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Inspection on 10/11/08 for Peter Shore Court

Also see our care home review for Peter Shore Court for more information

This is the latest available inspection report for this service, carried out on 10th November 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The health, personal and social care needs of individuals are set out in their individual care plans and are generally being met. A range of policies and procedures are in place and systems are in place to ensure these are implemented. The expert states the residents who are most articulate in this home seem to be generally satisfied with it and were complimentary about the staff, the care and the surroundings. The service supports people to continue practising their religious faith.

What has improved since the last inspection?

There are no outstanding requirements from the last inspection. Improvements include better care plans and improved management monitoring of work. Overall the manager of the home with support from senior management of the organisation has taken effective action to address staffing issues, including more support and training for staff, minimising staff complaints. This has resulted in improved staff morale and staff performance and therefore better service provision at Peter Shore Court. This was reflected in the positive views expressed by people living in the home. Some people we spoke with said that they loved the home and that the carers could not be nicer.

What the care home could do better:

Whilst individual care needs are on the whole well identified and met, this needs to extend to all individuals and is an area where the home could improve further. The service needs to evidence better consultation and the outcome of this consultation with individuals in the home about matters which directly affect the way their service is run. Recommendations are given to ensure the environment is conducive to meeting the needs and comfort of people living in the home.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Peter Shore Court Beaumont Square Stepney London E1 4NA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nurcan Culleton     Date: 1 0 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. the things that people have said are important to them: They reflect 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 36 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Peter Shore Court Beaumont Square Stepney London E1 4NA 02077902660 02077907331 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Miss Cheryl McShane Type of registration: Number of places registered: Dovecote Manor Healthcare Ltd t/a Dovecote Manor care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 41 The registered person may provide the following category of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Peter Shore Court is a purpose built residential home providing personal care and support for 41 older people. The premises consist of four separate units, located on the two floors. They contain day rooms for dining and social functions and an additional big lounge area on the ground floor for large functions. All bedrooms are en suite rooms. There is also a quiet/smoking area. The home has lift facilities and aids and is suitable for people with disabilities. It is located within Stepney Green and is a short distance to Care Homes for Older People Page 4 of 36 Over 65 41 0 Brief description of the care home Mile End, the Royal London Hospital and the City. The home is within walking distance of local shops, amenities and transport links. The fees are currently a minimum of 440 pounds per week and are subject to review. Care Homes for Older People Page 5 of 36 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: This unannounced inspection was conducted on 10.11.08 with one inspector and an expert by experience. This is a person with personal experience of a similar service who could give their independent point of view. This inspection reviewed the requirements made at the last inspection and examined whether improvements had been made to the service. The inspector spoke with residents whilst touring the premises, interviewed the manager and four staff. The regional manager was also present during the inspection. We looked at the files of people using the service including their care plans, assessments, daily records and took into the account the homes AQAA, the Annual Quality Assurance Assessment. This is the homes annual self assessment of their service. Care Homes for Older People Page 6 of 36 At the time of inspection the AQAA stated that there were 37 white British, one person of another white background, two Irish people and one Caribbean person living in the home. They included 24 female and 8 male individuals. Staff employed are from a mix of ethnic backgrounds. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 36 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 9 of 36 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. People are provided with sufficient information about the home to help them make an informed decision about their admission. Individuals needs are assessed and identified prior to their service provision. Evidence: The Statement of Purpose and Service Users Guide have been updated and are available in large print. The Service Users Guide is also illustrated in pictures. Both documents include all the relevant information about the home for prospective users and enquirers about the service. They also need to include the new regionalised contact details for CSCI. The home complete their own Excelcare initial assessments, available in individual files and are reviewed monthly. The home encourages continued religious participation and practice. People we spoke with informed that the