved since the last inspection? The kitchen had been kept clean and dry. This ensures the health and safety of residents and staff. The complaint made in December 2008 by a relative and identified in the last inspection had been investigated. A review of staffing levels was undertaken following the last inspection. This was aimed at ensuring that there is sufficient staff to meet the needs of residents. The home has a detailed evacuation plan. This ensures the safety of residents and all those in the home in the event of a fire. What the care home could do better: The risk of falls should be fully assessed prior to a resident being admitted into the home. This is to ensure the safety of residents. The blood glucose monitoring of the resident with diabetes, identified to the manager must be carried out in accordance with the care plan prepared. This is to ensure that the resident is well cared for. The home should review its admission procedure and ensure that each floor of the home has an agreed level of residents with high needs. This is to ensure that staff are able to care adequately for residents. A review of staffing levels must be undertaken so as to ensure there is sufficient staff to meet the needs of residents. This review must be carried out in consultation with staff and residents or their representatives. A report following this must be forwarded to the CQC. This is necessary to ensure that the needs of residents are attended to. All care staff caring for residents with challenging behaviour must be provided with training in the management of challenging behaviour. This is to ensure the safety of staff and ensure that residents are well cared for. The windows above the corridor seats on each floor must have window restrictors fitted. This is to ensure the safety of residents. The rooms used for storing hoist and weighing scales must be locked when not in use. This is to ensure the safety of residents. Key inspection report Care homes for older people Name: Address: Lady Sarah Cohen House Asher Loftus Way Colney Hatch Lane London N11 3ND     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Daniel Lim     Date: 2 5 1 1 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 33 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Lady Sarah Cohen House Asher Loftus Way Colney Hatch Lane London N11 3ND 02089204400 02089204414 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: www.jewishcare.org Jewish Care care home 120 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 120 The Registered Person may provide the following categories of service only: Care home with Nursing - Code N to service users of the following gender: Either whose primary care needs are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE Date of last inspection Brief description of the care home Lady Sarah Cohen House is a care home registered to provide nursing care for a maximum of 120 older people. The home opened in October 1997 and is operated by Jewish Care. Residents in the home are all Jewish. The home was previously registered as three different units (first, second and third floors). These three floors are now registered as a single home. The aims of the home are to create a homely, relaxed environment with emphasis on treating users with dignity and respect and enabling users to leading a full and active Care Homes for Older People Page 4 of 33 0 6 0 1 2 0 0 9 120 0 Over 65 0 120 Brief description of the care home life. The home is a large four storey, detached building. It was purpose built as a hotel style care home. On the ground floor are located the kitchen, laundry, coffee shop and synagogue. The reception area, clerical and administrative offices are also on this floor. The first floor of Lady Sarah Cohen House was previously registered to provide nursing care for a maximum of forty older people who have dementia. This floor continues to accommodate residents with dementia.The second and third floors of the home accommodate residents with general nursing care needs including some with dementia. The home is situated at the end of a private road (Asher Loftus Way) which leads away from the busy Colney Hatch Lane. It is a short distance from the North Circular Road. It is well served by a variety of shops, restaurants and other community services located along Friern Barnet Road. The new manager of the home is Natasha Carson. She is supported by three floor managers. The fees charged by the home per week can be obtained by contacting the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This inspection was started on 24 November 2009 by Daniel Lim (inspector) and Jane Shaw (pharmacy inspector) and took one and a half days to complete. We were accompanied by an expert by experience (an interviewer who has experience of being a service user). During this inspection we were assisted by the newly appointed manager of the home, Ms Natasha Carson. We were able to interview a total of eight residents and three relatives. The feedback received from them indicated that they were generally satisfied with the care provided. We attempted to interview three other residents, but they were unable to comment on the care provided due to their mental state. Completed CQC survey forms were received from twenty six residents and one staff. Care Homes for Older People Page 6 of 33 Statutory records including seven residents case records, the maintenance records, accident, complaints, financial records and fire records of the home were examined. The premises including bedrooms, laundry, kitchen, gardens and communal areas were inspected. The minutes of residents and relatives meetings were also examined. The arrangements for the administration of medicines was inspected by Jane Shaw our pharmacy inspector. Eight staff on duty were interviewed on a range of topics associated with their work and staff records were examined. In addition, the completed Annual Quality Assurance Assessment form or AQAA was received by