Inspection on 05/07/05 for Shamrock House

This inspection was carried out on 5th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Shamrock House 17/02/09

Shamrock House 11/12/07

Shamrock House 22/08/06

Shamrock House 06/12/05

Shamrock House 26/10/04

Shamrock House 20/05/04

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

CARE HOME ADULTS 18-65 Shamrock House 69 Hook Road Goole East Yorkshire DN14 5JN Lead Inspector Rob Padwick Unannounced 5 July 2005 at 2.00 pm 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Shamrock House Address 69 Hook Road Goole East Yorkshire DN14 5JN 01405 766217 01405 766217 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) Mrs Lila Chaudhary Mrs Marcia Dorothy Nicholls Care Home 12 Category(ies) of MD Mental Disorder (12) registration, with number MD(E) Mental Disorder - over 65 (12) of places Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: The category MD(E) refers to only five (5) named individuals already resident within the home. Date of last inspection 26th October 2004 Brief Description of the Service: Shamrock House is a care home, which provides twelve placements for male and female service users with mental health problems, and aims to enable them towards independent living. Bedroom accommodation is mostly in shared rooms. Service users have the opportunity to mix in the communal areas, which consists of a lounge, conservatory and a dining room. The garden area is accessible to wheelchair users, although the home’s two bathrooms are situated upstairs and therefore the accommodation is limited for those with mobility problems. The location of the home close to the centre of Goole ensures that there is good access to the local bus and train services for both service users and their visitors. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and lasted from 2.00 pm until 5.00 pm with a previous half day of preparation time. During the inspection, a tour of the premises was undertaken, and the inspector spent time talking with the service users in the communal areas of the home and observing their daily lives. Further time was spent reading care plans and files and talking to staff. The manager and the home’s administrator were not available at the time of this inspection and it was therefore not possible to determine whether a number of the outstanding requirements from the previous inspection had been implemented. What the service does well: What has improved since the last inspection? An improvement had been made in the standard of record keeping in service user files, which helped to ensure that the service users needs were met. Some of the home’s policies had been had been developed and the recommendations of the fire officer had been implemented. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 5 Service users had received an assessment of their needs, but better documentation was needed in order to demonstrate that the home was able to meet their needs and that they had been provided with information about the home. EVIDENCE: One of the service user files examined contained a statement of purpose and service user guide in order to provide information about the home. However, discussion with staff indicated that they were uncertain whether this information had been fully developed as previously required. Discussion with service users confirmed that their needs had been assessed that they had been consulted about this. The 3 service user files inspected contained evidence that the assessment process had involved the service user or their representatives and copies of local authority Community Care Assessments and care plans were included within them. One of the case files examined included evidence that the manager had developed the pre assessment procedure for service users newly admitted to the home and had complied with the previous requirement in this regard. Service users spoken were enthusiastic about the staff and confirmed that the home was meeting their needs. Staff stated that they had continued to benefit from training, though as outlined later in this report, it was not possible to Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 9 confirm that specialist training relevant to the needs of the service users had yet been implemented. The case files examined did not contain evidence that the service users had been given an individual contract or statement of terms and conditions and discussion with staff indicated that these were stored in the office and locked away at the time of this inspection. The inspector was therefore unable to determine whether the previous requirement had yet been implemented. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 The service users were supported by staff to be as independent as possible and to make decisions in order to that their individual needs and choices were met. The documentation of risk needed improvement. EVIDENCE: Service users indicated they were aware of their individual plans of care and confirmed that they were consulted about these. Service users stated that the staff “looked after them” and that they participated in reviews of their needs. The 3 service user files examined contained evidence of daily recordings, monthly summaries, risk assessments together with agreed multi disciplinary strategies of intervention as appropriate. A recommendation is made that care plans are further developed in order to demonstrate that service users are in agreement with what is recorded in them. Service users confirmed that staff supported them in making informed decisions and information was seen of other external sources of help within the home. Staff were observed to respect service users privacy and discussion with service users indicated they were assisted with their finances by staff, as appropriate. However the home’s documentation in this regard needed strengthening as outlined later in this report. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 11 Service users confirmed they were supported by staff to be as independent as possible and discussion with staff indicated that they were aware of the individual service users strengths and needs. Case files inspected contained known areas of assessed risk and the management strategies for dealing with these. However, a concern expressed by a service user and examination of his file indicated that improved documentation was needed, in order to demonstrate that any restriction on choice had been fully agreed with service user or his representative. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 Improved documentation of the meals served to service users was needed, in order to ensure that the nutritional needs of service users were being met. EVIDENCE: Discussion with service users indicated that they enjoyed their meals and were able to have input into the choice of food served. Inspection of the home’s agreed set menu confirmed that it provided service users with a balanced diet, but discussion with staff indicated that these were not rigidly kept to and depended on service users expressed wishes. Case files confirmed that service users were being monitored for weight and that the home was able to accommodate those in need of special diets, but improved documentation of the meals served was needed in order to confirm that their nutritional needs were being met. Inspection of the food stores indicated that these were being adequately maintained. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 The recording system for the administration of medicines given to service users needed strengthening, in order to ensure that they were not put at risk. EVIDENCE: Service users stated they “wouldn’t want to take control” of their own medication and had passed responsibility to staff in this regard. Staff confirmed that they had received training in the safe use and handling of medication, but confirmation of this was not possible as the staff training files were locked away at the time of this unannounced inspection. The home used the “Monitored Dosage System” for the dispensing of drugs to service users and a random check of this revealed that an old supply of a service users medication was being used up before commencing on the newly dispensed stock. Errors in the documentation system that could lead to service users being administered the incorrect dosage of their medication could therefore arise and this practice must cease in accordance with the Royal Pharmaceutical Society of Great Britain guidance “The administration and control of medication in Care Homes”. Staff advised that the home had a policy that enabled service users to self administer their own drugs if assessed as able to do so, however this was not available for inspection and could not therefore be examined. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 14 Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22, 23 The views of service users were taken into account and staff were aware of their responsibilities in safeguarding the service users from abuse. Better recording systems were needed in respect of service users finances in order to ensure that service users are protected from abuse. EVIDENCE: The service users expressed their satisfaction with the management and staff in the home and strongly indicated that views were taken into account and acted upon. The home had a formal complaints policy that had been satisfactorily updated since the last inspection and discussion with the staff indicated that no complaints had been received since that time. Service users were safeguarded from abuse by the home’s policies on the protection of vulnerable adults. Discussion with staff indicated that they had received training in this area of practice and were aware of their responsibilities in this regard. As indicated previously, service users stated they were supported by staff with respect to their finances. However, inspection of the home’s system for the storage and documentation of service users personal allowances were inadequate and the inspector was unable to confirm that they were sufficiently robust and transparent. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 27, 28 The home provided a homely environment for service users, but some repairs to the building were needed. EVIDENCE: Inspection of the building indicated that service users lived in a homely environment. The home was clean, bright comfortable and tidy and the furnishings in the lounge were of an adequate quality. Staff indicated that the home complied with the requirements of the Fire Officer and the Environmental Health Department and that the home had an ongoing programme of repairs. However, the guttering in the conservatory was leaking into the building and in need of repair. The service users individual needs were adequately met by the homes provision of bathrooms and toilets. Inspection of these indicated them to be lockable and that the requirement from the previous inspection had been implemented. A recommendation was made that the downstairs toilet cistern was more securely fitted to the wall was made, as this was loose on the day of this inspection. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 17 A range of communal and personal space was provided in order that the needs of the service users were met. Most of the bedrooms were shared, but discussion with service users confirmed that they were happy with this arrangement and that they had made a positive decision in this regard. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34, 36 The home’s recruitment, staff training and supervision practices needed development in order to ensure that the service users welfare was safeguarded. EVIDENCE: Service users spoken to were without exception positive about the caring nature of the staff that supported them. Staff members confirmed that they had received training that equipped them with the tasks to do their jobs and that a number of them were in process of undertaking NVQ training. However, the staff records were locked away on the day of this inspection and the inspector was therefore unable to verify that the requirement from the previous inspection had been implemented. The home had a recruitment policy and procedure in order to safeguard the service users. However, due to the staff records being inaccessible, it was not possible to determine whether the requirement from the previous inspection had been implemented in respect of this practice. As indicated throughout this report, service users confirmed that the staff supported them in meeting their needs appropriately. Staff indicated that the manager had partially implemented the previous requirement that a formal system of staff supervision be implemented. Further discussion with staff Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 19 indicated that they had received an individual appraisal of their training needs, but that they were still not in receipt of the minimum of 6 dedicated sessions of individual staff supervision. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 40, 41, 42 The systems for the management of information and checking with service users needed development in order to ensure that their welfare needs were met. EVIDENCE: Service users stated that they felt the home was well managed and that it was “the best home they had been in”. However, inspection of the records indicated that it could be improved further. The home had a registered manager who had worked in the care sector for a considerable number of years, but is hoping to step down from her current responsibilities in the near future. Discussion with staff confirmed that the registered person was seeking to appoint a new replacement manager and a recommendation is made in this regard. Service users confirmed that they were actively consulted in decisions concerning the home. However, it was not possible to verify whether the Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 21 previous requirement that a quality assurance system for monitoring the development of the home had yet been implemented and staff were unable to shed light on this matter. Discussion with staff indicated that the rights and best interests of service users were safeguarded by the home’s policies and procedures. However, a number of these were not available for inspection on the day and it therefore not possible to confirm that these had been developed since the last inspection, as had previously been required. The Inspector was similarly unable to verify whether the Registered Person was compiling monthly reports of her unannounced visits to the home in accordance with her responsibilities under Regulation 26 of the Care Homes Regulations 2001. The standard of record keeping and documentation in order to ensure that the service users rights and best interest were safeguarded, had improved since the last inspection. However, further development of care plans, risk assessments and of the policies and procedures was still needed. Recommendations were made in these matters. Discussion with staff indicated that the health and safety of the service users and themselves was being promoted and protected. Staff advised that the home complied with the requirements of the Fire and Environmental Health Department and up to date certificates were seen in relation to the servicing of fire equipment and the emergency lighting. A recommendation is made that the Registered Person makes alternative arrangements in order that staff have access to all of the necessary records and policies so that the service users health and safety is protected further. Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 1 3 1 x 1 Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 1 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x x 2 3 x x Standard No 11 12 13 14 15 16 17 x x x x x x 2 Standard No 31 32 33 34 35 36 Score x 1 x 1 x 1 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Shamrock House Score x x 1 x Standard No 37 38 39 40 41 42 43 Score 2 x 1 1 2 2 x J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement The Registered Person must produce an up to date statement of purpose for the home setting out its philosophy, aims, objectives and includes information on its services, facilities, terms and conditions and provides each of the service users with a service user guide to the home. (Previous timescale of 26/01/05 not met) The Registered Person must ensure that staff specialist training and development to equip them with the skills and experience to meet the needs of the service users. (Previous timescale of 27/3/04 not met) The Registered Person must ensure that copies of contracts or a statements of terms and conditions are provided to service users. (Previous timescale of 27/3/04 not met) The Registered Person must ensure that risk management strategies are drawn up and agreed with the service user or their representative) The Registered Person must ensure that staff adhere to the Timescale for action 1/9/05 2. 3 12 1/10/05 3. 5 5.c 1/10/05 4. 9 13, 14 1/9/05 5. 20 13 1/9/05 Page 24 Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 6. 23 16, 20 7. 24 8. 32 18 9. 34 19 10. 36 12, 18 11. 39 24 12. 40 17 Royal Pharmaceutical Society of Great Britain Guidence The administration and control of medication in Care Homes and that old stock of medication is returned to the pharmacy. The Registered Person must ensure that a robust system for the storing and dispersing money to service users is developed with accurate records kept. The Registered Person must ensure that the guttering in the conservatory is repaired in order to prevent it dripping. The Registered Person must ensure that staff have the competencies and qualities required to meet the Sector Skills Council workforce strategy targets within the required timescales.( Previous timescale of 27/3/04 not met). The Registered Person must ensure that staff recruitment proceedures are developed and that all of the information required by the regulations and schedule 2 of the Care Home regulations 2001 are available for inspection. (Previous timescale of 27/3/04 not met). The Registered Person must ensure that a formal system of staff supervision is implemented and that a record of staff supervion is maintained. (Previous timescale of 27/3/04 not met). The Registered Person must ensure that a a quality assurance system for monitoring the development of the home is implemented. (Previous timescale of 27/4/04 not met) The Registered Person must ensure that the policies and 1/9/05 1/10/05 1/10/05 1/9/05 1/9/05 1/10/05 1/10/05 Page 25 Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 13. 40 26 proceedures for the home are developed to comply with current legislation and recognised professional standards as set out in Appendix 3 of the National Minimum Standards for Younger Adults. ( Previous timescale of 27/4/04 not met). The Registered Person must ensure that she compiles a monthly report of her unannounced visits to the home in accordance with her responsibilities under the Care Homes Regulations 2001. (Previous timescale of 27/4/04 not met). 1/9/05 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 6 Good Practice Recommendations The Registered Person should ensure that care plans are further developed and that they can demonstrate that service users are in agreement with what is recorded in them. The Registered Person should ensure that a record is kept of the food actually served to service users in order to demonstrate that their nutritional needs are being met. The Registered Person must ensure that the downstairs toilet cistern is securely fitted. The Registered Person should continue her efforts to appoint a new manager for the home. The Registered Person should ensure that care plans, risk assessments and the homes policies and proceedures are further developed. The Registered Person should ensure that alternative arrangements are made in order that the necessary records and policies are available for staff and inspection. 2. 3. 4. 5. 6. 17 27 37 41 42 Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Shamrock House J53_s19723_Shamrock House_v228567_050705_Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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