carers were very nice. The home has Care Homes for Older People Page 10 of 36 Evidence: shown improvement in the overall service since the last inspection and that outcomes for people in the home have improved or are improving. On this note the service has shown its capacity to meet peoples needs. People are invited to visit and have trial stays before being admitted to the home, and evidence confirmed this in files and by a daughter visiting the home of a person who was recently admitted. The local authority funds most placements. Three people are currently self funding their placements and have individual contracts in their finance files. Care Homes for Older People Page 11 of 36 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. The health, personal and social care needs of individuals are set out in their individual care plans and are generally being met. However the personal care needs of some individuals could be better identified and met taking into account any needs arising from their racial background or needs as a result of disability. Medication practises are good and individuals feel they are treated with dignity and respect. Evidence: The expert who spent time observing and talking to residents recorded the views of people she spoke with. In her report she wrote as follows Resident x told me I love it here. I felt at home the first moment I came here. She also said The carers couldnt be nicer. Another resident, x said she Couldnt be treated better if she was in Buckingham Palace. One resident, x who had suffered a stroke, found communication extremely difficult and no particular aids were being used to help him make his views known, it seems. Care Homes for Older People Page 12 of 36 Evidence: A comment from x was that staff were, A nice crowd. She continued by saying Some of them can be a bit upsy daisy and this ambivalence seemed to be borne out more explicitly in a comment in the minutes of a residents meeting 30.9.08 that Staff can be a bit piggish at night and Some are better than others. Resident X told me that, They dont do black ladies hair here. She has plaited hair which apparently the hairdresser is unfamiliar dealing with. Resident X also mentioned that she would enjoy a massage for her chilblains and said she had aches and pains all over. One resident proudly showed me her nails which had been manicured and painted that afternoon by a carer. We informed the manager about the issues raised. Resident x mentioned that items of clothing go missing from the laundry so he now keeps a tally of items he has sent to be washed and what comes back. We discussed with the manager further issues brought to the attention of the expert by this individual including they had knocked their arm on the call bell attached to the wall when they were pulling their curtains back, which the individual described as jammed. There was a further issue for which the individual is awaiting results of blood tests. The manager stated that she would look into these matters. Resident x said that she enjoyed looking at the squirrels in the park and I understand that attempts are being made to see if she can become a volunteer at a local animal sanctuary. An imaginative idea. The expert wrote that one residents brother, a regular visitor, who visited during this time had told her how he was content with the care that the home offered his sister, and had no complaints. A care plan index form lists the documents contained in individual files. Each file we examined contained a number of key documents related to identify the background history, assessment of needs, care plan, risk assessments and monitoring forms related primarily to health needs. Evidence of consultation with individuals was seen as regards their care plans as each plan had been signed by the individual or their representative. The manager informed that they had liaised with social services for those individuals who could not sign their care plans and had no representatives to sign on their behalf. Wishes after death and responsibility for the management of individuals finances were identified in their files. The regional manager informed that seeking individuals wishes after death or End of Life wishes was a dialogue or process that was ongoing with some individuals due to the sensitivity of the issues being discussed. Care Homes for Older People Page 13 of 36 Evidence: We examined five individual files, each containing in house care plans. Care plans had much improved in their content and detail, better identifying individual personal preferences. One care plan, for example, recording that the individual was able to wash their face but needed assistance to wash their hard to reach areas, that they were able to clean teeth but needed assistance to put on the toothpaste. Their personal preferences were better identified also, such as one care plan stating that the individual likes to have a shower in the morning. Monthly reviews of care plans had improved by giving more detail about individual needs, present situation and actions needed for the month reviewed. For example, a review stating that an individual still required assistance to maintain their hygiene and that the action required was for staff to encourage the individual with this need. This was clearly an improvement compared with records seen at the last inspection where monthly reviews would repeatedly state, for example, that there was no change to identified needs. Daily diary sheets of observation notes made by staff had also improved in their content and detail than at the time of the previous inspection. One observation was made as regards the needs of an individual who has communication difficulties as a result of their physical condition. Their risk assessment identified that their inability to verbally communicate with staff was