Inspection on 01/08/07 for Shalom Residential Home

This inspection was carried out on 1st August 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Shalom Residential Home 15/07/08

Shalom Residential Home 25/05/06

Shalom Residential Home 19/01/06

Shalom Residential Home 22/07/05

Shalom Residential Home 31/01/05

Shalom Residential Home 18/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Shalom Residential Home 147 Yarmouth Road Norwich Norfolk NR7 0SA Lead Inspector Mrs Dorothy Binns Unannounced Inspection 1st August 2007 09:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shalom Residential Home DS0000046100.V347955.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shalom Residential Home Address 147 Yarmouth Road Norwich Norfolk NR7 0SA 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) 01603 432050 01603 432576 Medicare Corporation Ltd Position Vacant Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Old age, not falling within any other category (24) persons. Care Home only. No new admissions of service users who are wheelchair users to be accommodated on the first floor until the registered person ensures the establishment complies with regulation 23(2)(n). All service users accommodated on the first floor must have written risk assessments regarding the use of the stair lift. 25th May 2006 Date of last inspection Brief Description of the Service: Shalom is a large period residence located well back from the road on the outskirts of Norwich and overlooking the Yare Valley. The house has been carefully extended and adapted to provide residential accommodation to a maximum of 24 older people. There are 20 single and 2 double rooms. Two of the single rooms within the extension offer a bed sit type accommodation and the majority of rooms are spacious. Both the double rooms and 12 of the single rooms have en-suite facilities. The upstairs is accessed by a new lift. The care home has a large garden at the front though this is not very accessible for residents. A small courtyard in the middle of the building provides an area for sitting outside. There is a bungalow to the rear of the main building which provides accommodation for the supporting night care worker who sleeps in. The manager who had been in post for several years has recently left, but a new manager has just been appointed. She is not yet registered. Current fees range from £326 - £381. There are extra charges for hairdressing and chiropody. Most of the service users have been placed with the help of Social Services. The Service User Guide says that the inspection report is available on request. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection of the Home and lasted six and a half hours. Discussions took place with the new manager and the provider about how the home was progressing and records and policies were examined. Three staff were interviewed in private and four service users were seen in their rooms. Observations were made throughout the day in the lounges and dining room and the building was inspected. In addition, the Commission asks the home to complete an Annual Quality Assurance Assessment, (AQAA), of their home and to send the names of service users and their relatives so that survey forms can be sent to a sample for their views. The quality audit was only returned three days before the site visit and survey forms had to be given out at the visit. Only four service users and four relatives returned the survey and their views have been incorporated into the report. Information received since the last inspection on the Commission’s own record has also been taken into account and mentioned in this report where appropriate. The home has gone through a turbulent time in the last few months with staff and two managers leaving, one of whom wasvery long standing. The building has also been in need of renovation and repair and equipment has broken down. Both of these factors have meant that the provider has been struggling to keep the home functioning normally and that has been reflected in complaints to the Commission and two visits to the home by the inspectors during this last year. Some equilibrium has been restored with the completion of a new lift, new cooker in the kitchen and other repairs to the building and the very recent appointment of a new qualified manager who is experienced in the care sector. Staff are being recruited, systems changed and staff and service users are now feeling very positive about the ability of the new manager to tackle the problems of the home. There is still a lot of work to be done as reflected in the requirements of this report, but if this manager stays there is every possibility that the home will flourish. What the service does well: The home has a detailed assessment document which is completed before any service user comes into the home. This ensures that service users’ needs are fully understood when they come into the home. Service users are assisted to have good contact with community medical facilities and staff monitor health needs quite well. Service users can see the doctor at their request. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 6 Medication is being administered safely. Service users like the home and find the staff very friendly and kind. They have had to put up with a lot of staff changes recently, but feel that the staff treat them well. Staff are happy in the home and believe that they have enough time for the service users and are actively encouraged to support the service users in a positive way. They think the new manager is going to make the home work for the service users and make it a happy place. This is likely to lead to increased staff loyalty to the home and a better service for the people who live there. What has improved since the last inspection? What they could do better: Detailed care plans should be in place for all service users and particular attention paid to those who are unable to speak up for themselves. More activities and stimulation must be provided so that service users’ social needs are met. Those who suffer from mental frailty need separate stimulation. Most of the food is enjoyed, but there could be a choice of menu at the main meal which gives service users greater variety. More care needs to be taken to see that those service users who want to stay in their rooms are served. Diets need to be recorded. The home needs to show that it is listening to complaints from service users and their relatives and show what they are doing about them. Service users need to be better protected from abuse by a more rigorous procedure which links in with local multi agency protocols. Staff also need more training on the prevention and definition of abuse. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 7 A programme of renovation and redecoration needs to be planned. Some priority should be given in particular to service users having access to suitable bathrooms with equipment to help them get into the bath. The garden should be developed so that service users can have some fresh air and enjoy the outside. Staff should be better trained and be encouraged to study for a national care qualification. Staff should be able to have one to one meetings with a manager on a regular basis to ensure they are supported and keeping to good practice. The manager needs to develop a system for the quality of care to be reviewed including asking the service users anonymously for their views and drawing up a plan for improvement in the home. 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. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (standard 6 is not applicable to this home) Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users do have their needs assessed before coming in to the home to make sure the home can meet those needs and that staff can care for them properly. EVIDENCE: Three care files were examined and all contained a very detailed assessment of each person’s needs. The files also contained information from Social Services and a transfer letter from the hospital outlining particular needs regarding health. This information was used to write a care plan for the person in two of the records. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The care needs of service users are monitored, though detailed care records are not in place for everyone. Their health is taken seriously in the home and the staff try to ensure that service users have access to health care services. Medication is administered appropriately and safely giving protection to the service users. Service users say they are treated well and their right to privacy is upheld, though those who are unable to express themselves may need more careful monitoring. EVIDENCE: Three care records were examined. Although all three had detailed information from when the service users first came into the home and two had care plans prepared by Social Services from that time, only one had an up to date care plan prepared by the home detailing the main tasks which were to be carried out by staff. Two of the records did contain a risk assessment dealing with the prevention of falls, which is good practice and staff write reports three times a day, (at each change of shift), to ensure that service users are monitored. To make sure that care is provided consistently the manager has introduced an Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 11 accountability chart for staff to use so that all tasks are completed. One service user responding to the survey felt they were not being attended to as they should during the night. Their care plan was unable to be checked because of the anonymity of the survey, but the manager when checking the care plans should ensure that the service users are consulted. The care records did provide evidence of service users having access to community health facilities. Each file had a separate sheet for recording visits from doctors and district nurses and these showed the reason for the visit. One person responding to the survey reported that the doctor did not always come when requested by the home, (a problem which will have to be taken up by the manager). One record showed that the person had seen an optician recently. The manager confirmed that they have liaised with the continence advisor and have appointed a staff member to become the home’s liaison person and inhouse expert on this topic. The diary showed that one person had requested to see a dentist and this was being arranged. Falls are monitored and one example showed the home liaising with the GP and providing a pressure mat in order to reduce the falls. The home is looking after one person with a pressure sore and work in liaison with the district nurse. On the day of this visit, the chiropodist was in the home. In the kitchen, special diets were written on the notice board as a reminder to the cook and she confirmed that she knew the needs of the particular residents. Staff also monitor sleeping patterns or changes in eating or mood through their observations and this information was recorded in the records. Staff also confirmed that any changes in residents’ demeanour is discussed at the end of each shift in a handover meeting to ensure that action is taken if required. The way medication is organised was examined. The home uses a locked medication trolley kept in the hall. Medication is pre packed for individual people by Boots pharmacy. These packs were checked against the records and found to be satisfactorily administered, staff signing appropriately when they gave out the medication. A controlled drugs record was also kept with a tally kept of the number of tablets remaining. The manager confirmed that only senior staff give out medication and that they have received training. Of the three staff interviewed, two confirmed that they did not give out medication. Staff confirmed that personal care is always carried out in private and that service users wear only their own clothes. Nearly all need help in the bath, but staff said that two service users can bath without staff help. The service users said they saw the doctor or nurse in their own rooms and could have their visitors in their rooms to talk to them privately. Only two residents have keys to their rooms, however, and none have keys to their own locked cupboard. Several service users have their own telephone and most enjoy some time Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 12 privately in their room and watch their own choice of programme on television. One person described the home as “ a nice place” and she had “no complaintsstaff treat you alright”. She went on “if you want anyone someone will always come”. Another said “staff do what you say” and another said “you are treated OK – I have no problems with staff – they are very good”. Yet another said “you are treated lovely”, and another said “everything here is OK”. Overall the service users who were interviewed thought staff answered the call bell promptly, but one relative replying to the survey said that their relative was left in the same pad for hours. One service user in the survey felt the service from night staff was not so good. Overall the residents seen felt staff were kind and polite and they were treated well. However, several residents were unable to speak up for themselves or express an opinion and the home needs to ensure that staff training is rigorous in teaching the right of service users to dignity. All service users seen remarked on the number of changes of staff which has unsettled them. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Residents are quite comfortable in this home and feel the routines are flexible and to their liking. They would like more activities and even where the capacity for social activity is limited and residents need support from staff, there could be more stimulation or opportunities to go for a walk. More control could be given to service users to ensure their rights are acknowledged. More choice should be offered at the main meal and drinks and snacks offered to everyone. EVIDENCE: The four residents seen during the inspection were quite happy with the home’s routines and felt free to move around, stay in their rooms as they wished and get up and go to bed as they wished. Two of these residents stayed in their rooms as they were more mentally alert than others in the home and preferred their own company. Breakfast is served flexibly and some people have all their meals in their rooms. Bathing is reported to be flexible, though a bath list showed that most residents had a bath once or twice a week on regular days. Quite a lot of residents need to be guided by staff, but staff when interviewed said they Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 14 knew the residents well and their preferences about bedtimes. One staff gave an example of where a resident was watching a late film so would be left until he was ready for bed. On the day of the site visit, people were mainly sitting quietly or dozing in the two sitting rooms. One member of staff who did most of the activities left a few months ago. Two of the residents seen said there were no activities and one person in particular was missing them, especially the craft work and rug making. One person said she had suggested bingo, but nothing happened. Another thought that entertainers came in now and again, but that not a lot went on. One person said they had a sing song every two weeks. Staff confirmed that they were hoping to get activities up and running again and had started music and games. One member of staff said she talked to the residents about what was happening in the news and another that there was time to sit and talk to service users. No one was sitting in the garden on a very sunny day and the garden was only just being tidied up to make it attractive. Two of the residents seen were entertaining themselves in their rooms with books, painting and their own television. A new daily activities folder has been started by the new manager. She has also included activities into the new shift tasks for staff and expects them to find time to do social activities with residents every day. In the home’s own quality audit, it acknowledged that activities have had to be restructured with the loss of the member of staff who was so pro-active in this area. There are plans to develop the activities programme over the coming months. Residents said they can have visitors at any time and see them in their rooms. Relatives were seen to come and go during the site visit. There is very little contact with outside community groups, many residents being too frail. One resident said she had enjoyed going to the Salvation Army but does not go now. Residents are helped to exercise choice in a limited way and have some choices around the home in terms of routine and meals. They are also encouraged to bring some of their own possessions with them and look after their own money as the home does not administer any money on a resident’s behalf. Residents can opt to stay in their rooms all the time if they wish. The home subscribes to the Data Protection Act so residents should have access to their personal records. One relative said there had been pressure on his relative to move rooms, but he had resisted it. The menu record was examined and it contained a record of food provided on a day to day basis. No forward menus are planned, though the new manager is expecting to arrange this. There is a choice at breakfast and tea though only one choice is offered at the main meal. The tea list was seen which had two savoury choices on it and everyone had cake. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 15 The cook confirmed that if people were enjoying their food there was usually plenty left for seconds. The main cook works through the week and the home has been short of a weekend cook. The residents were fairly happy about the food, though more can clearly be done. Food was described as “very reasonable and some of it exceptional”, “OK and mustn’t grumble” and “always satisfying”. On choice, the comments included “they will find you something if you are not happy with the menu” and “I didn’t like the sausages, but I ate it as there was no choice”. Staff thought the quality and variety of the food was good though one said the food was better during the week with the regular cook. Drinks and snacks are also reported by staff to be served three times a day with the evening snack being larger with sandwiches or cakes if requested. Two residents who mainly stay in their rooms said they were never offered a supper drink, though others confirmed they had a drink in the evening. Even meals or parts of meals have been forgotten in the past for those who stay upstairs. The tea trolley was observed being taken round during the morning. In terms of diets, the cook was aware of what diets she had to cater for and they were written on the notice in the kitchen. There was no separate record which should be in place. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users feel they will be listened to if they have a concern, though there was no record showing this was the case. The prevalence of anonymous complaints to the Commission may indicate that communication is not as open as it should be, but also that the home has been under some strain during the last few months. Efforts will have to be made to reassure residents and their relatives that they will be listened to. The home is not taking enough action to protect service users from abuse and needs to increase training and procedures. EVIDENCE: A very brief complaints procedure including the address of the Commission was seen in the Service User Guide and all three service users seen in private said they could speak up about any concerns and the staff would deal with their problem. “Staff do what you say” one said and “Staff will deal with a problem very smartly” said another. None of them felt they had any complaints about the home. Several anonymous complaints have reached the Commission during the last few months which were largely to do with problems in the building such as lack of heating, risks to safety and a problem with the lift, though lack of staffing and not enough use of gloves to control infection were also raised. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 17 These were referred to the home for action and have been remedied, (see premises section). However the fact that they were referred to the Commission rather than taken up with the management and that they were anonymous may indicate that there is some dissatisfaction that could not be expressed within the home and this should be looked at by management. The home was undergoing building work at the time and a long term manager left leaving the home under some strain, but communication appears to have been lacking. The home is obliged to keep a record of complaints and show how they have dealt with them, but the record could not be found. The home’s own quality audit says that complaints are taken very seriously and that people are encouraged to come forward with complaints. The home’s new manager has started a suggestion box which may help residents to express their views. The home has an adult protection procedure which mentions linking in with local multi agency procedures, but there are no local phone numbers or addresses of the Norfolk Adult Protection Units in the policy. The new manager related an issue with a member of staff which should have been referred to the Adult Protection Unit and to the Commission, but was not. The staff member was asked to leave and went abroad. Letters were seen dealing with this situation showing the home had taken action, but nevertheless the allegations should have been reported to the unit and the Commission. The manager said she had received training in adult abuse and that some staff had. However only one member of staff interviewed confirmed she had received adult protection training. The training record showing all the staff training was not available to check this information. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 and 26 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The service users live in an environment which has much to offer in terms of individual single rooms and comfortable communal space, but which is in need of renovation. Much has been done to remedy defects in the house in recent months and the provider deserves praise for that, but a continuing programme of renovation is required and the garden made accessible. Bathrooms and the sluice need particular attention EVIDENCE: Some changes have taken place in the building in the last year which have caused problems for the service users as they continued to live in the premises. A boiler broke and took a long time to be replaced causing temporary heaters to be installed and in a few cases alternative bathing arrangements to be made. The cooker broke down and a new lift was installed causing building work in the house. Complaints were received at the Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 19 Commission and two visits were made to see what the home was doing about the problems. By March 07, a new lift, cooker and boiler had been installed so the home was warm, (interim heating arrangements were put in place), and functioning, though some parts of the building were looking shabby and the kitchen was dirty. Further requirements were made for improvement. At this visit a full inspection of the premises took place. Because of the new boiler, all rooms except the small conservatory were now serviced by central heating. The conservatory had one temporary heater, but this was behind a chair and not posing a danger to the service users. There had been some redecoration in the dining room, on the landing and in the kitchen. The new oven and other equipment, e.g. a milk machine, dishwasher and fish fryer were also in place. The fridge was small for the size of the home and the freezers were locked up in the adjoining house so not able to be seen. The dining room and large conservatory were looking attractive and the dining room had fresh fruit, sherry and chocolates on the table for service users. Most of the bedrooms are individual and homely and the majority have an ensuite facility. Both doubles are used currently as a singles, though there is a screen for privacy. All rooms have lockable cupboards, but all the service users seen had not been given a key. Two rooms have locks on the door, but only one person was seen who actually had been given a key and he could only lock the room from the outside. Some attention to detail was missing with one room without a lampshade and another with a broken chest of drawers. W.C.s are available around the building and most are adapted with handles and raised seats. The home has three bathrooms, two of which are adapted, one upstairs and one on the ground floor. One contains an electric hoist in the bath, and the other, although adapted with an electric hoist, is in a poor state with a very loud noise emitted when you use the hoist. The bath surface is in a poor state, the cover for the lift mechanism mouldy and perished and the metal work corroded. This bath is also not able to be used with a stand aid because the bath is boxed in and the legs cannot go under the bath to make it easier for residents to be moved. The remaining bathroom which has an ordinary bath is used as a sluice, (an existing sluice having been turned into a staff room). This means that neither bathroom nor sluice accommodation is entirely satisfactory. The laundry is small and contains an industrial washing machine which does not have a sluice wash, though does have a very hot wash. There is also a tumble drier and baskets and hanging space for residents’ clothes. Staff reported that they have plenty of access to gloves and aprons to ensure effective infection control and clinical waste is dealt with appropriately. In some parts of the building there was an offensive smell which should be removed. This was echoed by a resident replying to the survey who said “the room smelled and outside the bathroom smelled of urine” Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 20 The home’s new lift was used and worked well and the call bell was tested and found to be working, although the call box is located downstairs and staff have to go there first to see who the call is from. There are ramps and grab rails in appropriate places. A staff room has been created from a former sluice room which is good for staff, though the loss of the sluice facility may cause problems. Outside the home is looking in need of an uplift and needs painting. There is no access to the large front garden and the small enclosed courtyard was in the process of being cleaned up for use. There were a few benches and new garden furniture has been purchased. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The staffing problems over the last few months have shaken the home. Systems have been compromised and training put on hold. There are questions about the recruitment processes. All of this has an impact on the care to service users. Now new staff have been recruited and a new determined manager is in place. The provision of staff is better, though training needs to be more organised. The home has some catching up to do to ensure good practice, but service users are reporting that staff are effective and good natured. EVIDENCE: A staff rota was produced for the week and showed that the new manager had changed the shift pattern so that staff are not doing long shifts. The number of staff on duty in the morning has been increased to four carers which means residents are not rushed and can take their time. Staff thought the morning routine worked well. In the afternoon there are two care staff on until five and then three until 10pm when the night staff come on duty. The manager and domestic and catering hours are over and above this. The catering hours have also been increased so that the cook also prepares the tea. If these figures are held then this will provide a satisfactory level of staffing and an improvement on last year. There were a number of gaps in the rota, however, which still had to be filled and may indicate that staffing is still short. Overall staff thought Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 22 they were able to work well. There is only one night staff on duty with a sleepin member of staff on call. One service user said they were not getting the right attention at night and the manager needs to ensure that night staffing is sufficient to cater for the needs of the service users. No information was provided on staff qualifications either in the home’s quality audit nor at the site visit. One member of staff was interviewed who said she did have an NVQ2. At the last inspection in May 2006 the home was not meeting the standard for NVQ training and further progress has not been made. The standard is that 50 of staff should have been trained by 2005. The home has had to recruit a lot of new staff in the last few months as there has been some turnover of staff including managers. Residents said they were aware of the comings and goings of staff which was unsettling. Three staff recruitment files were requested for inspection, but only two were available, the provider saying his computer was frozen. Criminal records checks, application forms and references would normally be available in paper form. The two provided were examined and found to contain two references and a criminal records check and identity documents. The dates showed that the checks had been made before the person started work. One member of staff was interviewed who had just started work and she confirmed she was currently working under supervision as her criminal records check had not come through and she always worked with someone else. Hers was one of the records we were unable to check and therefore not able to confirm whether other checks had been made prior to the staff starting work. She did say she provided two referees, but was unsure whether they had been contacted. A full analysis of what training staff have done and what the development plan is for the next twelve months was not in place despite being a requirement of the last inspection, though there were records showing who had completed moving and handling training, first aid and health and safety training which are part of the induction. There was no clear evidence of induction training in staff files or what the training entailed, although two new staff interviewed referred to induction training and shadowing a member of staff. No workbooks were found. It was not possible to tell how many staff had undertaken abuse training or medication training, for instance. There was no evidence that staff had received any training in dementia or sensory support. The manager said this was an area she was expecting to work on when she had settled into the home. Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,,36 and 38 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The home has recently suffered from lack of management with changes at the top causing staff changes and interruptions in smooth working practices. Quality systems and staff supervision have lapsed and the provider has only recently given reassurance about the safety of the premises. But a new manager has been appointed who is energetic and making an impression with staff so the future of the home looks brighter. EVIDENCE: The home has had some turbulence in its management with a long standing manager leaving, the next manager leaving within a short time and now a new manager who has been in post for three weeks. She has experience in residential care and has her registered manager’s award as well as some training in dementia care. She is not yet registered. Accountabilities were not Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 24 discussed and will need to be clear between the manager and provider if the partnership is to succeed. Staff spoke well of the new manager and felt she was getting to grips with problems in the home. They felt things would change for the better. The manager acknowledges that there is a lot to do to restore the standards in the home. The home’s own quality audit arrived late making it difficult for us to check out surveys with residents and their relatives. It was only partialy completed. However, it is acknowledged that the