CARE HOMES FOR OLDER PEOPLE
Sharnbrook House High Street Sharnbrook Beds MK44 1PB Lead Inspector
Dragan Cvejic Unannounced 06 September 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Sharnbrook House Address High Street Sharnbrook Beds MK44 1PB 01234 781294 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) The Greensleeves Homes Trust Susan Whitehouse Care Home 30 (30) (30) (30) Category(ies) of DE(E) - Dementia over 65 registration, with number OP - Older People of places PD(E) - Physical Disability over 65 Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 01/02/05 Brief Description of the Service: Sharnbrook house was a home owned by the Greensleeves Homes Trust, an old Victorian house located in a small village with the same name which is close to Bedford and positioned in 2.5 acres of land with a lake and swans at the bottom of its garden. The house was well maintained and tastefully furnished following its original style. The home offered a real village atmosphere in a very homely environment. In the small village all amenities were close and the home has developed community connections with local people and institutions. The Victorian building provided 23 single and 7 single en-suite rooms. All three floors were accessible by a lift and there was a stair lift too, between the floors. The home offered good care provided by experienced and skilled staff. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection. It was carried out during one working morning. The manager was not present, so the deputy manager assisted the inspector with directions and answers to the questions. The inspector talked to 3 staff members, 9 service users and case-tracked 3 service users. The inspector read the file named “Quality systems”. This was where the philosophy and working practices were written together with appropriate policies. The findings of this inspection confirmed that the home continued to provide good standards of care to service users who enjoyed their independence as far as possible. The home was owned by the Greensleeves Homes Trust. The trust invested resources into the environment and the service ensured that they worked towards the National Minimum Standards and Care Standards Act. What the service does well:
The home provided good care in a very nice and comfortable environment. All new service users had been given opportunity to choose the home from the information provided and from trial visits. Prospective service users were assessed prior to admission to ensure that their needs would be met if they decided to move into the home. One of the newest service users commented: “I have been so lucky, extremely lucky to get place here.” Several service users stayed in the comfortable dining room after breakfast and expressed their satisfaction with services and provisions to the inspector. One of them stated, referring to the staff team: “They are very good indeed, there isn’t anything that I can’t get if I ask for it.” Staff on duty commented on a friendly and caring atmosphere. Service users were treated with full respect. Some of the staff members knew the service users since they were children. A local voluntary group met together during the inspection, they were taking the service users out for day outings. The ground and garden was very well maintained and used by some service users totally independently, as one user commented to the inspector while walking next to the lake: “I love walking here on my own”, although registered blind, the service user could find their way in the garden. Records were kept in order and regularly reviewed with service users’ involvement, apart from some risk assessments that were not dated and signed. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 6 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. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4,5 The home had very good written information that allowed service users to make an informed choice before moving into the home. EVIDENCE: The home had an excellent pack called “Quality systems” in which the services and provisions were described in a simple form, easily understandable for service users. The information was arranged according to the National Minimum Standards and Care Standards Act and demonstrated that the home was working on the principles required by the regulation authority. The admission procedure was clear and ensured the service users were properly assessed in order to ensure that their needs could be met upon the admission. The service users spoken to confirmed that they were visited and assessed prior to admission. Pre-admission visits and a trial period of 4-6 weeks were part of the admission procedure. The users’ files contained information collected from, either previous official carers or from the families if they cared for a service user prior to admission. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 9 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Well organised and appropriately written service users’ files provided a good source of information for carers to get to know service users and carry out their duties well. EVIDENCE: The files contained basic information, personal profile, assessment records, risk assessment, information about medication with signed consent forms, review sheet, records of visits by the external health professionals, appropriate charts covering diet, weight, continence etc and daily records. The care plans addressed the needs in a “page per need” format and were clear of the goals and responsibilities set for each service user. Service users stated that they were involved in care planning and knew what was written in the plans. The staff spoken to confirmed that they knew what was written in the plans and knew service users well. Care plans were up to date, regularly reviewed and were dated and signed. Risk assessment was included in the file and was well written, related to the care plan, reviewed and adjusted when there was a change of needs, but not all risk assessments were signed and dated. Service users that held their medication had signed consent forms, signed agreement by their families and an appropriate risk assessment.
Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 10 Records of professional visitors and health care needs demonstrated that the needs were met. Appropriate charts helped staff monitor any area of individual needs that needed close and regular monitoring and action. An optician’s appointment was arranged within 2 weeks of admission for a new service user that had glaucoma on admission. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 Service users enjoyed respect for their individual preferences, for the promotion of their independence and involvement into local community. EVIDENCE: The files contained records of service users preferences, likes and dislikes and users’ confirmed that their individuality was promoted and respected. The list of activities was displayed at the appropriate places around the home and in the staff room, reminding staff of the plans for the current month. “C.A.S.T. 2005”, an activity with a play and a barbeque was planned for the coming week. Volunteers played an important part in the life of the service users, as they were arranging outings and visits to places of interest for service users. Religious needs were recorded and it was stated, who would like to attend a service and what the arrangements were for each individual to fulfil their needs. Service users choice was promoted and encouraged. They were asked at each activity if they wanted to take part. They were encouraged to suggest any potential activity that the home could organise for them. Service users had meetings once a month. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 The standard related to the complaints was not inspected on this occasion, as the home did not have any formal complaints since the last inspection and the standard was met on the previous occasion. Protection of service users was ensured and promoted through safe working practices and knowledge and determination of staff to protect service users. EVIDENCE: The staff that spoke to the inspector confirmed that they were fully aware of the protection issues and were determined to ensure that users protection was ensured all the time. Service users stated that staff were open, friendly and supportive and that they were sure that staff would protect them if need be. Financial matters of service users were protected by the accurate and safe financial procedure implemented in the home. Records of transactions were accurate. Service users that wanted to keep their personal allowances with them were supported to do that in a safe way. Secure, Lockable facilities were provided to ensure protection. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) The home offered an excellent, clean, comfortable and pleasant environment where service users could enjoy and benefit from the domestic style of the setting. EVIDENCE: These standards were not inspected on this inspection, but the home was clean, bright and the garden was amazing as always. A service user, partially sighted, was enjoying his regular independent walk through the garden and sitting by the lake watching swans. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 14 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Service users enjoyed and benefited from the stable, committed and skilled staff team, who were properly trained to meet the needs of service users. EVIDENCE: The home employed sufficient number of skilled and experienced staff. The home had two rotas, one for seniors and one for care assistants. This way, it was easy to organise responsibilities and provide clear instructions to each staff member of their duties and responsibilities. Staff spoken to, confirmed that they knew what was expected of them, they knew the home’s aims and objectives. Many of the staff came from the local community and knew the existing service users for a long time before they moved into the home. The organisation ensured that recruitment procedure was followed and respected. The staff member spoken to stated that they could not start before they received their CRB disclosure and the home had received two written references for them. A staff member confirmed that the induction based on TOPSS principles was carried out fully and included all necessary training prior to staff working unsupervised. The home’s mandatory training was comprehensive and exceeded requirements from the NMS to ensure users’ conditions were also mandatory for all staff. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 15 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,33,35,38 The home was run in the best interest of service users. They were safeguarded by the good policies and working practices. EVIDENCE: The service users stated that the atmosphere in the home was friendly, professional and highly caring. The staff confirmed that they knew the philosophy, aims and objectives of the home. The organisation carried out their own quality assurance review that covered all aspects of running the home. Another review was in the process during the week of the inspection. A deputy explained about the business plans of the organisation to build an extension and slightly increase the number of beds. Service users were encouraged to keep control of their finances, the home kept records of appointees for each individual, if they had them, as well as data about the Power of Attorney for those users who had assigned responsible person.
Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 16 Moving and handling process was observed and found to be appropriate. Service users commented that they were helped in the way they liked and that staff knew how to use equipment- hoist. Training records confirmed further that manual handling training was up to date and of good quality and variety. Staff felt confident as a result of the ethos in the home, the support they were receiving and the training they attended to offer appropriate, good care to service users. Equipment was regularly checked and inspected by the appropriate contractors and approved companies. Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 17 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 4 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x 3 3 x 3 x x 3 Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 18 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 7 Regulation 15 Requirement Individual risk assessments must be dated, signed and review dates recorded. Timescale for action 10/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Sharnbrook House I51 s14967 Sharnbrook House v248007 060905 stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK44 1EY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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