Care Home: Spanish & Portuguese Jews Home For The Aged

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What the care home does well This is a home for Jewish elders and every member of staff works together as a team to provide a service that meets the needs of the residents. Great care is taken to ensure that the facilities of the home and the routines in the home are in accordance with the Jewish culture and religion. The home recognises, respects and observes the religious festivals throughout the calendar and dietary laws are observed within the home. Activities include a Yiddish group and attending a fellowship club and when outings or a holiday take place these are planned so that certain obligations are met.A resident described the home as a "lovely club, close knit". Another resident said that that they "loved it (living here)" and they enjoyed the activities. One resident said "Wednesday`s are my favourite day, the discussion group in the morning and the fellowship club in the afternoon". When asked on the survey form what the home does well a relative said "a very difficult job" and that the home was "the best I have seen". Among comments made by relatives on the survey forms are "I am fully confident at all times that their care of my mother is professional, sensitive, knowledgeable and very caring and patient and attentive", "It has a warm and caring attitude to residents, making them feel that they matter and that they will never be neglected" and "the atmosphere is good, not staff and residents apart but one care family with residents treated as individuals with needs and all valued". The strength that the home has in providing good social care for residents means that residents are able to continue to enjoy a range of activities, continue to enjoy the company of their family and friends and continue to take a holiday, if they wish. Activities are designed to meet the abilities of different groups of residents within the home and are imaginative and stimulating. All members of staff play a part in supporting residents and are particularly aware of the needs of the residents with dementia. There are many ways in which residents and their relatives can give feedback on the quality of the service. The home has listened to the views of residents and relatives, and where possible have implemented their ideas and the refurbishment of the ground floor, which is due to commence shortly, is a good example. What has improved since the last inspection? The previous key inspection took place in July 2007 and we carried out a random inspection in February 2008 to check that the home had met the requirements made in July. We saw that the complaints records were now more comprehensive and that it was clear to see the investigation of complaints and how and when the outcome was communicated to the complainant. This confirmed the importance that the home placed on feedback and assured the complainant that their comments had been listened to and valued. Recruitment practices were examined and a random inspection of files confirmed that all the necessary checks were being carried out to ensure the safety and welfare of residents. The annual quality assurance questionnaires had been despatched and plans had been drawn up to analyse the feedback so that people with an interest in the service had a means of helping shape its development. CARE HOMES FOR OLDER PEOPLE Spanish & Portuguese Jews Home For The Aged Edinburgh House 36-44 Forty Avenue Wembley Middlesex HA9 8JP Lead Inspector Julie Schofield Key Unannounced Inspection 28th April 2008 08:40 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Spanish & Portuguese Jews Home For The Aged Address Edinburgh House 36-44 Forty Avenue Wembley Middlesex HA9 8JP 020 8908 4151 020 8908 3103 enquiries@edinburghhouse.org.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Spanish & Portuguese Jews Home for the Aged Ms Christine Gibson Care Home 51 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (41) of places Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th July 2007 Brief Description of the Service: Edinburgh House is a home accommodating up to 51 elderly Jewish residents and provides personal care. It is part of a complex, which includes sheltered housing units and a day centre and is situated on Forty Avenue. This is a busy road linking Wembley Park with East Lane. Transport facilities include bus routes and a nearby underground train station (Wembley Park). The home has a large car park in the grounds and there are garden/patio areas around the building, which are attractive in appearance. The home consists of three floors (ground, first and second) and there are residents’ bedrooms and toilet/bathing facilities on each floor. There are a number of lounge areas on the ground floor including a large entrance hall that opens into a conservatory and there are residents using each of the communal spaces in the home. Sunflower is for the mentally frail residents and is situated on the ground floor. Rose Lounge is for the high dependency/very frail residents and is situated on the second floor. The home has a spacious dining room for most of the residents although Sunflower lounge and the Rose lounge have their own dining area within the room. There are separate meat and milk kitchens, in accordance with dietary laws. There are offices on the ground floor for the manager and other senior staff. There is also a suite of offices on the first floor, which are used by the finance staff. The home has a number of pets. Fees charged for the service vary between £584 and £700 per week, according to an assessment of the needs of the individual resident and the accommodation occupied. These figures were given on the 3rd June 2008. Information regarding the service and fees may be obtained, on request, from the manager of the home. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The inspection took place over 3 days. It began on the 28th April when we carried out 2 visits. The first visit started at 8.40am and finished at 12.30pm. The second visit started at 3.30pm and finished at 5.10pm. We called back on the 29th April and the first visit started at 10.45am and finished at 12.30pm. The second visit started at 1.50pm and finished at 5pm. We finished the inspection on the 20th May calling at 9.20am and leaving at 11.50am. During the inspection we spoke with the manager, members of staff and residents. Records were examined and the care of a number of residents was case tracked, a tour of the building took place and compliance with the statutory requirements identified during the previous key inspection in July 2007 and the random inspection in February 2008 was checked. We also saw some of the activities taking place in the home. As most of the residents in Sunflower Lounge were unable to give direct feedback on the quality of care received we spent time there observing the care practice and the interaction between residents and members of staff. Survey forms were sent to relatives and at the time of writing the report 21 of these had been returned. We would like to thank everyone for their assistance and for their comments during the inspection. We have also received the Annual Quality Assurance Assessment (AQAA) that the CSCI sends to services for the service to complete. What the service does well: This is a home for Jewish elders and every member of staff works together as a team to provide a service that meets the needs of the residents. Great care is taken to ensure that the facilities of the home and the routines in the home are in accordance with the Jewish culture and religion. The home recognises, respects and observes the religious festivals throughout the calendar and dietary laws are observed within the home. Activities include a Yiddish group and attending a fellowship club and when outings or a holiday take place these are planned so that certain obligations are met. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 6 A resident described the home as a “lovely club, close knit”. Another resident said that that they “loved it (living here)” and they enjoyed the activities. One resident said “Wednesday’s are my favourite day, the discussion group in the morning and the fellowship club in the afternoon”. When asked on the survey form what the home does well a relative said “a very difficult job” and that the home was “the best I have seen”. Among comments made by relatives on the survey forms are “I am fully confident at all times that their care of my mother is professional, sensitive, knowledgeable and very caring and patient and attentive”, “It has a warm and caring attitude to residents, making them feel that they matter and that they will never be neglected” and “the atmosphere is good, not staff and residents apart but one care family with residents treated as individuals with needs and all valued”. The strength that the home has in providing good social care for residents means that residents are able to continue to enjoy a range of activities, continue to enjoy the company of their family and friends and continue to take a holiday, if they wish. Activities are designed to meet the abilities of different groups of residents within the home and are imaginative and stimulating. All members of staff play a part in supporting residents and are particularly aware of the needs of the residents with dementia. There are many ways in which residents and their relatives can give feedback on the quality of the service. The home has listened to the views of residents and relatives, and where possible have implemented their ideas and the refurbishment of the ground floor, which is due to commence shortly, is a good example. What has improved since the last inspection? The previous key inspection took place in July 2007 and we carried out a random inspection in February 2008 to check that the home had met the requirements made in July. We saw that the complaints records were now more comprehensive and that it was clear to see the investigation of complaints and how and when the outcome was communicated to the complainant. This confirmed the importance that the home placed on feedback and assured the complainant that their comments had been listened to and valued. Recruitment practices were examined and a random inspection of files confirmed that all the necessary checks were being carried out to ensure the safety and welfare of residents. The annual quality assurance questionnaires had been despatched and plans had been drawn up to analyse the feedback so that people with an interest in the service had a means of helping shape its development. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Carrying out an assessment of the resident, prior to admission, ensures that the needs of the resident are identified and that the home is able to determine whether these can be met. Specialist care offered by the home is underpinned by training for the staff team. This assures residents that members of staff understand their needs. Standard 6 was not inspected, as the home does not offer an intermediate care service. EVIDENCE: Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 10 The case files of 4 residents that had recently been admitted to Edinburgh House were examined. Two of the residents had been admitted on a permanent basis and 2 residents had been admitted for respite care. We saw that each file contained certain documents, depending on whether the placement was funded privately or by a local authority. Each file contained an application form and a prospective resident’s assessment portfolio. Files also contained a pre-admission assessment carried out by the manager or a deputy manager unless the resident had been admitted on an emergency basis. Residents whose care was funded by a local authority also had information on file that had been supplied prior to their admission including an in depth assessment of need and a copy of the health and social care plan. There