Inspection on 30/01/06 for Partnership In Care, Sherrington House

This inspection was carried out on 30th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Partnership In Care, Sherrington... 15/01/08

Partnership In Care, Sherrington... 18/01/07

Partnership In Care, Sherrington... 21/04/05

Partnership In Care, Sherrington... 22/02/05

Partnership In Care, Sherrington... 13/01/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

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Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Sherrington House 71 Sherrington Road Ipswich Suffolk IP1 4HT Lead Inspector Jill Clarke Unannounced Inspection 30th January 2006 1:22 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sherrington House Address 71 Sherrington Road Ipswich Suffolk IP1 4HT 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) 01473 464106 01473 464107 The Partnership in Care Limited Mrs Nicola Reynolds Care Home 40 Category(ies) of Dementia - over 65 years of age (11), Old age, registration, with number not falling within any other category (30), of places Physical disability (5) Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 One place in the category of DE(E), is to accommodate and provide care for one named person, as stated in the application of September 2005. 21st April 2005 Date of last inspection Brief Description of the Service: Sherrington House, registered to provide care for 40 older people, is set within a residential development in Ipswich, close to shops and the main town. The town offers a range of facilities including cinema, public houses, restaurants, shops, swimming pool, library and has good rail, bus and coach transport links. The home is divided into 4 areas called units. Sunset and Park View units provide care for 22 frail older people. Horizon unit offers short-term care for 8 residents. Dales View unit provides care for 10 older people with dementia. Each unit has their own lounge, dining room, communal bathroom and toilets. All bedrooms are single, and have a wash hand basin, 2 also have en-suite toilets. Residents can access all areas of the home by stairs or passenger lift. The large garden has seating areas, and there is car parking to the front and rear of the home. The home is in the process of changing to a non-smoking home. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of 2 regulatory inspections, undertaken between 1 April 2005 and 31 March 2006. The inspection undertaken by the Lead Inspector for the home, took place over 5 ½ hours, on a Monday in January. The aim of this inspection was to look at relevant standards, which had not been looked at during the first inspection undertaken on the 21 April 2005. Commission for Social Care Inspection (CSCI) feedback cards were sent to the home in November 2005. This gave an opportunity for relatives, visitors and staff to give feedback on how they thought the service was run. Comments from the completed residents (12) joint relative/visitor (23) and staff (4) feedback cards have been included in this report. During the inspection, time was spent talking with several of the residents (4 in private) to hear their views on what it was like living at Sherrington House. Time was also spent with members of staff in private, which included the Registered Manager, Deputy Manager, Cook, and 3 Care staff. A tour was made of all the communal accommodation, 2 toilets, 1 bathroom and a sample of 3 bedrooms, to check the condition of the décor, furniture and hot water temperatures. Records inspected included care records, medication records, training programme, financial accounts and staff rotas. Discussions during previous inspections identified that people living at the home preferred to be known as residents, rather than service users. This report respects their wishes. What the service does well: Residents spoken with, liked the staff, and felt well cared for. Their comments included “care okay”, “very good” “happy with everything” and described staff as “very kind”. This was also reflected in relative’s comments (CSCI feedback cards) that ‘staff are always friendly and polite’, ‘very good’, ‘caring’ and ‘I have the greatest confidence in the staff at Sherrington house’. Further comments made by visitors and relatives included ‘we are very pleased with Sherrington House’, ‘the whole atmosphere is lovely’ and that residents are ‘looked after wonderfully’ Residents felt safe, staff treated them with respect, and their privacy was also respected. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 6 The owners are committed to improving the general standard of the environment. Staff uses coordinating soft furnishing, pictures and ornaments to help promote a homely atmosphere. Residents are encouraged to personalise their bedrooms. Visitors are made to feel welcome, and feel that they can visit in private if they wish. The home is committed to developing individual training plans, to support the staff in having the skills and knowledge to carry out their work. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 6. Prospective residents are given sufficient information to help them decide if the home offers the level of care are looking for. EVIDENCE: Since the last inspection, people using transitional care (residents who have left hospital and are waiting to return home, or waiting a permanent bed in a care home), are now given more information on what the home has to offer, and how they will be supported. All the beds at the home are Social Services contracted, and contracts held on file, give a break down of fees payable, and by whom. The ‘Service Users Guide’ gives a summary of ‘Terms and Conditions’ of residency, which covers ‘Payment terms, and extra charges’. This included information on what was (care and activities), and what was not included in the fees (toiletries, hairdressing, chiropody, physiotherapy, dry cleaning). One relative felt that residents ‘who are fully funded should be supplied with free toiletries’. Records looked at, and discussions with residents confirmed that they were aware of how much they had to pay. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 9 From the 23 relatives/visitors who had completed CSCI comment cards, 8 had indicated that they did not know the location of the CSCI inspection reports, although 1 relative wrote, that they were sure if asked, staff would show them the report. This led to discussions with the manager, that although the inspection reports were displayed in the entrance hall (on the wall opposite the signing in book), that not all visitors were aware of it’s location. They said that information on where it was located could be included in their next ‘news letter’. Since the last inspection the home has worked hard to define what is meant by ‘transitional’ care, which sometimes can include residents who are waiting to go back home or into sheltered housing. It was identified at the last inspection, that care plans did not give clear guidance on how staff were going to support the residents to maintain their independence, and life skills such as making a cup of tea. The manager after carrying out their own assessment, will then discuss any extra support required with the ‘Integrated Discharge Planning Team’, before the person’s admission. Whilst at the home, the Social Worker from the team, regularly visits and keeps residents up to date. Formal reviews (including the resident and their representative) are held once a place has been identified. Time was spent with 3 residents staying in the ‘transitional’ care unit, all of whom were waiting for permanent care places, closer to their families. Asked about their admission to the home, 1 resident said that the Manager had come and visited them in the hospital, and their next-of-kin had visited the home to look around. All 3 were happy with the level of care received, and further discussions identified that they felt in control of their placement, and would decide which home/area they wanted to move to. This was further reflected in 1 resident’s comment, who was being taken to look at another home, in the area they wanted, said “they are taking me to see a place - “I shall decide” if it was the home they wanted to move to. Another resident said that a Social Worker had come in to discuss where they wanted to move to and what homes were located in that area. One relative wrote (CSCI comment card) that they felt ‘very fortunate to have found such a nice home for their relative, who had been admitted from hospital, and felt they had ‘settled in well and was very happy there’. Another relative wrote that their next-of-kin ‘likes the home and that they felt they were looked after well’. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. People using the service can expect staff to monitor their care, and take appropriate action to support their changing physical, and mental health needs. Staff must ensure following Doctors visits, that care records reflect fully what has been said, and reasons for any action taken. EVIDENCE: Two residents care was tracked on Horizon during the inspection, which included looking at their care plan, talking with the resident to gain their views of level of support given, and discussing their care needs with staff. This identified that the residents felt that they were being given the level of support they wanted, which was recorded in the care plan. Staff had a clear understanding on the level of support residents required. Care plans covered the resident’s physical and mental health and were reviewed monthly. Samples of 2 other care plans were looked at. The format and layout of the 2 care plans were both different. Although both contained enough information to give staff guidance on how the resident wished to be after other, one care plan gave more detailed information. The manager said that the more informative Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 11 care plan was part of a pilot scheme, which was introduced on to one of the unit’s (Sunset). The home was just in the process of introducing a new care plan system, which will involve all information being stored on a computer, and updated by staff, using computer terminals around the home. The new system will be started, once staff have received training (February 2006). Asked how the residents would access the information, the inspector was informed that residents will be able to use the computer to access their own information, or will be able to have a copy printed off using a font type that they can easily read. Eleven out of the twelve residents had also said they felt well cared for, with 1 stating ‘sometimes’. Residents during the inspection were happy on the level of care received; with 1 resident describing the staff as “great” another said care “very good”. All relatives (23) had stated (CSCI comment card) that they were satisfied with the overall care provided, with 1 saying that they always found their next of kin well cared for when they visited them. One relative’s feedback card, arriving after the inspection, which raised concerns over a resident’s nutritional intake, was not looked into at the time of the inspection. The relative was contacted, which enabled them to discuss their concerns in more detail. With their permission, the home was asked to monitor the situation, and give feedback to the relative direct. The homes system for recording, storing and dispensing medication was looked at. Good practice was seen with the use of ‘audit sheets’, which were used by the management to monitor staff practice, and ensure Medication Administration Records (MAR) are fully completed. If any shortfalls in staff’s practice were identified, this would be fed back to them, and their work continue to be monitored, and any action, such as re-training or stating disciplinary action would be taken if necessary. They confirmed that all staff had undertaken training, provided by the dispensing pharmacist, and some had also completed distance-learning courses in administering medication. A review of all the homes MAR sheets, identified 1 medication which was missing from the blister pack, indicating that it had been