home was undergoing some difficulties during this time and that the format for the quality audit required by the Commission is new. Only four survey forms from service users were returned to the Commission. The home has not conducted its own survey of residents recently to hear their views and at the last inspection in May 06, we criticised their survey because of its lack of anonymity with service users being assisted to complete the form by the provider. Currently the home does not have systems in place to look at its own quality of care, but the new manager is expecting to make changes. Most of the requirements identified in inspection reports have been attended to. The manager stated and staff confirmed that no money belonging to service users was handled by the home and that residents had control of their own money or help from their relatives. The one to one supervision of staff which was in place at the last inspection has been curtailed with the lack of stable management in the home in recent months. No evidence of supervision was seen on staff files examined, though the record showed that the last one had been conducted in January 07. The new manager said she has experience in supervision and will be starting the process again soon. The health and safety of service users has been an issue in recent months with problems identified with the lift, the heating, the cooker and other areas of safety. The new lift is now installed and up to date certificates have been received at the Commission for gas and electrical wiring and equipment. The new manager has ensured that there are policies in place for health and safety, dealing with clinical waste and safe systems of work. Staff confirmed they are provided with enough gloves and aprons to prevent the spread of infection and the cook has been instructed on food hygiene. The staff induction training showed that moving and handling, emergency aid and infection control are all covered. The fire record showed that the system was checked in June 07 but that the last fire drill was in 2004 though instruction was recorded in 2006. The fire alarm is tested every week. The environmental health officer visited the home in January 07. An accident book is kept and was satisfactorily recorded. (A service user had been referred to the GP because of the number of falls he had had). Checks are carried out on water temperature to safeguard against scalding. Some were as low as 39 Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 25 degrees which may if anything be too cool. Risk assessments were in place for individual service users Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 2 x 2 x x x x 2 STAFFING Standard No Score 27 3 28 1 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x N/A 2 x 3 Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 27 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 OP7 Regulation 15 Requirement The manager must after consultation with the service user prepare a written plan as to how each service user’s needs will be met. The manager must consult service users about a programme of activities and provide facilities for recreation. The manager must provide suitable and nutritious food as may be reasonably required by the service users. (In this instance a choice at the main meal is required and a system that ensures that all service users are offered all meals and drinks wherever they are.) The manager must maintain records of the food available to service users and any special diets prepared for individual service users. The manager must ensure that any complaint is fully investigated and that a summary of the complaints made and the action taken is recorded. The manager must make DS0000046100.V347955.R01.S.doc Timescale for action 30/09/07 2 OP12 16(n) 30/09/07 3 OP15 16(i) 30/09/07 4 OP15 17, Schedule 3 22 30/09/07 5 OP16 30/09/07 6 OP18 13(6) 30/09/07 Page 28 Shalom Residential Home Version 5.2 7 OP19 23(2)(o) 8 OP21 23(2) 9 10 OP21 OP30 23(2)(k) 18 (1)© 11 OP33 24 12 13 OP36 OP38 18(2) 23(4)(e) arrangements by training staff and by other measures to prevent service users being harmed or suffering abuse. (In this instance, the abuse procedure needs to show that local agencies will be contacted if an allegation is made and the manager must ensure that outside agencies including the Commission are informed. Staff training must be provided) The registered person must ensure that external grounds which are suitable and safe for service users are provided and maintained. The registered person must ensure that equipment provided at the care home is maintained in good working order. (In this instance the hoist in one of the bathrooms was in a poor condition and there were minor furnishing details which need attention.) The registered person must ensure that any necessary sluicing facilities are provided. The manager having regard to the needs of the service users must ensure that staff receive training appropriate to their work The registered person must establish and maintain a system for reviewing and improving the quality of care in the home. The registered person must ensure that staff are appropriately supervised. The registered person must ensure by means of fire drills and practices that staff and so far as is practicable, service users are aware of the procedure to be followed in case of fire. 31/12/07 31/12/07 31/12/07 31/12/07 31/12/07 31/10/07 31/10/07 Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP24 Good Practice Recommendations To allow for more privacy, service users should be provided with keys to their doors unless their risk assessment suggests otherwise and locks should be suitable to service users capabilities. To allow for more privacy, service users should be provided with keys to lockable storage for medication or money and valuables and be able to retain that key. The home should be kept free from offensive odours. The manager should ensure that the recruitment process is following the correct procedures and protecting the service users. The manager should encourage staff to study for a national care qualification to achieve the standard of 50 trained. 2 3 4 5 OP24 OP26 OP29 OP30 Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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. Extracts may not be used or reproduced without the express permission of CSCI Shalom Residential Home DS0000046100.V347955.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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