Inspection on 27/07/09 for Shannon Court

This inspection was carried out on 27th July 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shannon Court 16/11/09

Shannon Court 27/09/07

Shannon Court 21/03/07

Shannon Court 17/05/06

Shannon Court 13/09/05

Shannon Court 26/05/05

Shannon Court 30/11/04

Shannon Court 05/04/04

Similar services:

Springfield House

Springfield House

Sutton Lodge Nursing Home

The Shelley

1 Marten Road

St Helier`s Residential Hotel

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Shannon Court Portsmouth Road Hindhead Surrey GU26 6DA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Suzanne Magnier     Date: 2 7 0 7 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 36 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Shannon Court Portsmouth Road Hindhead Surrey GU26 6DA 01428604833 01428606422 mmaughan-otten@rmbi.org.uk www.rmbi.org.uk Royal Masonic Benevolent Institution Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Type of registration: Number of places registered: care home 52 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 52. The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) Dementia - (DE) Mental disorder, excluding learning disability or dementia (MD) Date of last inspection 52 52 0 Over 65 0 0 52 Care Homes for Older People Page 4 of 36 Brief description of the care home Shannon Court is a care home for older people and provides care for Freemasons and the dependent females of Freemasons. The large house offers accommodation for residents on two floors and is separated into five units. Each unit has its own dining room and lounge facilities. Access to the first floor is via passenger lifts. The units named Alvernia and Davis are specfically designed to provide accomodation and care to residents with dementia. All bedrooms throughout the home are single occupancy and have en-suite facilities. There is a large communal lounge in the main building with a licensed bar and a shop. Residents can purchase goods, for example toiletries, stamps and sweets and spend time socialising with friends and visitors in the communal areas if they choose. There is an activities room, a library and a hairdressing salon in the main building, all of which are accessible to residents. The well maintained private grounds are accessible to residents and there is ample car parking available to the front of the building. Care Homes for Older People Page 5 of 36 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 2 star. This means the people who use this service experience adequate quality outcomes. This inspection was an unannounced key inspection and was undertaken by Ms S Magnier and Mrs P Collins Regulation Inspectors. As part of the inspection the commission invited an expert by experience from Help the Aged to be part of the visit in order to speak with residents and people visiting the home about their experience of the home. The expert by experience produced a report and the findings have been added to the commissions report. We (the commission) arrived at the service at 07.00 and concluded the inspection at 18.00. We looked at and assessed how well the service was meeting all the National Minimum Standards for Care Homes for Older People and have in this report made judgments about the standard of the service. Some additional standards have been Care Homes for Older People Page 6 of 36 assessed and are included within the report. The service was represented by the registered and deputy manager. The home had supplied the commission with their completed Annual Quality Assurance Assessment AQAA which includes information about the service. This and any other information received helped to prioritise the order of the inspection and identify areas that require more attention during the inspection process. The AQAA is referred to within the report. For the purpose of the report the individuals using the service are referred to as residents. The information contained in this report was gathered from observation by the inspectors and the expert by experience, speaking with a number of residents, visitors to the home and staff, touring the premises and looking at a range of documents which included residents care plans, daily records and risk assessments, medication procedures, health and safety records, staff training and recruitment records and some of the homes policies and procedures including complaints and safeguarding vulnerable adults. The last key inspection had been undertaken in August 2008 and as a result the the service was rated as delivering adequate outcomes for people using the service and several requirements were made which included the strenghtenning of medication practices, consulting residents more fully about the about the programmes of social and leisure activities available, improving the homes complaints and safeguarding adult procedures and ensuring improved management of the home and supervision of staff. It has been concluded that these requirements have been met. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of residents who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 36 What the care home does well: What has improved since the last inspection? The home has met the previous requirements. Training programmes for staff have been upgraded and more staff are undertaking the National Vocational Qualification in Care Training. The home have improved the standard and provision of activies both within and Care Homes for Older People Page 8 of 36 outside of the home. Care planning systems have been reviewed to ensure improved practice to meet the needs of residents. Additional specialist equipment has been purchased following the assessments of resident needs in order that they are with safety and comfort. Recruitment of staff has been undertaken in order to offer continuity of care for residents. