CARE HOMES FOR OLDER PEOPLE
Sharnbrook Lodge 17a Park Road North Houghton Regis Beds LU5 5LD Lead Inspector
Andrea James Announced 24 May 2005
th 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 Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Sharnbrook Lodge Address 17a Park Road North Houghton Regis Beds LU5 5LD 01582 866708 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) Mr John Philips Mrs Elizabeth Ann Fearn Stay Care Home 12 Category(ies) of OP Old Age - 12 registration, with number DE(E) Dementia over 65 - 12 of places PD(E) Physical Disability over 65 - 12 Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Old age, not falling within any other category (OP) 12 Dementia - over 65 years of age (DE(E)) 12 Both Physical disability over 65 years of age (PD(E)) Both Date of last inspection 18/11/04 Brief Description of the Service: Sharnbrook Lodge is a privately owned residential care home with a 12-bedded occupancy level. The home is registered for older people with due care of old age, physical disability and dementia. The large detached property is situated on Park Road North that provided direct access from Luton, Dunstable and Houghton Regis. The home is in close proximity to local shops and other amenities. The home has parking at the front of the building with a large garden at the rear of the building that can be accessible by service users. The home has one lounge, and a dining area within a conservatory all situated on the ground floor. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an announced inspection carried out 6 months after the last inspection. The registered manager was present for the duration of the inspection and the registered providers were available for some of the inspection process. The inspection was carried out on the 24th of May 2005 over a 6.5 hour period. The inspection followed a case tracking methodology where a sample of the service users were randomly selected and their files were inspected in detail. The inspector was able to speak to service users, relatives, staff and the management team in order to gain information for the inspection report. What the service does well:
The home provided satisfactory standards of care to the service users in a homely environment. The service users spoke of the staff who worked above and beyond the call of duty to care for them in special individual ways. One service user said she had to go into the hospital and could not wait to be returned to the home because the care was much better. Another service user said under no circumstances did she want to leave the home and had her daughter write a letter to say that she would spend her last days in the home because she felt the staff would care for her to the best of their ability. One relative also spoke positively about the care her mother received. She said the girls really looked after her mother. The home had regular visits from external professionals who assisted with meeting the health care needs of the service users. A letter was received from the district nurses stating the good care the service users received from the care staff. The meals provided to the service users were also very nutritious and well balanced. The inspector was able to taste the meals. The home provided choice and variety for the service users. The catering staff had been employed in the home for several years and knew the dietary needs of individual service users. There was evidence that the environmental standards of the home had improved since the last inspection. Various areas of the home were freshly
Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 6 decorated and some carpets replaced. The manager spoke of future plans to make further improvements to the environmental standards. The home had satisfactory recruitment procedures in place and had maintained a good retention of staff, an average of 5 years was the length of time staff were employed. The continuity of the staff team demonstrated that the care staff had a good understanding of the service users needs. What has improved since the last inspection? What they could do better:
The care plans seen in the home needed further development in order to ensure the needs of the service users were being met. The outcome for the service users were satisfactory but the evidence to substantiate the care was not available. The inspector was concerned that the service users case tracked did not have any care plans available. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 7 The care plan had full assessments of needs identified but the care interventions were not recorded. This was most concerning as the home had service users who had developed terminal illnesses and needed close monitoring. The need to develop the care plans was also highlighted in previous reports. The changing needs of the service users and the monitoring of these were not evident in the plans. Needs were identified in district nurses notes that were not evident in service users care plans which showed that care staff were not aware of all the needs of the service users. The home also had service users with MRSA and there were no correct procedures in place for transporting and laundering service users clothes. The home also failed to have a sluicing facility in order to maintain satisfactory levels of infection control. Quality monitoring systems should be available in order to identify the service users and relative’s views of the service. The providers should ensure the manager received regular supervision and support in order to carry out her managerial role effectively. The inspector would like to thank the service users, relatives, staff, providers and the manager for their cooperation in the inspection process. 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 Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 8 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 Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 9 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 and 5 The home provided sufficient information to enable service users to be able to make a choice of living at the home. The relatives were also able to view the environment prior to admission, which enabled the home to adequately meet the needs of the service users. EVIDENCE: The home provided all service users with a statement of purpose and a service users guide that highlighted the facilities available for the service users. The home manager carried out assessments on the needs of the service users prior to admission, to ensure they were in accordance with the registration category and the skills of the staff team. The admission documentation needed further development, but the information presented suggested that the home understood the principles of assessing service users. Relatives spoken to said they were able to view the home prior to their relative being admitted. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 10 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) 7,8,10 and 11 The care plans did not demonstrate the needs of the service users were being addressed. EVIDENCE: The care plans inspected did not demonstrate that service users needs were identified and, as a result, the staff did not have a consistent care package by which to work. The care plans seen had identified some needs for the service users in the form of an assessment but again these needed further development. There was also a need for further risk assessments, where some service users welfare had posed a risk. Their were service users with MRSA, terminal illnesses or those who were bed bound who needed correct care procedures to ensure consistent monitoring and care was provided. There were some monitoring forms seen, but these were not completed, which could result in service users being put at risk. One example of this was with a diabetic service user who had blood level charts that were not completed. The plans also failed to demonstrate any consultation from the service user, but this was due to lack of recording. Service users spoken to said staff regularly consulted with them about the care they received. An immediate
Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 11 requirement was left at the home for action to be taken to address the need to develop the service users care plan as a matter of urgency. One relative spoken to said she was also consulted about the care provided. On the day of the inspection a service user had made a written request about her future care in the home and there was evidence of consultation in this respect. Staff were observed to carry out personal care to service users in a respectful and dignified manner. One service user said she was allowed to have a lie in and, when she was ready had staff to assist her with her personal care needs. Service users were also asked what they wanted to eat for lunch. The service users spoke about the positive attitude staff showed towards them. The home did not have a death and dying policy and the arrangements for service users once deceased was not documented. One service user who had recently died was case tracked, and the documentation seen suggested that the home acted in the best interest of the service user. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 12 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, and 15 Service users were able to have a choice of activities. They were also able to have regular visits from relatives and friends that resulted in a fulfilled lifestyle for the service users. EVIDENCE: The home had a display of structured activities that appeared to be a permanent set of activities, which could suggest other choices were not offered. The manager said service users were offered other activities but no records were available to substantiate this information. On the day of the inspection a new entertainer had arrived at the home to sing with the service user. The service users spoken to said they were able to have newspapers and staff sometimes had a singsong with them when they were not too busy. The activities available to service users did not appear to demonstrate the choice. The lack of identified needs in the care plans could suggests that some service users cultural, religious and social needs were not being met. Relatives were seen visiting the home. Those spoken to said they were always made to feel welcome and visited the home on a regular basis. The manager explained that she encouraged service users to make choices over their own lives. One example presented to the inspector was where one
Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 13 service user asked not to be sent to hospital, but to be cared for by the care staff. The home had a 4 weekly menu, which was displayed on a daily basis. The meals provided were of a nutritional balance and service users were able to have choice. The catering staff were experienced in working in the home and appeared to know the individual dietary requirements of all the service users. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 14 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) 16 and 18 The home was not adequately prepared to handle complaints, which could result in a negative outcome for the service users and other users of the service. The procedures for reporting abuse were satisfactory and no alleged abuse had been reported. EVIDENCE: The home had been asked to make further development to their complaints procedures but, in viewing the policy, there were various inconsistencies, and the management team were not clear of the procedures to follow in the event of a complaint. The home had not received any complaints since the last inspection. The home had a satisfactory procedure for reporting suspected abuse. The training programme had also highlighted further training in abuse awareness for the care staff. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 15 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) 19,20,22,23,24,25 and 26 The home provided a safe and welcoming environment where the service users can live comfortably. EVIDENCE: The home was recently decorated in pastel colours that created a clean and welcoming feel as you enter the building. The manager said that she was also due to have new carpets to compliment the colours of the wall. The service users were able to have their bedrooms in their own individual tastes; one service user had his relative to decorate his bedroom and was proud of the outcome. Other service users bedrooms seen had individualised touches with personal belongings on display. The home had various hoisting equipment and other equipment that enabled the safe transfer of service users when performing personal care. The environment appeared to be safe for the service users. The home was clean and no offensive odours were identified.
Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 16 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) 27,28,29 and 30 The staffing levels at the home were satisfactory in meeting the needs of the service users. EVIDENCE: The home had maintained a stable staff team that had the skills and experience to meet the needs of the service users. The staff observed appeared competent and able to do their jobs. The staff files inspected suggested that care staff had been trained in courses relating to old age. The manager had also identified further training needs that would further develop the skills required to meet the needs of the service users. The staff files seen suggested that the home had satisfactory recruitment procedures. The home had a core of ancillary staff that helped to maintain satisfactory environmental standards, but a need for a maintenance person remained outstanding from the last inspection. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 17 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) 31,33,34,36 and 38 The manager created a good sense of leadership that produced a more secure environment for the service users. Further development was needed to support the manager in encouraging effective management of the home. EVIDENCE: The manager had been in post for over a year and appeared to have stabilised the home in respect of leading the team in a positive manner. It appears however, that she often manages most aspects of the home independently from the providers, and there was no evidence to suggest that she received any formal supervision. The manager said she had access to the providers via telephone conversations where they would advise her. The records inspected showed that the manager carried out regular supervision for the care staff.
Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 18 There was evidence to suggest that the home was financially viable. The inspector was shown a business plan, which detailed the financial income and expenditure for the past two financial years. The home had a health and safety policy but further development was needed to the policies and procedures for infection control. The home did not have a sluicing facility and, despite having had several requirements to have this facility, the home failed to meet the requirement. The inspector was concerned that due to the changing needs of the service users sluicing was needed to ensure proper procedures satisfactory standards of hygiene were maintained. The transporting of linen had improved because the staff used red bags for transporting soiled linen, however the procedures for managing linen for those service users with MRSA was not recorded, and the inspector was concerned that inconsistencies could compromise the safety and welfare of both service users and the staff team. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 19 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 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 3 3 x 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 3 x 3 3 x 3 x 2 Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 20 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 OP7 Regulation 15 (1) Requirement Arrangements must be made for all service users to have a care plan that details the identified needs and the care interventions to be carried out by the care staff. Immediate requirement left at the home to produce an action plan in 7 days stating when they would achieve this requirement. All care plans, once implemented, must be reviewed on a regular basis and consultation must be sought where possible about the care provided Arrangements must be made for the home to have a death and dying policy and the procedures must be made available in the home. The safety and welfare of the service users must be addressed by having appropriate risk assessments in place detailing the level of risk posed to each service user. . Correct procedures must be in place for reporting, recording and investigating complaints. Arrangements must be made for Timescale for action previous date: 30.01.05 New date:15.07 .05. 2. OP7 15 (1) 15.07.05 3. op11 16 (2)(n) 30.07.05 4. op13 13(4) 5. 6. op16 op38 22(1) 23 (2) (b) previous date :30.01.05. New date:30.06 .05 30.07.05 previous
Page 21 Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 a sluicing facility to be made available in the home to prevent the spread of Infection. 7. op38 23(2) 8. op38 23(a) Procedures must be in place for the transporting of linen for those service users with MRSA to ensure consitent care procedures are in place and the prevention of infection. Arrangements must be made for all internal doors to be kept shut when not in use and if acceptable by the fire officer, magnetic door closures be fitted to those doors which remains open. dates:16.0 3.04/10.09 .04/30.02/ 05. new date:30.06 .05 30.07.05 Previous dates:10.0 8.04?30.02 .05.new date:30.06 .05 9. 10. 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. 2. 3. Refer to Standard op7 op31 op31 Good Practice Recommendations The current assessment tool should be developed to include all the areas in standard 3. Arrangements should be made for the manager to be appropriately supervised on a regular basis. The manager should consider embarking of further care planning training. Sharnbrook Lodge I51 S14966 Sharnbrook Ldge V213091 AI 240505 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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