us. Information provided in the assessment was used for this inspection. Care Homes for Older People Page 7 of 33 What the care home does well: What has improved since the last inspection? What they could do better: The risk of falls should be fully assessed prior to a resident being admitted into the home. This is to ensure the safety of residents. The blood glucose monitoring of the resident with diabetes, identified to the manager Care Homes for Older People Page 8 of 33 must be carried out in accordance with the care plan prepared. This is to ensure that the resident is well cared for. The home should review its admission procedure and ensure that each floor of the home has an agreed level of residents with high needs. This is to ensure that staff are able to care adequately for residents. A review of staffing levels must be undertaken so as to ensure there is sufficient staff to meet the needs of residents. This review must be carried out in consultation with staff and residents or their representatives. A report following this must be forwarded to the CQC. This is necessary to ensure that the needs of residents are attended to. All care staff caring for residents with challenging behaviour must be provided with training in the management of challenging behaviour. This is to ensure the safety of staff and ensure that residents are well cared for. The windows above the corridor seats on each floor must have window restrictors fitted. This is to ensure the safety of residents. The rooms used for storing hoist and weighing scales must be locked when not in use. This is to ensure the safety of residents. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Significant time and effort is spent making admission to the home personal and well managed. Prospective residents and their families are treated as individuals and with dignity and respect for the life changing decisions they need to make. Admissions are not made to the home until a full needs assessment has been undertaken by the manager or a sufficiently skilled member of staff. This ensures that the home is able to meet the needs of residents. Evidence: The homes AQAA states: Before a new admission takes place Jewish Cares social work service ensure that a comprehensive social work assessment has taken place. If the person is privately funded the assessment will be make by our social work team. This means that a professional judgement has been made as to the suitability of the person to the home. Prospective admissions and their families are sent a brochure which includes Care Homes for Older People Page 11 of 33 Evidence: information on fees and services provided. They are also offered the opportunity to visit the home and be shown around either by myself or another senior member of staff who can answer any specific questions. When they visit the home they are able to view a copy of the most recent inspection report as well as the statement of purpose and service users guide. The prospective resident is then invited to spend a day in the home so that they can see if it is right for them and have a chance to try the facilities as well as chat to residents and staff. This day is also used as an assessment day for the prospective resident as we are able to see how they behave in the home. A sample of seven residents case records which was examined contained appropriate pre admission assessments. The pre admission assessments which were examined were noted to be appropriate and comprehensive. The assessments included details of the personal, physical, mental, cultural and social needs of residents. Risk assessments and other essential assessments had also been prepared for residents admitted to the home. This ensures that the needs of prospective service users can be met by staff. Residents in the home were noted to be clean and appropriately dressed. The residents who were interviewed informed us that they were well treated and their care needs had been attended to. This was reiterated by their relatives and in completed questionnaires received by us. Comments made by them included the following : I am very impressed with the reception my relative received on arrival at the home. I have found a great improvement in his well being. Wonderful, truly professional. A very friendly place. Immediate responses to any need. I see how good the staff are and how quick they respond to people. Satisfied with care provided. Staff help me when needed. We observed that residents in the home were clean, appropriately dressed and appeared well cared for. This was also noted by our Expert by experience. The manager stated that the home does not provide intermediate care Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have access to healthcare services both within the home and in the local community. Health needs are monitored and appropriate action taken and these are recorded in residents care plans. However, there are deficiencies in the arrangements for the administration of medication. These put people who use the service at risk. Evidence: The AQAA states : We have comprehensive care plans for each resident which are divided into multiple sections to give more depth and individuality to the documentation, these sections include personal and health care needs, emotional, cognitive, social and spiritual needs and preferences, dependency profile, GPs, Dentist, Optician, nurse, CPN and chiropodists visits and hospital appointments. Residents are able to register with the homes GP if they choose to and the 3 GPs from the same practice visit 3 times a week for in-home surgeries. Dentist, optician, chiropodist also visit regulary for check ups and as necessary, we are also lucky enough to have in house physio and a language therapist. Medication policy in respect of storage is strictly followed. In addition to Care Homes for Older People Page 13 of 33 Evidence: health support already mentioned we also employ a physiotherapist, holistic therapist and language