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 36 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 36 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written information regarding the services and facilities is provided by the home support prospective individuals and their representatives to make an informed choice about moving to the home. The admission and assessment procedures ensure that residents needs are appropriately identified and met. Intermediate care is not offered. Evidence: The homes Statement of Purpose and Service User Guide were sampled during the inspection and contained the required information to inform prospective residents and their representatives about what the home offers. The documents however referred to the Commission for Social Care Inspection which ceased to function in April 2008 and should be updated to include the new Care Quality Commission details. There was evidence to support through sampling a variety of care plans that peoples individual needs had been assessed, prior to admission to the home, by the registered manager or a member of staff with the ability and qualifications to undertake the assessment in order to ensure that the homes staff could meet the individuals care and support Care Homes for Older People Page 11 of 36 Evidence: needs. The home have an admission and assessment policy and procedure which includes encouraging prospective residents to visit the home and to meet with other residents and staff if that is their choice. The home does not offer intermediate care. Care Homes for Older People Page 12 of 36 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are generally offered a good provision of health care and personal support by the home. Care is provided in way that generally promotes residents privacy and dignity. The care planning system and monitoring of risk assessments generally ensures that residents health, safety and wellbeing is promoted. Medication procedures and some risk assessment practices need to be further strenghenned to ensure residents welfare and well being. Evidence: The inspectors sampled seven care plans from a variety of residents who were residing in Heydon, Langdon, Davis and Alvernia areas of the home. The care plans indicated that they had been developed from the pre admission assessment and were generally well recorded and contained up to date information about the care and support needs of the individual. Some documentation included specfic care plans for identified needs which also cross referenced to assessments of hazards identified in the residents life in the form of risk assessments. Care Homes for Older People Page 13 of 36 Evidence: The care plans included each residents medical history and health profile, life story information and lifestyle preferences, nutritional and body weight assessments, moving and handling risk assessment and falls risk assessments, skin integrity, safe moving and handling procedures, the residents current mobility, communication and sensory abilities, medication requirements, specialist care, and day and night time choices and preferences. Whilst sampling the care plans it was noted that several had been recently reviewed and updated. As a result some care records did not indicate a retrospective recording practice for example one residents food and fluid chart was incomplete and did not provide an audit trail of fluid intake and output or food consumption. It was also noted that some care plan records were fragmented for example for residents nutritional needs and records of dietary intake and weight checks were kept seperatley. Additionally the recent changes in the record template for recording and monitoring personal hygiene for example the records for one resident initially suggested that their hygiene needs were not being met however when tracked back the problem was relating to the recording system which staff found confusing with some using the old template and some the new one and with not all staff being aware of the changes. One residents care plan sampled from Alvernia indicated that the family had been involved in the decisions of support for their relative which may infringe the individuals rights. This was brought to the registered managers attention and a recent practice discussed. It has been recommended that decisions made by family members regarding the support and care requested for their relative be more formalised in order to ensure that the individual is not deprived of their liberty and are safeguarded from any allegation of abuse or harm. Concern was raised with the registered manager during the inspection regarding one resident who told the inspector and expert by experience that they were unhappy at the home and that their needs were not being met. On investigation there was evidence to support that the homes staff and managers had been proactive and had identified the increased needs of the resident and were in consulataion with the resident and their relatives. Following the inspection the commission have been advised that due to the increased needs of the resident that they have been accomodated in another area of the home where their needs can be more appropraitely met. From the care plans sampled there was documented evidence that regular visits by the new general practitioner had been attended on a weekly basis. Residents Care Homes for Older People Page 14 of 36 Evidence: confirmed that health care professionals visit the home or they attend appointments to the optician, dentist and chiropodists. Documentation was sampled to evidence that specialist advise regarding falls clinics, use of specialist equipment, tissue viability, management of continence and diabetic care appointments and consultations were also available to residents as the need arose. During the inspection concern was raised, due to feedback from a resident, regarding the change of the district nursing service to the home as it was reported that the district nurse had failed to keep two