frustrating for this person. Staff were reliant on interpreting the individuals body language, however we did not consider this to be an effective way to assist the individual to communicate and express themselves. The manager said she would like to have a communication box with pictures in it to assist staff to communicate with the individual. It is recommended that this box is implemented. Outside therapists may be called apon if required. The home uses NHS chiropodists, dentists and opticians. Most treatments are available under NHS, though some treatments or prescriptions may require additional fees. A folder is available for each individual containing Professional Contact Sheets recording contact or visits from health professionals and actions taken or recommended. Carers also note here when they make telephone contact with health professionals. Prior to the inspection we received two notifications by the manager of medication Care Homes for Older People Page 14 of 36 Evidence: administration errors by the seniors. Appropriate action had been taken following these incidents, including daily audit checks, updated training and competence assessment of the seniors. Daily medication audits are now being undertaken, presently by a specialist nurse who is training all staff in medication administration procedures who will be handing over to the senior to take over this responsibility. Medication administration practises covering two units were examined and observed to be satisfactory. Blister packs were checked against medication administered. The date of opening medication had been written on labels containing medication and liquid medicines are returned at the end of the month. Medicines were prescribed individually. Homely remedies are generally avoided though a process is in place to contact the GP if a homely remedy is required. Fridge, freezer temperatures were being recorded. District nurses administer injections and are recorded on the medication administration records. There are no Controlled Drugs being administered in the home at present though a suitable Controlled Drugs cabinet is available. The homes Statement of Purpose has been updated and includes a statement on privacy, dignity, independence, civil rights, choice, and fulfilment. Residents in the home expressed more satisfaction with their service and care than they did at the last inspection. Care Homes for Older People Page 15 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals areas of social interests are better identified and recorded. Individuals are offered opportunities to participate in a range of social and cultural activities of their choosing. The mealtime experience for people in the home could improve and the home needs to evidence better consultation with individuals about their mealtimes. Evidence: The homes Statement of Purpose outlines the daily life and social activities that can be expected in the service. It states that their aim is to provide a lifestyle for service users which satisfies their social, cultural, religious and recreational interests and needs. At the time of the inspection an activity called SONAS was underway in one of the units. Five people were participating in this session with the activities coordinator and another person who was invited from elsewhere in the organisation to assist with the session. SONAS continues on Mondays and Thursdays and the activities coordinator is trained to lead this activitiy. There are a maximum of nine in a session who can participate. It Care Homes for Older People Page 16 of 36 Evidence: is designed for people with profound dementia, involving musical instruments, smells, sounds, taste, which is aimed to stimulate memories. The manager informed that the activity is chosen to take place before lunch as when the participants are more stimulated, they are likely to eat more at lunch time. We observed that the participants appeared to be enjoying the session, though considered that it may be necessary to have two people leading every session, rather than the activities coordinator alone. The expert wrote in her report, Resident X said that on a previous session one resident had found the music too emotional and had needed comforting. During training, X had been advised not to carry out the session on her own particularly in view of unpredictable reactions such as this. It was extremely encouraging to see that the home has invested in this type of activity. Staff and residents both enjoyed themselves. I wonder however if it would make better use of the SONAS resource to group residents more carefully. Abler participants tended to answer more confidently and join in more vigorously than those with dementia. It might be the case that residents who are more extrovert and less cognitively impaired inhibit the confidence of people with dementia. There is a reasonably full timetable of activities for residents. The expert concluded that, The home has taken steps to find an interesting therapy tailored for the needs particularly of people with dementia, which is heartening. I hope they will build on this and ensure that all the residents with dementia do actually benefit from it and that the activity co-ordinator gets the support she needs not only on the day of regulatory inspections. We questioned whether individuals who were not participating in SONAS had sufficient opportunity to participate in social activities at the same time. The manager stated that the aim of the home was to ensure that care workers also participate in undertaking activities with people in the home rather than seeing this as a separate activity that is confined to the role of the activity coordinator. Activity sheets were better recorded providing more detail about individuals social activities. Individuals former areas of interest are