therapist. These services are accessed via GP referal or through the nursing team. Residents and their families are supported in planning their end of life care, paperwork. The home has recently joined the GSF scheme (GOLD STANDARD FRAMEWORK). The GSF fits in neatly to the end of life for people with demetia training that is already underway with staff. The ethos of the home is to promote the residents dignity, choice, respect and independence this is reflected in our mission statement which is prominently displayed in the lobby. Residents who were interviewed by us and the expert by experience indicated that staff had treated them with respect and dignity. They stated that staff took good care of them and had attended to their personal and healthcare needs. Comments made included the following : Ok. We are always supported. She sees the doctor and the chiropodist regularly. Staff have given me my medication. I can see the doctor if I need to. Yes, they are respectful and treat me well. We noted that individual care plans had been prepared for residents following their assessment. The sample of seven case records examined was up to date and plans of care had been reviewed. Records of medical and healthcare appointments, including appointments with the chiropodist, dietitian, optician and physiotherapist were documented. Weight monitoring charts were in place. Staff interviewed were knowledgeable regarding the care to be provided to residents. The care plans of a resident with a pressure sore were examined. We noted that the pressure sore care plan was appropriate and pressure area turn charts had been completed. The care plans of a resident with dementia were found to be well prepared and informative. This ensures that staff are provided with the necessary guidance and the resident concerned can be well cared for. We also examined the care plans of a resident with diabetes. We note that blood glucose monitoring mentioned in the care plan had not been carried out. This was discussed with the manager who agreed to ensure that it is rectified. A requirement is made for this to be done. Care Homes for Older People Page 14 of 33 Evidence: The arrangements for the administration of medication were examined by our pharmacy inspector and discussed in detail with the manager. These are her comments: We carried out a specialist pharmacist inspection in all three units of the home. We looked at storage, the homes medication policy and procedures and the recording of receipts, administration and disposal. We audited several samples of medication to see if it was being recorded and given as prescribed. We checked requirements made at a previous inspection and noticed that the home had made significant progress in developing safe systems for managing medication.The recording of receipts, administration and disposal was much improved. We noticed just two gaps in administration in all the records we inspected. The recording of receipts was excellent in two units and the home now disposed of medication via a licensed waste carrier. We noticed that regular audits were being carried out to identify poor practice and that a laxative was no longer being shared between residents. On one floor we found medication management to be excellent. All records were complete. We noticed that the cover sheets for the Medication Administration Records were very person centred with details of likes and dislikes, special instructions and details of dietary foodstuffs that might interact with their medication. We counted 18 samples of medication supplied in their original containers on this floor and all could be reconciled with signatures for administration or the reason why the medicine was not given. This means that the residents health was being maintained. On another floor we noticed two gaps for administration. One medicine was not given and not recorded because it could not be found the evening before the inspection. For the other gap we could see from an audit that the medication had been given. We counted 12 other samples of medication in their original boxes on this floor and all could be reconciled with signatures for administration. We looked at the Monitored Dosage System and noticed a tablet of aspirin not given but signed as given on the day of the inspection. It was difficult to audit medication on one floor because there were gaps or errors in records of receipts and medicines carried forward from the previous medication cycle. Medication storage was also untidy, and out of date letters from hospital were not archived. There was careless recording of administration when a dose of warfarin was recorded in the wrong place. We audited 15 samples on this floor and 10 we found were accurate. For two residents no supply was received from the pharmacist or GP for two and five days respectively after the current medication cycle started. This means they were not able to have their medication. One resident had expressed a Care Homes for Older People Page 15 of 33 Evidence: wish to self medicate and a risk assessment was in place and the resident had been taking his own medication for a week. We were told that there would be regular reviews to check compliance and that the medicines were being kept securely. We looked at storage of medication including controlled drugs. It was secure on all floors. The minimum and maximum temperature of the fridges were not recorded and two of the fridges needed defrosting. Balances of controlled drugs were accurate when we checked them against records in the controlled drugs registers. We looked at lancets for checking blood glucose and noticed that only one floor again was using professional lancets to prevent the risk of blood borne infections. Several residents were having their medicines and nutrition via a feeding tube because they could not swallow. There was evidence of liquid medicines being prescribed to aid this process and the dietician visited regularly to review the feeding