booked appointments and which had also raised concern with the family of the resident. On further investigation the registered manager confirmed that she had met with the new district nurse several days prior to the inspection to detail some of the concerns raised by residents and assured the inspectors that district nurse attendance to the home would be monitored more effectively in order to ensure residents health care needs are met in a timely manner. During the inspection the district nurse contacted the home to offer advice and support regarding one residents ongoing concern which following the inspection had been resolved appropraitely. The sampled care plans contained documented risk assessments which had been completed following identification of hazards in residents daily lives for example moving and handling, use of pressure relieving equipment, night care and supervision, risk management plans for 30 minute checks during the night if resident unable to use the call bell system, nutritional assessments, access to hazardous substances, bathing risk assessments, hot surfaces and attending the hairdressers. It was noted that in one residents care plan that they liked to eat fruit and cut it up with a knife however there was no risk assessment available in the care plan regarding the use of a knife and it has been required that where potential hazards are identified that assessments of risks must be made and documented in order to ensure the safety and well being of the resident. One risk assessment regarding a residents tissue viability and potential pressure ulcers was discussed with the registered manager and it has been recommended that improved recording be developed within the care plan to cross reference with the risk assessment in order to ensure that the hazards identified are continually monitored to ensure the wellbeing of the resident. Of the seven completed surveys from residents five stated that the home makes sure their medical needs are met whilst two stated that their medical needs are ususlly met. In general the care records were professionally written and generally well maintained to reflect the residents needs and care provided however one residents records were Care Homes for Older People Page 15 of 36 Evidence: written in a judgemental way about the individual and their life style preference which needs to be addressed by the homes management. The home has a medication policy and procedure in place and continues to use a monitored dosage system. Medication records contained residents photographs and samples of signatures of staff were evident in the medication folder. Staff were observed undertaking the medication procedures in the home and demonstrated that they were methodical and confident in their duties. One medication chart indicated that the resident had not received their prescribed medicines and this was investigated during the inspection and evidence found that staff had made concerted effort to obtain the medicines following the residents recent discharge from hospital and the medication was delivered to the home by the end of the day of the inspection. One resident told the inspector that they had not received their medicines on one occassion and this was brought to the registered managers attention who later confirmed to the commission via email that the home had investigated the claim and evidence indicated that the event had taken place over a year ago. One shortfall was found which included a staff member signing to confirm that a resident had received their medicines yet the prescribed medication was found in the current blister pack. Records indicated that the staff member had received recent medication training yet in discussion with the registered manager it was confirmed that the staff members competency to adminster medicines was not robust and their duties to administer medicines in the home would be ceased with immediate effect until the appropriate level of compentency was achieved and residents were protected from harm. It has been required that records must accurately reflect when medicines have been administered and reasons for medicines not taken must be clearly recorded in order to ensure the health and welfare of residents. Residents written views regarding the administration of medicines in the home included it takes for ever, it comes when it comes, what they could do better is for the medication to be at more regular times. Throughout the day the inspectors observed that there was a lack of staff resources within the Heydon and Langdon areas of the home which was concerning and was addressed with the registered manager during the inspection as some residents complained that they felt their needs were not being met due to staff shortages. The evidence of lack of staffing levels has been more fully documented within the staffing section of the report. Care Homes for Older People Page 16 of 36 Evidence: The care and support for residents residing in the Davis and Alvernia areas of the home were robust and residents were noted to respond favourably to staff due to staffing consistency and staff demonstrated a clear knowledge and understanding of the residents welfare and support needs. All residents, throughout the home, were addressed in a polite and courteous way by staff and residents rights to be known by their preferred names was noted. Care Homes for Older People Page 17 of 36 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are able to make some choices about their daily routines and enjoy and choose from a range of activities offered by the home. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet. Evidence: The home has promoted an activities programme which has significantly improved following the previous inspection. The Friends of Shannon Court have contributed to the improvement by fundraising which has secured an additional activities organisers post which brings the total of activities co ordinators in the home to three. The activity organisers cover six days a week including some evenings and weekends. The expert by experience reported that they were impressed by the dedication enthusiasm and imagination of the three activity coordinators and amount of activities provided by the home. There was evidence of a list of the weeks activities in residents rooms and information on large wipe boards with the days date. Carers were encouraged to keep residents informed before activities were held and one of the coordinators said they write up notes about the residents participation and reaction to activities. The homes activities Care Homes for Older People Page 18 of 36 Evidence: include Wednesday coffee mornings when residents can specifically choose what they want to do and the activities are generated by the 15-20 residents attending. There have been outings to museums, Birdworld , the Country Market, local shops, meals to the local Indian restaurant on the evening of the inspection, visits to the seaside and rides in the new minibus in the countryside. Other activities include a mobile library once a month, golf putting, talks ,Countdown re-enactment, exercise classes seen on day of the inspection, quizzes, mobile shop, bingo, manicures and hand massage aromatherapy sessions. The home has a licesnsed bar and a shop which opens regularly. A number of visitors were in the home including the Chairman of the homes Association of Friends and two of its members. The fundraising activities were discussed with an inspector and it was determined that funds raised are for the activities and social care budget enhancing quality of life for residents at the home. It was confirmed that a number of members of the Association of Friends engage in voluntary work for example driving the three vehicles and members of the Friends Committee visit weekly to talk with residents. Discussion with committee members confirmed a wide range of social events and activities that take place throughout the year which was also evidenced as documented within the Shannon Court Journal. Residents spoken with about the activities provided in the home were enthusiastic about their involvement, written comments included there is always something organised morning noon and night so we are never bored. We are given a programme every week so we can plan our activities, whether outings floor games or quizzes to name but a few and the girls who organise our activities are second to none. Always happy, friendly,and helpful in spite of working so hard the activities are excellent. They have a good working relationship with the association of friends of Shannon Court and provide good transport to medical appointments. Activities are available but do not suit all tastes and some residents prefer to stay in their rooms. Links have been maintained with the local clergy of the Church of England and Roman Catholic church who hold services at the home whilst some residents attend the Grayshot Parish Church in order to support peoples spiritual and religious needs. Residents confirmed that their friends family and people that are important to them are welcomed into the home during the open visiting hours and facilities are available for residents to meet with their friends and families in private. Several residents have their own private telephone some with large buttons in order that they can keep in contact with family and friends by phone however it was found during the day that the outside phone booth in the corridor was not working correctly and the expert by Care Homes for Older People Page 19 of 36 Evidence: experience tried to use the phone and lost money on the first attempt. It is recommended in order that residents can maintain telephone contact with their friends and relations that a member of staff talk through the process of using the phone to new residents and the topic be discussed at residents meetings and a written clear notice is displayed by the phone describing how to use the phone and what coins are not accepted. It was observed that during the day of the inspection residents care plan records in files were stored on a window in the corridor by the staff desk and no effort was made to place these in the locked storage available. It has been required that records must be stored in accordance with the current legislation in order to promote and protect residents rights to privacy and confidentiality. An inspector and the expert by experience observed the meal times during the day which included breakfasts and the midday meal. On all units except Heydon staff served cereals toast coffee and tea to people in the dining room as they got up leading to a staggered meal time that was relaxed and unhurried. This was not observed on Heydon unit where the agency staff member was unfamiliar with the needs of the residents and explained to the inspector that they were not comfortable working on their own on the unit as one resident had already shouted and complained that the breakfasts were late. This concern was brought to the registered managers attention during the inspection and resolved immediately. Staffing resources are more fully documented within the staffing section of this report. There was evidence to support that residents were given choice at lunch time about the lunch and supper for the next day normally a choice of two meals or a salad at lunch. One resident said The meals are very good theres not a great deal of choice. Another resident said The meals are reasonable some better than others. There are 1st class salads. I dont care for the suppers as the corned beef hash is terrible, not made like it should be. In Haydon one of the residents asked what was for lunch but another resident said that the menu card had not been put out which the carer advised was normally attended by kitchen staff but as there was an agency worker in the kitchen this duty had been