Inspection on 02/06/06 for The Shires Care Centre

This inspection was carried out on 2nd June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 13 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Shires Care Centre 01/06/07

The Shires Care Centre 04/10/05

The Shires Care Centre 25/04/05

The Shires Care Centre 07/06/04

The Shires Care Centre 05/06/03

The Shires Care Centre 26/09/02

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Shires Care Centre The Oval Sutton In Ashfield Nottinghamshire NG17 2FP Lead Inspector Jayne Hilton Unannounced Inspection 2nd June 2006 09:00 Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shires Care Centre Address The Oval Sutton In Ashfield Nottinghamshire NG17 2FP 01623 551099 01623 550788 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr S A Zaman Lindsay Pargin Care Home 42 Category(ies) of Physical disability (42) registration, with number of places Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service Users shall be within category PD Date of last inspection 4th October 2005 Brief Description of the Service: The Shires is a care home providing accommodation, personal and nursing care for 42 service users aged 18-65 with physical and associated learning disabilities. The home provides both long term and planned respite care and is owned by Mr Zaman who also owns a number of other homes. The home is located in the centre of a residential estate in Sutton in Ashfield with access to local shops and facilities. The home opened in 1996 and is a two- storey purpose built building; all parts are accessible for wheelchair users. Staff actively encourages participation, independence and inclusion within the local community. All rooms are single with en suite facilities, there is a passenger lift to the upper floor and the home has a mini bus to facilitate access to the local community. Fees range currently between £442.50 and £579 .50 based on individual dependency levels. Additional charges include newspapers, magazines, some taxis and hairdressing. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Jayne Hilton carried out the key inspection on Friday 2nd June 2006 between 9am and 5.30pm. The assessment of outcomes for service users are based on evidence obtained from the methodology used at this inspection. The methodology used included the examination of four care plan folders and associated records such as accident records. By speaking with several service users and four staff and the registered manager. Other records and systems were assessed pertaining to health and safety requirements and medication management. The pre-inspection questionnaire and 19 service users comments cards were also used as part of the assessment. The registered manager informed the inspector that there had been some changes within the senior staff and that she was working on areas that the management of the home had identified as requiring this. What the service does well: A wide range of activities is catered for and service users are part of the local community and can engage in appropriate leisure activities. Service users are offered a healthy diet and enjoy their meals. Service users can engage in relationships as they choose and equality and diversity is promoted within the home. There have been some recent changes to the management of the home which staff report are for the better and outcomes for service users will be improved from. Quality monitoring systems are in place but further improvement to the promotion of this is identified as needed. Service users live in a comfortable and homely environment with personalised and suitable bedrooms. The home is clean and free of any malodour. Prospective service users are given the opportunity to “test drive” the home Service users appear to be protected by the homes recruitment policies and procedures, numbers of staff and by competent and qualified staff who are appropriately trained and supervised. Service users praised the staff however and observations on the day demonstrated that staff was attentive and respectful. Service users have the equipment they need and outside professional input as required. Medication management was generally satisfactory despite advocacy information and the complaints procedures being displayed and evidence of complaints being dealt with appropriately. Policies and training are in place to protect service users from abuse, neglect and self-harm. Service users were observed to move freely around the home and interact with peers and staff in a relaxed manner. Service users were noted to dress in their own personal style and had appropriate communication aids where needed. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 6 The atmosphere of the home was relaxed and service users appeared happy contented and well cared for The Commission received nineteen comment cards. Overall they demonstrated that service users were satisfied with the service provided. Comments included as follows: “I am very happy at the Shires and have a lot of friends and a nice bedroom”. “ I came ten years ago, everything has changed there is a lot more people here now” “ The food is very nice” “Fantastic meals” “The nurses are quite good they always listen” “I am happy here at The Shires” “ Staff are brilliant” “ I enjoy all activities I take part in” “ I am looked after very well very happy here” “Lovely Home” What has improved since the last inspection? A hazard analysis plan is in place and staff now record checks that have taken place to demonstrate these are followed. Appropriate risk assessments were now in place with regards the use of bedrails and photographs are in place with medication and care plans for identification purposes. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 7 What they could do better: Information is available about the home, but existing service users did not have their own individual copy, neither were they provided with individual copies of terms and conditions or an individual written contract. The admission and assessment procedures have not always been appropriate and improvement in this area is needed. The quality and contents of service users care plans are on the whole poor and although some service users said they could make decisions about life in the home, there was not enough clear evidence that they are fully consulted, enabled to take risks or that they fully listened to. Although service users said that they were happy with the support provided overall, the majority of the care plans assessed and healthcare records were poor in content and therefore are reflective of poor outcomes for service users. Service users did not always feel that they were listened to; neither did they all have keys to their rooms or their lockable facilities. Medication management was generally satisfactory but there are some areas to address to meet the standard and regulation fully. There are some minor repairs to address around the home and issues around safe storage of equipment and some there are some areas in relation the health and safety and infection control to improve further. The health, safety and welfare of service users may be compromised and requirements are set in relation to this. Records of training were not sufficient to meet the standard fully. The outcomes for service users would be improved by careful placing of complaint procedures and pro-active work in relation to enabling service users to be confident in raising concerns. The security of the building requires review to ensure service users are fully protected. Requirements are set in relation to these issues. Requirement 4, includes the following identified issues: Ensure the identified service users door lock is in working order and fits snugly into the rebate. Ensure adequate and safe storage facilities are provided. Ensure service users are not at risk of scalding from water outlets-seek advice from the environmental health officer in relation to this and for the prevention of legionella. Ensure the laundry room and walkways do not compromise service users safety. Ensure a fire safety risk assessment is in place Provide evidence of the five yearly electrical safety certificate Ensure protocols are in place for safe storage of service users alcohol and cough linctus. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available about the home, but existing service users did not have their own individual copy, neither were they provided with individual copies of terms and conditions or an individual written contract. Prospective service users are given the opportunity to “test drive” the home but the admission and assessment procedures have not always been appropriate and improvement in this area is needed. EVIDENCE: A statement of purpose and service user guide was displayed in the main reception and a copy of the inspection report from the last inspection was clearly displayed on the notice board. Service users however did not have their own copy. The documents were not inspected at the visit but the registered manager reported that the service users guide contained terms and conditions for living at the home and that contracts are agreed with placing authorities, however there was no evidence within the service users care plan files of any agreed contract. The registered person needs to address this and also to provide service users with confirmation in writing that the home can meet the individual and specific needs prior to them moving in to the home. The manager and inspector discussed area around admissions policies and protocols, which need to be reviewed overall. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 11 Of those service users spoken with none had the opportunity to stay for a trial visit prior to moving in, although the manager explained that this is arranged wherever possible. There was evidence that the admissions procedures had not always been appropriate and this needs to be improved. All of the four care plan folders examined contained an assessment, which was based on Activities of Living, however this nursing tool did not encompass all of the identified needs of service users and more detail is required. The registered manager explained and provided evidence that a new assessment document was now being used which met with standard 2 of the National Minimum Standards alongside the activities of daily living tool. It is recommended that foot care is included as a section within the assessment and care planning process for all service users and that a new document be devised which addresses self medication options, holding of keys to bedroom doors and lockable facilities and for issue of the service user guide. It is also recommended that a section be included for capacity of consent of service users also. Nursing and social worker assessments were seen in some of the care plans examined. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The quality and contents of service users care plans are on the whole poor and although some service users said they could make decisions about life in the home, there was not enough clear evidence that they are fully consulted, enabled to take risks or that they fully listened to. EVIDENCE: Four care plan folders were examined, the quality of the information contained within the four folders ranged variably. One folder was poor in relation to its contents and had only two specific care plans for night care and a ‘nursing’ one had excellent detailed care plans, which were holistic. Only one care plan included information about how the foot care needs of service users were to be met. One service users plan was noted to be fairly well detailed but did not contain correlating information obtained from staff and observations of the service user regarding use of adapted cutlery. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 13 Manual Handling and mobility assessments were generally found to be completed but not all nutritional assessments were completed and those that were had not been reviewed recently. Social assessments were also not completed in every case. Assessments were seen for tissue viability, but not all had care plans in place for how pressure relieving equipment and practice were to be used. Those that had assessments in place were not reviewed regularly despite being identified as high-risk service users. There was generally good information in relation to falls, risk assessment and monitoring. Blood sugar monitoring records were also satisfactory. Mental Health issues were noted to be covered within the scope of the care information and risk assessments. The information in relation to healthcare checks of individuals was extremely poor. Records of chiropody, dental checks, optician and annual healthcare checks were two years old or more or even not completed at all. Service users spoken with were happy with the care and that staff contacted GP’s promptly if they needed attention and that their healthcare needs were generally met. It appeared that the lacking structure and use of care plans did not reflect the actual care and support provided. Care reviews were recorded in some of the plans but not all. The registered manager did acknowledge