identified and recorded in their Pre admission assessment forms which helps with planning the activities for individuals in the home. Activities are generally well run, though not all people attend. People play cards, watch videos, there are dances and someone visits once a month someone to provide entertainment. Individuals birthdays and special occasions are celebrated. People are encouraged to maintain and practise their religious faith. One reverend comes to the home on a Sunday. Two people go currently go to Jewish day centres Care Homes for Older People Page 17 of 36 Evidence: and have been offered the choice of Kosher meals. We observed one person having her nails done in the lounge of one unit and also noted that this individual preference had been recorded in her care plan. Files had better recorded details of activities undertaken by individuals. The Statement of Purpose states that the service aims to help service users to exercise choice and control over their lives. The manager gave examples of individuals who were quite independent in aspects of their personal care or their day to day activities and how this is encouraged. For example, those who liked to do their own laundry or go out wherever to the shop to buy cigarettes, go to Bethnal Green or the bank with members of staff. Some individuals have a savings account which they are able to manager themselves or their representatives manage on their behalf. All people in the home are registered to vote and are able to vote in person or through a postal vote. Outside mail goes to seniors who pass them on to the named individuals and will read it to them if requested or needed. Care plans were seen signed if people express a request to have a key to their bedrooms and their cupboards. There was evidence of contact with family or friends recorded in separate contact sheets. A menu displayed on tables reflected meals served on day. People are asked for their meal choices and alternatives recorded and given to the chef. Food sampled was nutritious and tasty. The following observations were made. When sampling the food we offered only apple juice and not offered an alternative choice of Cranberry juice as was stated on the menu. The Expert stated she did not observe anyone drinking Cranberry juice whilst eating their meal. The manager must ensure that alternative drinks are offered to individuals as may be their preference. Secondly, the manager informed that the home has now implemented a Protected Meal times policy that is a company policy. This means that relatives or friends of individuals can eat together though this must be in a separate room to the main dining areas whilst other residents of the home during meal times. As a result of implementing this policy the manager informed that issues concerning one or two incidents of disruption to other individuals from relatives during mealtimes have been resolved. Due to the policy, we were asked to eat in the main lounge downstairs away from the other residents. Whilst the manager gave the reason, based on their experience, that this was more beneficial to the individuals during mealtimes, we Care Homes for Older People Page 18 of 36 Evidence: questioned this practice which could otherwise be seen as a normal, social activity with its own benefit. The expert questioned whether arrangements at mealtimes was conducive to companionable enjoyment, though accept that the manager has implemented company policy. We considered that any difficulties with particular individuals living in the home or with relatives could be better managed with the individuals concerned rather than adopting a general policy which applies to affects the mealtime experience for all individuals throughout the home. The expert wrote, I was surprised and sorry that the Inspector and I were not welcome to join the residents at lunch. Even if the concept of a Protected Lunchtime had been properly consulted upon, no evidence was produced to show that it had been, there was no good reason to exclude a regulatory inspection team from observing and participating in lunch with residents and the scope of the inspection was restricted as a result. In the case of this being an implementation of company policy, we considered nevertheless that consultation with individuals on this issue is appropriate in any case, given that this effects their daily experiences in the home. At this stage, this may only be possible retrospectively, including peoples views on the policys current implementation. The expert wrote further, Because of a protected mealtimes policy, it was not possible to fully ascertain how residents experienced mealtimes or how staff interacted with them during meals. For the brief period in which I observed meals, residents seemed to eat in silence with little conversation amongst them or offered from carers. The expert continued, A resident, x, commented that the food is not too bad however on the day of the visit it was very good, well presented and appetising. Minutes from a residents meeting noted that meals are not always hot. After lunch I sat in one of the dayrooms and observed staff and residents when refreshments were offered. The member of staff in charge of the drinks had a very pleasant manner towards the residents, but I was a little concerned that the cup of tea for x, a resident with dementia, was balanced on the arm of her chair. Another resident with dementia, x was given tea which was too hot for her. More care is needed to ensure that frailer residents are supervised when taking hot fluids. Care Homes for Older People Page 19 of 36 Evidence: A further observation we made was the information board in one unit which identified diabetic people on the unit who were to have certain foods and drinks due to their medication. The manager stated that it was important for