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Inspection on 22/11/05 for Shakespeare House

Also see our care home review for Shakespeare House for more information

This inspection was carried out on 22nd November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

What the care home does well

The majority of the inspection took place in the lounge at the rear of the property where most of the service users were seated. The room was warm, clean and comfortably furnished. The majority of the service users had some degree of cognitive impairment. Activities for recreation and stimulation were provided that took this into account and which moved on to other activities as service users` attention changed. Members of staff were observed to approach service users with courtesy and kindness and in a manner that was sensitive to service users` short-term memory loss. The majority of the staff team had worked in the home for a significant time and were conversant with service users` needs. A member of the commented on the effective teamwork in the home and the constructive and pleasant working atmosphere.

What has improved since the last inspection?

Action had been taken on environmental shortfalls in relation to safety requirements and the deteriorating condition of bathroom flooring, all of which had detracted from the home`s overall performance at the previous inspection.Arrangements to monitor health and safety matters had improved; the manager had undertaken training in Occupational Health and Safety and a policy statement for the management of safety had been drawn up and given to the manager. This document and a comprehensive tool for monitoring the environment had not been implemented as yet. The manager stated that she was planning to do this in the near future. It is a priority that she does so. The home`s written guidance on situations/practice that could lead to abuse of service users had been reviewed and were satisfactory, with the exception of no reference to misuse of medication in relation to service users` care.

What the care home could do better:

The documents, which set out how service users` needs would be met, required a little more detail. Similarly recruitment practice must evidence that gaps in employment have been explored at interview and that job offers are in writing and set out any special restrictions that would apply to any member of staff awaiting clearances. It was noted that the home had been unable to weigh frail service users, which is particularly important when monitoring nutritional needs. An appropriate set of scales must be provided. The manager, as seen at the previous inspection, had been required to work occasional shifts each week to cover care staff absences through ill health. The proprietor is advised again that the manager must be supported to fulfil her role and that vacant shifts must be covered by agency personnel if necessary.