neglected. Written comments received by the commission about the serving of the meals included they should check the breakfast trays more regularly they give us food and frequent drinks It was observed that lunch is brought to the units in heated cabinets and served up by a carer. The vegetables are served on separate platters for the residents to help themselves. The lunch was baked gammon and parsley sauce with mixed vegetables and mashed and croquette potatoes followed by rhubarb crumble. Tables had been Care Homes for Older People Page 20 of 36 Evidence: laid up and residents helped themselves to apple juice. There were many nods of approval in both Norfolk and Haydon Units and comments included the foods pretty good. The meats a bit tough. Not tough a bit chewy There was some social interaction between residents in Norfolk and less in Haydon where there was only half of the residents eating in the dining area and at least four chose to eat in their rooms. Though the menu refers to cooked breakfasts being available it was observed that none of the people using services were asked if they would like a cooked breakfast and all but one of the small fridges in the kitchen did not have any provisions to make a cooked breakfast. The staff said if anyone asked for a cooked breakfast they would go to the main kitchen for the provisions and staff will cook this for them. Throughout the inspection constant checks were made on access to Davis kitchen as the door was open. Staff presence was maintained in this area, as the kitchen opens onto the lounge and dining room and it is policy for staff to be in this area at all times. It was noted there were no sharp kitchen knives kept in Daviss kitchen, only ordinary steel cutlery kept in an unlocked drawer. Meals served during the day were observed to be nicely presented, appropriate condiments and crockery were available and the meal substantial in size. Staff were observed to be attentive and sat with residents after the meal reading from the next days menu and offering choice of meals. It was confirmed with residents that the chef visits all units daily to obtain their feedback about the meals served in the home. One resident stated that they felt the food could be warmer when served and had spoken with the chef about this yet was emphatic it was not the carers fault stating that the carers serve meals as soon as they arrive in the heated trolley and wondered if the heated trolleys were hot enough. Care Homes for Older People Page 21 of 36 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedures in the home need to be further strenghenned. Safeguarding adults procedures are in place to ensure that people are protected from harm and abuse. Evidence: Whilst touring the premises it was noted that on several notice boards the homes complaints policy and procedures were displayed yet some not prominently. Whilst speaking with residents there were varied responses about what they thought about the homes complaints procedures. One resident who had no complaints said they would go to the office if they had a complaint. The resident said it would be helpful to have more residents meetings. Another resident who said he was disenchanted and down-hearted explained that they would not make a complaint for fear of discrimination. Another resident stated I dare not ask questions as nobody answers you. Its difficult to find out about things going on. Last year two members of staff disappeared overnight and no one told us. I dont make complaints as I dont like to stir up trouble. I want a bit of peace. The seven written surveys from residents received by the commission stated they knew how to make a complaint and staff generally listenned and acted upon what the resident said or requested. In the light of several comments received about the complaints processes in the home it has been recommended that enquiries be made Care Homes for Older People Page 22 of 36 Evidence: by senior management regarding the reluctance of some residents to raise complaints or concerns about the services provided by the home in order that all residents feel that they have a right to raise concerns and complaints which will be handled with transparency, sensetivity and without any fear of recrimination. The AQAA advises that the home have received two complaints in the last twelve months. The complaints log was sampled and confirmed that the complaints had been received and responded to promptly and that satisfactory conclusions had been reached. The home has a copy of the current local authority Multi Agency Procedures for Safeguarding Vulnerable Adults and a whistle blowing policy and procedure. Four staff files were sampled and indicated that staff had received safeguarding training and contained evidence that Criminal Records Bureaux checks had been completed in order to ensure the safety and well being of individuals at the home. The registered manager confirmed that no safeguarding vulnerable adult referrals had been made following the previous inspection. On arrival at the home the inspectors found that the home was secure and the entry phone system was responded to by two night care workers who confirmed the identity of the inspectors before admitting them to the home. A visitors book is signed to confirm entry of people to the home. During the inspection the security of the home was raised by a visitor who advised that they had been let into the home via the entry phone system yet were unfamiliar with the homes layout and left to find their own way around. The registered manager confirmed that she was aware of this incident as it had been brought to her attention following the event and gave assurances that measures were in place to improve the security of the home. Staff acknowledged that health care professionals may visit the home to attend to residents care needs yet staff may not be aware the professionals have visited as the reception staff would