was evidence that the residents and their relatives had been involved in the assessment process but some forms were not dated after completion. Two residents we spoke with during the inspection had been admitted to the home following a stay in hospital. One of the residents had visited the home in the past and knew the service provided but the other resident said that a relative had visited the home before the admission and had told the resident what the home was like. The manager has previously told us that all prospective residents and/or their families are encouraged to view the home as part of the pre-admission process. The home provides a service for Jewish residents and the home honours each Jewish festival. Meals prepared and served in the home are in accordance with Jewish dietary laws. Most of the staff team are non-Jewish and they receive training in the Jewish culture and religion. This specialist training begins during their induction and includes sessions given by an executive member of the committee overseeing the home. Specialist training is given on an ongoing basis and this is often delivered in advance of particular festivals e.g. Passover. Staff have also received training in respect of the rituals surrounding the death of a Jewish person. Residents said that all aspects of the home respected their beliefs. Relatives were satisfied that the home provided an environment where the needs of Jewish people could be met and a relative commented that “all needs are catered for within this ethnicity both dietary, religion and otherwise”. Edinburgh House has a dementia care unit and all staff working on this unit have undertaken dementia care training. As getting verbal feedback from the residents about the quality of care provided on this unit would be difficult we spent about 1 hour 15 minutes sitting in a corner of the lounge and observing the interaction between residents and staff and looked for signs from the residents of well being. We saw that residents enjoyed the company of staff and this included sitting having 1:1 conversations. Residents certainly were happy singing songs with a member of staff that was able to engage a number of residents in this activity. Domestics coming into the unit joined in the singing as they worked and also spoke with residents. Although one resident appeared restless for a significant part of the time they beamed when a particular member of staff walked into the room. Even when a carer was Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 11 making up a breakfast tray for a resident they sat at the table doing some of the tasks while talking with another resident that was new to the home and needed help to “settle in”. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are assured of a service that meets their individual needs by regular reviews and evaluation of their care plans. The health and well being of residents is promoted through regular health care checks and appointments. Residents are supported in taking their medication, as prescribed by their GP, in order to maintain their general health. Discreet and caring support is given to residents by staff so that the privacy and dignity of the resident is respected. EVIDENCE: Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 13 We looked at the case files of 5 residents that have been in residence for over 12 months. Each file contained evidence that the needs of the resident had been identified. From this a plan of care had been developed and the plan was subject to 6 monthly reviews and monthly evaluations. There was also an assessment of the resident in terms of wellbeing/ill being. We saw that review meetings took place about 6 weeks after admission. Some of these meetings and some of the six monthly review meetings had also been attended by relatives, supporting the residents. Relatives were asked on the survey form when the last review meeting was held to discuss the resident’s care plan and placement and whether the relative was invited to attend. Of the 20 relatives that answered this question 15 relatives said that a meeting had been held within the last 12 months (10 relatives said within the last 6 months) and that they had been invited to attend. One relative said that they had requested the review meeting. Files also contained a manual handling care plan and a risk assessment for falling. Individual files contained other risk assessments that were tailored to the particular needs of the resident e.g. the risk of choking when eating. A relative commented on the survey form that they had concerns about the resident’s condition, which they felt should have been raised with them prior to them noticing it themselves. However, another relative commented that they were phoned immediately and always told of any treatment the resident might be receiving. One relative commented, “The arrangements for health needs (GP, physiotherapy, dental care and prescriptions) seem very well organised”. A resident said that a member of staff escorts the resident when the resident has an out patient appointment at hospital and the resident commented “I couldn’t have done it on my own”. On one of the inspection days we met the physiotherapist that is on duty in the home on 2 days per week and she said that between her visits members of staff follow on with the exercises set. The manager said that a trained fitness instructor also visited the home to lead gentle exercises that were suitable for residents to do while seated. We looked at the 5 case files in respect of health care information and there was evidence that a record of the resident’s weight was kept on a monthly basis. Residents had appointments with the GP, DN, chiropodist, dietician, psychiatrist, dentist and optician, as necessary. Medication is kept in a room and there are separate trolleys for the units. Inside the trolleys we saw that the storage of medication was orderly and that the home uses a blister pack system. Blisters had been appropriately “popped” according to the day of the week and the time of the day that the blister packs were examined. We saw that while most blister packs started with a Sunday and finished on a Saturday for the week there were some that started on a Friday and finished on a Thursday, which could cause an error if the member of staff was not vigilant. When examining the blister packs they were placed on a flat surface and when a collection of blister packs (linked by a Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 14 ring binder system) were then returned to the trolley there was a loose senna tablet on the flat surface. We think that the tablet had been caught up in the silver foil at the back of the blister and this had been dislodged as the blister packs were placed on or taken off the flat surface. We examined the records. One box on a MAR sheet had not been initialled for a resident during one medication round. Each resident has their own single bedroom and some rooms have an ensuite toilet. A resident that had an ensuite facility appreciated the privacy that this gave. Single bedrooms give residents somewhere they can entertain visitors in private and privacy when the GP or other health care professional needs to talk with them or to examine them. We noted that if a member of staff wanted to enter a resident’s room they knocked on the door and waited for the resident to invite them in. During the inspection we saw that assistance with toileting was offered discreetly and tactfully. Residents praised the staff that supported them and a resident said that the carers were “so kind”. A relative commented on the survey form “even if they have a piece of clothing that is crooked they straighten it” and “they speak to all the residents with respect and kindness”. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. A comprehensive programme of activities, both inside and outside the home provide residents with opportunities for stimulation and enjoyment. Residents said that they enjoyed the company of their visitors, who were made welcome by the staff when they visited the home. Residents praised the atmosphere in Edinburgh House and said that they were able to exercise choice in their daily lives. Residents’ nutritional needs are met through the provision of a diet that is wholesome and varied and which is in accordance with religious and dietary laws. EVIDENCE: Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 16 A relative commented on the survey form that their elderly parent is always telling the relative about the enjoyment the resident has. The relative goes on to confirm that there are various entertainments and trips that are fun and stimulating. Another relative said that the home has a “good activity programme”. We saw on display in the entrance hall a poster for a show to be held in the home in July. The weekly activities programme was also on display. Activities included a Yiddish group, board games, bingo, word games, movement and music, skittles and walks on a 1:1 basis. We spoke with the activities co-ordinator and during the inspection saw the residents taking part in a discussion group and in a poetry reading session assemble and begin the activity. We spoke with residents after the poetry session and they were lively and enthusiastic about the session. Residents have the opportunity to take part in activities within the home, attend a friendship club or a day centre and go on outings as the home has its own transport. The co-ordinator talked about encouraging a “feel good” factor. One relative said that they were very pleased that the home arranged a holiday away for people with dementia. This year is the 5th year that the home has arranged a holiday for some of the residents and for the first week residents from Sunflower lounge (dementia care) went on holiday. Less dependent residents went on holiday for the second week. The choice of accommodation and catering arrangements were in accordance with the Jewish faith and all arrangements were first discussed with the executive committee. On the last day of the inspection the photographs from the holiday were on display and these showed the residents having fun. Two residents said that their family or friends visited them in the home and that the staff on duty made them welcome. They said that they could sit and talk with their friends in the lounges or in the privacy of their rooms. They added that their friends were offered a cup of tea when they visited. During the inspection we saw visitors meeting and greeting residents and saw that the relatives “felt at home” in Edinburgh House. We noted that one of the resident’s case files that we saw included a record of the resident’s wish not to see a particular family member and this wish is respected. The manager has drawn on resources in the community to support a resident that is Farsi speaking by arranging for volunteers to visit the home twice a week that can speak Farsi. One of the members of staff speaks Farsi and a communication board has been drawn up to help other members of staff. Residents are encouraged to make choices in their day to day lives and residents said that they were able to choose whether they wish to take part in activities, choose whether they want to spend time in their rooms, choose whether they want to socialise, choose from dishes on the menu and choose when they get up in the morning and when they go to bed at night. One resident was sitting in a chair in the main lounge that they had chosen to bring with them when they were admitted to the home. Other residents had Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 17 personalised their rooms with small items of furniture, pictures and ornaments that they had brought with them to Edinburgh House. The home has a 4-week menu cycle. At the time of the inspection the special Passover menus were being used. These menus are drawn up with the assistance of a member of the executive committee. At lunchtime there are homemade soups