Inspection on 27/06/06 for Shaldon House

This inspection was carried out on 27th June 2006.

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 no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shaldon House 10/07/07

Shaldon House 27/01/07

Shaldon House 24/01/06

Shaldon House 10/10/05

Shaldon House 07/12/04

Shaldon House 15/06/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Shaldon House 77 Shaldon Road Horfield Bristol BS7 9NN Lead Inspector Sandra Gibson Key Unannounced Inspection 27th June 2006 3:45pm Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 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 Shaldon House DS0000026554.V293881.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Shaldon House Address 77 Shaldon Road Horfield Bristol BS7 9NN 0117 9518884 0117 9521492 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) www.craegmoor.co.uk Parkcare Homes (No. 2) Limited Mrs Lisa Marie Cole Care Home 9 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (1) of places Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate one named person with Physical Disability (PD). Will revert to 9 LD when named person leaves. 24th January 2006 Date of last inspection Brief Description of the Service: Shaldon House is registered with the Commission for Social Care Inspection (CSCI) to provide personal care for eight people with learning disabilities who are aged 65 years or younger and one resident with a learning disability who is 65 years and over. There is also a condition of the registration that one named resident who has a learning disability and a physical disability may be accommodated in the home. Parkcare No 2 Ltd, a subsidiary of Craegmoor Healthcare, operates Shaldon House which is situated in a residential area close to amenities and bus routes. Single bedroom accommodation is arranged over three floors. There are two bedrooms on the ground floor. There is no lift facility available. Disabled access is to the rear of the property. There is a pleasant garden, which is also situated at the rear of the building. This area is reached by steps and has a grassed area and patio with seating. There is currently no appointed registered manager. The fee is £326-£540/week and extra charges are made for chiropody, hairdressing, toiletries etc. This information is provided in the service users’ guide. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was unannounced key inspection conducted midweek between the hours of 3:45pm and 8:45pm. Evidence was gathered from: Examining previous correspondence with the home including Regulation 37 (Death, illness, other events notifications), inspection reports, information from pre-inspection questionnaire, relatives comment cards (2), talking to/observing residents, talking to the deputy manager/talking to and observing staff, talking to and case tracking three residents, examining records, policies and procedures. What the service does well: What has improved since the last inspection? Further progress has been made since the last inspection to seek the wishes of each resident during the ageing process and in the event of end of life. There are other improvements that have taken place in this home since the last inspection but further action is required in these areas. Please see below. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 6 What they could do better: The information provided to prospective residents and current residents and their representatives is in need of attention to ensure that people have the full information they need to make an informed choice about where to live and that they are kept up date with information about the support and services that are provided by the staff. Resident’s needs are fully assessed to ensure the home is suitable to meet individual requirements. Minor improvements are required to ensure that residents and their representatives (where appropriate) are fully consulted during the process. Residents’ individual needs are on the whole met in this home. However, residents would benefit further from staff being given further opportunity to receive specialist training to meet individuals’ complex needs. The care planning system in place is good. However, further action is required to ensure that to ensure that residents changing needs continue to be fully identified. The medication administration system and practice is not wholly satisfactory. It needs to be improved to ensure that residents and staff are fully protected. The complaints procedure remains satisfactory with some evidence that the service users feel that their views are listened to and acted upon. However, action must be taken to ensure that all representatives are made aware of the procedure and who to complain to in the absence of a current manager. Measures in place to ensure that residents are protected from abuse are not wholly satisfactory. Systems must improve to ensure that the information in place is up to date and that residents are protected from risk of harm at all times. There have been improvements in the health and safety, comfort and cleanliness of Shaldon House since the last inspection. However, further attention in respect of the health, safety and comfort of the home to ensure that residents live in a consistently safe, comfortable, environment, which meets the needs of all residents. The relationships between staff and residents are good and create a warm positive environment to live in. However, there is a lack of clarity about who is managing the home following the recent departure of the manager. Urgent attention is required to ensure that resident rights and best interests are met and staff are aware of who is responsible for day-to-day management of the home. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 7 Staffing levels have deteriorated since the last inspection. Urgent action must be taken to ensure that residents’ dependency needs are met at all times. Staff training has remained satisfactory since the last inspection. However, further attention to specialist training is required to take place to ensure that all residents’ individual needs are met and that staff have an awareness and understanding of equality and diversity. Support to care staff is not satisfactory. There has been deterioration since the last inspection. Further improvement in the formal support system is needed to ensure that residents benefit from staff that are appropriately supervised. The home is going through a transition period following the departure of the registered manager. Arrangements must be put in place to ensure that the home is competently managed to ensure the health, safety and welfare of residents, staff and visitors are promoted and protected at all times. Shaldon House is currently in financial difficulties. Urgent plans must be put into operation to ensure that residents rights and best interests are safeguarded at all times. 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. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The information provided to prospective residents and current residents and their representatives is in need of attention to ensure that people have the full information they need to make an informed choice about where to live and that they are kept up date with information about the support and services that are provided by the staff. Residents’ needs are fully assessed to ensure the home is suitable to meet individual requirements. Minor improvements are required to ensure that residents and their representatives where appropriate are fully consulted during the process. Residents’ individual needs are on the whole met in this home. However, the residents would benefit further from staff being given further opportunity to receive specialist training to meet individuals’ complex needs. EVIDENCE: The home has a full occupancy and has an established group of residents. There have been no admissions to the home since May 2005. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 10 The service has developed a statement of purpose, which sets out the aims and objectives of the home. There is also a residents’ guide, which provides basic information about the service. Written evidence confirmed that this guide has been provided to all current residents in a symbolic format. These documents were last reviewed in May 2005. They now need to be reviewed again following the departure of the registered manager in May 2006 and to include further information about the services they provide to residents with complex needs. It was noted that the last inspection report was attached to these service users’ guides. However two relatives comments cards were received from nine sent out and both relatives stated that they did not have access to the last inspection report. Residents have been provided with a statement of terms and conditions. It gives basic information on what residents can expect to receive for the fee they pay and it sets out terms and conditions of occupancy. The inspector was informed after the inspection that the fees for the residents funded by Bristol City Council were currently under urgent review. Written evidence demonstrated that prospective residents have a needs assessment carried out before they are admitted to the home. Information seen at the inspection confirmed that the service consults the assessment and any other information to see if they can meet the prospective residents needs before they make the decision to accept the application for admission and offer a placement. The majority of residents have been living at the home for over five years. The service has received copies of assessments and care plans assessed through the care management arrangements for all new residents admitted in the last five years. It was pleasing to see detailed assessments in place for all residents completed by the staff in consultation with the resident and their representative where appropriate. However it was noted from the sample seen that the majority of those had not been dated or signed by the member of staff responsible for completing the assessment or the resident / representative that had been consulted during the assessment process. Evidence confirmed that staff have the necessary basic skills and ability to care for residents who live in the home. There was, however, very little evidence of any specialist training that had been provided to staff during the last couple of years to support them to work with residents complex needs such as pre-senile dementia, cerebral palsy, behaviours that challenge the service, obsessive compulsive disorder, etc. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The care planning system in place is good. However, further action is required to ensure that residents changing needs continue to be fully identified. Staff have a good awareness of individuals needs and rights and treat the residents in a warm and respectful manner, which means that residents can expect to receive care and support in a secure setting Residents are supported to take risks in their daily lives within their home and out in the community. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 12 EVIDENCE: As seen at the last inspection conducted on 26/01/06 each resident has a comprehensive personal portfolio and person centred assessments, which means that staff put the views, wishes, likes and dislikes of each resident at the centre of all care provided. The information for each resident was very informative and useful enabling staff members to instantly provide the appropriate care to support their health and social needs. From the assessments staff had identified needs enabling them to form written care plans. These were written clearly and concisely and in a sense that the residents had contributed to the implementation of each plan. As highlighted at the last inspection there was no written evidence to confirm this, as signatures for consent to the plans had not been obtained. Evidence indicated that plans had been reviewed regularly on a monthly basis and assessments had now been updated following the last inspection. During the last inspection the manager stated that she was developing a programme whereby each resident, their family members and any significant health/social professionals were going to meet and