CARE HOME ADULTS 18-65
Sharmer Fields House Fosse Way Radford Semele Leamington Spa Warwickshire CV31 1XH Lead Inspector
Kevin Ward Unannounced Inspection 21st August 2007 08:00 Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sharmer Fields House Address Fosse Way Radford Semele Leamington Spa Warwickshire CV31 1XH 01926 614048 01926 613048 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Burgess Care Miss Sarah Busby Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th July 2006 Brief Description of the Service: Sharmer Fields’ registered premise consists of 3 five-bedded self-contained facilities. Each unit is individually identified as the Meadows, Sharmer Fields House and the Paddocks. Each unit is home for up to five people with learning disabilities. Burgess Care provides 24 hours support to the people living in the home. The home is set in a rural area, 300 yards off the Fosse Way at the end of a shared drive. There are extensive grounds to the property. Shared facilities in all units consist of a lounge, quiet room, kitchen and laundry. Shared facilities are on the ground floor of each unit; there are also office facilities in each unit. Available also is a converted stable, which offers day-care facilities for the service users. There are well-maintained lawns as well as an allotment area maintained with the assistance of the service users. Two of the units are not suitable for access by wheelchair users. However the provision of another five-bedded selfcontained unit on the premises has full facilities to enable wheelchair access. Fees range between £1500 - £4,000 per week depending on the level of staffing support people require to meet their needs. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a Key unannounced inspection which addresses all essential aspects of operating a care home. This type of inspection seeks to establish evidence showing continued safety and positive outcomes for residents’. The inspection focused on assessing the main Key Standards. As part of the inspection process the inspector reviewed information about the home that is held on file by us, such as notifications of accidents, allegations and incidents. Questionnaires were returned by 7 people who live at the home prior to the inspection. Due to the high communication needs of some people it was not possible for them to complete questionnaires. 2 people’s relatives, 2 social workers and a community nurse also completed questionnaires, giving their views of the service. An annual quality assurance questionnaire was completed and returned by the manager in time for the inspection, providing information about the home. The inspection included seeing the people who live at the home and case tracking the needs of three people. This involves looking at people’s care plans and health records and checking how the person’s needs are met in practice. Discussions took place with the staff on duty during the morning as well as the team managers and the home manager. A National Vocational Qualification (NVQ) assessor was also spoken to for her views of the service. A number of records, such as care plans, complaints records, staff training certificates and fire safety records were also sampled for information as part of this inspection. What the service does well:
People’s needs are assessed before they move into the home and their move is planned with the involvement of relatives and a range of professionals so that the move takes place at the correct pace for the person concerned. New care plans are being devised for people at the home. Overall the new care plans contain satisfactory levels of information to assist staff to meet people’s needs in a safe manner. The home makes positive use of other health professionals, such as psychiatrists, community nurses and speech and language therapists when writing people’s care plans and reviewing their care. People are being supported to gain access to other health services where necessary to assist them to stay in good health.
Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 6 The people at the home looked relaxed and at ease as they went about their home at breakfast time and during the day. Staff were friendly and responded well to people’s needs for support and assistance. The people looked comfortable and happy in the company of staff indicating they get on well together. Comments made in questionnaires indicate people feel they are treated well by staff and are supported to choose what they like to do. Relatives’ quotes in questionnaires indicate a positive view of the home and the support provided. One relative speaking of the support provided to her daughter whilst in hospital states “They provided 24 hour care when she was in hospital. The family were very impressed as staff went beyond the call of duty”. Another persons relatives says after a struggle to find an appropriate placement “we could not ask for anything more suited to his needs than where he is now”. People’s religious requirements are being supported. One person attends a temple to worship, in keeping with their personal religious needs. A member of staff explained plans to support a new person to attend church on Sundays. Complaints are recorded and logged and easy read versions of the procedures are on show in the living units for the benefit of the people at the home and visitors. Staff are being provided with training to assist them to recognise and report any abusive incidents that might come to their attention. The home provides sufficient staffing to meet people’s needs safely. Extra sessional staff are provided to support people to receive the support they need to carry out their chosen daytime activities. A small number of staff have been provided with equality and diversity training and the manager explained that training is planned for more staff. This training helps staff to see people as individuals with their own specific needs, preferences and lifestyles to be respected. Good arrangements are in place for checking that the home is running properly, including shift handover checks to make sure that people’s money and medication is in order. The manager carried out a monthly audit of the home. This includes checking that records, such as care plans are being properly kept and the accommodation is maintained properly. What has improved since the last inspection?