and a choice of 2 main meals so that a vegetarian option is available. At supper there is soup and a choice from 2 light meals. On Friday the main meal is served in the evening and the light meal is served at lunchtime. We saw that the menu included fresh fruits and vegetables and the manager said that residents are encouraged to have their “5 portions a day”. The menus were varied, wholesome and with choice within the food groups, as appropriate. The home also provides meals suitable for low fat diets and for diabetic residents. A relative commented on the survey form that staff sit with residents “prompting and aiding” feeding and “caring and ensuring they are eating well and good food is provided”. Another relative said that the home provided “good and varied menus”. One relative said that the food is “very good” and another said that it was “excellent”. A resident also said that the food and the cook were “excellent”. The resident was pleased that the home was able to offer them meals at a later time in the evening when the resident returned from synagogue during Passover. Another resident said that they needed to have their food pureed and that “it doesn’t taste too bad”. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. A complaints procedure was in place and residents said that they were able to bring any concerns to the attention of the manager or to senior members of staff. Protection of vulnerable adults training for staff and familiarity with the home’s procedure and the interagency guidelines contribute towards the safety of residents. EVIDENCE: A copy of the complaints procedure was prominently on display in the reception area. The procedure included timescales for each stage of the process and referred to the CSCI. The manager said that no new complaints have been received since December 2007. Records were inspected and we saw that records included the date that the complaint had been made, the name of the complainant, the content of the complaint, details of the investigation carried out and contact with the complainant to notify them of the outcome. A summary of the complaints received, recorded on a monitoring form at the front of the complaints book would be useful. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 19 A copy of the complaints procedure is placed in the brochure. Residents taking part in the inspection said that if they had a complaint they would speak to someone in the home, mentioning the manager or senior staff. Nineteen of the 21 relatives that completed a survey form said that they knew how to make a complaint about the care provided by the home if they needed to. One relative said that they could not remember whether they had been given information on how to make a complaint. A relative commented, “We have been given a copy of the complaints brochure”. Another relative said that they were supplied with a full care pack on admission and have been told several times if they have any concerns, worries or complaints, how to do this. One relative said that on the rare occasion that they have mentioned a concern “it has been addressed straight away and sorted”. There is a protection of vulnerable adults policy and procedure in place. It includes a link to the whistle blowing procedure. Training is given to staff during their NVQ studies. The manager has attended a training course since the last inspection and is now qualified to train members of staff regarding adult protection procedures during in house sessions. Staff that we spoke with during the inspection confirmed that they had received training and were able to describe their responsibilities in the event of an allegation or incident of abuse. There is a copy in the home of the local authority interagency guidelines in the event of abuse. The manager said that a relative had notified her of an allegation of possible abuse and she has referred this to the adult protection co-ordinator in the local authority, the placing authority and the CSCI. Policies and procedures are in place in relation to the safe handling of residents’ monies and in relation to the conduct of staff e.g. not accepting gifts or gratuities from a resident. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents enjoy comfortable surroundings that are maintained to a good standard. Residents are assured of hygienic surroundings as good standards of cleanliness prevail. Odour control systems must assure each resident of being able to enjoy a bedroom that is odour free. EVIDENCE: The location of the home is by a busy main road in Wembley and it is close to a synagogue. It is conveniently sited for bus routes, underground stations and shops. During the inspection a site visit was carried out and it was noted that Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 21 the home was in a good state of repair with furnishings and fittings of a good quality. There are a number of lounge areas in the home and decoration, ornaments and layout are designed to give them a “homely” appearance. A relative commented on the survey form about the homely environment and gave the example of the home having pets (cats and goldfish). A resident said that their room was “lovely” and other residents expressed satisfaction with the accommodation. There is an attractive garden and patio area, which is popular in good weather with residents and their visitors. Changes to the layout of the ground floor are planned and these were discussed during the inspection and highlighted in the comments included in the AQAA. The proposed changes address concerns raised by relatives about the location of the high dependency unit on the second floor. This unit is to be relocated on the ground floor. Staff receive training in food hygiene and infection control procedures during their NVQ studies. The manager confirmed that additional training in infection control procedures is arranged on a regular basis. There has also been the opportunity to attend training for caring for a resident with MRSA. It was noted during the site visit that all areas of the home were clean and tidy and with the exception of one of the residents’ bedrooms were free from offensive odours. Laundry facilities are sited away from any areas where food is stored, prepared or consumed. Washing machine programmes have a sluicing cycle. A relative commented on the survey form that there is a lack of unpleasant odours in the home and 2 relatives commented that the home is always very clean. Another relative said that the resident’s room was spotless. Residents said that the home was “very clean”. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Although residents are assured of sufficient staff on duty to meet their needs the deployment of staff during handover sessions may compromise this. Residents benefit from a service provided by carers that have demonstrated their skills and understanding through NVQ training. Recruitment practices protect the safety and welfare of residents. A comprehensive programme of training for staff encourages good working practices. However, residents would be assured that the training programme supports the aims and objectives of the home if a training plan is developed, based on individual training profiles. EVIDENCE: Staffing levels within the home were discussed with the manager and a copy of the rota was available. Teams of carers are allocated to each of the 4 lounges in the home and are supported by a unit manager and /or Team Leader(s). Staffing levels are sufficient to meet the existing needs of current residents. The manager said that the deployment of staff within the home is kept under Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 23 review and that a domestic will now put items of laundry away in the bedrooms for Sunflower unit and tidy the rooms so that the carers have more time in the afternoons to spend with residents. A relative commented on the survey form “a good ratio of staff to residents. Staff often have time to talk and listen to residents socially”. Another relative commented on the survey form “the home needs to rethink how handovers between staff coming onto/going off duty are managed, particularly between the late shift and the night shift”. When this happens “there are often no staff members visible/easily available”. A discussion took place with the manger regarding NVQ training for carers. She said that 95 have completed either an NVQ level 2 or 3 qualification. The target for care homes to reach is one of 50 of carers achieving an NVQ level 2 qualification. The home has exceeded this. A relative commented on the survey form “the staff are well trained, gentle, sweet, sensitive and understanding”. Another relative said “all the staff at Edinburgh House are excellent, confident in their work duties, seeing to all the members needs”. One relative described them as “little angels” as they are so helpful and obliging. Some one else said, “The staff put real love and care into the residents”. However, a relative commented that the long-standing care staff are wonderful but the new younger care staff have a lot to learn. Residents said that carers were “very nice and helpful, very friendly”, “nice” and “so kind”. Four staff files were examined to check the thoroughness of recruitment practices. We saw that each file contained an application form, a pova first check and enhanced CRB disclosure, 2 satisfactory references and proof of identity (passport details. Where necessary, the right to work and to reside in the UK had been established. Edinburgh House has achieved Investors in People accreditation and their certificate was on display. The home has an active training programme for staff and in April a group of staff, mainly from Sunflower lounge, attended a person centred care course. Last September a number of staff attended a 4day dementia care mapping course and senior staff attended an intensive first aid course. In February this year 95 of staff working in the home, including domestics, attended an update course on understanding the basics of dementia care. The manager said that all unit leaders or team leaders have done a level 3 qualification in First Line Management. There is a need to draw up a training plan for the staff team, based on individual training profiles, that supports the aims and objectives of the service. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People who use this service experience excellent outcomes in this area. This judgement has been made using available evidence including a visit to this service. Continuing to undertake further training enables the manager to develop her knowledge, skills and understanding and to provide a service that is responsive to the needs of residents. Information gained through the quality assurance systems is used to shape the future development of the service and ensure that the changing needs of residents are met. Support is given to residents who need assistance in managing their finances so that residents’ financial interests are protected. Training for staff in safe working practice topics promotes the health and safety of residents, staff and visitors to the home. Testing and servicing of equipment and systems in the home demonstrate that they continue to be safe to use. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 25 EVIDENCE: The manager has completed the RMA. She was appointed to the post of manager of the home prior to the Commission for Social Care Inspection and prior to its predecessor, the National Care Standards Commission. Since the previous key inspection she has started a degree course in Dementia Studies and she completed a health and safety courses for managers and supervisors in March 2008. Certificates on display in the manager’s office were in respect of dementia care training, risk assessment training, managing and working safely and an NVQ internal verifiers award. A relative commented on the survey form that the home was well run and another relative said, “the manager particularly seems very experienced, knowledgeable, helpful and informative”. The manager said that a quality assurance assessment/feedback from staff of the service provided by the Sunflower Unit (dementia care) was being carried out while staff were supporting most of the residents from this unit on a holiday. The annual quality assurance surveys were sent out in January 2008 and the information received has been reviewed. Changes in the catering arrangements have taken place as a result. Also a copy of the complaints procedure is now on display close to the visitors’ book. Monthly residents’ meetings are now in place and the chairperson informs the manager of any points for action. There is also a residents’ discussion group where from which comments on the quality of the care are passed to the manager. We saw that the manager walked around the home each day and stopped to greet residents and to ask then how they were and to listen to any concerns that they might have. It was observed during the inspection that the manager and senior staff have an “open door” policy, which applies to residents and their relatives. The manager spends time in the home during some of the evenings and at weekends so is able to meet relatives that may have difficulties visiting the home during weekdays. Relatives are invited to attend the Annual Court (AGM) and this meeting includes a question and answer session. Relatives also have the right to contact members of the executive committee. Committee members visit the home, including on an unannounced basis, and feedback their comments to the home during committee meetings attended by the manager of the home. A relative suggested on the survey form “there could be more involvement of relatives in relation to fund raising and perhaps an in house magazine”. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 26 Six residents have assistance from the home with their personal allowances but no one in the company acts as an appointee. If a resident prefers to receive their allowance each week, records are kept. The resident signs to acknowledge receipt of the allowance. Other residents have their own accounts and their personal allowance is transferred into their account. The records include a running total, details of any items of expenditure (accompanied by receipts) and details of credits into the accounts. Detailed records of money left with the home by relatives on behalf of residents are also kept. Accounts are subject to auditing by an accountant. Policies and procedures are in place in respect of handling residents’ finances. Health and safety documentation in the home was kept in good order and was comprehensive. There were valid certificates for the servicing/checking of the hoists and lifts. Fire extinguishers had been serviced in February 2008. The fire alarms are inspected over the period of a year with 25 being inspected each quarter. The most recent inspection had been carried out in April 2008. The electrical installation is tested over a 5-year period with 20 being tested each year. The most recent certificate for this had been issued in December 2007. There was an up to date Landlord’s Gas Safety Record and evidence that a bacteriological analysis of the water had been carried out in August 2007. There was evidence that fire drills are carried out on a regular basis and that a list of attendees is kept. Fire alarm testing is carried out on a weekly basis and was up to date. A visit by the Environmental Health Officer had taken place in April 2008. The report said that “the standard of food hygiene noted at the time of the visit was good and there were adequate measures n place to ensure food safety”. There was evidence that staff have received training in safe working practice topics. Last month the manager and the team leaders all undertook training in health and safety for managers and supervisors. The accident book was available for inspection. A copy of the employer’s liability insurance certificate was on display and covered the period between the 1st November 2007 and the 31st October 2008. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 3 X X 4 Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 16(2) Requirement In order to assure each resident of a bedroom that is free from odours a system must be in place to identify when there are problems with continence and to keep odours under control. In order to assure residents that staff support is readily available during handover sessions the manager must review how this task can be carried out with minimal disruption to residents. To assure residents that the programme of training provided to staff supports the aims and objectives of the home a training plan must be developed, based on individual training profiles. Timescale for action 01/08/08 2 OP27 18(1) 01/08/08 3 OP30 18(1) 01/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000017448.V361140.R01.S.doc Version 5.2 Page 29 Spanish & Portuguese Jews Home For The Aged 1 2 OP3 OP9 3 OP9 4 5 OP9 OP33 That all forms completed during the assessment process are dated before being placed on the resident’s case file. That after administering the medication during a medication round the person checks all the records before replacing the record books in the room to ensure that each box on the MAR sheet is initialled. That before “popping” the blister the number of tablets in the blister is counted so that the member of staff can check that all the tablets have dropped into the plastic cup. That the pharmacist is asked to supply blister packs that begin on the same day of the week as the other blister packs. That ways of involving relatives in fund raising for the home are discussed and developed and that the management team within the home consider the development of an in house magazine. Spanish & Portuguese Jews Home For The Aged DS0000017448.V361140.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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