The Care Quality Commission
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Archived: Jack Simpson House Residential Home

Overall: Good read more about inspection ratings

North Street, Heavitree, Exeter, Devon, EX1 2RH (01392) 686486

Provided and run by:
Guinness Care and Support Limited

Important: The provider of this service changed. See new profile

All Inspections

3 December 2014

During a routine inspection

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.

1 July 2013

During a routine inspection

Jack Simpson House provides care and support for older people. We talked with six people who lived at the home, seven staff including the manager two visiting professionals and three relatives. We looked at the care records of nine people living in the home including records relating to their community nursing support. There were 29 people living in the home at the time of our inspection.

We inspected the home as we had found some aspects of the service did not meet the standards expected when we last inspected the home in April 2013. The provider now had a more stable management structure and improvements had been made. The people we spoke with and their visitors were complimentary about the home and told us they had been involved in planning their care, treatment and support. One person told us, 'It's a very good home, I'm well looked after. I'm very satisfied here.' We saw how people's care and welfare was provided with dignity and respect in line with their identified needs.

People received a balanced and nutritious diet which met their needs. There was a varied menu with a choice of two meals at each meal time. Other choices not listed on the menu were also seen to be available. People told us that, 'The meals are very good here, I've no cause to grumble,' and 'We get a good choice of meals here.'

Medication was now managed more effectively following a change in pharmacist and additional staff training. People received their medication as prescribed by their GP and record keeping relating to medicines had improved.

The home was well maintained, secure and accessible to all people using the service.

Records relating to people's care had been reviewed and updated and reflected more accurately the current needs of people living in the home. Staff demonstrated a good knowledge of people's needs and how to meet them.

16 April 2013

During a routine inspection

Jack Simpson House provides care and support for older people. We talked with six people who lived at the home, nine staff including the providers' compliance manager, the acting manager and four relatives. We looked at the care records of six people living in the home including records relating to their community nursing support. There were 32 people living in the home at the time of our inspection.

The home had recently under gone a number of management changes which had led to an inconsistent service; however a more stable structure was now in place. The people we spoke with and their visitors were complimentary about the home and told us they had been consulted about their care, treatment and support. We saw how people's care and welfare was provided with dignity and respect in line with their care needs.

Medication was not always managed in a way which ensured people received their medication as prescribed by their GP and some recording was not correct.

The recent inconsistencies in the service management had led to quality assurance processes which fell below the levels expected by the providers policies; however we saw audits and checks were in place for services such as fire, Legionella testing and maintenance and improvements had been identified.

Records were not always complete and care plans did not always reflect the current needs of people living in the home; however staff demonstrated a good knowledge of people's needs and how to meet them.

25 July 2012

During a routine inspection

This was our fourth visit to Jack Simpson House since the introduction of the Health and Social Care Act 2008 (HSCA). Our first visit was a responsive inspection in April 2011 in response to a whole home safeguarding alert, which has now been closed as the professionals involved are now satisfied that significant improvements have been made within the service. Throughout this process, Guinness Care and Support Limited worked closely with the professionals involved to provide reassurance that identified concerns were being taken seriously.

When we last visited Jack Simpson House in October 2011, we found that improvements had begun but that further work was needed before the service was compliant with the HSCA. The service provided us with a comprehensive action plan which detailed how they were addressing concerns.

During this unannounced inspection on 25 July 2012, we saw that further improvement work had taken place and that staff were committed to maintaining good standards of care. We spent over seven hours at the home. This meant that the service was compliant under the HSCA and no compliance actions were made on this inspection.

The manager told us that there were 28 people living at the home. During this visit, we spoke with seven people who lived at Jack Simpson House. We also looked at surveys completed by six people about their views on the home and the care provided. We spent time in the dining room while people were being served their lunch, which helped provide insight into the quality of people's care. We also spoke with four staff members and looked at records, including care plans, recruitment records and quality assurance records. We also completed a tour of the building with the registered manager who showed us the improvements that had been made to the environment.