regime. The home responded immediately to our concerns and was able to clarify some of the irregularities in audit. They confirmed that all fridges were defrosted and that the maximum and minimum temperature would be monitored daily. Overall we were satisfied with the progress made in ensuring that residents received their medication as prescribed and that the home would action the shortfalls identified in this inspection. Requirements and recommendations have been made in this report for improving the administration of medication. Care Homes for Older People Page 16 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily life and routines are carefully organised to meet the needs of residents. The preferences and views of residents and their relatives are being sought when planning the homes programme of social and therapeutic activities. Residents are given the opportunity to take part in activities that are appropriate and varied. They also have opportunity to maintain important relationships. Evidence: The homes AQAA states: The home employs 2 dedicated social care co-ordinators and one activity organiser. Between them and with the support of the holistic therapist, they organise the activities programme for the home. The activity plans are then displayed on each floor on the notice board and copies are given to the residents to keep. We continue to have very good links with the local schools, day centres, homes and synagogues. We hold regular services on Saturdays and special services on festivals. Residents are able to pop out to the shops either by themselves or more usually with a carer if they need the extra support. If residents dont feel like going out or are too frail to do so then we also have a vibrant coffee shop and gift shop staffed by volunteers where residents and visitors are able to make purchases or enjoy a drink or a snack. Residents in the Care Homes for Older People Page 17 of 33 Evidence: home are encoraged to make choices and decisions about their lives in many areas. Our catering is provided by sub contractors who work closely with us to ensure that a tasty and varied kosher diet is provided. The chefs take effort to make sure that meals look attractive and use good quality produce. On the days of inspection we noted that activities were organised for residents on each of the floors. The activities manager informed us that there was a talk on life in the East End of London and a choir was singing for residents in the afternoon. Our expert by experience noted that a quiz was also being organised. We were informed by the activities manager that residents had gone on an outing to The Albert and Victoria Museums. There is an activities organiser on each floor. Activities provided included music and movements, bingo, talks by visiting speakers, Discussion Group, Orientation Group, manicures, card games, entertainment sessions and outings to theatres and museums. In addition, there were religious activities such as Talks on the Torah, Shabbat Blessings on Fridays and a synagogue on Saturdays. Individual social care plans had been prepared for residents which reflect their preferences. Residents interviewed were of the opinion that the home had activities which were appropriate to them. The home has a complimentary therapy room where hand massage, aromatherapy, music and light therapy are provided. We note that there was a lunch club for some residents in a room set apart for them. Residents were noted to be enjoying the food. Our expert by experience was able to meet a resident who was keen to talk about the Experts by Experience programme and was applying to become an expert. She noted that the resident was able to use her computer in the home. The provision of meals was discussed with residents. On the whole, residents were satisfied with the meals provided. The hotel services manager and the chef informed us that regular food forums had been organised in which the views and concerns of residents are noted and responded to. They stated that there is a comments book available on each of the floors for residents or their relatives to register their comments. The hotel services manager stated that comments made are regularly checked by her. The kitchen was inspected on the first day and we noted that it had been kept clean. The dry food store was tidy, well stocked and kept clean. A record of daily fridge and freezer temperatures had been kept. These were satisfactory. The menu appeared varied, balanced and reflected the ethnic composition of residents. We also noted that the kitchen had been awarded a five star rating by the local environmental health department. Care Homes for Older People Page 18 of 33 Evidence: Comments made by residents and heir relatives in this area included the following: Portions very good. Meals are fabulous, as good as a New York hotel. Never overcooked, I dont know how they do it. Perfect. Somes nice, somes not. Must not grumble. I eat the same as anyone else. She loves the food. She knows its kosher, in spite of her dementia she has a subconscious knowledge its kosher and that is very good for her, she was always very observant. She used not to eat so much when she was well as she was watching her weight, now she has put on weight because she loves the food. Care Homes for Older People Page 19 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The arrangements for responding to complaints and for adult protection are satisfactory. The home has an open culture that allows residents to express their views and concerns in a safe and understanding environment. The required policies and procedures for safeguarding residents are in place and give the required guidance to staff. Training in safeguarding had been provided for staff. Evidence: The homes AQAA states : Jewish Care has a clear complaints and compliments policy and procedure called your view counts. The policy is advertised clearly on notice boards arround the home and in leaflets available