The care plan records now include evaluation sheets, which are signed to demonstrate that staff have reviewed and updated people’s care plans where necessary. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 7 Focus meetings are held every month in each of the living units to check if people have any concerns and to involve them in everyday decisions, e.g. planning activities and agreeing tasks for a barbeque. Comments by people at the home confirmed that they are involved in reviews of their care support and planning their activities, indicating that the home seeks to involve people in decisions that affect them. The views of the people at the home and visiting relatives and professionals have also been sought as part of the home’s quality assurance measures, so that people have a say in the running of the home. Protocols are in place for giving out “as needed” medication to people. This includes a requirement for staff to seek the permission of a manager before doing so. A person at the home was appropriately referred to the dietician for an assessment following the last inspection. A new complaints procedure has been devised, providing clearer information about timescales. Positive new procedures have been introduced to encourage staff to raise any concerns they may have about care practices so that the manager can investigate them. The home has been extensively refurbished during the last year to provide more comfortable and clean living accommodation for people. The toilets and bathrooms were found to be clean and suitable for people to use. New cleaning schedules have been introduced and a high priority has been given to arranging infection control training for all staff as shortfalls were identified in this area of practice at the last inspection. Suitable arrangements are now in place for managing continence laundry in the home, including a new industrial type washing machine and dissolvable wash bags. Suitable arrangements are in place for interviewing and vetting staff to ensure they are suitable to work at the home. The home now has four vehicles to help people to venture into the community and a member of staff is employed to organise other day activities at the home. What they could do better:
Whilst the care plans contain the essential information necessary to meet people’s needs safely, it is recommended that consideration is given to increasing levels of information about people’s preferred routines and include communication dictionaries. This is particularly beneficial for new staff so that they can quickly understand and meet people’s needs in the manner they prefer. Accessible care plans would be beneficial for some people to help them to have a greater understanding of their care and to take greater control of their lives. Overall the home is clean and well maintained, however the carpet in the hallways in the paddocks is badly stained in places and in need of upgrading.
Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 8 The manager said that this is being addressed. The road surface at the top of the drive has been improved but the rest of it is in poor condition and pot holes need to be filled in so it is safe for people to walk on and suitable for visitors to drive on. The manager has carried out an audit of staff training needs and is providing training to bridge gaps in people’s training where necessary. Only one person has completed a National Vocational Qualification (NVQ) training so far but others are in the process of doing so and more training is planned to enable the home to meet the recommended level of having at least 50 of staff trained at NVQ level 2 or above. There is a recommendation for the home to proceed promptly with negotiations to connect the home to the mains water supply to remove the problem of the cold water running at a tepid temperature in the Meadows unit. It is recommended that closer monitoring of the fire logs is carried out to ensure that emergency lighting tests are carried out routinely each month, to ensure people are properly protected in the event of a fire. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are properly assessed and they are provided with information about the home so that they are clear their needs can be met before they move in. EVIDENCE: The admissions process continues to take place in a carefully planned way, to ensure that it is in a way, and at timescales, most beneficial to existing people at the home as well as new people moving in. The file of a person who recently moved into the home was checked. This included appropriate referral information and an assessment completed by a manager before the person moved in. The person’s records included evidence of ongoing meetings with other professionals to support a full assessment of needs and to assist a sensitive admission process. A unit manager confirmed that people are supported to visit the home before they move in where this is agreed to be in the best interests of the person concerned. Where appropriate the home involves the individual, and their family or representative in developing a care plan to meet the person’s assessed needs. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 11 Comments by a new person at the home confirmed that she had been made to feel welcome and had been given pictures of the home before she moved in. People are also provided with an illustrated service user guide, including information about the home and how to complain. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s needs are planned for and reviewed so that staff have information to enable them to meet their needs effectively. People are being encouraged to take part in decisions that affect them so that they have greater control over their daily lives. EVIDENCE: Three people’s care plans and records were checked. The manager explained that the home is in the process of updating the care plans and risk assessments into a new format to make the information clearer and easier to manage. Overall the care plans were seen to contain sufficient levels of clear information and advice for staff to enable them to meet people’s needs. Similarly documents are in place that demonstrate people’s needs have been risk assessed. Where particular hazards have been identified, (e.g. the management of challenging behaviour), strategies have been recorded to address the risks.
Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 13 A unit manager agreed to increase the level of detail in the risk assessment of a person who eats inappropriate items to make the hazards and safeguards more explicit. There is scope for increasing for adding more information about people’s preferred daily routines into the care plans and for developing illustrated versions for people at the home. An excellent life history book was seen that has recently been devised for a new person at the home including pictures of people and places that they value. Discussions with staff confirmed that they had seen people’s care plans and demonstrated a satisfactory understanding of their support needs. Staff were seen to respond well to a person who uses his own vocabulary to communicate with others. A unit manager was able to interpret some of these words for the inspector. People’s files include communication passports, explaining their personal communication needs. These documents have been drawn up with the assistance of the speech and language therapist. The manager agreed to devise communication dictionaries for people who use the own words or signs, to assist new staff that join the team to communicate with people. Information provided by the manager, included in the annual quality assurance assessment, confirms that staff have been provided with communication training and makaton training to assist them to communicate with people at the home. “Talking mats”, (using photographs and symbols) and pictorial boards are also used to help people to make everyday choices and decisions. The manager confirmed that the use of a listening monitor for a person with epilepsy has been reviewed with the consultant responsible for his care and it has been considered necessary to continue the use of this device. Information in the person’s records confirmed they have had a number of significant seizures that would justify close monitoring at this time. Care plans are being dated to demonstrate they are being regularly reviewed. The notes of social work reviews demonstrate that relatives and advocates are encouraged to take part and provide people with support at these meetings. Information on a person’s records indicates that the home is maintaining close contact with a person’s relatives to keep them informed of important changes and events that take place. Key worker meetings also take place each month to focus on people’s progress and changing needs. The reports are then shared with other professionals and relatives to keep them informed and updated. People at the home confirmed that they are supported to go shopping for clothing, and other personal items. People also confirmed that they are involved in choosing day activities and outings and colours for their bedrooms. Monthly meetings are now being held in each of the three units to discuss everyday issues and check if they have any concerns Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 14 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are involved in panning activities and meals so that they are provided with a suitable range of activities and meals they enjoy. EVIDENCE: Comments by a person at the home confirmed that they had been consulted about their structured activities plan and said that they enjoy the activities being provided. The unit manager explained that the plan was highly structured to purposefully occupy the person concerned, in keeping with their needs and choices. Comments by people at the home confirmed that they are supported to enjoy a good range of social and leisure activities. Some people attend day services part of the time, including access to supported work projects in some cases, e.g. gardening and woodwork.
Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 15 People’s activities are summarised on a tick list in their files and the details are recorded in their daily notes. A sample examination of these records indicates that people are supported to be constructively engaged and have enough to do. The home provides a good range of activities for people that stay at home during the day. The home employs an activities team leader to lead on the provision of day activities at the life skills centre in the grounds of the home. People confirmed that they are consulted about their day activities plans and indicated that they enjoy a good range of options. Examples include: gym, bowling, swimming, shopping and lunch, massage, walks, parks, sensory room, cookery, arts and crafts and literacy projects. Several people were seen to work co-operatively together painting a new garden bench at the home. People are also being provided with opportunities to stroke and walk a dog that visits the home with its keeper. Recent trips out have included, Bourton on the Water and Woburn Abbey. Most people go out together to a disco every month to meet up with friends they know. Entries in care reviews and daily records demonstrate that people are supported to maintain contact with their relatives. This is also verified in comments by two people’s relatives in questionnaires that were completed as part of the inspection process. Staff confirmed sexuality training has previously been provided at the home for some staff. This better equips staff to offer advice to people involved in relationships where this may be necessary. The home has four vehicles to enable people to get out and about. This is essential in supporting people to maintain good community access as the home is in a rural setting. Comments by people at the home and the manager confirmed that they are supported to visit hairdressing salons for haircuts. One person at the home is supported to worship at a temple, in keeping with their personal religious needs and a member of staff explained plans to support a person to attend church shortly, indicating that people’s religious needs are supported by the home where required. Comments by the people at the home indicate that they are happy with the food provided and are consulted about what they eat. Some also take part in shopping for food and groceries. A sample examination of recent menus and records of meals taken (on personal files) indicate that people are provided with a reasonably balanced diet and that their food intake is monitored where necessary. Comments by the staff and the manager show that attempts are made to strike a fair balance between personal choice and healthy eating. Comments by staff, the manager and information in the staff training matrix confirmed that healthy eating training has been provided by a community nurse (for the people that live at the home as well as the staff). Encouragement is being given for people to take part in preparing some meals and snacks. During the inspection one person was supported to do some baking at the life skills centre. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s personal care and health needs are planned for and monitored with the involvement of health professionals and safe medication procedures are in place so that they the receive the appropriate care and health support they require. EVIDENCE: Comments by people at the home indicate that they like the staff that support them and find them to be friendly and helpful. Staff were observed to be responsive to people’s needs and to show them respect when talking to them. Staff showed a suitable regard for people’s privacy and dignity and confirmed that they always knock on doors before entering. On the morning of the site visit personal care took place behind closed doors, demonstrating an appropriate regard for people’s dignity. People were observed to be well groomed and dressed in age appropriate clothing, indicating they are supported to maintain a good self-image. People were seen to rise at varying times in the morning and take unhurried breakfasts in keeping with the preferred routines.
Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 17 A protocol was seen to support a safe response to the needs of a person with epilepsy. The copy of the protocol on file had not been signed by an appropriate health professional. The manager said that the original protocol was signed but must have been replaced. She agreed to arrange for the current protocol to be signed by the epilepsy nurse specialist involved in the person’s care. Since the last inspection a person with fluctuating weight has been referred to the dietician for advice. Files were seen to contain weight charts as evidence that their weight is being monitored. One file contained evidence of ongoing meetings with health professionals to review medication and to consider the side effects this is having on their weight. Frequent walks and light sporting activities have been appropriately built into the person’s day activity plan to help offset the impact of these side effects. Comments by staff and entries in people’s records demonstrate that the home makes good use of health professionals in the assessment and care planning process, including close involvement with consultant psychiatrists and community nurses. The home has made good use of the speech and language service to devise communication passports and other visual aids to assist staff to consult with people with high communication support needs. Two medication cabinets were examined. Both were tidy and well ordered. A sample examination of creams and boxed tablets demonstrated that the medication was in date. Two returns books were seen indicating that all unused medication is recorded and returned to the pharmacist. A sample examination of three people medication records highlighted no recording anomalies. Unit managers carry out a daily shift handover report, which includes a check of medication records so that any recording / medication errors might be identified promptly. Protocols are in place for the use of as needed medication (PRN). A professional scale is used to define the conditions under which medication should be given to help in the management of challenging behaviour. All PRN medication has to be sanctioned by a member of the management team. A sample examination of medication records and incident forms indicate that the protocols are being properly applied. Comments by staff and unit managers confirmed that they had been provided with medication training and their practice observed on a series of occasions before being permitted to give out medication. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place for respond to people’s concerns and complaints and staff are being trained to report suspicions of abuse so that people are protected form harm. EVIDENCE: There has been one complaint to us since the last inspection involving a number of concerns and differences of opinion between a person’s parents and the home about how their care should be provided. This has resulted in the home and the social worker meeting with the parents and maintaining closer contact with them to seek to resolve these differences. The home’s records indicate that they are now in regular contact with the person’s parents to keep them informed and updated of events and to respond to any ongoing concerns. The manager said that an advocate is also being sought to provide an independent perspective. There have been no allegations of abuse at the home since the last inspection. The home notified us of an allegation made by a person at the home that they had been prompted to behave inappropriately by a member of staff. The manager explained that this had been retracted upon further investigation. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 19 The home has updated the complaints policy to include a clearer process and timescales for the management of complaints by the home. People are provided with a copy of a service user guide as part of the admission procedure, which includes a more accessible version of the complaints procedure. Copies of the complaints procedure are also on show in the home for people to refer to. As previously noted, informal monthly meetings take place in each of the units to make plans and check if people have any concerns. A new system has been set up for staff to register any concerns they have about the home’s practices. At the time of the inspection one concern had been raised concerning the possible inappropriate use of “as needed” medication in one instance. The unit manager was properly investigating this. In the annual quality assurance assessment the manager reports that staff are provided with adult abuse awareness training. This was also verified by the staff who were spoken to on the morning of the site visit at the home. Discussions with staff indicated an awareness of different types of abuse that may occur and the reporting procedures. The training plan indicates that more in depth training on this subject is also in the process of being provided to staff. Two people’s financial records were viewed. The records indicate that suitable measures are in place for accounting for people’s monies. A breakdown of people’s individual expenditure is retained along with numbered receipts. The staff and the manager now sign the expenditure record to verify every entry. People are given £30.00 per week for personal activities. This is over and above their personal allowance which is recorded and accounted for separately. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 20 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Refurbishment has taken place and cleaning and hygiene procedures have been improved so that people benefit from a cleaner more comfortable living and environment. EVIDENCE: The site visit included a tour of the communal areas, kitchens and bathrooms and eight bedrooms were seen. During the last year the home has been extensively refurbished including communal areas and people’s bedrooms. The lounges are well decorated and attractively furnished and the bedrooms have been decorated with personal colour preferences in mind. Bedrooms contained evidence of personal belongings, equipment and pictures indicating that people are supported to personalise these areas to their own liking. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 21 The bathrooms were clean and the home was free from unpleasant odours. Cleaning schedules have been put in place since the last inspection to support cleaning in the home. Comments by staff and people at the home confirmed that encouragement is provided for people to take part in some light cleaning and tidying of their rooms where they are happy to do so. Overall most of the carpets are in satisfactory condition. The light coloured carpet on the hall stairs and landing in “Sharmer Fields House” is stained in places and would benefit from replacement. The home manager said that this is being addressed. The home has purchased an industrial type washing machine that is capable of washing continence laundry. This is currently available for people in the other units to use if necessary. The manager said that the washing machines in the other units would in future be replaced with industrial type washers with the same facilities when the current machines no longer work. Comments by staff confirmed that they have access to protective aprons, gloves and bags for the safe disposal of waste. Red dissolvable wash bags are now used for the safe management of continence laundry in the home. Stacking systems containing gloves, aprons, bags etc are in place in toilets convenient for staff to use. Comments by staff confirmed that they are being provided with distance learning Infection Control training to heighten their awareness of safe hygiene practices. Regular house audits are carried out and reported upon by the home manager and action points are referred to the unit managers to address (copies of which were seen in Sharmer unit). The manager explained that Severn Trent are involved in discussions with neighbouring farmers to put the home on the mains water supply. This is necessary to support new proposed developments at the home and to remove the ongoing problem of the cold water running tepid in “the meadows”. The manager explained that the water has been tested to check it is safe and a maintenance certificate was seen as verification of this fact. Work has taken place to improve the road surface at the top of the drive but the rest of the driveway remains in poor condition. The manager said that this is to be addressed very shortly. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 22 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are being appropriately vetted so that people are supported by suitable staff. Gaps in staff training are being appropriately addressed so that people may benefit from a team of workers that are suitable equipped to meet their needs. EVIDENCE: At the time of the inspection site visit there were sufficient staff on duty to meet people’s personal support needs. Five staff were on duty in the Meadows, including two staff providing sessional cover to support people with their day activities. There were three staff on duty in the other two living units. Comments by staff confirmed that there is always a member of the management team on duty during the day and night so that they can receive the advice and support they need. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 23 The files of two new staff were checked and found to contain records to confirm that appropriate recruitment and vetting procedures are followed, including taking up Criminal Record Bureau checks before staff start work at the home. Comments by new staff confirmed that they had been subject to an interview process before starting at the home and had been provided with induction training covering a range of Health and Safety related subjects, (e.g. food handling, fire safety handling, adult abuse) as well as care related subjects, such as autism awareness, mental health, positive approaches to behaviour, epilepsy and communication. Two people’s files were seen containing a list of induction training that has been signed off by managers as evidence it has been completed. The administrator explained that following an audit of staff training needs she has set up individual training records for staff. The administrator said that there are some gaps in staff training histories where staff had not kept their certificates when the home was managed by the