the care staff to be fully reminded of these individuals needs during mealtimes. We considered that the location of the notice itself could be more appropriately hidden away from public view and kept in a way that was still easily accessible to staff, ensuring confidentiality as well as to create an environment that is more pleasant and homely for the people living in the home. Outcomes were recorded in discussions at residents meetings, though this could be improved, for example, with an agenda starting with matters arising to review issues at previous meetings. Care Homes for Older People Page 20 of 36 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. Individuals and staff in the home know how to make a complaint. The complaints procedure is robustly implemented to protect and safeguard the interests of people using the service. Evidence: Following the last inspection, complaints and the complaints procedure have been discussed with individuals in the home, their relatives and with staff, collectively and individually. People in the home have each been asked if they have any complaints and have copies of the complaints procedure in their rooms. All staff were given a copy of the complaints procedure that outlines what constitutes a complaint. There have been three complaints since last inspection in May 2008 from family members and a Community Psychiatric Nurse. These have been investigated and their outcomes recorded in the investigations, though not all had been recorded in the folder containing complaints logs. For accessibility to these records it is recommend that all complaints are also recorded on the complaints log sheets. An anonymous complaint about staffing and management was received and investigated by the Regional Manager, who also had a staff meeting to discuss the issues raised. Staff informed us that the management actions taken over the last few months have had a positive effect on the service they give to people in the home and Care Homes for Older People Page 21 of 36 Evidence: that people in the home are more satisfied with their service as a result. The manager made a safeguarding adults referral to the local authority safeguarding team after suspecting that one of the carers had neglected an individual in the home. The manager informed the home never received any communication back from this team and a strategy meeting never happened. However the manager investigated and the carer underwent disciplinary action. The notes taken indicated a robust investigation and were available for examination. We observed that incidents and accidents recording procedures had been discussed with staff and were clearer to them. Procedures are in place for the management of individual finances. Care plans now identify who is responsible for managing individuals money. One individual however advised the expert that she had difficulty accessing her money and this was discussed with the manager at the time of the inspection. Care Homes for Older People Page 22 of 36 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is an attractive environment that contains is suitably equipped for meeting the needs of people living in the home. Certain aspects of the environment are affecting some individuals and need more consideration to improve their experience and comfort of living in the home. Evidence: The environment is generally pleasant and generally well maintained at Peter Shore Court. It is bright, well ventilated with pictures and photographs adorning the walls throughout the home. Individuals are given opportunities to personalise their rooms and use their own furniture. Evidence was seen of individuals being consulted about the colour scheme of their rooms. There are two lounges used also as dining rooms on each floor, a hairdressing room and there are suitable bathrooms with an Apollo bath on the premises. The large ground floor lounge is used to provide entertainment for all the individuals in the home. The garden at the back now has large containers filled with flowers and seating for people to enjoy an outdoor space if they wish and another garden around the side of the building has also been further improved. Whilst the gardens have seen some Care Homes for Older People Page 23 of 36 Evidence: improvement, we considered that further improvements could be made to create a more attractive and inviting outdoor space for people living in the home. There are aids and adaptations throughout the home, including wheelchairs, hoists and lifts suitable for disabled persons and pressure relieving mattresses, where individuals have been assessed by occupational therapists. The manager informed that maintenance has been improving as she has become firm with the maintenance contractor to ensure that outstanding jobs get done. The Expert by Experience wrote of her observations of the premises in her report as follows, The home consists of four separate units on two floors. Day rooms on each unit for dining and social functions looked attractive and homely, and a spacious lounge area looked a good size for large functions. A quiet smoking room had been provided which understandably, smelt of cigarette smoke. One residents room smelt strongly of urine. Many of the easy chairs in dayrooms had frayed, worn or discoloured arms, resident x described these as disgusting, but otherwise the home looked clean and attractive. A resident showed me her bedroom, which had been recently redecorated to her specification and with which she was delighted. Bathrooms appeared clean. A resident complained to me about the noise of doors banging on the first floor. She said the sound of crashing doors kept her awake at night and gave her headaches. Another resident, also commented on the noisy doors. On the day of the visit heavy rain prevented access to garden areas, but