to relatives, residents, staff and visitors. All care staff have received SVA training. For newer staff this is part of the induction process. The training covers Jewish Care and Barnets policy, definitions and indicators of abuse as well as the law and care staff responsibilities. Jewish Care has a quality assurance manager who is involved when a serious complaint is raised. When a complaint is made it is recorded on a standardised complaint form, all complaints are treated seriously and acted on appropriately however minor. All new staff and volunteers must have satisfactory POVA and CRB clearance prior to starting work. Residents and their relatives who were interviewed stated that they had been well treated by staff and staff had been respectful towards them. The home has a record of Care Homes for Older People Page 20 of 33 Evidence: complaints received. There was documented evidence that the complaints recorded since the last unannounced inspection had been responded to. Three of the complaints made since the last inspection had been brought to our attention. We are aware that they had also been reported to Social Services and adult protection meetings had been held. The home had co-operated fully with Social Services to ensure that concerns raised were fully investigated. Recommendations were made for improving the care provided. The manager agreed to ensure that the action plan is implemented. One of the recommendations is that the home should review its admission procedure and ensure that each floor of the home has an agreed level of residents with high needs. This is to ensure that staff are able to care adequately for residents. The home has an adult protection procedure. It included examples of abuse and guidance to staff on reporting allegations of abuse to Social Services and The CQC. The local authority guidelines were also available. Staff who were interviewed were aware of the homes policy and procedures for the protection of vulnerable adults. There was evidence that staff had been provided with the required training. The manager provided us with letters and cards expressing appreciation and gratitude for staff and the care provided at the home. Comments made by residents and their relatives included the following: The nurses gave care that was a credit to their profession. The cleaners and other staff were always sympathetic. Many relatives have complimented the effort that staff make and how caring they are. We would like to thank you for all the care and kindness. Thank you for the patient way you looked after my mother. Care Homes for Older People Page 21 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is modern, clean and well furnished. The manager and her staff have ensured that the physical environment of the home provides for the individual requirements of people who live there. The necessary equipment and adaptations for supporting residents are available. Residents are allowed to personalise their bedrooms. Overall, the home provides a pleasant, comfortable and attractive environment to live in. Evidence: The homes AQAA states: Lady Sarah Cohen House is built on beautiful land set well back from the main road to provide a unique and modern style nursing home. We have a beautiful courtyard area in the centre of the building. The garden is a focal point where service users can enjoy sitting in the sun with their relatives having tea, join in BBQs, mingle with staff, general public, relative and friends on our fete days raising funds for the home or simply look out from their bedrooms and view the lovely flowers and shrubs. When the weather is colder we also have a coffee shop, library and synagogue that can be used by visitors and residents on the group floor. We encourage residents to make the room their own by personalising them as they choose. The home is fitted with appropriate aids and adaptations such as corridor grab rails, bath hoists, lifts, toilet raisers, special nursing beds, ripple mattresses and apprpriate seating and wheelchair Care Homes for Older People Page 22 of 33 Evidence: storage. The home both smells and looks clean and has a dedicated team of domestic staff led by an enthusiastic housekeeper. Residents interviewed stated that they were happy with the accommodation provided and their bedrooms had been kept clean. The bedrooms, lounges, and other communal areas were found to be clean, tidy and cheerfully furnished. Flowers and plants were placed in the communal rooms and in the reception areas. The courtyard garden was attractive and seating had been provided. We noted that it was colourful and flowers were still in bloom. The manager informed us that volunteers and some residents had assisted in maintaining the garden. She added that residents had used the garden regularly when the weather was warm. Various specialist equipment for the care of residents was available. These included hoists, assisted baths, toilet handrails, wheelchairs, and a call bell system.The home had safety inspection certificates for the gas and electrical installations. The portable appliances had been checked. Bedlinen which had been laundered were examined. These were found to be clean and neatly folded. Laundry staff were aware of the need to wash soiled linen in a special wash cycle. They further stated that labels were usually attached to clothes of residents. This ensures that they can be returned to residents concerned. The carpet in one of the bedrooms was soiled and stained. This was brought to the attention of the unit manager. She reassured us that it would be cleaned without delay. We also note that in the same room was a stool which was broken. The unit manager immediately removed this item from the room. All other bedrooms inspected were noted to be clean. We were informed after the inspection that the bedroom concerned had been fully cleaned. Our expert by experience confirmed our findings that the home was clean and residents were on the whole satisfied