Inspection on 26/07/06 for Burgess Care Limited

This inspection was carried out on 26th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Burgess Care Limited 15/07/09

Burgess Care Limited 21/08/07

Burgess Care Limited 02/11/05

Burgess Care Limited 06/07/05

Burgess Care Limited 02/03/05

Burgess Care Limited 19/10/04

Burgess Care Limited 03/03/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Sharmer Fields House Fosse Way Radford Semele Leamington Spa Warwickshire CV31 1XH Lead Inspector Sheila Briddick Key Unannounced Inspection 26th July 2006 09:30 Sharmer Fields House DS0000004296.V301828.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.V301828.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.V301828.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.V301828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd November 2005 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. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for service users and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place over one day and commenced at 10.00am on Wednesday July 26, 2006 and finishing at 4.00pm. The inspection involved: • • Discussions with the Manager and care workers on duty at the time. Three service users were identified for close examination by reading their, care plans, risk assessments, daily records and other relevant information. This is part of a process known as ‘case tracking’ where evidence is matched to outcomes for residents. A tour of the environment was undertaken, and records were sampled, including staff training, health and safety, rotas and fire records. Interactions between service users and staff were observed. The views of service users were sought through informal discussion where possible. The views of staff were sought at interview. The views of a visiting speech and language therapist visiting at the time were sought through discussion. • • • • • • Finally, feedback took place with the Registered Manager and a manager of Autism Care about the inspection findings. What the service does well: The service continues to provide a friendly atmosphere where the diverse needs of people are supported in a manner that is focused on strengths promotes independence. Staff continue be enthusiastic about the progress made by the people living in the home, feeling this is something they do well. A speech therapist supported this view and of the way staff are committed to the ongoing development of their communication skills with service users. Service users views were sought where possible and the following comments were made. ‘I like the staff and going out to the pub’ ‘I like doing everything, going walks, picnics and visiting the pub for crisps’ I like watching TV’ ‘I visited here first and have settled in well’ Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 6 ‘I get on with other service users’ What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. Prospective people wishing to use this service, and their representatives, have the information they need to make a decision about living there. They have their needs assessed and a contract which clearly tells them about the service the will receive. 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 and new service users. Admissions are not made to the home until a full needs assessment has been undertaken. The assessment is through the Care Management Assessment process and completed by the Social Services funding the placement. The home involves the individual, and their family or representative, where appropriate in developing a care plan to meet identified needs. There is evidence to suggest that existing services involved in meeting the needs of the service user are also involved in the admissions process. For example, a speech and language therapist visiting the home at the time of this visit explained the service level agreement in place for a service user recently coming to live at the home. This involved the previous speech and language Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 9 therapist continuing with support for the first month of the placement to maintain continuity in the development of the service user’s communication needs. The speech therapist said this ‘handover’ arrangement had been ‘good’ and had been supportive to the service user and staff during the ‘settling in’ period. Admissions to the home only take place if the service is confident that staff have the skills, ability and qualifications to meet the assessed needs of the prospective service user. The staff training programme shows that the staff team have opportunity to develop the necessary skills to meet the diverse needs of the people coming to live here and this includes, Epilepsy Management, Mental Health, Autism Awareness, Conflict Management and Breakaway Techniques. Prospective service users are given the opportunity to spend time in the home and a relatively new service user confirmed they had visited the home prior to living there and felt they had ‘settled in well’. Each service user is given a Service User Guide and this is in a pictorial and written format which is clear for them and easy to understand. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a clear assessment and care planning system in place to adequately provide staff with the information they need to satisfactorily meet service user needs. A variety of communication methods are available that could be used more effectively with service users to involve them in care planning and decision making. Strategies implemented to minimise risk to service users are not being discussed with them and their views recorded on the care plan. EVIDENCE: Care plans are developed following person centred planning principles. Each of the service users whose care was being examined had a care plan, but the practice of involving them in the development and review of the plan is variable. For example, at Sharmer House, care plan review documentation examined showed that service users are fully involved in preparing for their care plan review and the documentation for the record of the review in photographic and Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 11 symbol format, is clear, and records the outcomes for the service user and their views on this. A care plan for another service user, however, although clear, with specific guidelines for staff to follow, did not evidence that the views of the service user had been sought in risk management strategies implemented as part of keeping them safe. This included the use of movement monitoring systems, (a pressure mat and sound monitor), during the night time and daytime of the service user’s movements in the home. Use of these systems, during the daytime and in shared areas especially, not only allows staff to hear and monitor the service user’s movements but also other service users and any visitor who may there at the time. The use of the monitor, and the ‘pressure mat’ had not been explained to the service user, including the elements that may infringe on their privacy and dignity, and their views documented if possible. It would be considered good practice if the service user had advocacy support when reviewing the use of this risk management strategy to keep them safe. The assessment process calls for the individual needs, likes and dislikes of service users to be identified with them and choices are documented. It is not clear however that choices being made during the care planning process are being carried forward consistently with service users. An example of this is documented later in the Lifestyle section of this report against Standard 17. Service users are encouraged and supported in general however to generally make informed choices and decisions. Care practice was for the most part supporting this with choices being offered and time being given for service users to consider options, i.e. the days activities and times for getting up and taking lunch. Care plans in most cases include basic information necessary to plan the resident’s care and includes a risk assessment element. They are written in plain language, are easy to understand and consider all areas of the individual’s life including health; specialist treatments, personal and social care needs. There are guidelines in place for staff to follow when meeting specific and individual needs and these are being reviewed regularly. Care plans evidence that independence is promoted and in general activities, including swimming, bathing, kitchen activities and mobility both in the home and the community have been assessed for risks. Staff spoken with felt that promoting independence was something they did well and that they had seen changes in service users becoming more independent and ‘trying new things’. Staff demonstrated a clear understanding of the individual needs of the people they were supporting. However, care plan records and discussion with some staff indicated some inconsistency in following guidelines written on care plans. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 12 It was noted on one care plan in place to support a service user with managing their cigarette smoking, the action and guidance informed staff to adopt a consistent approach, however daily records suggested that there is some inconsistency in the approach of staff towards meeting and supporting this need. For example, the care plan calls for his first cigarette at 7:15 a.m. but records show that sometimes he is told to wait for this with no clear information as to how long they will have to wait. An entry states lots of crying all morning and all because he couldnt get his own way yet the care plan identifies that crying and weeping is an indication that the service user is communicating a need for a cigarette. Care plans are being updated and action taken to respond to any changes although documents and entries are not consistently dated or signed by the worker. A key worker system enables staff to establish special relationships and work on a one to one basis. A staff member spoken with confirmed that a key worker system is in place and advised that ‘key worker sessions’, i.e. meetings between a senior staff member and key worker had just been implemented and this was separate to supervision. There is an excellent life story work being developed in this home and family members are being involved in this. Where service users have limited communication, staff are skilled in using other methods of engagement. Discussion with the visiting speech and language therapist confirmed that staff are keen to develop skills to support service users with their communication and a variety of aids are now used, including Board Makers, (a communication support linked to specific individual needs), Communication Passports, Talking Mats, which involves use of symbols and photographs, and signing, (Makaton). The Therapist spoke highly of the commitment of the staff team to promote communication with service users however, was mindful that time to develop skills is a factor that has an impact on ‘keeping things going’. The therapist said, The biggest challenge for the service is keeping the momentum going”. She confirmed that her advice is sought regarding dementia care needs and promoting communication strategies to support any deterioration that occurs. This involves supporting staff to use the service user’s preferred means of communication. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Opportunity for service users to participate in appropriate activities in the community to meet their needs and wishes is improving slowly. Choices being made by service users during care planning are not always respected in practice. Service users are supported to maintain family links and friendships. EVIDENCE: The service has a strong commitment to enabling service users to develop their skills, including social, emotional, communication, and independent living skills. Individuals are supported to identify their goals, and work to achieve them. Service users are given the opportunity to take part in a variety of activities both within the home and in the community. Where possible staff gather information on community based events and try to make individual arrangements for people to attend. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 14 Service users are supported to lead a lifestyle that enables them to become part of the local community although due to the location of the home in a rural setting this can be limited and reliant on transport being available. This places some restriction on supporting service users to be independent when accessing community activities. A sample of activities enjoyed by service users over the two weeks preceding this visit included meals out, spending an evening at the local pub, a picnic in the park, home visits to family and shopping. Staff are maintaining a separate record of activities and this includes recording the service use’s satisfaction of any activity, or not, and this good practise is to be commended. Staff spoken with informed that the individual interests of service users are taken into account when planning activities and recently individual service users have attended a pop concert to see Status Quo and other festivals locally. A staff member confirmed that getting people to college to develop skills was taking place although availability of more transport facilities again would assist in promoting a more independent lifestyle when accessing services and facilities in community. There is significant evidence that service users are being supported to maintain relationships with family members and care plan diaries show that visits home are supported. Lunch was taken with service users at The Meadows and Sharmer Fields. Mealtimes were relaxed; staff were helpful and allowed service users the time they needed to finish their meal comfortably. Service users were encouraged to help with chores such as clearing the way and drying up plates as part of the development of personal skills. The meal at both houses was cheese salad and bread rolls. Care plans clearly indicate the food preferences and support needs of service users at mealtimes. It was noted however on one care plan that a service user dislikes salad however, salad was offered to them at the lunchtime meal on the day of the visit. The service user did not eat their salad and an alternative was not offered. When asked of staff why salad had been given when it was clearly identified on the care plan that the service user did not like salad it was advised that salad was on the menu as part of promoting healthy eating in the home. Whilst it is commended that the service is considering healthy eating options for service users this should be in accordance with service user’s preferences regarding healthy options available and the service aims and objectives of promoting individual choice. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 15 There is significant evidence that speech and language and dietician services is sought as part of meeting specific eating and drinking needs. Clear guidance for staff to follow was noted on one care plan seen and this included specific instruction as to the special equipment necessary to enable the service user eat their food as independently as possible. The training matrix suggests that all staff attend training in Food handling as part of Induction and nine staff have completed a Food Hygiene certificated course which is externally assessed. Sharmer Fields House DS0000004296.V301828.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 at least once during a 12 month period. 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. Care plan programmes in place ensure that personal support is consistent, reliable and responsive to changing needs. The health needs of service users are well met with evidence of good multidisciplinary working taking place on a regular basis. The home was eager to improve their current system for medicine management. EVIDENCE: Specialist health and personal care requirements are clearly recorded in each service users plan; they give clear guidance for staff to follow. Review notes are clear and it is evident that staff encourage personal hygiene and independence. During discussion with them staff demonstrated an understanding of ensuring privacy and dignity when delivering personal care and being sensitive and responsive to the changing and individual requirements of service users. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 17 Good practice in this was observed when staff were supporting a service user with specific healthcare needs. It was clearly demonstrated by staff that the specific needs of a service user who has autism were fully understood by them and innovative strategies were in place, that were acceptable to the service user, for maintaining their health and well-being without putting them under undue stress. For example, it was identified by staff that in order to maintain the service user’s health and well-being sitting and resting at various times during the day was important and necessary. The service user was not happy about sitting or resting at any time, however, the staff had identified that sitting in a car was acceptable to them and in this way the service user is supported to have the rest that is required at times during the day. Service users have access to health care services that meet their assessed needs both within the home and in the local community. This includes GPs, psychiatric services, learning