let them into the home and as a result care records may not be updated. It is recommended that the homes management review the procedures in place regarding visits by healthcare professionals in order that staff are fully informed and if necessary report on the findings following the visits made. Care Homes for Older People Page 23 of 36 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service experience a homely, clean safe and comfortable environment which is well maintained and reflects the individuality of the people using the service. Evidence: Throughout the day all the areas of the home were sampled. Whilst touring the premises it was noted that the majority of the residents bedrooms were very homely, contained appropriate furnishings, leisure appliances and were personalised reflecting the individuals character and personality. The Alvernia area of the home is a purpose built unit which incorporates best design principles. The Davis and Alvernia units create a positive environment for people with dementia combining a variety and distictiveness of different areas with safety, security and recognisable features to facilitate and promote an individuals independence. Colour, signage and memory boxes are used to aid orientation and entry to the units is by a coded key pad, the code prominently displayed above the door. The units were clean, domestic in character and contained single rooms with ensuite facilities which were mostly personalised. Communal areas were spacious and comfortably furnished, using features such as a fireplace and pictures that are recognisable in the context of the earlier lives and background of people using the service. A wipe board was used to display other orientating information, such as date, day, weather conditions. Both units have access to gardens and patio areas with alarmed external doors. Care Homes for Older People Page 24 of 36 Evidence: It was observed that the home provides a comfortable environment for residents with a large lounge area, liscensed bar, comfortable and homely furnishings, specialist equipment including mobility aids, a variety of beds including some height adjustable types with integral bedrails, specialist baths and pressure relieving mattresses and cushions were in use. Throughout the home windows were fitted with restrictors and radiators covered to ensure the safety and well being of residents. The corridors throughout the home were wide and spacious and a new specialist bath has been purchased for Langton Unit to enable residents who cannot access the existing bath to be comfortably and safely supported which is best suited to their needs. The gardens were noted to be extensive and well maintained. The home has an infection control policy in place and staff confirmed they are trained and aware in infection control procedures. Staff were observed adhering to infection control measures for example wearing protective clothing and washing their hands to prevent the spread of infection in the home. It was noted that there were good supplies of protective aprons and gloves. A senior staff member confirmed that only medium gloves were available yet when asked if there was access to other size gloves we were informed that large gloves had recently been ordered after a staff member raised this and it was understood that these were in the clinical room of a unit. There is a daily cleaning schedule in place and the home was well maintained, clean and hygenic throughout with only one room having a malodour which the housekeepers were aware of. It was confirmed that two housekeepers were on holiday and one off sick, one housekeeper spoken with advised that they would clean the bathrooms and lavatories but said that the bedrooms probably would not be cleaned on the day as they were not always done each day. Improvements to the home include a new wheelchair accessible toilet and a new laundry facility which has been completed to a high specification. The homes completed AQAA received by the commission states that the friends of Shannon Court have raised funds to provide a specialist bath to assist residents with dementia and advise that the home will continue to be upgraded according to the five year plan with Langton unit being redecorated with the inclusion and consulattion of residents who have provided the registered manager with a written report as to how they want to see the unit decorated. Care Homes for Older People Page 25 of 36 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are not in sufficient numbers to support all the residents which could have a detrimental affect on the residents health and personal care needs. The home has a system for the induction and training development programme for staff to ensure peoples needs are met appropriately and safely. Management of recruitment files were adequate to protect the welfare and safety of individuals living at the home. Evidence: As previously documented within the report there were concerns regarding the staffing levels in the home and the staffing numbers on the day of the inspection were observed to be insufficient in specfic units of the home to meet the current needs of the residents. The Alvernia and Davis units were observed to have adequate staffing ratios to meet the needs of the residents and staff were noted to be cheery and had a caring friendly manner with the residents who appeared content. They tried to take into consideration the residents former interests and all carers in these units spoke animatedly and seemed to enjoy their work. The other units in the home especailly the Hayden unit were not staff appropriately and there was evidence to support that staff were not able to be prompt to support residents who required immediate assistance. Time management in the home regarding the administration of medicines and provision of support and care for people Care Homes for Older People Page 26 of 36 Evidence: who relied on