one part, a small paved area, was visible through the door that led out to it. It did not seem a particularly enticing prospect even without the rain, as plants were minimal. A resident told me she was afraid to go out into it on her own as she had found the surface slippery. In the residents rooms which I visited, the call bells were loose by the side of residents beds or on another side of the room. The wall fittings for the bells which would keep them firmly secured in one location seemed to always be at a location away from the bed head. Rather than having the bells loose, would it not be better to move the wall fittings to the bedside? The bell units have long flexible leads which can fall about or the whole bell unit be removed by cleaners or other visitors to the room. Wall fittings for the units which are properly located would ensure that call bells were always in the expected location. We spoke to the manager about these observations. The urine smell in the room may have been as a result of laundry in the room that needed to have been removed, Care Homes for Older People Page 24 of 36 Evidence: however we recommend that should the odour persist, that suitable action is taken to ensure the odour is eliminated from the room. The manager informed that it is the heavy fire doors which cause the noise when they close in the home. The fire doors bang as a result of the draft caused by the windows being open or shut and that the fire doors have been adjusted several times by the maintenance team, however the banging problem remains despite this. The manager explained that the doors are adjusted to shut when the windows are open which causes slight banging of the doors when the windows are shut. We recommended consultation with the fire authority to seek advice as to what solutions may be available to address this problem to improve the comfort and minimise disruption experienced by people living in the home. The manager stated that the call bells were portable for residents in their rooms as they needed, for example, when being transferred to and from chairs that may be away from their beds. Consultation with the local fire authority is recommended to seek a solution to the problem of excessive noise created by closing fire doors to ensure the comfort of people living in the home. 20 We recommended further improvements by way of additional plants in the gardens to create a more attractive and welcoming outdoor space for people living in the home. 22 Further to observations made by the Expert, we recommend that the manager reviews the current call bell system to ensure the set up in individuals rooms is suitable for the purpose and that there are no increased safety risks to the way they are located in rooms. 24 It is recommended that frayed, worn or discoloured furniture in dayrooms are replaced. 26 We recommend that that suitable action is taken to ensure that offensive odours are eliminated from rooms. Care Homes for Older People Page 25 of 36 Evidence: Care Homes for Older People Page 26 of 36 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. Staff are sufficient in numbers and well trained to carry out their duties and responsibilities. Recruitment procedures are robust to ensure that only suitable persons are employed to work in the home. Evidence: The manager stated that six new staff had been recruited, including two new seniors since the last inspection. On the day of inspection throughout the home across four units there was one senior and seven carers on duty, though one carer accompanied a person to hospital. In the afternoon there was one senior and five carers on duty. The manager informed that staff numbers were presently in excess of what the home currently needs. Staff on duty on the other hand informed that they considered themselves to be stretched at peak times, such as in the mornings when there may be one or two carers on each unit performing personal care tasks. The manager stated that the senior carers on duty are expected to assist if required, however carers informed that senior carers are not always available when needed. The rota was seen in the rota file. A note to the seniors in the file stated that they must telephone other homes named in the file for staff cover if they are short of staff. Care Homes for Older People Page 27 of 36 Evidence: Five staff files were examined and considered to be in good order containing full and current records expected to be available in personnel files. These included application forms, three month probationary period letters, job descriptions, employment contracts, two references, completed medical questionnaires and proof of identification. Criminal Bureau Record CRB forms are destroyed after six months, however the CRB numbers and expiry dates were recorded in staff files. A newly recruited care worker had a new starter checklist form in their file with a checklist of all key documents for their file ticked. Their application form had gaps in the employment details and the interviewing manager had checked this during the recruitment process and recorded on the reasons for the gap in employment in their application form. We were informed that an independent regional coordinator has been checking all staff files and produces a matrix of documents in place or which appear to be missing. Each care worker now has a Personal Development file in place containing a portfolio of individual training and development. Induction records are kept in this file. Records and certificates of training undertaken were available in these files. In records of recent supervision notes seen, carers had informed their manager how they had benefited from the training they received and how their practise had progressed as a result. The list of training completed in staff files included NVQ Level 2, first