given, by the member of staff had not signed to confirm this. The audit sheet also identified that the missing signature had been picked up, and the member of staff concerned would be informed. Residents MAR sheets also contained ‘administration instructions’ with the residents photograph attached. This alerted staff to any information they needed to be aware of such ‘needs to be observed when taking medication’. To ensure the resident has taken and swallowed the liquid or tablets. One resident’s MAR sheet, identified they had been seen by their Doctor that morning, who had increased the dosage of a bowel medication. The inspector raised concerns why, as previously records showed that the resident had refused the medication for 4 days had the medication been increased. The Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 12 residents care plan, although an entry had been made about the doctor’s visit, gave no mention of why the bowel medication had been increased. To ensure the safety of residents, the home was asked to take immediate action to ensure information obtained during doctors’ visits was fully recorded. Staff confirmed, for the comfort of the resident that the medication would not be given until the resident’s Doctor had been consulted. Staff had dated when they had opened medication, which had a short shelf life. Controlled medication was held securely, and staff had safe systems in place for dispensing medications. On each of the 4 units, a sample of 2 medications, not held in ‘blister’ packs, were checked against the homes records and found to be correct. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13. Staff make relatives and visitors feel welcome, and where appropriate keep them updated on residents welfare. Residents feel they have control over their lives, but would like to see more social activities and outings arranged. EVIDENCE: The home has a Social Activities Team, whose role is to develop an calendar for residents. Minutes of their meeting held 13/1/06, showed events planned for the year, which included Italian lunch (March) Egg hunt and Easter parade (April). Discussion with the Manager identified that the weekly activity programme, still needs further development, to ensure it meets all the residents’ interests and needs. Although the home tries to rotate the activity person to be an addition to the normal care hours, this was not always possible when the carer was required to cover last minute sickness. From the 12 residents who had completed the CSCI comments cards, when asked if the home provided suitable activities? 5 had said ‘yes’, 3 ‘no’ and the remaining 4 were left blank (with 1 resident saying they were unable to participate). Comments made included ‘not any activities other than bingo – would like DVD nights, more visits out and more music nights’. Another resident felt that the home ‘has plenty to do, but nobody seems to be Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 14 interested to join in’. Discussions with a member of staff identified that they “would like to see more social outings” for residents. One resident spoken to, confirmed that staff had recently been round to see what activities they wanted to take part in. The resident said that they would like to take part in baking sessions again, which they had fed back to staff who were going to arrange this. To support residents with dementia, the home is currently in the process of printing ‘life story’ books, which they hope to involve the resident’s family and friends as well. Once completed the books will contain information on the residents past personal history, including occupations and hobbies. The information will then be used to organise one to one activities. Care plans viewed also gave information on residents social interests and listed what activities they had joined in with, such as Bingo. The January 2006 ‘Residents Newsletter’ which is produced quarterly, gave information on fundraising events and how money raised can be used towards funding a mini-bus, which they can rent for the week to take residents out and about. The newsletter stated how successful it had been when they had recently tried the mini bus for a week, which was cost effective, as they were only required to contribute towards the running costs. Residents were invited to contribute any information or ideas to be included in the next newsletter. Relatives comment cards identified that the majority felt that the home kept them well informed over matters concerning residents welfare, with 1 stating that they ‘always felt included in all the decisions involving’ their next of kin’s care’. Two out of the 23 relatives felt there were not kept up to date although 1 said that if they went to the office they would be given the information. The example given by the relative (although no name was given to ensure confidentially) was discussed with the manager. They said although they have built good links up with families, and residents representatives, it was still up to the resident how much information they wanted the home to give out to relatives. Especially with personal care, which could cause embarrassment for the resident. Standard 15 (Meals and Mealtimes) was assessed as met during the last inspection and found that the home does offer a range of nutritious, balanced meals. This was further evidenced with discussion during this visit, where 1 resident said that they had asked staff to send their compliments to the cook. Residents who had completed the CSCI comment cards (12 out of 40), when asked if they liked the food, 9 had replied ‘Yes’, 1 ‘No’ and ‘2’ sometimes. One resident wrote that they found the ‘meat tough’ and vegetables ‘hard’, which resulted in them leaving most of their meal. Residents spoken with during the inspection were happy with the food, and these concerns were not raised. The Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 15 home was asked to monitor to see if any residents were leaving food to try and identify if it was the way it was cooked, or if perhaps the resident would prefer a ‘soft’ (minced meat, purees) menu. One relative had written ‘some variation to the menu might be appreciated’, but no further information had been given on what variations they would like to see. The Manager said that they were constantly asking residents for their opinions and feedback on the menus. An article in the January (2006) residents newsletter, informed residents that ‘the new menu’s have been produced in ‘draft’ copy and are currently with the kitchen staff to check over for changes in ordering of supplies’. Staff then went on to thank ‘everyone who completed the catering survey (most of you did!) and as soon as the menu’s have been checked, they will be circulated for your approval and comments’. Time spent around the home, talking to residents and observing the daily routines, confirmed that residents felt able to choose what they wanted to do. One resident felt that they instructed staff at times and helped new staff to get to know the routines. Residents and staff interacted well, with residents taking an interest on who was on duty – greeting the staff when they came on , instigating conversations. Residents felt that there was a good atmosphere, which was also reflected in staff’s comments, who clearly (by their manner and body language) enjoyed working with the residents and putting their interests first. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. People living at the home, can expect any concerns they have to be listened to, and acted on in an appropriate manner. EVIDENCE: From the 4 staff who had completed the CSCI feedback cards, only 1 had confirmed that they had received training in the homes abuse policy. This was fed back to the manager, who said they were currently organising ‘Protection of Vulnerable Adults’ training programme for all staff, starting Wednesday (1 February 2006). To ensure all staff are able to attend, and receive on-going refresher training, the home aims to provide the training every 4 weeks. A Vulnerable Adults training resource pack has been purchased, which covers the following areas: ‘What is abuse?’, ‘Minimising the risk from abuse’, and staff ‘Roles and Responsibilities’. The manager said that the training pack links in with the NVQ training module on abuse. Posters were displayed in the staff room advertising the forthcoming training, which staff had written their name on to confirm that they would attending. Discussions with the Manager identified that they were aware of local protocols, and their responsibility in reporting any incident or suspicion of abuse. One member of staff had written on their comment card, that ‘no abuse’ would be ‘tolerated’. Following the inspection, a staff comment card received (31 January 2006), indicated that completed staff CSCI forms, which had not been returned following a previous visit (22 February 2005), had been opened and read by Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 17 staff at the home. All CSCI comment cards are sent with an envelope, with postage paid to enable people to send them back, direct to the Commission. The member staff indicated that this was the reason why staff had not completed them this time, as they felt they could not truly write what they wanted to. The homes complaint policy informs staff how they can contact the CSCI. A member of staff had made a formal complaint to the CSCI following last year’s inspection (5 February 2005), which was investigated. Although not upheld, it showed that staff are aware of how to contact the Commission, and are freely able to raise any concerns direct. Following this inspection the manager was contacted, and asked to look into the situation, and report back to the lead inspector. Staff spoken with (7) during the inspection, raised no concerns about completing comment cards, and answered fully any questions asked. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 and 26. Staff are committed to providing a clean and homely environment for residents, which meets their individual needs. EVIDENCE: The home has continued with their refurbishment programme, which has included decorating corridors and having new kitchen units, net curtains, doors and carpets fitted. Twenty-seven out of the 40 bedrooms, and they had just purchased new furniture for 2 bedrooms. Areas that had been redecorated were bright and homely, which was reflected in residents and staffs comments. This included “its lovely” “homely” and much “brighter”. Bathrooms looked at (2) showed signs of wear and tear. The Manager said theses areas would be addressed through their on-going decoration programme. Residents who were asked said that they felt the home was warm enough, and they felt comfortable. A sample of 2 hot water temperatures were checked (toilet and Bathroom) which at 38°C and 42°C, were within safe limits. However, records kept of residents bath temperatures, showed that sometimes Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 19 the temperature of the bath was as low as 34°C and 35°C, which was felt too cool – unless a resident had requested a cooler bath. Staff were asked to look into this, to ensure it was at the resident’s request. The call bell in the bathroom was too short, and did not reach the bath, to allow the person bathing to call for assistance. A maintenance book is completed by staff to report any item or hazard that needs fixing. Two minor maintenance problems identified during the environmental tour, had been listed in the maintenance book. A relative wrote that they always found the resident’s bedroom clean when they visited. Another commented that the ‘home is always tidy and clean never a smell of urine which is a great credit to all concerned’. In the staff room was a memo (29/06/05) from the manager, informing staff that they had ‘nominated the domestic team to receive an group reward for all your hard work –maintaining high standard, sometimes in difficult circumstances’. Disposal gloves, liquid soaps paper towels, were freely available for staff. Cleaning fluids were safely locked away. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30. Staff are friendly, polite, approachable and committed to proving a good level of care. The new training programme offers flexibility to staff to be able to update their knowledge and skills. EVIDENCE: A resident said that they were “very fond of their key-worker”. A relative described the staff as caring and attentive. Over 50 of the resident’s relatives completed CSCI feedback cards. When asked if they felt the home always had sufficient staff on duty, 16 replied ‘yes’, 6 ‘No’, and 1 person had ticked both boxes. There was no further information given, to indicate if it was at certain times of the day, however, 1 relative wrote ‘ not enough senior staff to provide the necessary motivation and stimulation for clients’. Senior staff rotas showed that on each shift there was at least 1 senior carer, in addition to this, extra senior support was given by the manager (Monday – Friday 9-5), and the deputy manager 3 days a week. The manager gave the staffing levels as 5 carers and 1 senior in the mornings and afternoons, and 2 carers and 1 senior at night. This gave a staffing ratio of 1 carer to 5 residents on the dementia care unit, and 1 carer to 10 residents in the main home. Staffing rotas also showed on weekdays that the deputy manager, and senior staff also worked in addition to the above staffing levels. The manager said the hours were used to monitor practice, update and review care records, undertake residents reviews, and able senior staff to provide Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 21 training and supervision for carers. A resident asked if they felt there was enough staff, said there were normally, recognising that any shortfall was normally due to last minute sickness which they felt couldn’t be helped. Another resident asked, said that the “carers say that we are short of staff”. Further discussion identified that they had never been left waiting for care. Other residents spoken with confirmed that when they used the call bell, staff always came. No one-raised concerns that they were not getting the level of support they needed. A member of staff, who was also asked the same question, felt there was enough staff, although they felt “some staff do long shifts” and said that they no longer used Agency Staff. The Manager felt that when visitors came, they might not always be aware of how many staff are on duty, as they may be out of sight assisting residents. During the inspection, the staff working upstairs were both males, which did not reflect the gender of the residents they were looking after. This was fed back to the Manager who said, that although there were 2 male carers upstairs, the senior carer was female, and could offer support with residents personal care if required. A resident discussed the changes in staff, they felt the new staff did not get enough induction, saying that sometimes “staff on here have to ask me” and felt that sometime residents on the unit can get fed up, with having to be asked. A new member of staff was asked about their induction and training, they said that they had received “so much training – it was unreal”. They confirmed that they had undertaken a 6-week induction programme, which included Manual Handling and Food Hygiene. They said that the support and training they had received had been “very helpful”, and they were hoping to go on to take their National Vocational Level (NVQ) 2. A list provided by the home showed 11 members of staff had obtained their NVQ 2 or above. This left 17 currently not holding an NVQ qualification, less then 50 of their staff. Asked what action they were taking, the manager said not all staff wanted to undertake the training. However, new staff are now made aware at the interview stage, that they will be expected to undertake the training, and will be put forward, once they have completed their full induction training. The home is committed to developing an on-going ‘refresher’ training programme, which will give staff flexibility in when they want to attend, as long as they put their name down within the required timescales. The programme gives a list of core training, which is compulsory for carers. This included ‘Principles of Care Practice’, ‘Dementia and Person Centred Care’. Each training information sheet, states how long the training will be, what is covered, and how often staff should repeat the training to keep their knowledge updated. Senior staff has developed training information and resource boxes, for each of the training modules. This allows greater flexibility, as the 1-hour training session can be carried out by any of the senior staff, following the same format and can be undertaken on a 1 to 1 basis, if need be. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35, 36 and 38. Staff are committed to providing a safe environment for residents to live in. Too much money is being held in safe keeping for residents, which could result in residents losing out on interest. EVIDENCE: The registered manager Mrs Reynolds, who is experienced in managing care homes for older people, runs the home. Her qualifications include Diploma in the Management of Care Services, Registered Managers Award, and are currently undertaking NVQ level 4 in Care. A relative wrote (CSCI comment card) ‘Mrs Nicky Reynolds runs a good residential home, integrates with the staff and is aware of the needs of the residents’. They felt that ‘Mrs Reynolds should be commended for her capable management skills’. Another relative commented that the ‘Manager is rarely seen, except when showing a new resident around, and felt that they ‘delegated too much of their work to their subordinates and doesn’t provide sufficient support to them’. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 23 The management structure of the home consists of a Manager, Deputy Manager, and Senior Carers. Discussions with staff identified that they were aware of the management structure, and the role of the manager was not hands on, but more office work. Staff felt that the deputy manager (all staff and residents spoken with, spoke highly of their work and character) worked more of a mixture of ‘hands on’, as well as undertaking office work, which was reflected in the shifts they worked. Time spent with 1 resident discussing the role of the manager identified that they still compared the Mrs Reynolds with the previous manger, whom they were very fond of. This led to discussions that if that manager were still in charge, their role would have been more office based, to ensure the home met the required standards (copy of the National Minimum Standards was shown). This led to further discussions that the Manager was not seen as a ‘hands on’ role, and time would be spent away from the home assessing new residents, attending training and meetings. In their absence, the deputy manager or senior carers provided management cover. Due to comments made at a previous inspection by residents, relatives and staff, in not knowing the whereabouts of the manager. To address this issue, the manager now keeps a weekly timetable, displayed outside their office, to inform everyone where they are. The manager said that they always go round the home each shift, to say hello to residents, and let them know they are in the building. This was also reflected in the January resident’s newsletter, where the manager had written ‘I do try to come around the home regularly to say “hello” to you all, (not as often as I would like). They went on to say that they were always ‘available to talk to if you need to – just give me a shout!’. During the last inspection, staff raised concerns over communication between staff and management, which they felt was not always good. Only 4 staff cards had been returned to the CSCI, 2 positive (felt the home was well run) and 2 negative, who felt it wasn’t. A member of staff said they felt communication was getting better. They confirmed that they received supervision every 6 weeks, when they can raise any issues, but said if anything were worrying them, they would raise it straight away. Senior staff rotas showed that all senior staff met once a month, which enables any management/staffing issues to be discussed. Another member of staff said that they were “happy working” at the home, they felt communications were better, and if they went to the management, they felt that they would be listen to. They were also aware, that the manager’s job, did involve them being out of the home. Two other members of staff also confirmed that they were happy working at the home and when asked about the management of the home replied that it was “good”. The home had safe systems in place for storing and recording resident’s monies held for safekeeping. A sample of 2 residents monies was checked against the home’s records and found to be correct. However, concerns were Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 24 raised over how much money they were holding for residents, with 1 resident’s money being over £500. The home said the contents of the safe were insured for up to £1,500. This led to concerns that they were holding over that amount, and also residents were losing interest on their savings. Staff confirmed that the money would be paid into the bank the following day. Two members of staff have been trained as Fire Marshals and training records showed that staff received Fire training, and other training to ensure a safe environment for residents (Food Hygiene, Manual Handling, Infection Control). Prior to the inspection, concerns were raised by a family that they felt they should be given more information. Discussions with the Manager and records looked at showed that the home did work closely with relatives. However, if the resident does not want personal information to be shared with their next of kin, this is respected by the home. Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 X X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 x COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 3 X 2 X X 3 3 STAFFING Standard No Score 27 3 28 2 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 2 3 X 2 Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? No Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 27 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 OP7OP9OP 37 Regulation 13 (2) (4) Requirement Any changes in medication following a Doctors visit must be fully documented (to the reason why) in the resident’s care plan, and where required a new prescription requested. The home must ensure that call bells in the bathrooms, are long enough to reach the bath, and can be used by the resident if required. Timescale for action 30/01/06 2. OP22OP38 13 (4) 01/04/06 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 OP8 Good Practice Recommendations Although staff state that the resident has not lost weight, staff should monitor the nutritional intake of the resident discussed, to identify how much, and the reason why they leave their food, and liaise back with the family. Following the recent survey on resident’s thoughts on meals, the home should look at carrying out a similar survey on resident’s thoughts on activities, the results of which could be published and included in the newsletter. 2. OP12 Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 28 3. 4. OP25 OP28 5. OP35 Staff should monitor the temperature of residents’ baths, to ensure that the temperature is not too cool, and is at a comfortable temperature for the resident. The home should continue to monitor to ensure that all new staff are offered the NVQ level 2 training, as soon as possible, to support them in achieving having 50 of their staff trained to NVQ level 2 (or equivalent). The home should monitor the amount of resident’s money held in safe keeping, to ensure that amounts do not become too high (unless requested by the resident), which results in residents loosing any interest payable. Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 29 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 Sherrington House DS0000029250.V281078.R01.S.doc Version 5.1 Page 30 - 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. 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