Inspection on 24/05/06 for Shedfield Lodge

This inspection was carried out on 24th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Shedfield Lodge 14/05/08

Shedfield Lodge 22/05/07

Shedfield Lodge 26/01/06

Shedfield Lodge 13/07/05

Shedfield Lodge 05/01/05

Shedfield Lodge 13/09/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Shedfield Lodge St Annes Lane Shedfield Southampton Hampshire SO32 2JZ Lead Inspector Isolina Reilly Unannounced Inspection 24th May 2006 03:30 X10015.doc Version 1.40 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 Shedfield Lodge DS0000012320.V296637.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 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. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shedfield Lodge Address St Annes Lane Shedfield Southampton Hampshire SO32 2JZ 01329 833463 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) Mr Robert Barrie Geach Mrs Christina Geach, Mr Andrew Robert Geach Mrs Karen Samantha Batten Care Home 33 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10), Old age, not falling within any other category (33) Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The additional room registered 9C must not accommodate any service user with dementia on admission. Two named service users over the age of 60 may be admitted in the MD category. 26th January 2006 Date of last inspection Brief Description of the Service: Shedfield Lodge is a residential care home. It is registered to provide support and accommodation for up thirty-three people over the age of sixty-five. Within this number, up to twenty people can have dementia on admission and up to ten can have a mental disorder, excluding learning disability or dementia. The home is situated on the outskirts of the village of Shedfield. It is a large period house in its own grounds and adjacent to an equestrian centre. Communal areas include a dining room, two lounges and a conservatory. Service users also have access to garden areas. The layout of the home is such that some of the bedrooms would not be suitable for any person with mobility problems. Twenty-three of the bedrooms are single. Six of these have en suite facilities. The remaining five bedrooms are double of which three have en suite facilities. The provider makes information available about the service, including the commission’s reports to prospective residents on request. Copies of this information are available at the home and may be sent out by post on request. The manager confirmed over the phone that the fees for the home range from £385.21 to £450 for residential care and there are additional charges for hairdressing, chiropody, toiletries, activities, magazines and newspapers. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit took place over two days. The two inspectors looked around the home, viewed records, procedures, spoke with residents, relatives, the staff and observed the interaction between them. The manager helped the inspectors during the visit and feedback to the owner at the end of the second day. Information has taken from correspondence with the home and monthly reports on how the service is doing, sent in by the owner. What the service does well: What has improved since the last inspection? There has been a considerable amount of refurbishment and redecorating throughout the home. The owner is making substantial investments by replacing fittings and furniture to improve the quality of the surrounding for residents. This is on going and they are slowly moving towards improving the Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 6 other parts of the home. New comfortable chairs have replaced the old warn chairs in the lounge. The organisation has an improving system in place for monitoring the quality of the service being delivered at the home. 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. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 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 the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good admission process that is well managed and residents are given clear information regarding the service. The home does not provide ‘Intermediate Care’. EVIDENCE: The residents spoken with explained that they were given an opportunity to spend time at the home prior to making a the decision to stay but many said stated that their relatives often came around and choose the home for them. One service user was happy and pleased with the choice made by their family. Several residents stated the staff greeted them on arrived at the home, shown around, taken to their room and introduced to other residents and staff. One resident stated that the staff had been very kind helping them move in, unpacked their things and answered their questions. The relatives spoken with said that the home asked lots of relevant questions and looks after the residents well. The staff spoken with confirmed this. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 9 Inventory lists were seen within the residents’ records of their possessions on admission. The manager and deputy undertake an interview with the resident and family completing a full assessment of needs and aspirations. They undertake the initial assessment as they have the necessary skills and experience to assesses individuals’ needs. To ensure that the home and its staff are able to meet prospective residents needs. Satisfactory records of these assessments were seen on the files. Part of the admission process at the home includes a personal history for the individual about key relationships, cultural and religious aspirations, likes and dislikes. These personal histories were available on the files seen and the residents spoken with stated that they had been fully involved in this with their family and friends. There were copies of the Adult Services care management assessment and the instructions to care staff mirror the needs identified by the home and copies of a health assessment prior to admission. The manager confirmed that all new residents undergo a full assessment of their needs. These cover the necessary areas including, personal care, physical well-being, dietary preferences and records of regular weights. Information was seen on each file that described issues with sight, hearing, mouth and foot care. There was information on the level of mobility and dexterity and a history of falls, continence and behaviour. Two residents spoken with stated that they had been given documents about the home and a contract that stated the fee for the home. The four residents records seen contained a signed contract that were informative and contained all the necessary information. The residents and relatives spoken with confirmed that the contracts had been explained to them when they first came to the home. The manager confirmed that the home does not provide ‘intermediate care’ rehabilitative short-term type care for Social Services. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care received by the residents is in the main satisfactory supported by good assessments of need. However, specialist needs for two residents had only been partially met. There are various different systems for recording care and instructions to staff, which is confusing and fragmented. The home promotes the resident’s privacy and dignity, and stores and handles medicines well but records still have some gaps in them. EVIDENCE: Four resident files tracked and discussed with each individual, confirmed that whilst the staff give them satisfactory care they are not aware of the records held on them. However, the inspectors noted that the four residents had signed their records on their last full review. They described the staff as being approachable and on a day-to-day basis asking questions about how they want to be helped. The inspectors observed this on the visit. The relatives spoken with stated that they are involved in the care of their loved ones. One relative felt the home has been very flexible in looking after the resident by helping Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 11 them keep their independence as much as possible. The home has helped this resident by putting a system in place for them to look after and take their own medicines. They also have there own key to their bedroom so they feel secure that their own space is kept private. The inspectors observed that several residents had chosen to keep their rooms locked and had their own keys. Two of the residents tracked had specific care needs and instructions recorded on their assessments and care plans. However, these needs appear to have only been partially met. The residents and staff spoken with confirmed this. The manager and staff stated that the layout, high number residents choosing to remain in their rooms and the number of staff on duty have restricted their ability to provide better support to these individuals. The home does not have an established system or experience to provide for the specific mental health care needs. The manager is working with the health and social care professionals to increase staff knowledge and improve care. The inspectors found three very different systems in place for recording risk assessments, care plans and instructions for staff. The home also had a good system in place for recording personal care and a daily record. However, there were many gaps in the records were information had not been recorded. Whilst care instructions and risk assessments had been completed and reviewed, the varying recording systems makes it difficult and confusing to establish what and if care had been given as instructed. The staff confirmed this but stated that they keep themselves updated through handovers, diaries and discussion between them and the residents. The manager confirmed that currently the paperwork is confusing because the home has gone through a period of trial and error to try and find the right recording system that is easiest to use. The manager was able to show the inspector the new electronic system to be started next week. This new system includes electronic recording for risk assessments, reviews and instruction to care staff, and will replace all previous care planning paperwork. The staff and residents confirmed that staff are always very busy. Staff explained that there are times when they are being called away to help someone and are not able to do the paperwork. The manager and owner stated that they are aware of this issue and are looking to increase staff numbers on duty during peak times as well as on going recruitment. The staff and manager explained that currently there is high number of residents who have chosen to stay in their rooms. This takes carers away from the communal areas as they undertake regular checks on individuals. Records of doctor and nurse visits and information on outpatient, dental, optician and chiropractic appointments were seen on the files. Various residents stated they had seen the visiting dentist and opticians recently. This was confirmed by the staff and seen on records. The recent treatments and the corresponding medical notes were present in the file. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 12 The residents and relatives spoken with were generally happy with the care provided by the home. Stating that staff are caring, helpful, appear to know what they are doing and look after them well. They also said that the staff are always respectful and mindful of their privacy and dignity. The inspectors noted that residents were dressed appropriately and those spoken with confirmed that they were able to wear and choose their own clothes. The inspectors observed the staff interacting with the residents and found them attentive and professional. However, a wipe board in the kitchen, that is often visited by residents and visitors, held confidential information about changes to care, medication, medical tests and appointments for individuals. This was discussed with the manager and she confirmed that a new handover reporting system has just been introduced that will incorporate confidential essential information, so there would no need to write this on the wipe board. The staff were observed administering medication appropriately and there is a good medication policy and procedures. The home has had to revert to the ‘Nomad’ system because there was a large volume of errors being found in the ‘single blister pack system’ being provided by the local pharmacist. This was taking a member of staff too much time to sought out. The medicines were correctly stored in an appropriate cupboard, with current medication held in a medicine trolley securely stored in the kitchen. Since the last visit the home has put in a large wall hung medication cupboard in the kitchen that has the appropriate smaller locked cupboard for control medication and is used to safely store medicines for return to the pharmacist. There were not control medicines at the home on this visit. The home has one resident who is self administering part of their own medicines, these were seen to be stored securely by the resident who was pleased to be able to keep their independence