CARE HOMES FOR OLDER PEOPLE Shakespeare House 19 Shakespeare Road Bedford Bedfordshire MK40 2DZ Lead Inspector Leonorah Milton Unannounced Inspection 22nd November 2005 14.00 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 Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 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. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Shakespeare House Address 19 Shakespeare Road Bedford Bedfordshire MK40 2DZ 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) 01234 359224 01234 359224 Mr Sada Camiah Mrs Vijama Camiah Ms Louisa Bedeau Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18), of places Physical disability over 65 years of age (18) Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10/05/05 Brief Description of the Service: Shakespeare House was registered to provide for eighteen older persons who may also have physical disabilities and/or dementia. The arrangements to care for older people with physical disabilities associated with old age can be accomodated under the registered condition of OP. It had therefore agreed with the proprietor that the category PD for physical disabilities would be removed from the conditions of registration. The home was located in a pleasant suburb of Bedford within walking distance of the town’s amenities including bus and train links.The physical environment had been suitably adapted internally to meet the needs of frail older people.. Access to the building from the garden to the rear was restricted for those with mobility problems. Accommodation was arranged over three floors with seventeen bedrooms, one of which could be used for double occupancy. Access was provided to the upper floors via a shaft lift. The communal accomodation of a dining room and a lounge was located on the ground floor. A range of adapted bathrooms and toilets were located for convenient access throughout the building. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the second of the statutory two inspections that the Commission for Social Care Inspection (CSCI) is required to carry out each year. This inspection was carried out in accordance with the CSCI’s procedures to assess core care standards within the two inspections as detailed on this report. This inspection therefore focused on the progress to meet requirements from the previous inspection and the core standards not assessed at that visit. During this inspection the arrangements for the care of one service user and her case file were assessed, as was the personnel file for a recent employee. Three service users were spoken to, albeit those conversations were brief because of the service users’ cognitive impairment. Conversations took place with a member of staff and the manager. A partial tour of the building took place. It is recommended that this report be read in conjunction with the report of the inspection carried out in May 2005 for a complete overview of the standard of the operation between these dates. What the service does well: What has improved since the last inspection? Action had been taken on environmental shortfalls in relation to safety requirements and the deteriorating condition of bathroom flooring, all of which had detracted from the home’s overall performance at the previous inspection. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 6 Arrangements to monitor health and safety matters had improved; the manager had undertaken training in Occupational Health and Safety and a policy statement for the management of safety had been drawn up and given to the manager. This document and a comprehensive tool for monitoring the environment had not been implemented as yet. The manager stated that she was planning to do this in the near future. It is a priority that she does so. The home’s written guidance on situations/practice that could lead to abuse of service users had been reviewed and were satisfactory, with the exception of no reference to misuse of medication in relation to service users’ care. 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. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 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 Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 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 Satisfactory written guidance was available to enable prospective service users to make an informed choice about moving into the home. EVIDENCE: The statement of purpose had been reviewed and made reference to the details required by the legislation. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 9 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): 7,10 Care plans were not sufficiently detailed for all service users so that there was a risk that needs could be overlooked and remain unmet. EVIDENCE: The written guidance to show how service users’ needs would be met had been compiled in language that demonstrated the sensitive approach that was to be adopted to care for service users. However the documents assessed at this inspection were not sufficiently detailed to show how the nutritional and skin care needs of a service user were to be met. It was noted that a service user was able to meet her visitor in the privacy of her room and that another shared a private meal with her visitors. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 10 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): These standards were not assessed at this inspection. EVIDENCE: Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 11 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): 16,18 Satisfactory arrangements were in place to enable service users to raise concerns and for their protection from abuse. EVIDENCE: The previous inspection had noted that there was no systematic approach to complaints investigation and that the home’s written procedures should be displayed more prominently. The manager stated that since then she had taken account of the need to maintain records of investigation but had not put this into practice, there having been no recent complaints. Information about complaints procedures had been openly displayed around the home. A review of the home’s protection procedures had improved the guidance for staff. The manager agreed to add guidance to these documents in relation to abuse through medication. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 12 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): 19,20,22,23,24,25. The premises were mostly suitable for the care of frail older people. EVIDENCE: There had improvements in safety aspects of the home and the appearance of the bedroom doors on the upper floor, which had been scratched and worn at the previous inspection. At this inspection it was noted that there was discernable dip in a section of the floor at the top of the staircase. This constituted a trip hazard. It was also noted that bedrooms were not provided with appropriate locks or lockable facilities. The room temperature in one bedroom was too cold. The manager switched on the radiator as the inspection took place. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 13 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): 27,29 Staffing arrangements were sufficient to meet service users’ needs. EVIDENCE: Despite the team having been depleted for sometime through short-term and long-term staff sickness, the willingness of other personnel to cover vacant shifts had meant that the requisite numbers of staff had been available to care for service users. The member of staff spoken to had under taken sufficient training in her previous care job to meet service users’ needs. The record of training in the office indicated that the shortfalls in manual handling training noted at the previous inspection had been dealt with. Recruitment practices had improved. There was evidence to show that permits to work had been taken into account. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 14 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): The manager was competent and had strategies in place to consult with service users and provide guidance for staff. EVIDENCE: The manager was qualified and experienced in the operation of a residential home. Records were seen to show regular meetings with service users and also with staff. There was evidence to show that members of staff had received individual supervision but not with the frequency detailed by the standard. The manager explained this was because the supervisor was on long-term sick leave. A quality review had taken place in consultation with service users and the resulting action plan showed that all of the arising issues within the manager’s brief had been dealt with. The outstanding issue in relation to the garden was Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 15 the proprietor’s responsibility. It was noted that the action plan did not include review and action dates, as is good practice. Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 16 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 1 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 3 x 2 2 2 2 x STAFFING Standard No Score 27 3 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x x 2 x 2 Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 17 Are there any outstanding requirements from the last inspection? Yes 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 2 Regulation 5(1)(b)17 (2)Sch4(8 ) Requirement Each service user must receive a copy of a contract/terms and conditions of residency. A copy of each contract and records of payments of fees must be maintained in the home. (Not assessed at this inspection) Care plans must include nutritional needs assessments and where necessary the outcomes of risk assesments in relation to skin care. Guidance in relation to the risk of abuse of service users by the malicious use of medicines must be added to the home’s protection procedures. The dip in the flooring by the top of the staircase must be eliminated to remove the risk of falls. Appropriate equipment must be provided so that every service user can be weighed on a regular basis. Bedrooms doors must be fitted with locks for service users’ privacy but which also enable DS0000014965.V264283.R01.S.doc Timescale for action 31/07/05 2 7 12(1)(a) 15(1)(2) 31/01/06 3 18 13(6) 31/01/06 4 19 12(1)(a)1 3(4)(a)(c) 12(1)(a)2 3(2)(n) 12(1)(a) 23(2)(e) 31/12/05 5 22 31/03/06 6 24 31/03/06 Shakespeare House Version 5.0 Page 18 7 24 12(1)(a)1 6(2)(c) 8 25 12(1)(a) 23(2)(p) 18(1)(a) 9 27 10 29 19(4)(a) 11 30 18(1)(c) (i) 12 38 13(3)(4) staff entry in the event of an aemergency. Individual risk assessments must be in place to show why such a provision is not required. Bedrooms must be provided with lockable facilities. Individual risk assessments must be in place to show why such a provision is not required. The ambient temperature in bedrooms must be suitable for the comfort and needs of service users at all times. Sufficient care staff must be rostered each day to meet service users needs so that the manager is not required to assist the care team on a routine basis. (Previous timesacle of 30.06.05 had not been met) Recruitment records must show that gaps in employment have been explored and where necessary verified. All care staff must receive induction training to NTO specifications (Not assessed at this inspection.) The home must have a robust health and safety policy and that all the required procedures are in place to protect service users and staff from unnecessary risks or measures are in place to minimise risks. (Previous timescales of 31.07.04, 31.04.05 and 31.07.05 had not been met in full) 31/03/06 30/11/06 30/11/05 30/11/05 30/06/05 31/12/05 Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 19 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 2 3 Refer to Standard 26 17 26 Good Practice Recommendations A means of ventilation should be installed in the laundry.(Carried forward from previous inspections). Service users should be supported to vote in local and general elections via postal voting procedures.(Not assessed at this inspection). Staff should receive supervision at least six times each year.(Carried forward from previous inspection. Where a supervisor are absent for a prolonged period another supervisor should be introduced ). Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Shakespeare House DS0000014965.V264283.R01.S.doc Version 5.0 Page 21 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!