Three people told us how their dignity was respected by staff who supported them with personal care. They told us they did not feel embarrassed and felt at ease with staff. Other people told us the standard of care was 'good'. Six people said in response to a survey sent out by Guinness Care and Support Limited that they felt valued as an individual and felt that their views were considered.

Our conversations with people living at the home confirmed that they were happy with the quality of care and access to health professionals. People told us about their opportunities to be involved in activities in the home, such as the knitting club. We saw that posters were displayed advertising trips to the seaside and people told us that they were supported to visit the local shops, although one person wished this could happen more often.

People living at the home told us that their rooms and the home were kept clean. They told us they were happy with their surroundings. Several people commented positively on the work that had taken place in the courtyard to make it a more pleasant place to sit. We saw people using this area during our visit.

People living at the home expressed satisfaction with the quality of the staff. People told us that there were residents' meetings where their views were sought on changes and improvement to the home. Some people told us that they chose not to attend but other people said they appreciated the meetings and felt listened to. One person told us about the action that had taken place in response to requests or suggestions from people living at the home, for example, providing cooked breakfasts and buying a darts board for the home.

4 November 2011

During an inspection looking at part of the service

This was our third visit to Jack Simpson House in 2011. Our first visit was a responsive inspection in April 2011 in response to a whole home safeguarding alert, which remains open. This type of inspection meant that we focussed on key areas of concern. We returned in June 2011 to carry out a planned inspection, which included 16 essential standards under the Health and Social Care Act 2008 (HSCA) to check on improvements. Our third inspection was in November 2011 and the purpose was to check for improvement against the action plan that Guinness Care and Support Limited (Guinness) had supplied. An action plan was required as there were 12 standards that were not compliant with the HSCA on our last visit.

After our inspection, the Care Quality Commission held a management review meeting to help us decide what actions we would take because of a lack of improvement in three areas of care. We will review the quality of care at the home again in early 2012.

During our unannounced inspection on 4 November 2011, we were joined by an expert by experience from Age UK, whose role was to speak with people living at Jack Simpson House to gain their views on their care. The expert by experience spoke with 15 people and two relatives. We also spoke with two further people living at the home, and spoke by phone with two relatives.

The expert by experience told us that as a result of their conversations with people living at the home, there were no concerns raised regarding staff practice and how they were treated. However, people told the expert by experience that they wished staff could spend more time with them and talk to them while they supported them. Some people said in their response to a Guinness survey that they did not feel they were treated as an individual. People living at the home and relatives visiting the home gave us individual staff names who they felt had a kind and courteous manner but the overall ethos of the home was not one where dignity and respect was always maintained by all staff.

The expert by experience told us that as a result of their conversations with people living at the home, there were no direct concerns raised regarding their care but people indicated that they were unclear about the content of their care plan, which showed a lack of involvement in what was recorded within them.

People told the expert by experience that they sometimes had to wait a long time for their call bell to be answered, and they said this was because in their opinion there were not enough staff on duty. Since our last inspection, there have been several day trips and people told the expert by experience how much they enjoyed these experiences. People said there was no structured timetable and people's impression was that activities only took place if staff had time.

We saw when we arrived that a person was eating a cooked breakfast in the dining room. This reflected the action plan submitted by Guinness to CQC, which said that the morning kitchen shift would start earlier to ensure that a cooked breakfast was a regular option for people living at the home. The expert by experience did not ask people specific questions relating to mealtimes but no one raised meals as a concern.

People told the expert by experience that they had no problems with accessing health services.

The expert by experience did not ask people specific questions relating to safeguarding.

The expert by experience did not ask people specific questions relating to medication. However, we saw during our inspection that the medication rounds were finished earlier than on our last visit and two seniors were designated for this duty. On this inspection, staff told us that medication rounds were now generally quicker and there were fewer interruptions for the staff administering medication, which made practice safer.

The expert by experience said that people had no strong views on the home's security.

People said there was a residents' committee at the home but not everybody had become involved. People told the expert by experience that they had concerns about staffing levels and their opinion was that the handover period between the evening shift and night staff was particularly problematic as some people said they were tired but had to wait for help to go to bed or tried to manage alone.

The expert by experience did not ask people living at the home to comment on record keeping.