that some care plans were not up to satisfactory standards and efforts were being made to address this. Service users were not able to inform the inspector of their key worker and said they were not involved in their care planning. There was no evidence of service user involvement within the care plans, which substantiated this. The registered manager agreed a whole overhaul of the systems to ensure that service users needs were being met fully. Accident records were cross -referenced with reports in daily notes. Weight records were generally in place and continence management where applicable. Diabetes care appeared to be well managed also. One plan noted a routine smear test for one service user but no follow up was recorded. Personal profile history sheets were in place but not always completed. Authorisation sheets and risk assessments were seen for use of bedrails. Care plans were not always dated and signed when or who devised by. Some service users were able to confirm that they lived their daily lives as they chose within reasonable limitations of their conditions and individual needs and risks. Risk taking and independence is promoted but again this was not fully demonstrated within the care plan process. Service users reported that they have choices and make decisions about most aspects of their lives such as getting up and going to bed, what food from the menu offered. The inspector observed service users being asked by staff how many sugars in their Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 14 drink and if they required any pain relief. Service users were observed being as independent as possible and staff assisting when appropriate. Service users reported that staff on the whole was respectful and polite. The inspector discussed one issue with the manager for further enquiries. An issue was raised that staff on occasions may say that they are going to help service users with personal care at certain times and then the arrangement/appointment is not kept. Plans seem to be changed too often. Although the service user said that they respected that others do call upon staff service users, improved communication is needed in this area. Not all service users were aware of resident meetings taking place or how to make a complaint despite information being posted on boards in the reception area. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A wide range of activities is catered for and service users are part of the local community and can engage in appropriate leisure activities. Service users are offered a healthy diet and enjoy their meals. Service users can engage in relationships as they choose and equality and diversity is promoted within the home. EVIDENCE: The home employs two activities coordinators to work with service users and a varied plan of activities is arranged during service users meetings. Activities take place in groups and on an individual basis according to the level of service users needs and preferences. Several service users attend the day centre and college and undertake studies of their choice. One service user also has a job within the community. Staff facilitates service users to access these services and gain employment if required. Records were seen of activities and participation. Service users commented that the minibus is limiting for those who use large chairs. The registered manager has tried to address this by the provision of a new bus. Some service users felt that they did not get out and Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 16 about as often as they liked. Toiletries needs can be ordered and fetched by the activities person on Fridays. There are no restrictions on visiting and service users may choose who they wish to see. If desired relatives are involved in service users meetings and their plan of care. Visitors can be received in private should it be desired and personal relationships are dealt with accordingly. Equality and Diversity is well promoted but staff have not had formal training in this area. A varied menu is on offer and service users are given choice at each meal, service users spoken with were able to substantiate this and stated food was plentiful and at a good standard. Special diets are catered for. Food and drink is provided at intervals throughout the day and services users also have access to drink making facilities should they choose to use them. Due to the size of the kitchen and health and safety issues service users do not access the kitchen, however baking days do take place in the dining room for service users to join in. Documentation within the kitchen was observed and all records were up to date. The kitchen was clean and tidy and there was evidence of stock rotation taking place. A hazard analysis plan is in place and staff now record checks that have taken place to demonstrate these are followed. The two fridges in the dining room are for service users own use, there were a number of bottles of alcohol and a bottle of cough linctus found in one of the fridges by the inspector and there was no record of temperatures for these particular appliances. The nurse in charge of the shift removed the contents and the registered manager ordered an enquiry into how this practice had occurred and will follow up this with a report to the inspector. [Reference standard 42 also] Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Although service users said that they were happy with the support provided overall, the majority of the care plans assessed and healthcare records were poor in content and therefore are reflective of poor outcomes for service users. Service users did not always feel that they were listened to; neither did they all have keys to their rooms or their lockable facilities. Service users praised the staff however and observations on the day demonstrated that staff was attentive and respectful. Service users have the equipment they need and outside professional input as required. Medication management was generally satisfactory but there are some areas to address to meet the standard and regulation fully. EVIDENCE: Evidence in relation to standards 18 and 19 was very limited in some care plans. Service users themselves were happy with the support provided in general. One service user said he didn’t feel listened to and none spoken with said they knew about self- advocacy although information was clearly posted in the home. On the whole service users said they could voice their opinions and choices but clearly if they were more involved within their individual care plan process and goal planning