and dignity. The resident was clear about their medication and how and when to use it. They confirmed that staff had regular chats on how it was going. There was an appropriate assessment and agreement recorded signed by the resident and the staff keep a record of stock held. The deputy manager is responsible for ordering and checking all medicine received and returned, recording date, name, quantity and signing for them. The records were seen and found to be satisfactory. The home uses the ‘Medicine Administration Record Sheets (MARS) system for recording the administration of medication and medication received in the home. It was noted that there were several signature gaps in the administration records for three at out twenty-four records seen. This has been an issue in the past but had improved on at the last visit. This was discussed with the deputy manager and manager who confirmed that they would undertake further instruction of staff on record keeping. They also explained they were Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 13 starting a weekly monitoring system for checking the administration of medicines to ensure that gaps in records do not occur. During the visit a resident’s prescribed tub of cream was found in an open staff locker in the staff toilet. The manager was made aware of this and stated would investigate. She confirmed in writing to CSCI the outcome of that investigation concluding that the individual member of staff had inappropriately wandered into the staff toilet with the cream and meant to put it back but had genuinely forgotten. The manager has appropriately used the home’s disciplinary procedure. The carers stated they only give out medicines if they have completed their training and are confident to do so. The home’s medical room and cupboards stored were clean and reasonably orderly with medication stored correctly in date and in sufficient quantities. The manager and staff spoken with confirmed that they had attended update medication training and training records were available in individual staff files. The home has a copy of the Royal Pharmaceutical Guidelines for residential care and samples of staff signatures and initials. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents experience a varied life at the home with visitors made welcome with routines planned around them. However, there was a perception of lack of stimulation from the residents, this will be greatly improved with the introduction of extra staff at key times throughout the day. The meals and choice are good at the home. EVIDENCE: The inspectors observed residents reading large print books, daily newspapers, magazines and crosswords. They also socialising with each other and two staff were seen sitting and chatting to residents in the evening, painting residents nails. By the front door there were information leaflets on local events, history, contact numbers and other information including comment cards for relatives, visitors and residents to complete. The residents spoke with were aware of the organised activities and some said that they enjoyed joining in especially the musical events but other residents had no wish to join the activities and preferred their own company. However, several residents stated that they would like more trips out in the minibus and Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 15 to go for walks around the home with staffs’ help. However, this was not possible at present as there were not enough staff to go out with them. Some residents also stated that they would appreciate more time to chat and socialise with the staff but felt unable to do so as they are often busy. The organised activities are varied and displayed in the entrance hall. These include sing-a-long, two weekly visits from the Patsy Day Centre who undertake a variety of activities including arts and crafts and reminiscing, a vocalist, guitar player and French entertainer (music and dance) come monthly. The home also hosts a mobile Fashion show giving residents an opportunity to buy new clothes. Three residents stated that they enjoy and participate on the monthly church service held at the home, which includes communion. The hairdresser visits weekly and many of the female residents enjoy having their hair done though some prefer the staff to wash and set. The care plans seen and the individuals spoken with confirmed this. One resident explained they had weekly visits from the Quakers and enjoyed the readings. The home has an accessible minibus that has been used in the past for day trips out to the seaside, cream teas and for fish and chip lunches. The manager explained more trips would be organised for when the weather improves. Information about residents’ religious preferences and cultural aspiration were seen on file. The care plans seen held information about individuals likes, dislikes, want and aspirations. One resident’s care plans there were clear instructions and agreed action with community psychiatric nurse on the importance of socialising and participating in activities for the individual’s mental health wellbeing. The staff are aware and doing their best to meet this. The individual’s key worker had built up a good relationship with them. However, the actions and instruction had not been fully implemented due to the constraints on staff time. Another resident’s care plan identified appropriate activities, risks and actions to be taken but due to the layout of the home and high level of needs within the home these are inconsistently carried out. Such as providing quality one to one time for activities and social interaction, taking the resident out for walks and monitoring to prevent wandering away from the home. The relatives spoken with feel the clients are well cared for. They are made very welcome and feel part of the home. The visitors signing in book showed that visiting time is varied. The inspectors observed that relatives visiting that day had been offered refreshments. There were cold and hot drinks, biscuits and cakes taken around regularly throughout the day. All the residents stated that the day routine is flexible and a meal can be put aside should they wish. One resident who stated that he was a vegetarian felt that the food was varied and good. Several of the residents spoken with had Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 16 keys to their bedrooms and one resident unlocked they room to sit in private and speak with the inspector. Many of the bedrooms had been personalised and the residents spoken with stated that they were able to bring