CARE HOMES FOR OLDER PEOPLE
Shalom Residential Home 147 Yarmouth Road Norwich Norfolk NR7 0SA Lead Inspector
Dot Binns Unannounced 22 July 2005 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 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 I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Shalom Residential Home Address 147 Yarmouth Road Norwich Norfolk NR7 0SA 07974 979644 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Medicare Corporation Ltd Mrs Lorraine Walkinshaw Care Home 24 Category(ies) of Old age, not falling within any other category registration, with number (24) of places Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Old age, not falling within any other category. 2. Care Home only. 3. No new admissions of service users who are wheelchair users to be accomodated on the first floor until the registered person ensures the establishment complies with regulation 23(2)(n). 4. All service users accommodated on the first floor must have written risk asssessments regarding the use of the stair lift. Date of last inspection 31 January 2005 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 care home stands in attractive grounds, surrounded by mature trees. There is a bungalow to the rear of the main building which provides accommodation for the supporting night care worker who sleeps in. There is currently no passenger lift in the Home. A stair lift has been provided but until a new passenger lift is installed, there are restrictions on admitting service users who use wheelchairs to the first floor. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection of the Home lasting three hours. The purpose of the inspection was to see how the Home functioned on a normal day, to see what staffing was in place and what was happening in the Home. Another reason for the inspection was to conduct a tour of the premises as some alterations are planned and the Commission wanted to see what the effect of these proposals would be. Discussions took place with the manager about the requirements of the last inspection, records were examined and some service users and staff were seen during the tour of the building. What the service does well: What has improved since the last inspection?
The record showing the profile of each service user has been improved though there is still more work to be done. The amount of activities provided for the service users has increased with a member of staff providing something every day. This includes group and individual activities. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 6 All rooms have been checked to ensure that service users have plenty of sockets and chairs and are comfortable in their rooms. More chairs have been provided so that service users can offer a seat to a visitor in their room. Staffing has been improved recently with more care staff on duty for longer hours. This brings the Home up to standard on staffing hours. 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. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None of these standards were inspected. EVIDENCE: Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 8 Individual care plans need improving to ensure the records reflect what is happening to the service users, though the hands on care is good. The health care needs of the service users are being met. EVIDENCE: Two files were selected at random and found to contain information about the service user to enable staff to assist them in the Home. The assessment documents had been improved to meet the standard. Risk assessments for such things as falling were in place though not always clear. There was in various forms information about the service user but not in a very logical format though it was clear from the daily notes written by staff that the care delivery was good. It is clearly more to do with recording than with the hands on care. Some further work needs to be done to make the care records more cohesive with a clear assessment, a risk assessment and what can be done to reduce the risk, a care plan and a periodic review of care alongside the daily notes. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 10 There was plenty of evidence of doctor’s visits and assistance from district nurses. One fall by a service user was correctly cross referenced with the accident book. Daily fluid charts were in place where a service user was vulnerable. The care notes showed that staff were considering the health of the service users. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 Service users are able to benefit from a variety of recreational interests in the Home offered on a day to day basis. This provides stimulation and fun and adds to a livelier atmosphere. Service users are able to maintain contact with their family and friends, the Home having an inclusive atmosphere. EVIDENCE: It had been a requirement of the last inspection that the service users be consulted about the provision of activities offered by the Home. A member of staff is now taking charge of activities and reported that she does offer something every day, sometimes in a group and sometimes with one person. Craft, reminiscence, flower arranging and music are all offered. Evidence of the craftwork was on display. Entertainers are also regularly provided and an expert from Norfolk County Council has been doing sessions on life story work. Some service users are taken out for walks. This is a big improvement and the staff have worked hard. One relative was seen by the inspector and reported that she was very pleased with the care received. She was able to visit at any time and was kept informed of any changes. She was also able to participate in her mother’s care which she liked. Overall relatives are welcomed in the Home and can see the service users in their rooms.
Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Procedures are in place and service users can be confident that there complaints will be taken seriously. EVIDENCE: The complaints procedure is in the service users guide and in the statement of purpose. There have been no recent complaints and none has come to the attention of the Commission. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24 and 26 Overall the Home provides attractive accommodation for the service users and many of the facilities are adapted for those who are less mobile. Some improvements are required however in particular the provision of a shaft lift and some adaptation of the garden. Some minor works would improve facilities. The decoration and furnishing is generally good and the warmth in the atmosphere is evident. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 14 EVIDENCE: This is a very pleasant home with good facilities for the service users. There is a problem in that there is only a stair lift at the moment but a shaft lift and other maintenance works are planned in the near future. Communal space is very attractive with a light dining room with views to the river, a small conservatory and a large lounge. Decoration and furnishings are to a high standard. There is also a hairdressing room. The outdoor space needs to be improved. There is a large front garden but it is inaccessible to the service users because of the steps and there is no encouragement to sit out there. The re is one enclosed patio area but this looked bedraggled and needs renovation. The Home has three bathrooms, two upstairs and one down. All three bathrooms are assisted with hoists. In addition there are six further toilets, not counting the en suite facilities which many bedrooms have. These are equipped with handles and high seats to encourage independence and all facilities are on the call bell. Four of the toilets are on the ground floor, two of which are near the communal areas. Although an assessment of the building has not been made by a qualified person, the Home is equipped with ramps to assist with changes of level and with grab rails and hoists. One omission is the provision of a shaft lift which is the subject of a condition on the registration. (No one who uses a wheelchair may be accommodated upstairs) Some handrails in the corridor are supplied but more are recommended. A call system is installed in all the rooms. One area which does need to be made more accessible as previously stated is the garden. There are twenty single rooms and two double rooms in the Home. This complies with the standard that 80 of rooms should be single. Some rooms are smaller than others but all are very attractive. Twelve of the rooms have en suite facilities. One wheelchair user is in a large room giving them space. Service users are able to bring their own possessions to make their room individual and the furniture provided by the Home is of a good standard. All have an extra chair for visitors, enough sockets and a television aerial and a small safe for their valuables. Radiators are covered to prevent burning. The heating system is old and is due for renewal. There were some patches in the home that could do with some maintenance and this will be carried out when the main work is done to the house in the near future. Overall however the bedrooms are very nice and comfortable. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 15 The premises are free from odours and the cleaning is satisfactory. All the laundry is carried out on the premises and the Home has an industrial washer and tumble drier. High temperatures can be reached to control infection. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 The numbers and skill mix of staff is providing a good service to the service users. The Home is on the right track with training of staff but needs to keep going in order to ensure the service users are in safe hands at all times. Recruitment procedures are tight and give good protection to the service users. Induction training must be more thorough so that new staff understand how to assist the service users safely and kindly. EVIDENCE: There was a requirement at the last inspection for more staffing. From the rota provided, this has now been put in place with increased care hours being allocated to each day. The allocation of hours to catering tasks is short but the extra care hours compensate for that. Domestic hours were satisfactory. There is currently only one waking night staff with a sleeping in staff for back up. This is being monitored to ensure it is sufficient. Staff are mature and young staff are not left in charge of the Home. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 17 Two staff are currently studying for their NVQ and two are already qualified. This brings the proportion of staff with this training to 44 . The standard is for 50 of staff to be trained by 2005 so the Home is currently not meeting the standard. However more training is being applied for. The staff record of the newest member of staff was examined in order to look at recruitment procedures. An application form, references, identity check and criminal records check were all in place. Induction training was not in evidence though the manager reported that it had started but just not been documented. The essential moving and handling training had been completed but basic training on care principles and methods were not completed. A more organised system should be in place that clearly shows what instructions and training new staff are receiving in their first weeks of work. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 18 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not inspected on this occasion None of these standards were inspected EVIDENCE: Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 2 2 3 2 3 3 x 3 STAFFING Standard No Score 27 3 28 2 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x x Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 20 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. 2. Standard 22 30 Regulation 23(2)(n) 18(1) Requirement A shaft lift must be installed to allow greater mobility for the service users. The provider must ensure that each new staff has induction training at the start of their work in the Home and that this is documented. Timescale for action 31.1.06 Immediate and ongoing. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 7 20 22 Good Practice Recommendations The care records still need some work to make them more comprehensive. It is recommend that the garden is made more accessible for the service users. It is recommended that more handrails are provided in the corridors. Shalom Residential Home I55 S46100 Shalom V240620 220705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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