People told the expert by experience that the manager was approachable and this was confirmed by two relatives that we spoke to. We saw that people living at the home and people visiting the home seemed at ease with the manager.

23, 24 June 2011

During a routine inspection

During our visit to Jack Simpson House we talked to eight people who lived in the home and observed other people interacting with staff in a positive way. People told us that they received the care and support they needed at the times, and in the way, they requested. They were also confident that any concerns or complaints they had would be dealt with satisfactorily by the staff team.

Staff treated people in a friendly and respectful way and were attentive and quick to recognise when people needed assistance. However we also overheard a staff member speaking inappropriately and disrespectfully to a person who lived in the home and none of the staff who were present raised this as an issue with the manager. We found that people are not always treated with respect and their dignity was not always upheld by every member of the staff team.

The care planning system was not person-centred, proactive or up to date therefore some essential care needs were not being met.

Whilst people had no complaints about the food provided in the home, their right to choose meals and change their minds about what they wanted to eat was not always respected by every staff member.

The home was clean and well maintained but some staff members were not complying with infection control practices which puts people at risk of infection.

Medication systems were not robust and people were not always receiving the medication they needed at the correct times.

Staff recruitment procedures were not thorough enough to ensure that new staff members were suitable to work with vulnerable people but staff received an induction and ongoing training following recruitment.

4 April 2011

During an inspection in response to concerns

We spoke with nine people who were living at the home; seven people in their rooms and two people in a communal area. People expressed satisfaction with their care, and generally felt carers knew what to do to assist them. Two people commented that they would also tell carers what to do if they did not know. People felt generally listened to by staff, although one person told us they had learnt to 'be tolerant' and another felt that some staff did not appreciate the impact that pain could have on their mood and sense of well-being.

We heard an interaction between staff members providing personal care for someone living at the home. The person sounded unhappy, and a staff member's response did not sound appropriate. We asked a senior to check on the well-being of the person. We also met with the person afterwards but they did not raise any concerns with us.

Several people described staff as 'lovely' and said 'some are very good'. Two people spoke positively about the role of their key worker, who assisted them with certain areas of care, such as having a bath.

We visited ten bedrooms, all of which were clean and odour free. The people that we met took a pride in their surroundings, and expressed satisfaction with the size of their rooms, the en-suite facilities and the cleanliness. These comments showed that these factors contributed to people's sense of well-being. Everybody we met told us they were warm and that their rooms were warm.

The nine people that we spoke to generally expressed satisfaction with their care, and appeared relaxed in their surroundings and with staff. Although there had been a number of thefts at the home and the police had been involved, nobody that we spoke with raised this as a concern. We saw that during a residents' meeting people had been offered reassurance and a secure place to keep items.

We did not ask people directly about their medication as this was not area we had planned to cover during this responsive review. However, we observed while looking at records in a communal area that some practice needed to be improved. For example, for some people there was interaction between the staff member and themselves about their medication, but on one occasion a staff member stood over a person to give them liquid medication whilst speaking to another staff member, which is not good practice.

We were told by people living at the home that agency staff were no longer being used and that there were 'lots of different faces'. Recently a group of ten new staff have been recruited. People told us that new staff were 'shadowing' more experienced members of staff to learn how to care for people, and staff confirmed this arrangement, which was also reflected on the duty rota.

We spoke to nine people and they expressed satisfaction at the competency of the people that provided their care. However, a number of people expressed concern about a lack of leadership at the home, and wanted to know what was happening regarding the role of manager.

People told us about the recent residents' meetings (there was one in November 2010 and one in February 2011) and we could see from the minutes for one meeting that people who chose to attend had the opportunity to influence aspects of the service, such as the range of meals offered and places to visit. People told us that they were not regularly asked if they were happy with their care, but several said they were quite vocal and would soon let people know if they weren't.

We asked nine people that lived at the home if they knew how to make a complaint. Most people told us that they would go to the home's office and speak to the seniors. They felt confident that issues would be addressed. However, for some people who needed assistance from others to move around the building, they told us they were less sure how they would make a complaint. Most people were clear that they did not have any complaints.