disability nurses, speech and language therapists, dentists, chiropodist and psychology services. The health needs of service users are monitored and appropriate action and intervention taken. Records relating to professional interventions were up-todate and in good order on the care plans examined. All information required by psychologists for the monitoring of health care is recorded well and includes monitoring records of significant behaviours, and epilepsy management. The home must however take particular attention to ensuring that all records completed, and required of them, are dated when any entry is made as without this monitoring will not be beneficial at review. The service works with speech and language services in identifying the preferred communication methods used by service users and this is recorded on care plans so that staff know and understand how service users will communicate their feelings to them if they are unwell. The home has a medication policy which is accessible to staff and medicine records were generally up to date for each service user whose care was being examined. A record is made of medicines received, administered and disposed of. There are written protocols in place for the administration of medicines to be given as required, (PRN), and these are being reviewed with GPs and specialist services regularly as needs change, or on an annual basis. Changes to medication made during reviews with GPs or psychology services are noted and amended on the medication administration record. There is a medical profile at the front of each service user’s medicine administration chart however, not all medicines/treatments are included on this profile. It was noted on one file that a service user had been prescribed ‘Oneprazole’, there was no information on the record as to what this had been Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 18 prescribed for, or when it was to be administered and this had the potential to cause harm to the service user. There is some indication on records that errors in administration of medicine have been made occasionally however, records show that these errors had been managed appropriately and safely. There is no system in place for monitoring medicine management in the home, or of staff competency when administering medicines, without this the manager cannot be sure that systems are being used according to policy and procedure. All staff spoken with had attended training in medication and administration of medicines prior to carrying out the task. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a satisfactory complaints policy and procedure in place, however there is no evidence to suggest that service user’s views are listened to or acted upon. Staff have an understanding of the importance of providing a safe environment where people are protected from abuse or possible harm. EVIDENCE: Pre-inspection information received from the manager suggests that there have been no complaints made to the home in the past 12 months and the Commission has received none in writing. There is a policy and procedure for listening to concerns and complaints and this was reviewed in May 2006. Staff spoken with have developed a good understanding of the communication needs through training and working with speech and language services, therefore they would be able to recognise when a service user may have a concern and be able to support them appropriately through the complaints process. A copy of the complaints policy and procedure is on each service users file and this is in symbol and written format. Staff spoken with indicated that at present there are no house meetings held with service users at which consultation and discussion could take place regarding the day-to-day activities in the home and development of the service. There would also be opportunity at house meetings for reviewing the complaints policy and procedure with service users so that the document remains live and understood by them. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 20 Understanding how people communicate their needs and concerns will also enable staff to recognise when a service user may be being harmed or suffering abuse. The training and development program indicates that all staff access training in the Vulnerable Adults policy and procedure as part of their introduction training however it is unclear if this training includes Protection of Vulnerable Adult, (POVA), policies and procedures and their role and responsibility within this. Service users appeared to be happy and relaxed with the people supporting them. They said they liked the staff and living in the home. The financial needs of each service user are documented on their care plan and the support required to maintain some independence with money. A service user confirmed they hold their own money when out. Receipts of service users expenditure however are not always recorded and this includes any moneys given to them as a gift. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28 and 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The standard of the decor at The Paddocks and Sharmer Fields is poor with little evidence of improvement through maintenance or future planning. The standard of the environment at The Meadows environment however is good providing service users with an attractive and homely place to live. Infection-control practice, policy and procedure is poor in all areas and has the potential to cause outbreaks of infection. EVIDENCE: A tour of the three living environments took place with the following outcomes. The Paddocks. In general the environment was warm and welcoming and service users were seen to be able to access all shared areas easily. The lounge and kitchen were clean and furniture and fittings were acceptable. Service users each have their own room and share bathroom and toilet facilities in the house. A tour of the bathroom and toilet facilities found that there were insufficient supplies for Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 22 personal care, i.e. towels, soap and toilet rolls not being available and plugs were missing in one bathroom. Toilet seats and surrounds were heavily stained and staff advised that cloths or cleansing wipes are not used when cleaning these areas. The cupboard containing all COSHH materials was locked and safe. Another locked cupboard was found to contain toiletries belonging to a service user. Staff advised that this was to prevent misuse of the toiletries by the service user and that they are accessed by staff when needed by the service user. The toiletries were not stored on a shelf in the cupboard but in relative disorder with toothbrushes and hair brushes and combs lying next to each other. This practice does not promote independence for the service user or good hygiene and it is not clear that this practice had been agreed with the service user and documented on the care plan. There is some redecoration required at The Paddocks and the carpet in the lounge and on the landing is badly marked and should be replaced. Sharmer House. Shared areas of the home were clean and reasonably well presented. Shared areas consist of a large lounge, kitchen, a quiet room, bathrooms and toilets. Staff advised that there has been no recent maintenance or redecoration of the house and areas are clearly showing that this is now needed. This should include replacing of carpets on landings, the stairs and lounges. There is sufficient storage space in the home however there are cupboards that are not being used effectively, for example, one large cupboard underneath the electrical cupboard for the home is filled with carrier bags and this compromises fire safety . The sleep-in facility for staff in this house is in the office, which is very small, and there is a sofa bed in the lounge also used, if necessary by staff for sleep in duty. Staff advised that use of the lounge at this time does not infringe on service users activities however, discussion took place with staff regarding the possibility of using the quiet room as a more appropriate place for staff covering a sleep in duty. There is policy for the sleep in arrangements which staff said would be reviewed against changing needs in the house. As at The Meadows, there were insufficient supplies of toilet rolls, soap and towels in bathrooms. There is a small laundry room, which accommodates a domestic washing machine. There are some continents issues in this house and staff advised that soiled linen would go on a hot wash in the washing machine. This practice may not be satisfactory in addressing infection-control. There is no tumble drier facility in this house and tea towels were seen to be drying on radiators in the kitchen, this again does not promote infectioncontrol practices. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 23 Bathrooms and toilet facilities were clean and staff are using separate cloths, which are colour-coded for use in identified areas, i.e. toilets, baths and kitchen areas. The Meadows This house has recently been built and as such furniture and fittings are in good order however there are some odour issues and staff advised that carpets on the stairs and in selected bedrooms may be changed so that the flooring is more suitable to meet service user needs. Infection control policies, procedures and practices again are not satisfactory, for example, soiled clothing is being rinsed in the toilet and then soaked in a bucket before being washed in a domestic washing machine. This is poor practice and must not continue. The ironing board cover was in disrepair and should be replaced. The new owners, Autism care, recognise the need for a refurbishment and redecoration programme and advised that this is to be implemented. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. 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. Service users are being supported by a skilled and knowledgeable staff team who understand their needs and wishes. The recruitment policy and procedure must be more robust to ensure that service users are protected from harm by the people caring for them. EVIDENCE: At the time of this visit there was sufficient staff on duty to meet the needs of the people living there at the time. Staffing levels were enabling service users to access work placement activities, individual trips out to the community and personal care and support needs. All staff spoken with demonstrated a clear understanding of the individual needs of the people living in the home and were seen to be good listeners, approachable by, and comfortable with, service users. Staff spoken with felt they had sufficient skills to meet the collective and individual needs of the people living in the home and had accessed training in medication, epilepsy and autism. This visit has identified that dementia care needs have been diagnosed and some development of staffs skills in meeting the communication needs of people with dementia has been supported by the Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 25 speech therapist however a broader view of the needs of people with dementia is required if support offered is to meet needs satisfactorily. The training programme includes Equality and Diversity training for staff however the training matrix shows that no staff have completed this. Discussion with staff during this visit regarding the need to seek the views of service users when care planning or implementing risk management strategies and implementing collective programmes, i.e. Healthy Eating, suggests that they, and service users, would benefit from accessing training in this area. Pre-inspection information indicates that staff complete a full