this could be improved. Only one care plan, out of Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 18 four examined, [which was for a nursing client with very high dependency needs] was deemed to be sufficient and fully completed. Resident meetings take place and minutes are kept. Staff appeared to have a good knowledge about the needs of service users despite information within the plans being poor. One service users needs mean that staff need to be with her one to one 24 hours a day. Staff were observed being attentive and offering appropriate support. Service users may choose who tends to their personal needs and staff are trained and instructed in these areas. Each service user has undergone a manual handling assessment which staff are aware of to ensure manual handling is performed according to service users preference and safety is maintained. The routines within the home are stated to be flexible which both service users and staff spoken with substantiated. All appropriate equipment and aids are available within the home. Relevant services are accessed within the community and specialists also visit the home if required. Service users confirmed that their privacy and dignity is respected. Not all service users had keys to their bedroom doors or lockable facilities and this is an area that requires addressing. Medicines management was assessed and overall this appeared to be well managed. The drugs trolley for the nursing clients was examined at this inspection and generally found to be in order. Care should be taken not to tear off use by dates from paracetomol boxes. There was one drug error notified to CSCI earlier in the year, which has been dealt with appropriately. The person in charge holds the medicine cabinet keys but these keys are also attached to other keys in the homes collection. Drugs keys should be kept separate to the main bunch. There are three trolleys in use one for nursing clients and one for those service users who receive personal care only. The other is used for medication fed through pegs. Policies are in place, but these were not examined in detail and because it was apparent that the manager and staff were not aware that storage room temperatures must be taken that they obtain a copy of the Royal Pharmaceutical Society’s guidance for medicine administration in care homes. The medication Administration records seen were neat and there was good recording for PRN [as required] and where service users refuse medication. Service users may administer their own medication following a risk assessment. There was evidence of this within one service users mar sheet examined and an appropriate policy was in place. It was reported that there were no controlled drugs in use on the day of the inspection. The manager is currently looking at additional training for registered nurses to ensure they remain up to date with current issues, senior care assistants have undertaken training with regards to the safe administration of medications. Competence assessments should be carried out where staff undertake distance learning in safe handling of medicines. Medication on the day of the inspection was satisfactory and medication checked with the service users prescription chart Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 19 was correct. Appropriate checks and documentation were maintained to a satisfactory standard apart from maintenance checks on suctions machines/tubes. A medication profile should be included within the care plan, which holds a running record of prescribed medications, medication reviews and any adverse effects noted from medications. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Service users did not feel their views are listened to, despite advocacy information and the complaints procedures being displayed and evidence of complaints being dealt with appropriately. The outcomes for service users would be improved by careful placing of complaint procedures and pro-active work in relation to enabling service users to be confident in raising concerns. Policies and training are in place to protect service users from abuse, neglect and self-harm, however the security of the building requires review to ensure service users are fully protected. EVIDENCE: Complaints procedures are displayed in the home but are in small print and above wheelchair height. Service users spoken with did not have a copy of the service users guide and did not know how to make a formal complaint. There appeared to be some reservation within the group of service users spoken with about their confidence in making a complaint, which was discussed with the manager, and she reported that she was sad about this and said she was committed to ensuring that further work would be undertaken in this area. Complaints are discussed in resident meetings and the manager felt she encouraged service users to speak up if they were not happy. Staff also said they would report on any concerns expressed by a service user through the appropriate channels. The inspector discussed with the manager further ways to encourage service users to be more confident in raising issues they are not happy about. Two service users made comments about feelings of not being listened too and this was discussed with the manager to be addressed. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 21 Two complaints were documented within the complaints records. One was in relation to issues around errors of several agencies in the admission of a service user and associated treatments, which is still unresolved. Another was in relation to poor care practice, some areas were partly substantiated. There was also an ongoing issue which the registered manager informed the inspector about that was being dealt with by the Registered Provider, because of the complex nature of the issue and confidentiality issues, was not fully recorded in the complaints records. Service users expressed that they felt safe and one service user said he was ‘too safe’ and wished to go out and about more by himself. The manager is now aware of the correct protocols for referral of safeguarding adult’s issues if they should arise. Two recent safeguarding adults issues were not proven with no further action. Staff confirmed they had attended training in adult protection and were generally aware of the principals of the whistle blowing policy. A sample of service users finance records were examined and checked appropriate systems appear to be in place but improved receipting and numbering would provide an easier and robust audit trail. Policies have been approved regarding appointee ship but there was no audit system in place for this to protect both service user and the nominated appointee. One service user was observed to request cash on the day of the inspection. The administrator who had the key was off as was also the deputy manager, so service users were not able to access their cash. The registered manager was able to arrange a loan of cash to the client but clearly the system in place had been found to be flawed. The registered manager assured the inspector that this occasion was a one off, however contingency plans need to be clearly in place for events such as this. Any limitations placed upon on service users for their safety or others safety, were generally noted within the care plan. [See standard 24-The security of the building was discussed with the manager and although panic alarms are fitted the inspector felt that further security measures should be explored to ensure service users are fully protected.] Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable and homely environment with personalised and suitable bedrooms but there are some minor repairs to address and issues around safe storage of equipment. The home is clean and free of any malodour but some there are some areas in relation the health and safety and infection control to improve further. EVIDENCE: The home is spacious and appeared homely and comfortable. Acceptable wear and tear of doorways and carpets was evident but not assessed as excessive or unsafe. The Shires appeared homely and decorated, furnished and maintained to an acceptable standard. Individual thermostats can control heating and radiators were covered or low surface types. Windows were fitted with safety restrictors. Bedrooms were well personalised. One service user who had recently moved rooms informed the inspector that she had chosen the colour scheme and all of the new décor and accessories herself. Service users who smoke have to smoke outside of the building, provision of a shelter from Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 23 adverse weather should be considered. All areas observed were clean and free from malodour. The security of the building was discussed with the manager and although panic alarms are fitted the inspector felt that further security measures should be explored to ensure service users are fully protected. Storage in the home is limited and an upstairs bathroom and toilet was being used for storing equipment. As adequate toilet facilities are otherwise provided, it is acceptable to use this room for storage as long as the room is kept locked and that fire and environmental health officers agree to this. The computer room was also noted to have an unused bed and pressure relief mattress, a chair and oscillation fan stored in the room. Another oscillation fan was laid outside of the bathroom currently used as storeroom. A service user commented that she had an amount of continence aids stored in her room, that she did not use and therefore they were surplus to requirements, she had requested they be removed but was told as storage was limited they had to remain. The service user said she had put them outside of the room as she did not wish for them to be kept within her room and they had been left there for some time, although when we the inspector went to observe, they had been removed. A door lock was loose in the service users door and did not close into the rebate without the door being slammed shut. The handyperson had kept records of water outlet temperatures but had recorded these in zones rather than by individual outlets. The records indicated that water outlet temperatures were all within the safe temperature limit, however one out of three water outlet tested by the inspector demonstrated that one hot tap in a bathroom sink was being distributed at 57 degrees. The registered manager close off the bathroom from use until this could be resolved. The storage facilities of towels and laundry posed a risk of cross infection, as they were stored openly in bathrooms and on trolleys in the walkways in the home. The laundry room was inspected and had appropriate equipment in place. Staff have undergone training with regards to infection control and were able to discuss practice and were observed wearing protective clothing. The laundry room however was left unattended and unlocked and drying laundry on handrails is not appropriate. On the day of the inspection it was a very warm and sunny day. Suitable drying facilities should be used. A cable and extension in one service users room was not labelled as Portable appliance tested and the cable needs securing as presented a trip hazard. Some waste bins around the home were noted not to have lids or they were broken. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 24 Checks appear to be in place to prevent legionella but not all records were available in respect of this and must be provided to CSCI. Fire safety records were satisfactory. There is a planned redecoration programme and maintenance is well managed. A new nurse call system was installed in May 2006. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service Service users appear to be protected by the homes recruitment policies and procedures, numbers of staff and by competent and qualified staff that are appropriately trained and supervised. Records of training were not sufficient to meet the standard fully. The hours provided for domestic cleaning and laundry are not sufficient according to records held. EVIDENCE: For thirty seven service users between seven and nine staff are provided in the daytime with one trained nurse. Two care staff are senior care assistants. On occasions there are two nurses on shift. The registered manager is also on duty some days in addition. At night one nurse and five care staff are provided. From the information provided 150 hours a week are provided for cleaning and laundry, which is sufficient. 119 hours catering is provided which is more than satisfactory. The administrator works 40 hours a week, two handyman work 40 hours a week each and sixty hours activities co-ordinators are provided. Full records of those staff that have achieved NVQ’s was not obtainable on the day of the inspection. The estimation within the pre inspection questionnaire is Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 26 25 of staff hold NVQ or above. The registered manager is to collate the information and submit this to CSCI. Four members of staff personal files were examined and all were satisfactory in relation to recruitment standards. From the examination of staff files speaking to the manager and staff it appears that a good level of training is provided. However the manager reported that since she has taken over she is has been trying to collate a training information/update and plan and will send this to CSCI when completed. Information deemed from the manager and staff confirmed that an induction to skills for work standards is undertaken and that staff are paid to attend training. Copies of GSCC code of conduct were also confirmed as issued. There was evidence of formal supervision and the manager is working to achieve six sessions a year for individual staff. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been some recent changes to the management of the home which staff report are for the better and that outcomes for service users will benefit from. Quality monitoring systems are in place but further improvement to the promotion of this is identified as needed. The health, safety and welfare of service users may be compromised and requirements are set in relation to this. EVIDENCE: The manager was registered early in 2006 and has been undertaking changes to improve some previously not so good practices in record keeping and care administration. She is a qualified nurse and holds the Registered Managers qualification. She states she is committed to ensuring equality and diversity is promoted within an overall quality service to clients. She stated she was aware of the poor state of some care plans and seeks to address these areas for prompt improvement. Staff spoken with confirmed confidence in the managers Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 28 abilities to run the home and that teamwork was good. They also remarked that improvements had been made such as rotas and the skill mix of staff on duty at one time etc, which will improve outcomes for those who reside at the home. Quality monitoring systems are in place including regulation 26 reports from the provider. Service user surveys are carried out periodically, although some service users were not aware of these taking place, evidence was seen of completed questionnaires and action taken from feedback. There are a number of areas in relation to health and safety records that require attention. A fire risk assessment must be in place. Evidence must be provided that the five yearly electrical circuit test has been carried out. The health and safety poster should be up to date, with the name of the person responsible for health and safety. A security review should be undertaken and innovative ways to improve security should be explored. All other servicing and equipment checks appeared to be satisfactory. There are some infection control issues, water outlet temperatures, safety of the laundry room and storage issues to take into account raised earlier in the report. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 3 X 3 X X 2 X Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 30 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 YA3 Regulation 14 (1) Requirement The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so— (a) needs of the service user have been assessed by a suitably qualified or suitably trained person; (b) the registered person has obtained a copy of the assessment; (c) there has been appropriate consultation regarding the assessment with the service user or a representative of the service user; (d) the registered person has confirmed in writing to the service user that having Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 31 Timescale for action 02/08/06 regard to the assessment the care home is suitable for the purpose of meeting the service user’s needs in respect of his health and welfare. (2) The registered person shall ensure that the assessment of the service user’s needs is— (a) kept under review; and (b) revised at any time when it is necessary to do so having regard to any change of circumstances. (1) Unless it is impracticable to 02/08/06 carry out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan (“the service user’s plan”) as to how the service user’s needs in respect of his health and welfare are to be met. (2) The registered person shall— (a) make the service user’s plan available to the service user; (b) keep the service user’s plan under review; (c) where appropriate and, unless it is impracticable to carry Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 32 2 YA6 YA7 YA9 YA18 YA18 15 out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan; and (d) notify the service user of any such revision. The registered person shall 02/08/06 make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person shall 02/08/06 ensure that— (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety; (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, 3 YA20 13[2] 4 YA23 YA24 YA25 YA30 YA42 13 [4] Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA1 YA5 Good Practice Recommendations Ensure all service users are issued with a service user guide and terms and conditions and are issued with keys to their bedroom door and lockable facilities unless a risk assessment states otherwise Consolidate the assessment documentation and care plans to ensure that service users needs are fully addressed and include the arrangements for foot care and goal plans Improve communication, consultation and information sharing with service users. Ensure medical equipment is serviced and evidence of this is provided. Include medication profiles within care plans Ensure ‘use by dates’ are not removed from medicine boxes. Medicine keys should be kept separate to other home keys. Explore ways to encourage service users to feel confident to make complaints/their views known Place clear complaint procedures at an accessible level for wheelchair users Implement contingency plans to ensure service users always have access to their money. Review the security arrangements in the home 2 3 4 YA2 YA3 YA7 YA20 5 YA22 6 7 YA23 YA23 YA24 8 YA42 YA30 Review the system for storage of towels and continence aids in relation to prevention of cross contamination. Ensure training records are available for inspection and devise an annual training programme which indicates which staff have undertaken which training and when. Further improve consultation with service users in relation DS0000024660.V296630.R01.S.doc Version 5.2 Page 34 9 10 YA35 YA39 Shires Care Centre to quality monitoring. Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Shires Care Centre DS0000024660.V296630.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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