Background to this inspection
Updated
8 May 2015
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
Prior to the inspection we reviewed a range of information to ensure we were addressing potential areas of concern and to identify good practice. This included the Provider Information Record (PIR), which asks the provider to give some key information about the service, including what the service does well and improvements they plan to make. We also reviewed previous inspection reports and other information held by CQC, such as notifications. A notification is information about important events which the service is required to tell us about by law.
The inspection took place on 3 December 2014 and was unannounced. We were accompanied by an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. Their area of expertise was in older people and dementia care.
We spoke with spoke with eight people who lived in the home. We alsospoke with seven visitors including relatives, friends and also representatives of an organisation which provided links with the community. We observed staff supporting people in the lounge areas and dining room. We also spoke with the manager and three members of staff. After the inspection we wrote to eight health and social care professionals to ask for their views on the service. We received comments from one community nurse who visited the home regularly. We looked at the care records for three people, observed the midday medication administration round, walked around the home, and looked at records of recruitment, training, supervision, maintenance and quality assurance.
Updated
8 May 2015
The inspection took place on 3 December 2014 and was unannounced. The service was previously inspected on 13 July 2013 when it was found to be fully compliant.
Jack Simpson House is registered to provide accommodation for 35 older people who require personal care. They do not provide nursing care. Nursing is provided by the local NHS community team who visit when required to meet individual nursing needs.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
We saw and heard examples of staff demonstrating care and taking pride in their jobs, for example, one staff told us “It makes me happy if people appreciate my care. It is important to me that I have followed people’s wishes. I want people to feel happy with my care.” However, we also saw some missed opportunities to offer reassurance, information or greater understanding for when staff walked past a person who was agitated.
People told us they felt safe. Comments included “I feel more secure here. I chose it and I’ve never regretted coming here…if I’m taken ill they do everything for me.” Security of the home had been improved in the last year with the installation of security cameras at various points outside the home. A new call bell system had also been installed after people had complained about the waiting time for call bells to be answered. The new call bell system could be monitored easily to check call bells had been answered promptly.
Staffing levels had been increased in recent months and more staff were in the process of being recruited to complete the staff team and reduce the use of agency staff. Most people we spoke with had seen improvements in the staffing levels and said staff provided assistance when needed. Three people said at times call bells were not answered promptly but evidence showed this was no longer the case since new staff had started. Staff said staffing levels had improved and they were able to meet people’s needs.
Medicines were administered safely. Each person had been assessed to check on their preferences and needs relating to storage and administration of their medicines. Secure storage facilities for medicines were provided in each bedroom. Some people had agreed to their midday medicines being stored in a secure medicine trolley which was taken to the dining room at lunch time. People said their medication was given on time and brought to wherever they were in the home, for example it was administered to them in their rooms if they wished to stay in bed.
Staff received induction and ongoing training on all health and safety related topics, and other topics relevant to the needs of people living in the home. The registered manager was aware of the need to provide training on dementia and was in the process of arranging this. Staff said they received regular supervision and good support. “If I have any queries I can go to someone else and they will give me the time to answer my queries.”
The registered manager and staff understood the Mental Capacity Act (2005) (MCA) and how it applied to their practice. The registered manager had made a Deprivation of Liberty Safeguards (DoLS) application for one person. They were also considering the possible need to make similar applications for other people who may be unable to leave the home safely because of the risk of harm or accident.
People were offered a good choice and variety of food and drink. Menus showed there were at least two main options for the midday meal each day plus special meals for people with dietary needs such as diabetes. Drinks and snacks were available throughout the day. Staff met with every person each day to let them know what was on the menu for the following day.
Most staff understood how to comfort people when they were upset, although we saw some staff missed opportunities to reassure a person who was agitated while waiting for their lunch. The registered manager said this had been discussed in staff meetings and also informally with staff. They had seen improvements in the way staff ‘connected’ with people in recent months. They told us “We are not there yet, but we are getting there.” After our inspection they told us about improvements they had made to support people at meal times including staff allocated to sit with people who showed signs of agitation. They had also further staff training to help staff understand how people
Each person had a care plan which set out their normal daily routine, personal and health care needs and the support they needed from staff. People had been fully involved and consulted over their care plans. Staff said they had spent time with people finding out about their personal histories. Staff explained the care plans were easy to use and they were able to find important information quickly. People told us they had access to whatever medical support they needed. Risks to each person’s health had been assessed and regularly reviewed.
People enjoyed a varied programme of activities. They had identified each person’s interests and talents and had been creative about how they could support and promote each person to lead a fulfilling life. There were weekly visits from students who ran a reading project. Poems people had chosen or written were attractively printed and framed and displayed around the home. One person had written a pantomime and a local secondary school was about to put on a public performance. A choir from a local school visited the home regularly. Group activities included quizzes and board games.
The home was well run. People were consulted about all aspects of the routines and management of the home through regular residents’ meetings. Since our last inspection the management structure had been reviewed and the post of team leader had been introduced. On-call management arrangements had also been reviewed to ensure cover was available to staff outside of normal working hours. The manager and provider had a range of monitoring procedures in place to make sure the home was running smoothly and people received the care they needed. Monthly monitoring visits were carried out by a senior manager on behalf of the provider. They also asked people, relatives and visitors to complete annual questionnaires. Action plans were drawn up to address any improvements identified.