staff support was not well managed. Observations of lack of resources included that an inspector sat for half an hour in Hayden unit without sight of a staff member and went to find a staff member who was giving out tea trays and answering call bells. At 16.00 two carers covering the first floor units were observed to be struggling to keep up with the demand of their workload, both advised they were working a long day and had not had a lunch break. Staff during the inspection confirmed that the staffing levels in the home had been reduced but this did not reflect the reduction of residents needs which the majority of staff stating they thought some residents dependancy needs had increased. It was observed that call bells were not promptly answered, an agency carer was moved from one unit to another following intervention from an inspector. Some staff commented that in Haydon unit, which is designed as a self caring unit, that six residents needed help and assistance in bathing or going to the toilet and one carer was not enough as the staff just dont make tea and coffee and if the hoist has to be used they have to get help which makes it very difficult. One resident advised the inspector that due to staff shortages they had not received the care they needed and that their bed had not been made, another resident said that if they wanted to go downstairs to join the activities they would have to go down in the wheelchair yet they needed someone to push them and then someone to bring them back but didnt go as they said they might be stranded there so I dont go. A resident rang the bell on Norfolk unit and it was observed that they waited for several minutes and the registered manager, not the agency worker, who was in the unit kitchen responded, the resident it was noted apologized several times for being a nuisance. Mid morning drinks were served later than 11am and lunch was not served till about 1.20pm on both Hayden and Norfolk units. Staff were seen to be busy and rushed on the Hayden unit and confirmed it was sometimes difficult having different agency staff as everything has to be explained to them and they dont know the residents. Verbal and written comments received by the commission and during the inspection regarding the staff and staffing levels at the home included They [the staff] are so kind. Another resident said they could wait ten minutes but up to two hours for the call bell to be answered. One resident said, There are staff shortages and added there have been five managers in four years and there is no management organization. We need regular staff. One resident commented at 1.05pm, nothings happening as usual blooming marvellous!. Another resident said, The staff are very good, very helpful, couldnt be better with so many of us, cant fault them. Other residents stated Im quite happy actually. I get on with the staff very well. Another Care Homes for Older People Page 27 of 36 Evidence: said, We have a good laugh. Wrtitten comments received by the commission included that the staff are very good, caring and attentive there are not sufficient staff particularly at weekends causing lack of communication and too many agency carers are used, what the home could do better is to have a briefing and acclimatisation of new residents and a briefing and better supervision of staff employed on an agency basis and staff should look around and see what needs to be done and then do it. More staff are required as I ring the help bell and it rings for long periods sometimes. The communication between staff and residents not always perfect. we need to have more staff to help us. The staffing issues identified during the inspection were raised with the registered manager who confirmed that she was aware that there were some shortfalls and gave reassurances that the staffing levels would be improved following the inspection. It was confirmed by telephone the following day after the inspection that staffing levels on all the units other than Alvernia and Davis had been increased and residents and staff were benfitting from the arrangements. It has been required that the staffing levels in the home are maintained and regularly reviewed in order that the residents receive the appropriate level of care and support in a timely way. Four staff recruitment files were sampled and evidenced that the home undertakes safe vetting practices concerning the recruitment of staff in order to ensure the safety and protection of people living in the home yet there was a shortfall which included the lack of good quality photo identity in two files. It was confirmed following the inspection that six new staff have started an induction programme at the home and four other care staff have been recently recruited. The staff induction and mandatory training records were sampled and evidenced that staff receive induction to the home and mandatory training. One inspector met with the Learning and Development Advisor for the organisation who is responsible for coordinating training and works in close liaison with the organisations specialist dementia advisor on the organisations dementia strategy. It was explained that the local management is responsible for sourcing and delivering training to staff and that meetings with managers had been held to raise awareness about the Mental Capacity Act and Deprivation of Liberty safeguards. There was some evidence to support that staff were to receive in house dementia care training and evidence to support that where shortfalls had been identified staff would receive further training in person centred care plan approaches. Care Homes for Older People Page 28 of 36 Evidence: The AQAA advises that fifteen staff have left employment at the home in the last twelve months and sixteen of the twenty nine care workers have achieved their National Vocational Qualification in Level 2 or above. Care Homes for Older People Page 29 of 36 