with their accommodation. She remarked that the facilities surpassed that of homes of comparable size that she had visited. Care Homes for Older People Page 23 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a good recruitment procedure that is followed in practice. The manager recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Residents and their representatives are on the whole satisfied with the staffing arrangements. Evidence: The homes AQAA states : Staffing levels are continuously monitored through dependancy audits of the residents needs. There is a clear and easy to follow rota in place on each floor and allocation sheets to demonstrate where staff have been assigned to work on any given shift. The home has a clearly set out training programme. Jewish Care places a strong emphasis on staff training and development. Our nurses are encouraged to access appropriate external course such as wound, diabetes, palliative care. A majority of care staff are already qualified or studying for their NVQ. We have strict recruitment procedures in place following a clear policy. This includes shortlisting, interview, checking of eligibility to work and CRB and POVA first, references on headed paper and a week induction programme for permenant staff covering a wide range of topics. We are lucky enough to have 130 volunteers linked to the home in various capacities from running the coffee shop to assisting with mealtimes or group activities. All staff have an allocated supervisor who meets them for 1 to 1 supervision sessions. Care Homes for Older People Page 24 of 33 Evidence: Residents and relatives who were interviewed indicated that they had been well cared for by staff and staff were respectful and polite towards them. They further indicated that when they needed help, staff were responsive towards them. Our expert by experience observed that she found staff responsive to residents and there was much interaction between residents and staff. She noted that when a resident was distressed, staff responded reassuringly towards this resident. Staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. The records of four staff, including two nursing staff were examined. These indicated that the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. Nurses employed in the home had up to date PIN numbers. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss any work related problems, issues related to the care of residents and their training. The issue of equalities and diversity was discussed with the home manager and her staff. Staff were aware of the Jewish culture and demonstrated an understanding of the need to treat all residents sensitively and with respect. They were aware that they must not discriminate against residents. The duty rotas were examined. On the first floor we note that in addition to the unit manager, there were normally a minimum of 7 carers and 3 nurses on the day shift. On the night shift there were 4 carers and 2 nurses on waking duty. This floor had 38 residents. On the second floor we note that in addition to the unit manager, there were normally a minimum of 6 carers and 4 nurses on the day shift. On the night shift there were 4 carers and 2 nurses on waking duty. This floor had 36 residents. On the third floor we note that in addition to the unit manager there were normally a minimum of 7 carers and 3 nurses on the day shift. On the night shift there were 4 carers and 2 nurses on waking duty. This floor had 35 residents. Some staff who were interviewed stated that the staffing levels were not always adequate and they had difficulty attending to residents. They explained that residents Care Homes for Older People Page 25 of 33 Evidence: in the home have high needs and require a high level of care. They said that a large number of residents require assistance with eating their meals. The situation was exacerbated when some staff are off sick at short notice. We also note that three of the twenty six residents indicated that more staff is needed. One stated that he or she had to wait a long time for staff to attend to her. This finding was discussed with the manager who agreed to review staffing levels to ensure that they are adequate. In view of the concerns expressed by some staff and comments made in The CQC surveys received regarding staffing levels, a requirement is made for staffing levels to be reviewed. This review must be carried out in consultation with staff and residents and their representatives. A report following this must be forwarded to the CQC. This is necessary to ensure that the needs of residents are attended to. We were informed by a senior staff member that some of the residents had challenging behaviour and staff had sustained minor injuries from one of the residents. We were also informed that not all staff had received training in the management of challenging behaviour. All care staff caring for residents with challenging behaviour must be provided with training in the management of challenging behaviour. This is to ensure the safety of staff and ensure that residents are well cared for. The manager agreed to look into the matter and ensure that staff have the required training. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems were in place to ensure that the rights and interests of residents are safeguarded and the quality of care provided is maintained. Equality and Diversity issues are given priority by the home. Arrangemets are in place to ensure the health and safety of residents. Evidence: The homes AQAA states : Our ethos is to create a friendly, safe, welcoming and inclusive home that residents enjoy living in and staff enjoy working in. Service Managers within the organisation conduct unannounced regulation 26 visits each month during which they ask stakeholders and management about what has been happening and their views on the home. We have our own quality assurance process within Jewish Care, this is headed up by our quality assurance manager, however it is also an internal process inside our home. Our financial administration is clearly documented and follows organisational policies and proceedures which comply with regulations. Money is never spent without Care Homes for Older People Page 27 of 33 Evidence: either the residents or their appointees knowledge.There is a clear supervision proceedure in place following the homes organistational chart. Jewish Care has a health and safety manager who reviews and updates the companies policies and procedures annually. He conducts 3 walkarounds per year to check the property and equipment ass well as to speak to staff about health and safety issues. All of our equipment is serviced regularly. We carry out weekly fire panel, alarm and door tests and regular file drills, we have a fire risk assessment in place. The manager had been in post since April 2009. She has many years of experience in the care field, including experience of managing another Jewish Care care home. She has applied for registration with us. Feedback received from residents and their representatives indicated that the manager had been successful in fostering a caring and welcoming environment where residents are cared for with respect and dignity. Those interviewed expressed confidence in the management of the home. There was evidence that residents are informed of changes affecting the management of the home. Residents and relatives meetings had been held. The minutes of these meetings indicated that residents and relatives were given opportunities to voice their opinions and their concerns had been listened to. Consumer surveys had been carried out recently and there was evidence that the respondents were generally satisfied with the management of the home. The home has a comprehensive range of policies and procedures. We note that policies and procedures in the homes were subject to regular reviews and we were informed that a senior manager was responsible for this. The fire logbook examined indicated that the required fire drills and weekly checks of the fire alarm had been carried out. These included drills carried out after dark. Fire training had been arranged for staff. When questioned, staff were knowledgeable regarding the fire procedure. The detailed evacuation plans specific to the home was in place and seen by us. The home has a current certificate of insurance. The financial records of four residents were examined. These were noted to be well maintained by the admin staff of the home. Receipts had been obtained for transactions made on behalf of residents. We note that raised windows above the corridor seats had not been restricted. This was brought to the attention of the manager. To ensure the safety of residents, these windows must be restricted. The manager agreed that this would be done. We also note that the unused communal bathrooms used as storage rooms for hoists and other equipment had not been locked. These must be kept locked. This is to ensure the safety of residents. The manager agreed that this would be done. Care Homes for Older People Page 28 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 12 Improvement are needed in the care of residents with diabetes. This must include ensuring that monitoring of the blood glucose levels as documented in the care plans is carried out. This is to ensure the health and safety of residents concerned. 26/02/2010 2 9 13 The home must work with the GP and pharmacist to ensure that there are continuous supplies of medication for all residents. This is to ensure the health and safety of residents 15/02/2010 3 9 13 The home must continue to robustly audit medication and ensure that medication is recorded accurately when received into the home and administered. 26/02/2010 Care Homes for Older People Page 30 of 33 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 This is to ensure the health and safety of residents and provide evidence medication is being given as prescribed. 4 27 18 A review of staffing levels 22/02/2010 must be undertaken so as to ensure there is sufficient staff to meet the needs of residents. This review must be carried out in consultation with staff and residents or their representatives. A report following this must be forwarded to the CQC. This is necessary to ensure that the needs of residents are attended to. 5 30 18 All care staff caring for residents with challenging behaviour must be provided with training in the management of challenging behaviour. This is to ensure the safety of staff and ensure that residents are well cared for. 6 38 13 The rooms used for storing hoist and weighing scales must be locked when not in use. 08/02/2010 15/03/2010 Care Homes for Older People Page 31 of 33 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 This is to ensure the safety of residents. 7 38 13 The windows above the corridor seats on each floor must have window restrictors fitted. This is to ensure the safety of residents. 08/02/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 3 The risk of falls should be fully assessed prior to a resident being admitted into the home. This is to ensure the safety of residents. 2 9 Balances of medicines carried forward from one medication cycle to the next should be recorded accurately. This is to ensure that stock levels can be maintained and audited. 3 9 Only the current information regarding changes of dosages of medicines should be kept with the Medication Administration Records. This is to prevent medication errors occuring. 4 18 The home should review its admission procedure and ensure that each floor of the home has an agreed level of residents with high needs. This is to ensure that staff are able to care adequately for residents. Care Homes for Older People Page 32 of 33 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. Care Homes for Older People Page 33 of 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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