previous provider. The manager said that this has been addressed and that all certificates are now being copied and recorded before the originals are returned to staff. New certificates were seen in the office ready for copying and filing. The staff training matrix indicates that progress is being made to catch up with gaps in Health and Safety related training subjects so that staff are better equipped to provide safe care. The manager explained that an emphasis is being placed on supporting staff to access National Vocational Qualification (NVQ’s) courses, as this has not occurred previously. The manager reports that to date one member of staff has completed this training and four others are having their work assessed and verified. The manager reports that another 8 staff have signed up for this training and 8 more will be doing so in 3 months time. Comments by the manager and staff and training information confirms that a high priority has also been attached to providing hygiene and infection control training as this was a source of concern at the last inspection. The manager reports that 4 staff have attended equality and diversity training and more training is planned. This training helps staff to see people as individuals with their own specific needs and lifestyles. The manager said that the diagnoses of a person previously thought to have dementia is in the process of being reviewed following improvements in their condition. Consequently, as yet, it has not been necessary to provide dementia training for staff. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed. Suitable arrangements are in place for monitoring the service and addressing any shortfalls that occur. The views of the people at the home and other relevant people are sought so that they can contribute to the development of the service. EVIDENCE: Since the last inspection positive work has taken place to improve the home’s quality assurance measures. Questionnaires have been sent to the people at the home as well as relatives and professional visitors and the results have been summarised into a report. As previously noted monthly “Focus meetings” provide an opportunity for people to contribute to everyday living plans at the home. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 25 Monthly audits are being carried out to check that records are satisfactorily kept, the accommodation is well maintained and safe and the home is running well. Regular monthly visits are taking place at the home and any concerns are reported to the home manager to follow up and address. Reports of recent visits were seen as verification of this fact. A copy of shift handover records were seen on the meadows unit. This includes the shift leader checking the medication records and money records so that any errors can be promptly identified and addressed. The record is also used to highlight the use of any as needed medications given to people to assist the manager to monitor this area of practice. Staff confirmed that they are provided with planned supervision and evidence of this was seen on staff files. Comments in questionnaires received from professionals indicate a high regard for the quality of the service and one health professional comments very positively on the leadership and management qualities of the current home manager. The manager explained that she is leaving the home to take up another position. Since the visit a senior manager has confirmed that the post is in the process of being advertised and temporary cover arrangements are being investigated should this become necessary whilst recruitment takes place. Information provided by the manager in the annual quality assurance assessment indicates that suitable measures are in place for maintaining a safe environment and equipment in the home. A sample examination of Health and Safety records was carried out. Two fire safety logs were checked. The log in Sharer unit demonstrates that the alarms and lights are being checked at the correct intervals and fire drills are taking place. The log in the paddocks shows that the alarms are tested correctly but there is some confusion over the frequency of lighting tests. The manager agreed to arrange for these tests to be carried out monthly. An Environmental Health Officer visited the home on the same day as the inspection site visit. The manager said that this had resulted in no requirements being made in relation to hygiene practices at the home. Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x x x 3 x x 2 x Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 27 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. Standard Regulation Requirement Timescale for action 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 YA6 Good Practice Recommendations Communication dictionaries should be put in place for people with high communication needs to assist new staff to communicate and support them appropriately. The new care plans would be enhanced with information about people’s preferred routines so that new staff are quickly made familiar with the way in which people with high communication needs like their care provided. Accessible care plan summaries should be devised for some people at the home to further support them in taking control of their lives. Proceed with plans to improve the driveway surface so that it is safe for people to walk on and for vehicles to use. 2 YA6 3 YA6 4 YA24 Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 28 5 YA24 Proceed with plans to replace the carpet in the hall, stairs and landing in Sharmer Fields House as it is stained in places. Proceed with plans to connect the home to the mains water supply to remove the problem of the cold water running at a tepid temperature in the Meadows unit. Closer monitoring of the fire logs should be carried out to ensure that any confusion regarding the frequency of emergency lighting tests is resolved so that tests are carried out routinely each month. 6 YA24 7 YA42 Sharmer Fields House DS0000004296.V341846.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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