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home ensures the safety and wellbeing of residents. Residents are consulted regarding the running of the home and their health and financial interests are safeguarded. The health and safety of all persons in the home is promoted and robust policies and procedures are in place. Evidence: The atmosphere in the home was fairly calm and orderly yet the pace of the home apart from the Alvernia and Davis units was not designed to meet the needs of the residents due to the staff shortages recognised during the inspection. It was evident through observation and talking with the registered manager that she had good knowledge about managing the care home and had the skills and experience to ensure the safety and well being of all persons in the home. Residents and staff advised that the registered manager had resigned and was going to leave with some staff raising concerns that things will be up in the air again as every time there is a change of manager, each manager has their own ideas and Care Homes for Older People Page 30 of 36 Evidence: introduces change, some for the better and some not so good, but this has unsettled the team. Some views about the management of the home included there was still a problem with the management of the home but this was settling and better since the new deputy manager came into post five months ago. Written comments received by the commission about the home stated there have been one or two blips because of the roadworks round here and the building work here when a few extra carers would have been a help yet I would never think of moving from here to any other hotel as its good. The registered manager explained that residents views about the service were actively sought through Annual Quality Surveys, a weekly coffee morning with residents and activity organisers, monthly business meetings with residents chaired by the registered manager and attended by members of staff to feedback and to hear residents views and quarterly relatives meetings. Copies of all minutes are given to all residents and also displayed in all house groups and main lounge. The system and accounting process regarding the safekeeping of individuals money was sampled and all documentation was accurate and clearly recorded. Records indicated that health and safety checks are maintained, fire safety equipment and records were documented and equipment serviced. The sluice and laundry areas were noted to be clean and tidy. The home have maintained records relating to water and food temperature checks to ensure residents safety and well being. The home has the required gas safety and electrical certificates available in the home and a current insurance indemnity certificate displayed. The inspector re affirmed the procedures that the home must report any incidences to the commission under Regulation 37 notifications of any event that affects the well being and welfare of residents in the home. The homes policies and procedures promote the health, safety and welfare of people in the home. Care Homes for Older People Page 31 of 36 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 32 of 36 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 Arrangements must be made that records must accurately reflect when medicines have been administered and reasons for medicines not taken must be clearly recorded. In order to ensure the health and welfare of residents. 30/10/2009 2 7 13 Arrangements must be made that where potential hazards are identified in a residents daily life that assessments of risks must be made and documented. In order to ensure the safety and well being of the resident. 30/10/2009 3 14 12 It has been required that records must be stored in accordance with the current legislation. 30/09/2009 Care Homes for Older People Page 33 of 36 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action In order to promote and protect residnts rights to privacy and confidentiality. 4 27 18 Arrangements must be 30/10/2009 made that the staffing levels in the home are maintained and regularly reviewed. In order that the residents receive the appropriate level of care and support in a timely way. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 It has been recommended that decisions made by family members regarding the support and care requested for their relative be more formalised in order to ensure that the individual is not deprived of their liberty and are safeguarded from any allegation of abuse or harm. It has been recommended that improved recording be developed within the care plan to cross reference with the risk assessment in order to ensure that the hazards identified are continually monitored to ensure the wellbeing of the resident. It is recommended in order that residents can maintain telephone contact with their friends and relations that a member of staff talk through the process of using the phone to new residents and the topic be discussed at residents meetings and a written, clear notice is displayed by the phone describing how to use the phone and what coins are not accepted. It is recommended that enquiries be made by senior management regarding the reluctance of some residents to 2 7 3 14 4 16 Care Homes for Older People Page 34 of 36 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations raise complaints or concerns about the services provided by the home in order that all residents feel that they have a right to raise concerns and complaints which will be handled with transparency, sensetivity and without any fear of recrimination. 5 18 It is recommended that the homes management review the procedures in place regarding visits by healthcare professionals in order that staff are fully informed and if necessary report on the findings following the visits made. Care Homes for Older People Page 35 of 36 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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