Inspection on 17/04/07 for Shallcott Hall

This inspection was carried out on 17th April 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shallcott Hall 01/03/06

Shallcott Hall 01/07/05

Shallcott Hall 18/01/05

Shallcott Hall 16/04/04

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

CARE HOME ADULTS 18-65 Shallcott Hall 1 Ellenborough Crescent Weston Super Mare North Somerset BS23 1XL Lead Inspector Nicola Hill Unannounced Key Inspection 17th April 2007 12:30 Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shallcott Hall Address 1 Ellenborough Crescent Weston Super Mare North Somerset BS23 1XL 01934 620611 NONE i.hallscott@btinternet.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Ian Hall-Scott Jacqueline Hall-Scott Mr Ian Hall-Scott Jacqueline Hall-Scott Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (9) Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Shalcott Hall provides care and support for nine adults with mental health needs. The support offered is based on providing space for the service users to make their own choices and decisions in an environment of respect and trust to reduce needs for expressed emotions’. The building is part of a Victorian crescent, opposite a park and within easy walking distance of the town centre. The fee level for the service is £413.02 per week. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector undertook the unannounced key inspection of Shalcott Hall with the proprietor Mr Iain Hall Scott. The inspector also spoke to three residents and two members of staff who provided the verbal evidence that has been included in the report. The inspector reviewed the documentation relating to the key standards for younger adults. The service inspection took approximately 4 hours. The overall service provided at Shalcott Hall has been assessed as adequately meeting the standards and regulations appertaining to the service. What the service does well: What has improved since the last inspection? Recommendations from the last visit have been implemented. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 7 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 Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. EVIDENCE: The inspector reviewed the admission process for the most recently admitted residents. The process of admission to the home allows for prospective residents to visit and have short stays at home prior to becoming permanent residents. This process was seen to be put into practice, however it is adjusted to meet individual need for example, if a resident is admitted from hospital than the admission process may be shortened. The manager provided adequate documentary evidence of involvement in assessing residents prior to admission; either by a direct assessment of the individual, or by inclusion at the prospective residents Care Programme Approach (CPA) meeting. The information is then used to formulate with the resident a plan of care and support, which is then an informational resource used by staff at the home. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The plan in all cases includes the basic information necessary to plan the resident’s care and includes a risk assessment element. EVIDENCE: The residents and staff at the home participate in CPA reviews and residents are able to self advocate and state what their personal life choices are. In addition to the CPA documentation there are individual care plans held at the home which have been written with the residents and who have signed the plans to indicate with their agreement with the contents. The day book and individual daily records provide an ongoing evaluation of the care plan. The content of care plans did not identify any developmental work with residents to support them to develop personal skills for moving on from residential care services. Whilst this would not be appropriate for some residents, for other younger residents development plans toward a more independent future could be introduced. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 10 The residents have the trust of the staff and management of the home and are encouraged to take an active role in the community. This has an amount of risk attached but the procedures at the home support risk-taking. There was evidence in the daily records to demonstrate that when incidents occur the staff are able to deal effectively with the consequences. This supports the residents to continue to make informed decisions about their day-to-day lives. The home does not operate a key worker system as all the residents have a key worker through the CPA process. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents make their own decisions on how to spend their time. EVIDENCE: The evidence for this section was gathered from the residents at Shalcott Hall. All the residents have single rooms which are furnished and arranged according to personal taste and preferences. One resident has the cat and is supported by the other residents and staff to purchase the necessary items for the care of this animal. Residents are self-determined and have good relationships with the staff and residents, the house has a structure for mealtimes and staff shifts, but otherwise residents confirmed they make their own decisions on how to spend their time. Some people choose to spend time in the rooms whilst others access the community and any leisure activities and facilities they choose. For example, at the time of the inspection, one resident was at a day centre, whilst another had chosen to go to Wells. The people who use the service confirmed that relatives are welcomed and the home will provide food and refreshments. The manager confirmed to the Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 12 inspector that one bedroom remains registered as a double room in case any resident now or in the future developed a relationship and wished to