induction programme to include Learning Disability Award Framework, (LDAF), Nutritional Approach, Report Writing and Advocacy. There is an active NVQ programme in place and staff are enabled to work towards achieving an NVQ 2 and 3 in Care. Staff spoken with were satisfied with the level of supervision they were receiving from the manager saying this was regular and supportive to them. There is a recruitment and selection policy and procedure for this service, which indicates that recruitment does not take place until completion of satisfactory police checks including Criminal Record Bureau, (CRB) and POVA checks have taken place. Pre-inspection information however evidenced that seven staff had been recruited to the home in the past 12 months without Burgess Care carrying out these checks accepting previous CRB information supplied by the employee. The Care Home Regulations requires that prior to employment CRB and POVA checks must take place by the new employer. An immediate requirement was left with the registered manager for this to take place for the seven staff members. The manager acknowledged this shortfall and took the necessary steps to address this major shortfall prior within the set timescales. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 and 43. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has a good understanding of the areas in which the home needs to improve and has the support of an established Provider Group to resource the necessary improvements. EVIDENCE: The Manager has the required knowledge and experience and is competent to run the home. She is working to improve services and provide an increased quality of life for service users and demonstrated an ethos of being open and transparent in all areas of the running of the home. The Service Manager of Autism Care, the new owners, spoke of the positive and supportive role the manager had played during the handover period from Burgess Care. This visit highlighted the need for service development in the area of consultation with service users, their relatives and other professionals involved in the care provision as part of a quality assurance process. The new providers advised that their established Quality Assurance systems will be implemented Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 27 at Sharmer Fields. This system involves seeking feedback from service users and other stakeholders regarding the development of the service. The registered manager demonstrated their commitment to implementing monitoring systems for safe medicine management and infection-control. This inspection identified that record management could be more robust to ensure that all entries and amendments made on care plans, risk assessments and health records are dated and signed by the person making the entry. Discussion with staff, observation of care practice and examination of records demonstrated that there is safe working practice when moving and handling people, providing first aid, preparing food and in fire safety. Pre-inspection information suggests that staff are completing training in manual handling, health and safety, first aid, fire training, food hygiene and food handling and infection-control. This was confirmed during discussion with staff. Infectioncontrol management however is not safe and has the potential to cause harm by the spread of infection. The pre-inspection information received suggests that there are policies and procedures in place for the Control of Substances Hazardous to Health, (COSHH), fire safety, moving and handling and first aid. COSHH items were found to be stored safely and securely. A verbal concern was made to the Commission prior to this visit regarding the temperature of drinking water at The Meadows being ‘tepid’ and not running cold, this was checked during the tour of the environment. Water coming from the cold outlet in the kitchen did not run cold but remained at a ‘lukewarm’ temperature and this should be investigated further to be sure that the water supply is not a potential hazard to the people living and working there. Care plans seen during this visit demonstrated that risk assessments are completed for all service user’s activities although these are not routinely dated at the time of the assessment or reviewed. Care plans indicate that continence issues also include personal hygiene practices of service users which pose a potential risk to other people living in the home and this has not been risk assessed. A record is maintained of all accidents and injuries that occur in the home and these are reported to the Commission for Social Care Inspection. At the time of the visit it was confirmed verbally that Burgess Care Ltd had been purchased by Autism Care and a senior manager from this company was present for part of the inspection. The Commission for Social Care Inspection has not been advised in writing of the person who is to be the new Responsible Individual for Sharmer Fields House in respect of the new ownership. Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 28 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 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 3 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X 2 2 2 Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 29 Yes. Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 12.4(a) Requirement The registered manager must ensure that staff have a clear understanding of individual needs of service users and ensure their compliance with care plans in place to meet identified needs. The registered manager must ensure that the views of service users are sought and documented during care planning and any risk management strategy is discussed with them to include the expected outcome and any restriction that may be imposed on their lifestyle as a result. The registered manager must ensure that the programme of Healthy Eating respects individual service user’s food likes and dislikes. The registered manager must ensure that there is a written protocol for all medicines to be given ‘as required’ and this attached to the individual’s medicine record chart. The registered manager must make arrangements for service DS0000004296.V301828.R01.S.doc Timescale for action 30/09/06 2. YA7 12.2 30/09/06 3. YA17 12.3 30/08/06 4. YA20 13.2 30/08/06 5. YA22 12.2 30/09/06 Sharmer Fields House Version 5.2 Page 30 6. YA23 7. YA24 8. YA24 9. YA26 10. 