aid, fire safety, communication workshop, moving and handling, Mental Capacity Act, challenging behaviour, spoken English for speakers of other languages and medication. Online learning was also available including POVA, customer care, food safety and foundation in health and safety. Most care workers had achieved NVQ Level 2 or Level 3 qualifications. A list of planned training was displayed on the office wall. A dementia course is planned over three days between November and December this year. Training needs are identified during supervision. Care Homes for Older People Page 28 of 36 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. Management has taken robust action to address staffing issues, providing more support and training for staff and improving staff morale. This has resulted in improved staff performance and better a better service for people living at Peter Shore Court. Evidence: The last inspection highlighted tensions and unresolved issues and poor relations among the staff team and management of the service, not helped by successive changes in management over the last two years. Together with the input from senior management of the organisation, the service has taken action putting measures in place to tackle and address these issues, with positive effect as seen at this inspection. The manager of the home and regional manager informed that staffing issues and staff morale had much improved and that staff seem to have settled down. The manager discussed the importance of staff supervision as part of this improvement process, Care Homes for Older People Page 29 of 36 Evidence: allowing people the opportunity to discuss their issues and allowing them space to raise any issues of concern. Supervision notes examined evidenced that issues with colleagues and the management that need to be raised are a regular agenda item for all staff supervision. A random selection of supervision records sampled evidenced that staff had no management concerns or issues to raise and that staff morale had improved for individual staff. Four staff interviewed confirmed this analysis. One staff member stated as follows, Things have improved. There is more management consistency, getting to know individuals better, more stability, before there were alot of changes. Cheryl is approachable. Team meetings are monthly and people contribute positively in meetings. The staff member informed they were not personally aware of any tensions and were not aware of tensions amongst others but that previously everybody was affected by difficulties. Another staff member stated that the situation in the home had much improved. The manager is better, staff are not at odds with the manager, morale is much better. There is no major trouble with staff or the manager. Supervision notes of carers seen dated September 2008 recorded the progress and development of staff since their last supervision, their care plan progress, care towards service users, points of good practice shown by the care worker, sickness, absence record, concerns about their current practice and issues with their colleagues. This demonstrated that channels of communication had opened up between carers and the manager, providing the opportunity for issues of concern to be raised and positive action taken to address them before they develop into complaints. Through discussion with staff however we discovered that some bank staff have not receive supervision for a long time. The manager informed that this is because bank staff are used across the Excelcare homes. The manager said she would raise this as an issue when pointed out to her that bank staff must also receive supervision. The inspection report has been discussed with staff, company policies and procedures have been better clarified and regular team meetings are being better used according to the manager, staff we spoke with and minutes of staff meetings. There had previously been difficulties as regards staff not receiving their pay which exacerbated their low morale. The manager informed that she discovered how some staff had not taken ownership of their timesheets and were submitting them late thus delaying their Care Homes for Older People Page 30 of 36 Evidence: payments and that this had now been resolved with staff. Issues remain about the differential of pay for people who transferred over from the previous organisation. For the first time people who transferred over have received a pay rise. Overall it is evident that the manager of the home with support from senior management of the organisation has taken effective action to address staffing issues, to minimise staff complaints and provide more support and training for all staff. This has resulted in the improvement in staff morale and performance and therefore better delivery of service at Peter Shore Court. Management audits are being regularly undertaken at Peter Shore Court. Managers audit sheets were seen in files examined, including areas of outstanding actions. Medication and care plans are also audited by the manager and the service development team conduct a full monthly audit which we shown during the inspection. Customer satisfaction surveys have been conducted since the last inspection. Positive comments were made in the survey results, including, Staff are very friendly and efficient, we have been extremely pleased with PSC. Staff are welcoming, courteous. Provides a caring environment. Pleasure to visit, warm, welcoming, professional. Negative comments included, Spare call systems needed when room bells are not working. Same cloth has been used to wipe the toilet, sink and hand rails. More activities required. Home needs money spent, lounge areas are in a shabby state. The outcome of the survey stated that all issues will be addressed by the home manager and added to the homes