Inspection on 27/05/09 for Shakespeare House

This inspection was carried out on 27th May 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shakespeare House 30/06/10

Shakespeare House 17/05/10

Shakespeare House 27/05/08

Shakespeare House 10/05/07

Shakespeare House 13/06/06

Shakespeare House 22/11/05

Shakespeare House 10/05/05

Shakespeare House 22/12/04

Shakespeare House 18/05/04

Shakespeare House 15/01/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 15/11/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shakespeare House 19 Shakespeare Road Bedford Bedfordshire MK40 2DZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Katrina Derbyshire     Date: 0 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Shakespeare House 19 Shakespeare Road Bedford Bedfordshire MK40 2DZ 01234359224 F/P01234359224 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Sada Camiah,Mrs Vijama Camiah care home 18 Number of places (if applicable): Under 65 Over 65 18 18 18 dementia old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home 0 0 0 Shakespeare House is registered to provide care for eighteen people who are 65 years of age or over who may also have physical disabilities and/or dementia. Mr and Mrs Camiah have owned the home for a number of years and participated in the operation of the home as financial manager and care practice advisor. The home is located on a busy road in Bedford within walking distance of the towns amenities including bus and train links. The physical environment had been suitably adapted internally to meet the needs of frail older people. Accommodation is arranged over three floors with seventeen bedrooms, one of which could be used for double occupancy. Access is provided to the upper floors via a shaft lift. The communal dining room and lounge were located on the ground floor. A range Care Homes for Older People Page 4 of 27 Brief description of the care home of adapted bathrooms and toilets are located for convenient access throughout the building. Current fee rates at the time of this inspection are £457.00 to £475.00 per week. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection carried out on the 27th May and 4th June 2009. The care of three people was looked at in detail and this is known as case tracking. Tracking peoples care is the methodology we use to assess whether people who use social care services are receiving good quality care that meets their individual needs. Through discussion, observation and reading records, we track the experiences of a sample of people who use a service. During the visit the communal areas of the home were seen alongside some of the Care Homes for Older People Page 6 of 27 individual rooms. Time was spent with many of the people who live at the home in one of the sitting areas on the first day. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The managements submission of documentation was also considered prior to the site visit. The focus of this inspection was to look at the key standards. What the care home does well: What has improved since the last inspection? What they could do better: The checks that are undertaken before someone is allowed to work at the home needs to improve. Homes must as a minimum make sure that they have carried out a check known as the CRB check, and have two written references. They need to have this information to know if the person is going to be subtable to work in a care home. Not everyone had two references, we have made a requirement about this. The documents known as care plans, although improved since our last visit still require further development. The guidance within some of these plans was not clear, it did not give enough information to the staff for them to know how they should be supporting the person. This is important so people will always receive continuity of care. Although some of the carpeting had been replaced, there remains several areas in the home that require updating, either carpets need replacing or re decoration is required for example. This is important so that the home feels and looks homely throughout for Care Homes for Older People Page 8 of 27 the people living there. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have sufficient information available to them to be able to make an informed decision on whether to move into the home. Evidence: The home has an information pack for people who are interested in moving into the home. This contained useful information about what people can expect from the home, and had been updated to include the name of the acting manager. The statement of purpose included how people could complain if they were dissatisfied with the service, and explained the length of time that they would need to wait before the management responded to their concerns. We saw that pre admission assessments of peoples needs are on the individual files of people living at the home. When people move in, the staff assess their level of dependency and this is re assessed each month. In addition information from placing Care Homes for Older People Page 11 of 27 Evidence: authorities were also in place, the information from both assessments were used to identify the individual needs of the person. Content of these documents demonstrated that people and their families had been involved in their assessment and had been given the opportunity to be part of this process. Intermediate care is not offered at the home. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive access to health care when needed to help improve their overall physical well being. Evidence: For this inspection we looked at the paperwork the home has to keep, for three residents. Each person had a care plan in place. The care plans in use were new and had been introduced by the new manager since the last inspection. Those examined showed an improvement on those that had been in place at the previous visit, however further development is still required. One example was a person had been assessed as being at very high risk of falls, the guidance in the care plan to staff stated only to encourage to use their stick when walking and ensure to offer support. This is not sufficient, there was no guidance for example on checking footwear, the environment or if a referral had been made to the falls clinic. The files also contained risk assessments, for example for moving and handling, nutrition, and pressure areas. These had been evaluated monthly and changed when Care Homes for Older People Page 13 of 27 Evidence: needed, indicating a higher or lower need than the month before. The manager reported that the services provided by local District Nurses was good. Evidence seen within the daily records showed that people when needed had received treatment by them. In addition other documentation was seen to show that people had attended hospital appoints as needed and everyone was registered with a General Practitioner. Staff who administer medication have all received training in this area. Medication is stored securely and medication records are maintained for all medicines received into the home and administered. Observation made over the two days showed that staff spoke to people living in the home in a courteous manner. A good rapport was noted between them and people appeared very relaxed within their environment. Staff were also observed knocking on doors before entering. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel the food and the home meets their individual choices and preferences. Evidence: Activities in the home were noted to have improved in recent months. Several residents commented on increased activities since the new manager had stated working at the home and that they had enjoyed these and ones planned for the future. Staff at the home demonstrated their understanding of the importance of meeting the social needs of the residents. Activities available in the home are on display so that residents are kept informed of all events. Feedback from relatives and residents indicate that the home is supportive to both in maintaining contact, and involving families in the care of the residents. Relatives support is available from the manager and staff, both the manager and Deputy manager described it as an open door policy. Within the individual records information was available to show the contact details for each person and guidance to staff on assisting people to maintain that contact. Information seen within the care records of residents contained entries and Care Homes for Older People Page 15 of 27 Evidence: information to show that residents continued to make decisions in their lives examples included personal financial matters and voting. Menus available in the home show that a choice of food at mealtimes is offered that includes fruit and vegetables. One resident said the dinners are tasty and several other residents commented that they enjoyed their meals at the home. Nutritional risk assessments were in place, where required nutritional supplements were provided to those at risk of weight loss. Food provided included the main food groups including carbohydrates, protein, fruit and vegetables. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People feel that their concerns will be listed to and acted upon to improve the service that they receive. Evidence: Within the statement of purpose there was information on whom to contact if you wished to make a complaint as described within the choice of home section. At previous inspections records were seen at that time to show how complaints had been responded to and what action had been taken to remedy any shortfalls and this was assessed as meeting this standard. One complaint had been received by the service since our last visit. The management of complaints and concerns were seen to be important to the management of the service as they felt it was another way that they could improve the service. The complaint received was acted upon and changes were made as a result of this. The home had in place a policy on abuse and a copy of the most recent guidance for the Safeguarding of Vulnerable Adults that contained the correct reporting of any alleged abuse was secured during the visits. Training records showed staff had received training in this area. Staff they were able to demonstrate that they knew how to report any concerns. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some of the decor, furnishings and fitting require replacing to ensure all people have a homely environment in which to live. Evidence: The building is a converted Victorian house located on a busy street close to the town centre of Bedford. Some of the areas of the home are decorated to a good standard, however other areas require re decoration and renewal of furnishings and fittings to provide this level throughout. Following receipt of a complaint by relatives new carpet had been fitted in the corridor and communal area of the home, this had improved the standard of flooring in this area. Areas including bathrooms and toilets have fitted adaptations to meet the needs of the people living at the home including bath hoists, grab rails and raised toilet seats. There remains a need to replace carpets in some of the other areas in the home and further redecoration. All areas of the home were noted to be clean and free of any odours. Best practice in relation to infection control was seen to be carried out by the staff at both visits. Care Homes for Older People Page 18 of 27 Evidence: Stocks of aprons and gloves were in place as was appropriate with the disposal of clinical waste. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing procedures require improvements to ensure people receive care and support from staff who have been fully trained and vetted. Evidence: Training records that were available were examined. These showed that there was a deficit in some of the areas required for staff updates. The manager did advice that the records were not completed in full so may not reflect all the training undertaken by the member of staff. She had since starting at the home given care records her priority and staffing records were to be her next area of concentration, for improvement. The home has a recruitment policy and procedures. Examination of three staff files was undertaken to look at recruitment practices in the home. Evidence of an application form and Criminal Records Bureau check was seen in all files alongside some references. Two of the staff files had only one written reference and does not meet the regulation and places people at risk. People spoken to as previously assessed felt that staff would respond to them when they needed assistance. Everyone spoken with described feeling confident in their abilities and felt the owner and manager were especially friendly and courteous to them as they were always asking if they were alright. Observation showed that Care Homes for Older People Page 20 of 27 Evidence: positive relationships had been established between the people living at the home and staff. Conversation flowed freely with engagement between them evidencing that this was a usual pattern as previously assessed. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management of staffing procedures has not been sufficient to ensure residents are protected at all times. Evidence: People spoken to felt that the manager would respond to them when they needed her. Everyone spoken with described feeling confident in her abilities and felt she was friendly and courteous to them. Observation showed that positive relationships had been established between the people living at the home and staff. Conversation flowed freely with engagement between them. Information supplied by the home show that the new manager has several years managerial experience in varying care roles. The people living at the home and staff spoke positively about her approach and management style. The manager interacted with staff and residents throughout the inspection. Care Homes for Older People Page 22 of 27 Evidence: The home has a Health and Safety policy. There was evidence within the training records that some staff had undertaken fire, manual handling, food hygiene and first aid training. Risk assessments have been undertaken and were seen within the individual records examined. Records of the testing of water temperatures were maintained however the testing of the emergency lighting and fire equipment had not been undertaken as often as required. There had been many improvements made since the last inspection however there remains areas that still require improvement. It was evident that the new manager had actively sought to change things to improve the standard of care. However we had significant concern that two of the most recently employed staff had commenced their employment at the home without having all the required checks in place prior to this. Full details of this is described within the staffing section. Contracts relating to health and safety were in place, these included fire and electrical items receiving the required servicing from approved contractors. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 A care plan must be in place for each assessed need that provides sufficient guidance to staff on the care and support they must provide to meet that need. This is to ensure that all people receive continuity of care. 31/07/2009 2 19 23 Repair, renewal and 30/09/2009 replacement of carpeting in the home where it is worn and decor where it is scuffed must be undertaken. To provide a homely environment for people living at the home. 3 20 2 A minimum of two written 31/07/2009 references, one from the most recent employee must be secured prior to the appointment of any member of staff. This will help protect the people living at the home. Care Homes for Older People Page 25 of 27 4 21 4 Training and training records 31/07/2009 must be up to date to make clear all staff have received all required training to carryout their role safely. This will ensure people receive care and support by staff who are knowledgeable and whose practice is up to date. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!