11. YA27 YA30 users to become involved collectively in decision making and planning of the day to day routines in the home and that their views are listened to, documented and acted upon. This could be through house meetings involving service users and staff. 13.6 The registered manager must confirm in writing to the Commission whether the training staff access for Vulnerable Adults includes Protection of Vulnerable Adults policy and procedures, POVA and provide this information through further training if identified as necessary. 23.4(a) The registered manager must ensure that items being stored in cupboard space do not pose a risk to fire safety. 23.2(b)(d) The registered manager must provide the Commission with a written plan of proposed refurbishment and redecoration of each living accommodation and the timescales of completion. The programme must take into account all requirements and recommendations made in this inspection report. 16.2(c) The registered manager must ensure that service users have appropriate storage facilities in their bedroom keeping their toiletries and that if this is in a lockable cupboard to maintain health and well being this is documented on the individuals care plan. 16.2(j) The registered manager must ensure that all toilet seats at The Paddocks are replaced with new. 16.2(k) The registered manager must ensure that the practice of DS0000004296.V301828.R01.S.doc 15/09/06 30/08/06 15/09/06 30/08/06 30/08/06 30/08/06 Sharmer Fields House Version 5.2 Page 31 12. YA30 16.2(j) ‘soaking’ soiled and infected linen and clothing in open bowls and buckets is discontinued. The registered manager must ensure that policies and procedures are in place for the control of the spread of infection in all areas and to include; Provision of washing machines that have a specified programming ability to meet disinfection standards, including a sluice programme, where there are continence issues. Provision of a tumble drier at Sharmer House. Implementation of daily cleaning schedules for bathrooms and toilets that minimise the spread of infection by use of appropriate cleaning materials and equipment. Provision at all times of sufficient supplies of soap, toilet rolls and paper towels at all hand wash basins. Provision of protective clothing in bathroom, toilet and laundry areas. Provision of flooring in bedrooms and shared areas of the houses that promotes odour control. 15/09/06 13. YA32 18.1(c)(i) 14. YA34 19 The registered manager must ensure that keywork staff supporting service users with a diagnosis of dementia access training in this. The registered manager must ensure that POVA checks take DS0000004296.V301828.R01.S.doc 30/10/06 09/08/06 Sharmer Fields House Version 5.2 Page 32 15. YA39 24.1 16. YA41 17.3 17. YA42 23.2(j) 18. YA42 13.4 19. YA43 7.2(c)(i) place for the identified seven staff members on the Preinspection Questionnaire and a Criminal Record Bureau check is requested for each of these staff. The registered manager must establish a quality assurance and quality monitoring system which is based on seeking the views of service users and other stakeholders of the service of the quality of care provided by the care home. The registered manager must ensure that all records, including care plans, health records and risk assessments, are dated and signed by the person making the entry. The registered manager must ensure the cold water supply to The Meadows is investigated to confirm that the supply is compliant with the Water Supply (Water Fittings) Regulations 1999. The outcome of the findings, including any action taken as a result of the investigation, must be forwarded to the Commission. The registered manager must review all risk assessments to ensure that these are up to date and ensure the health and well being of the people living and working in the home. Maria Mallaband Nursing Homes must give Notice to the Commission the name, address and position in the organisation of the individual who is to be the Responsible Individual for the Service. 30/01/07 30/08/09 15/09/06 30/09/06 30/08/06 Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 33 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 YA7 Good Practice Recommendations It is recommended that advocacy support is accessed when necessary for service users as a support to their decision making during the care planning process which may involve a restriction on their lifestyle. It is recommended that the responsible individual review the transport facilities at this service against the needs of the people living there in accessing the community. It is recommended that the Complaints policy and procedure is discussed with service users on a regular basis so they can remain familiar with the process. It is recommended that the Quiet Room at Sharmer House be considered for use of the sleep in facility for staff. It is recommended that all staff access training in Equality and Diversity. The home should seek to ensure that relatives are better aware of inspection reports and of how to contact the Commission for Social Care Inspection. 2. 3. 4. 5. 6. YA13 YA22 YA28 YA32 YA39 Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sharmer Fields House DS0000004296.V301828.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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