share accommodation. The residents confirmed to the inspector that although on occasions some decisions they may make may not be in their best interests, the staff and management support them and try to minimise any problems by discussing the possible consequences. One of the staff confirmed that the type of relationship with residents was informal and that opportunities were routinely offered to residents to enable them to take more responsibility around the home, as well as for personal decision-making. There are no house meetings to discuss any issues arising from group living, as this type of forum was not seen as appropriate to the client group. However, residents confirmed that the manager was approachable, and the inspector observed positive interchanges between the manager and residents during the visit. The impression of the day to day routine of the home made on this visit is that the home provides “hotel” services and overall supervision of residents; interaction between residents appeared to be limited, for example, there were no residents using the communal areas, and residents stated that they preferred to remain in their own rooms. The home has a planned menu and residents can assist in the kitchen with meal preparation, or cooking items of their choice. The lunchtime meal appeared to be a balanced meal with fresh vegetables, and was well presented. The residents who spoke with the inspector, confirmed that they make personal choices about their diet, one resident is very keen on reducing their weight and therefore has a low calorie diet, whilst another takes an interest in nutrition and ensures that they have a healthy diet. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff understand the key principles of giving personal support and responsive to the varied and individual requirements of the residents. The medication procedures for the home are not always followed by the staff. EVIDENCE: The residents at Shalcott Hall generally do not require assistance with personal care, however the staff support the residents with making appropriate decisions about their personal care and well-being when required. As previously stated the residents of the home have regular reviews of their mental health through CPA, and this includes a review of prescribed medication. The CPA process allows the home to have easy access on behalf of its residents to mental health services if needed. In addition to this all of the people who use the service have their own GP, and attend appointments on their own or are supported by the proprietors to attend. There was evidence that any resident requiring specialist support, i.e. catheter care, have their needs met appropriately. Residents also confirmed that support was offered to enable them to attend appointments i.e. transport, and staff were supportive in promoting their general health and well-being. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 14 The home used a unit dosage system for regular medication, which was reviewed by the inspector and appeared to be understood and working effectively. The spot check of the when required medication showed a pattern of errors whereby this medication had been administered but not recorded. This meant that there was a deficit in the number of tablets in stock when compared to the record of medication given. This was discussed with the proprietor for remedial action. It is recommended that there is a protocol for the “when required” medication which gives staff guidance about the triggers/events which may lead to this medication being needed by the resident; it should also include information about dosage and the maximum a resident can have. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents at the home understand how to make a complaint and are clear in their expectations of what should happen if a complaint is made. EVIDENCE: The complaints information is readily available to residents, who confirmed to the inspector that they are able to raise issues directly with staff or the manager. The manager confirmed to the inspector that no complaints had been received and there were no recorded complaints outstanding at the time of the visit. The residents at Shalcott Hall are vulnerable but need to continue to be as independent as possible. In order to promote this the home provides a safe and supportive environment whilst retaining an oversight of resident activities outside the home. This is a difficult balance to achieve between protection and prevention of the potential abuse of residents, and infringement of personal decision-making. The residents have some insight and awareness that they can be vulnerable, and through conversations with the inspector, accept that the staff may intervene and have a role in abuse prevention. The staff at the home have an awareness of abuse issues relating to their client group and the procedures they should follow, but also have management support on a 24-hour basis. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a physical environment than meets the specific needs of the residents who live there. There is a rolling programme of maintenance that includes decoration, new fixtures and fittings. EVIDENCE: Shalcott Hall is an older property that is in need of regular maintenance and repair. All of the bedrooms are used as single rooms, which are furnished to meet the residents individual taste. Some of the corridor areas are quite dark and may benefit from redecoration in a brighter colour; the bathrooms have been recently refurbished and are very pleasant, clean and light. The communal lounge area is very bright and airy and has been equipped with domestic type furniture and audiovisual equipment. One resident is waiting for their room to be redecorated, and needs to have replacement flooring. This should be a priority as the flooring appears to be stained, and the resident needs to have flooring which is easily cleaned as there is a cat living in the room. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 17 Staff have overall responsibility for the cleanliness and hygiene of the house; residents can choose to be responsible for their own room or have assistance to keep it clean. Smoking is allowed in individual bedrooms only, and not in any of the communal areas within the home. The outside areas of the home are accessible and can be used for various leisure activities. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service ensures that all staff receive relevant training that is targeted and focused on improving outcomes for residents. The service has a recruitment procedure which meets the standard and requirements. EVIDENCE: The staff team at the home is quite settled and several staff in several years. There is 24-hour support available to the residents and a member of staff is always in the house. Staff confirmed that they are supported with professional development and attend training to give them underpinning knowledge about good care practice (NVQ) and attend specialist training days which are specific to clients need i.e. dealing with difficult behaviours. The recruitment practice at the home ensures that all staff have a POVA first check/CRB and a minimum of two references prior to starting work at the home. The home does not use an application form; the information recorded about each staff member meets the requirements of Schedule 2. The home does not keep any records of staff interviews. The inspector asked the manager how he would be able to demonstrate that the recruitment practice was based on the principles of equal opportunities, he stated that this has never been an issue at the home. This may be an area for development. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 19 The induction process at the home is a mixture of formal information on policies and procedures, a tour of the premises in order to meet staff and to get to know the building and residents, and informal training through shadow shifts which allows the new member of staff to be observed to be competent in practice. Residents are able to feed back their views about new staff directly to the manager. The induction process should meet the Skills for Care, Common Induction Standards, and the inspector would recommend that the induction documentation for the home be cross referenced to these standards. Staff confirmed that they were supported with training and the majority of staff now have NVQ 2 in care. Staff confirmed that they received supervision however the procedure followed does not meet the standard and the manager is advised to review this practise. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is experienced in running the home and is aware of and works with the basic processes set out in the national minimum standards. EVIDENCE: Mr Ian Hall Scott has been managing the home for several years and attends regular training in order to maintain an up to date knowledge base. The home is informal and the inspector was able to observe both staff and residents talking with the manager. The staff who spoke with the inspector have great respect for the manager who listens to them and is always available either in person or by telephone. One resident stated that they were very grateful to the manager for accepting them into Shalcott Hall. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 21 The quality assurance systems at the home were limited, the manager identified that there was a yearly resident survey but no other formal audits or service monitoring was established. The home does not have house meetings for residents or staff meetings. There is low staff turnover and low levels of sickness at the home, which means that there is a continuity of staff support to residents. The implementation of health and safety legislation at the home is good; staff attend regular updates to practice, all of which is documented. The risk assessments of the environment were reviewed but the inspector would advise linking the level of risk to the known number of incidents that have occurred, as this will give a balanced potential risk factor. Fire safety precautions are observed; PAT testing is up to date; the contents of the first aid box (staff) in the kitchen do not comply with the recommended health and safety guidance. Accidents are minimal, with two minor staff incidents and one relating to a resident being recorded. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 22 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 X X 3 X Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA39 Regulation 24,21, Requirement The proprietor should establish and maintain a system that measures the success in achieving the aims and objectives of the home. Timescale for action 17/10/07 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 4 5 6 7 Refer to Standard YA23 YA34 YA34 YA6 YA42 YA36 YA20 Good Practice Recommendations Staff should have an awareness of local policies and procedures to be followed when dealing with abuse. The proprietor should consider how equality and diversity principles are met in the home. The recruitment process should be based on equal opportunities. Care plans should identify any treatment or development plan for individuals. First aid boxes should meet the requirements of the Health and Safety at Work Act 1974. The proprietor should implement supervision arrangements for staff that reflect the standard. The manager should monitor the effectiveness of the implementation of the medication policy and procedures DS0000008126.V336247.R01.S.doc Version 5.2 Page 24 Shallcott Hall for the home. Shallcott Hall DS0000008126.V336247.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Taunton Local Office Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. 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