conduct re-assessments and revised plans of care annually. Family and residents responses had been very positive to this suggestion and evidence confirmed that the manager made arrangements to commence this programme after the inspection. However the manager had departed from Shaldon House on 31/05/06 and no plans for this programme to continue were seen. Written evidence confirmed from a sample of portfolios examined that they continue to demonstrate a great knowledge and understanding of all residents’ emotional and psychological needs. Information was available entitled ‘What makes me sad’, What I am good at’, Likes and dislikes ‘What makes me angry’ and ‘What can you do for me’ to name but a few. Information was also available about previous personal experiences for example, where they went to school, a family tree, and important family dates to remember like birthdays. Hospital appointments, visits to the General Practitioner and any other professionals are recorded to provide a history and quick reference guide. A sample of risk assessments were examined and demonstrated that staff were ensuring that residents were safe within their home and out in the community. All residents had individual risk assessments detailing for example, how much supervision was required when outside of the home, and how long should be allocated for a walk with one resident who walks particularly slow. However, some of the risk assessments were now out of date and were in need of an urgent review. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 13 Residents continue to be supported to take risks as part of living an independent lifestyle. This was evidenced by conversations with residents about different activities and outings they had participated in the community. This information was confirmed in resident’s surveys. Residents’ personal files are held securely and staff demonstrated how they respected individual residents rights for privacy and confidentiality. Residents’ surveys confirmed that resident’s confidentiality was respected. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents enjoy a range of activities and are supported to live a fulfilling life in and out of the home. Personal relationships are encouraged and supported. Residents take an active role in promoting and maintaining a healthy well balanced diet. EVIDENCE: All nine residents were either spoken to or observed during the inspection. The inspector arrived at 3.45pm when resident had just returned from day centres or college or were relaxing after a day doing daily living activities at home. On entering the home it was observed that the mobile hairdresser was visiting the home and several residents had requested to have their haircut. Another resident was looking at his crossroad book, a couple of residents were chatting to a member of staff, several residents were watching football on TV and another resident was setting the table for the evening meal. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 15 Daily routines and activities were discussed which included attending college and various day centres on weekdays. All residents regularly go out and enjoy the local community amenities by visiting local pubs, restaurants, shops, cinemas and Tenpin Bowling. Thee inspector was informed that no residents currently choose to attend a place of worship. This was confirmed in resident’s files Residents were able to enjoy hobbies such as football, music, watching soap operas and films on TV or DVD. An activities record is maintained and special sessions are arranged for the residents, for example a pampering night, Hazard awareness discussions, bingo, etc Some residents lead very busy lives and expressed one again that they often enjoy just ‘relaxing on the weekend’. Family and friendship contact is encouraged and supported whereby the residents invite people for tea and some resident’s stay with their families for weekend visits and holidays. Each resident has a list to remind them of important family dates and they send cards to mark these special occasions. During the course of the inspection a resident received a phone call from her mother. This telephone call was not private as it was taken in the communal lounge. One of the members of staff indicated that if the residents wished to have a private call then this could be provided in the office, which is situated close to the lounge. Residents are supported by the staff to be able to experience personal relationships and to be able to express their sexuality. This information was confirmed in residents’ personal files. One resident talked excitedly about her new boyfriend and how she hoped to see him at the weekend. All staff on duty throughout the inspection were observed as having a good humoured, warm mannered rapport with the residents. The home has a people carrier to enable residents to enjoy going out further a field, however due to the young age of some staff they are not able to be insured to drive it. Due to these circumstances the staff have taken out business insurance on their own cars so that there is greater flexibility for the residents to access amenities through travel. The inspector heard that residents had recently been on holiday to Minehead and that further day trips were planned for the summer. Evidence in the residents’ meeting minutes confirmed this information and those residents were able to be involved in choosing and planning the destinations. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 16 It was pleasing to hear that a new BBQ has been purchased for the residents to enjoy Summer Barbecues. However, it was disappointing to hear that the annual summer fete had been cancelled due to reduced staffing levels. The issue of staffing levels will be discussed later in the report in the staffing section. Information confirmed that residents meet every Sunday to discuss their chosen menu plan for the week ahead. This system enables the residents to make their own choices and with the support of the staff it was evident from the menus that they have produced a varied healthy diet plan. Alternatives were also made available and flexibility in meals was evident. On the day of the inspection residents enjoyed a communal evening meal, which consisted of a chicken salad and a dessert of choice. Both hot and cold drinks were available. The inspector was still present at suppertime and observed that residents were offered hot drinks and commented that snacks were available if they wanted something else to eat before they went to bed. Several residents confirmed they enjoyed the food and never felt hungry. Evidence confirmed that staff in the home continues to support residents to eat a healthy diet. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20,21 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents continue to be well supported to meet their physical and emotional health needs, they are monitored effectively and action is taken promptly when concerns arise so that residents may be confident that their needs will be met. The medication administration system and practice is not wholly satisfactory. It needs to be improved to ensure that residents and staff are fully protected. Further progress has been made since the last inspection to seek the wishes of each resident during the ageing process and in the event of end of life. EVIDENCE: A sample of care plans examined, residents comments and their body language throughout the inspection showed that needs were being met and that they were all of a happy disposition. Care plans were personalised with photographs and information about each resident as an individual. The plans stated how best to support each resident to meet their physical, mental, social, spiritual and sexual needs. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 18 A sample of the medication administration system in place was examined and was found to be up to date and accurate correct. It was noted during the last inspection that the medication administration policy and procedure had not been reviewed on an annual basis. Evidence confirmed at this inspection that this policy had not been reviewed since 2002. This is not satisfactory. It was observed that temperature of the fridge where medication and ointments are kept is not currently monitored. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Medication stocks for drugs prescribed as required were examined and the amounts are checked and recorded weekly. A recommendation was made at the last inspection for the manager to send excess stock back to pharmacy. It was noted during this inspection that this recommendation had been partially met. However, a sample of two residents PRN medication i.e. to be administered when required was noted to be out of date. New packets of medication were seen for one resident but not for the other. This is not satisfactory practice. Staff training records evidenced that staff had received competency training from the local pharmacist, which is updated annually. The inspector was informed that this training was now due and arrangements were in place. Before the manager left employment at Shaldon House staff had been concentrating on care plans to support the resident’s wishes for end of life. Some residents had enjoyed thinking about the future and plans examined showed very specific and personal information, for example, song requests, where they would be buried or where they would like their ashes scattered. During the course of the inspection a discussion took place about residents changing needs as they become older and frailer. One resident’s physical and social needs are changing according to staff. The resident in question is now beginning to find that Shaldon house is too noisy and too busy. This information is confirmed in the individual’s care plan. It was noted that South Gloucestershire Social Services are in the process of re assessing this persons needs with a view to supporting her/him to find alternative accommodation. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The complaints procedure remains satisfactory with some evidence that the service users feel that their views are listened to and acted upon. However, action must be taken to ensure that all representatives are made aware of the procedure and who to complain to in the absence of a current manager. Measures in place to ensure that residents are protected from abuse are not wholly satisfactory. Systems must improve to ensure that the information in place is up to date and that residents are protected from risk of harm at all times. EVIDENCE: Residents have information provided in the Service Users Guide on how to make a complaint or voice concerns, this information is also on display in the reception area. However, it was noted that not all representatives receive information about the complaints procedure. Two relatives comments card, which were returned, stated that they were not aware of the complaints procedure in the home. It was also noted that this policy and procedure had not been reviewed since 2002 A couple of residents talked about the residents meetings where they are able to discuss any issues and concerns they may have. A sample of residents’ meeting minutes was examined. It was noted that they are held on a regular basis. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 20 It was noted that the whistle blowing policy and procedure was reviewed in 2005 but the adult protection policy and procedure was last reviewed in 2002 An urgent review of this policy and procedure must take place to ensure that it complies with the Local Authority Guidance No Secrets in Bristol. No complaints have been made or received by residents or families in the last year. This was confirmed in the response to the residents’ surveys and relative comments card. Staff have received training on the protection of vulnerable adults. Staff had also attended training on ‘Non violent crisis intervention’ which is also updated annually. Staff spoken to were aware of the protection of vulnerable adults policy and procedure and one member of staff gave an example where they had used it on behalf of a resident. This was confirmed by a resident at the time of the inspection. Staff also demonstrated that they were aware of the whistle blowing policy, what it stood for and how to contact relevant people with any concerns they may have. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. There have been improvements in the health and safety, comfort and cleanliness of Shaldon House since the last inspection. However, further attention in respect of the health, safety and comfort of the home to ensure that residents live in a consistently safe, comfortable, environment, which meets the needs of all residents. EVIDENCE: Shaldon house is domestic in appearance and is in keeping with the other houses in the area. It is situated over three floors. There is no lift facility installed and the main entrance is at the front of the house with steps leading up to the door. There is however disabled access to the rear of the home. There are also disabled facilities including two bedrooms on the ground floor. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 22 A raised patio area has been built at the rear of the property where garden furniture is available in the summer months. It was observed that new rendering to the front wall has now been completed. During the course of the inspection the inspector completed a tour of all the communal areas and a sample of residents bedrooms. All areas inspected were observed to be clean, smelt fresh and reasonably decorated. The living room is comfortable and homely with portraits of the residents on the walls. Adequate seating was available for all residents to sit comfortably in the lounge together and visually everyone could see the television. The residents had a video recorder and DVD player and various videos and DVD’s were viewed offering a varied choice to meet individual tastes. The dining room accommodates all residents comfortably at the same sitting. There is no dedicated domestic assistant. Staff support the residents to carry out domestic chores. Each resident has a different task to carry out and this changes on a rota. This information was confirmed by residents. Four residents’ bedrooms were looked at and expressed individual choices in colours, fabrics and layout. Residents had accessorised their rooms with football memorabilia, soft toys, photographs and ornaments. Residents have televisions, stereos and such like to enable them to spend quality time alone. A sample of bedrooms seen were comfortable and homely. No bedrooms have a call alarms installed. The inspector was informed that only one resident has been assessed as needing an alarm. The resident in question is physically disabled and has a portable system available in her room. This call alarm system has not been located by the resident’s bed but is situated at the other side of the bedroom which according to the staff on duty would mean the resident in question would have to get out of bed to reach it. Members of staff indicated to the inspector that they were concerned that this resident may fall if she had to use the alarm in an emergency. There was no written information to confirm why this call alarm had not been located by the resident’s bed. This resident has communication difficulties and would not be able to call out in an emergency. The inspector was informed that the majority of residents would not use a call alarm but would call out or locate the member of staff on duty if they needed help. The inspector noted that until the 12/06/06 there been one sleep in member of staff who slept in a bedroom on the middle floor and one member of staff who carries out waking duties for one named resident. The inspector was informed that there is currently only one member of staff who carries out waking duties. This change in staffing levels at night will be discussed further in the staffing section. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 23 A tour was made of the toilet / bath and shower facilities for residents. All bathrooms, toilets and shower rooms were clean, tidy and smelt fresh. The bathroom on the first floor has had some work completed since the last inspection including the installation of new flooring, the bath panel has been replaced and the removal of two unused radiator pipes. A new boiler has also been installed on the second floor. It was noted on the day of the inspection that the hot water in the bathroom on the second floor was more than hand hot, but the water in the bathroom on the first floor was satisfactory. The inspector was informed prior to this inspection that there were two separate hot water systems. Attention is required to adjust the temperature of the water on the hot water in the bathroom on the second floor. A new shower has been installed on the ground floor. All minor repairs are reported to the maintenance section and evidence confirmed that appropriate action was taken in reasonable timescales. On the day of the inspection a tumble dryer was seen installed in the lounge /dining area. The inspector was informed that this was a temporary arrangement as the homes rented tumble dryer was in need of repair and the rental company was due to collect it and replace with another one. The tumble dryer is temporarily stored in the lounge /dining room and is used only when there are no residents using the area. There is no evidence to suggest otherwise. However, this arrangement is not satisfactory for health and safety reasons and it affects the comfort of the home. The kitchen is well equipped and is well maintained. There is a separate sink to wash hands prior to preparing food with soap and hand towels. Following the last inspection domestic items are now stored out of the kitchen area; this included a mop and bucket used for cleaning bathrooms, to ensure safe practice in minimising cross infection. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The relationships between staff and residents are good and create a warm positive environment to live in. However, there is a lack of clarity about the management arrangements. Urgent attention is required to ensure that resident rights and best interests are met and staff are aware of who is responsible for day-to-day management of the home. Staffing levels have deteriorated since the last inspection. Urgent action must be taken to ensure that residents’ dependency needs are met at all times. The procedures for the recruitment of staff are satisfactory. The system in place ensures the protection of residents accommodated at Shaldon House. Staff training has remained satisfactory since the last inspection. However, further attention to specialist training is required to take place to ensure that all residents’ individual needs are met and that staff have an awareness and understanding of equality and diversity. Support to care staff is not satisfactory. There has been deterioration since the last inspection. Further improvement in the formal support system is needed to ensure that residents benefit from staffs that are appropriately supervised. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 25 EVIDENCE: The registered manager left this home 31st May 2006. The manager has not been replaced by a temporary appointment. There was also no evidence to confirm that active attempts have been to appoint a new person in the management role. There is a deputy manager in post in the home who informed the inspector that a manager from another care home has been given the responsibility of overseeing Shaldon House until another manager was appointed. This manager was noted to be on leave of absence for a couple of weeks. Staff at the home were unclear about the management arrangements and who to contact at night in an emergency. Staff told the inspector that there was nobody officially on call. Informal arrangements were noted to be in place with the deputy manager. An immediate requirement was made following the inspection about on call arrangements. Prior to the inspection the inspector was informed that the manager was leaving on the 31/05/06. It was also noted that one other member of staff left at the same time. Following the departure of these staff members there was evidence to confirm that staff were working long shifts to cover the gaps in the staff rota. The home have been told not to use agency staff and that all staff must be encouraged to try to cover each other’s shifts to promote continuity for the residents. However, it was seen from the duty rota that these increased hours would not be sustainable over a long period. For example one member of staff worked from Saturday at 4pm until 7am Monday including two waking night shifts each week, along with other shifts and another member of staff shifts included 7am-10pm, a waking night duty (10pm –7am) day shift worked until 10am, off duty until 3pm and then started at 9pm. As discussed in the environment section until the 12/06/06 there been one sleep in member of staff who slept in a bedroom on the middle floor and one member of staff who carries out waking duties for one named resident who has been assessed as needing one to one support at night by South Gloucestershire Social Services. Evidence confirmed that the sleep in member of staff had been with drawn by Park Care No 2 Limited due to financial reasons from 12/06/06 leaving only one waking member of staff who is officially designated for one named resident. An immediate requirement was made following the inspection for the sleep in member of staff to commence duties again to be available for all residents. During the last inspection the recruitment process was examined for three members of staff, all staff records showed that the home follows a robust recruitment procedure. Records contained application forms, references, POVA first check and a CRB (Criminal Records Bureau) disclosure. There have been no new members of staff since the last inspection. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 26 Staff training records showed that staff receive mandatory training on food hygiene, POVA, fire, first aid, health and safety and manual handling. Specialist training is limited as discussed in Choice of Home section. However, it was noted that this training was intermittent and that no specialist training had been provided since the last inspection. The staff on duty were not aware of a staff training plan. All staff are either receiving NVQ training or have just completed. Five staff have NVQ2, and one has just completed NVQ3 and another has just started. One member has commenced her NVQ assessor’s course. During the last inspection the inspector was informed that the manager and deputy manager were receiving training on a new system for staff supervision within the organisation. Evidence confirmed that no members of staff had received supervision in the past year including one person who had not received any supervision since they started working in the home. Written evidence confirmed that staff meetings have been taking place on a regular basis. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The home is going through a transition period following the departure of the registered manager. Arrangements must be put in place to ensure that the home is competently managed to ensure the health, safety and welfare of residents, staff and visitors are promoted and protected at all times Shaldon House is currently in financial difficulties. Urgent plans must be put into operation to ensure that the service is achieving the aims and objectives of the statement of purpose and residents rights and best interests are safeguarded at all times. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 28 EVIDENCE: Three staff members spoken to expressed that they were experiencing difficulties at work due to the staffing situation including working long hours and the lack of manager presence in the home. All staff interviewed discussed how they were concerned about the welfare of residents at night and peak time in the morning when residents were getting ready for college or day centre work as a result of the withdrawal of the sleep in member of staff. Some of the Health and safety records in the home were examined. Documentation showed that the majority of relevant checks were maintained correctly and at the required intervals including all fire alarms and equipment, emergency lighting. There is also an up to date fire risk assessment in place, which is reviewed on a regular basis. As discussed ion previous sections it was noted that the water temperature and fridge temperatures were not available for inspection. The majority of corporate policies and procedures have not been reviewed since 2002. This is not satisfactory practice. The Area Manager visits the home monthly and carries out an audit (Regulation 26). However, it was noted that these reports are no longer sent to The Commission for Social Care Inspection. The last one received was dated December 2005. There was also no evidence to confirm that Senior management were aware of the potential impact on residents as a result of the long hours that staff were working and the lack of availability of management support at the time of the inspection. Following the inspection the inspector was informed that the home is in financial difficulties and the provider is in discussion with Bristol City Council re increased funding for residents. Prior to the inspection the inspector was informed that company audits are carried out on annual basis, which include a questionnaire for residents, relatives and staff, Health and Safety, Home audit and Medication. The company compile the results and feedback to the home. This information was not available during this inspection. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 3 26 3 27 3 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 3 33 1 34 3 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 1 3 3 1 3 3 1 Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 30 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 6 Requirement The statement of purpose and service users’ guide are in need of a review to up date information and ensure that information about specialist support is included. All residents and their representatives where appropriate must be provided with a copy of the most recent inspection report. All needs assessments must be completed in consultation with residents and their representatives where appropriate. These assessments must be dated and signed by the staff member resident and representative. If this is not possible. The reasons why must be recorded. Specialist training in conditions such as pre senile dementia, obsessive compulsive disorder etc must be provided to all staff to ensure that they can meet resident individual needs. There must be a staff training programme in place Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 31 Timescale for action 31/08/06 2 YA1 5 30/09/06 3 YA2 14 30/09/06 4 YA3 18 30/09/06 5 YA6 15(2) 6 YA20 13(2) Care plans must be reviewed by 31/08/08 care staff at least once a month and at least six monthly with the resident and their representative where appropriate Arrangements must be put in 31/07/06 place to monitor the temperature of the fridge that is used for the storage of medication Arrangements must be put in place to ensure that all PRN medication (To be given as necessary) medication is checked regularly to ensure that the expiry date has not been reached and that the appropriate medication is available at all times or if no longer needed returned to the Pharmacist The Complaints policy and procedure must be provided to all residents and their representatives in a format that they can understand. They must also be provided with details of how to make a complaint in the absence of a registered manager. The adult protection procedure available in the home must comply with the Local Authority guidance. The tumble dryer for residents and staff to be used, which is located in the laundry room, must be repaired or replaced. The temporary replacement in the lounge/dining area must be removed. The resident who has been assessed as requiring a call alarm at night must have one located by her bedside. 7. YA22 23(2) 31/07/06 8. YA23 13(6) 31/08/06 9. YA24 23(2) 31/07/06 10. YA29 23(2) 31/07/06 Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 32 11 YA24 23(2) Following the installation of the new water heater on the third floor. The temperature of the water must be checked and adjusted to 43 oC and then monitored frequently. Appoint a manager to take full time responsibility of the home 31/07/06 12 13 YA37 YA33 8 18(1)(a) 31/08/06 Sleep in member of staff must be 28/06/06 reinstated to ensure that staffing numbers at night include one waking member of staff to provide 1:1 support for named resident funded by South Gloucestershire Social Services and Health and one sleep in member of staff to provide support for all residents. Emergency arrangements for support/advice during day and night must be made clear to all staff whilst home is awaiting for manager to be appointed There must be a staff training programme in place Supervision must be provided to all members of staff at least 6 times a year 31/08/06 30/09/06 14 15 YA35 YA36 18(1) 18(2) 16 YA33 18(1) Staffing levels must be urgently 31/07/06 reviewed by the responsible individual to ensure that there are staff in place to meet residents dependency levels both day and night. Where there are gaps in the rota staff must not be expected to work in contravention of The European Working Time Directive. Agency staff may be used to cover these gaps. Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 33 17 YA43 25 A plan must be put in place to demonstrate to CSCI how Park Care No 2 Limited plans to ensure that Shaldon House will be financially viable for the purpose of achieving the aims and objectives set out in the statement of purpose and residents’ rights and best interests are safeguarded at all times. The registered provider must provide evidence to CSCI (by sending copies of Regulation 26 visits on a regular basis) that residents and staff are consulted on a regular basis All policies and procedures must be reviewed at least annually to ensure that they comply with the legislation and arrangements must be put in place for staff to be regularly updated with any changes 31/07/06 18 YA43 26 31/08/06 19 YA40 23 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 34 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Shaldon House DS0000026554.V293881.R01.S.doc Version 5.1 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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