action plan. Residents meetings are being held on a monthly basis. Attempts have been made to engage relatives with limited success. The manager informed that relatives are given two weeks to one month notice to attend relatives meetings, however no one turned up at the last meeting. Meetings have been held at weekends and evenings to try to fit in flexibly with relatives. The manager informed she will be writing to relatives to gage whether they still wish to have meetings. Residents meetings are being held. The expert wrote as follows, I saw the minutes of September 29 2008. One of the residents was keen to go out to the cinema or to enjoy a pantomime and had stated that she would like more things going on to keep residents active. The manager told us that there are plans afoot amongst other ideas to invite a community arts project to the home, and also a Pat A Dog scheme, both of which sound interesting. There was no indication in these Care Homes for Older People Page 31 of 36 Evidence: minutes when the previous meeting had taken place or whether any issues raised earlier had been acted upon. I also looked at the minutes of the last meeting for relatives which dated from July 5 2008. An anonymous letter of complaint had been discussed and relatives had raised issues over the use of agency staff, lack of consultation concerning the change of pharmacy used for the homes prescriptions, the type of soap powder used in the home which was thought to cause some allergic reaction, staff availability for personal care, the standard of cleanliness in the home and the hygienic use of rubber gloves by staff. A later meeting was cancelled because no one turned up. Again, earlier minutes were unavailable and have not been sent through subsequently. Also, there was again no indication in the July minutes of earlier issues having been acted upon. Health and safety procedures are in good order in the home. The maintenance folder and log book were seen. Maintenance persons conduct monthly checks, lifts are regularly checked, hoists are checked every six months, though are not currently not being used. Taps have fixed thermostats so are set at a fixed temperature and are also checked monthly. Emergency lighting is checked and other electrical safety checks are completed monthly. The water system is checked monthly to prevent Legionella Disease. The Apollo baths in the home are regularly checked. Health and safety certificates for fire safety equipment, gas safety electrical wiring and Portable Appliance Testing were all valid. All maintenance and repair work is recorded and outcomes and dates noted. Care Homes for Older People Page 32 of 36 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 33 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 1 7 The Statement of Purpose and Service Users Guide need to include the new regionalised contact details of CSCI. It is recommended that the communication box is implemented for the individual referred to in this report to enable more effective communication between them and workers in the home. Ensure that individuals assessment and care planning takes into account needs arising from their racial background. Improve the recording of the outcome and actions taken regarding issues raised by individuals or their representatives in minutes of their meetings, for example, through matters arising as a standards agenda item. More care is needed to ensure that frailer residents are supervised when taking hot fluids and risk assessment procedures are properly observed. Ensure people are offered the alternative drinks available on the days menu Ensure there is evidence of consultation with individuals and their representatives regarding the policy of protected mealtimes, that indicates this is their preferred practise. 3 7 4 14 5 15 6 7 15 15 Care Homes for Older People Page 34 of 36 8 16 It is recommended that complaints records are made more accessible by recording a summary of the complaint, investigation and outcome with actions taken in the complaints log sheets. Consultation with the local fire authority is recommended to seek a solution to the problem of excessive noise created by closing fire doors to ensure the comfort of people living in the home. We recommended further improvements by way of additional plants in the gardens to create a more attractive and welcoming outdoor space for people living in the home. Further to observations made by the expert, we recommend that the manager reviews the current call bell system to ensure the set up in individuals rooms is suitable for the purpose and that there are no increased safety risks to the way they are located in rooms. 9 19 10 20 11 22 12 13 14 24 26 27 It is recommended that frayed, worn or discoloured furniture in dayrooms are replaced. We recommend that effective action is taken to ensure that offensive odours are eliminated from rooms. It is recommended that the home further consults with care workers and senior care workers as to whether current working arrangements between them are causing any negative impact in the deliver of care. It is recommended that the agenda of residents and relatives meetings include matters arising to review whether matters raised at previous meetings have been acted upon. It is recommended that actions identified from surveys in the homes action plan are implemented. It is recommended that bank staff also recieve supervision meetings that are minuted to ensure they receive equal and adequate support in conducting their duties as received by other staff. 15 33 16 17 33 36 Care Homes for Older People Page 35 of 36 Helpline: 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 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 © (2008) Commission for Social Care Inspection (CSCI). 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