things from home with them. All asked were happy with their rooms. The inspector was able to speak to kitchen staff and found that there are good system in place for cleaning, hazards and risk assessments. The menus are kept in the preparation room off the kitchen for easy view by staff with the list for cook breakfasts. This is taken round by staff the evening before so residents can choice their cooked breakfast. On the first day of the visit it was noted that the menu had been removed from the front entrance. The manager stated that this was a regular occurrence and by the next day a new copy was available and the wipe board held the meal choice for the next meal. The cook confirmed that she had a list of individuals’ likes and dislikes and special diets such as diabetics, reducing and vegetarian. The inspector viewed the four-week menu and found it to be variable, balanced with alternatives. The records of food provided by the home showed that alternative meals were provided on a regular basis and the kitchen staff were aware of individuals preferences. The residents spoken with stated that the quantity of food was generous. They felt the food was varied and of good quality. The residents were very happy with mealtime experiences and felt they were not rushed. The evening and lunchtime meals was observed by the inspectors and found to be relaxed, unhurried and the food attractively presented. The inspectors noted that people were helped to leave the dining room when ready and were not left for long periods of times. Daily records of foods served and temperatures of hot probed meals and freezers and fridges are kept by the cooks. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents, relatives and staff are confident that their complaints will be listened to, taken seriously and acted upon. Staff have a fair understanding of Adult Protection issues that protects residents from potential abuse. EVIDENCE: The residents and relatives spoken with stated that they would go straight to the manager or deputy if they had a concern or complaint. They confirmed that the staff are good and listen to their concerns. However, one resident felt that some concerns were not always taken seriously but the manager was very approachable and made things happen. The relatives felt that the staff were patient, caring and willing to listen and the inspectors observed this during the day. One relative confirmed that the manager and staff were approachable and open to suggestions and followed up concern. The staff spoken with were aware of the home’s complaint procedure. The home’s complaint procedure includes the various stages, the address for the Commission and complaints will be dealt within 28 days. A copy of the home’s complaint procedure is displayed in reception. The home has received two complaints in the last twelve months, from the same complainant who felt their first complaint had not been dealt with Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 18 appropriately. Adult Services and the commission were made aware of the complaint and felt the home had responded appropriately. Adult Services and the home held a meeting with the complainants to resolve issues but resolution was only partially achieved. This has created a feeling of vulnerability within the staff group, which the manager is in the process of resolving. The complaint investigation identified that staff are at times busy and unable to complete records. The manager confirmed the home is looking to improve staff numbers at key times especially evening and weekends. All the residents spoken with stated that they felt safe at the home and the relative also confirmed this. From a Care Homes Regulation 2001 regulation 37 reports, it was noted that there had been an incident between two residents. The records for this incident have been completed and Adult Services had been appropriately notified. The manager confirmed this. Most of the staff spoken with confirmed that they have received instruction and are aware of the protection of vulnerable adults from abuse. However, one staff member spoken with was not aware of completing training in vulnerable adults and older person abuse but the manager was able to produce the staff member’s training records and a copy of the recent older person abusetraining certificate was present. This was discussed with the manager and owner who agreed that the member of staff would need further instruction to ensure understanding of Abuse. There have been two allegations of abuse at this home. Each allegation was promptly and appropriate reported and records kept. However, the complainants felt the home’s response had been patronising. The Vulnerable Adult Protection investigation led by Adult Services found the care to be adequate and consistent with medical condition of the individual. The home has an up to date copy of the Hampshire County Council ‘Protection of Vulnerable Adults’ policy and procedure and it’s own policy and procedures reflecting the guidelines from Hampshire County council’s own policy. There is a clear whistle blowing procedure within the home and the manager has encouraged an open and fair ethos within the home. The owner, staff and residents spoken with confirmed this. All the staff spoken with stated that there was an open and encouraging ethos to speaking up when things are not quiet right. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 19 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 the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home presents as a reasonably clean, homely, comfortable and suitable environment for the residents. The standard of the décor within the home is improving with evidence of on-going maintenance. However, there are key areas still in need of improvement. EVIDENCE: The residents stated that the home is clean, warm and comfortable. Within the lounges and dining areas no offensive odours were detected. However, the conservatory, bedroom 8, 9 and 17 and corridor outside rooms 8 and 9, offensive odours were detected. The manager and owner confirmed that these rooms are priority for a full refurbishment. Since the last inspection the home has purchased new chairs for the lounge and the manager agreed that the chairs in the conservatory need replacing. The manager has also asked the owner for a further six chairs to replace old Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 20 and warn chairs in bedrooms. The inspectors viewed the new furniture that has recently arrived for bedroom 14. The home has a large stock of new pillows and mattresses are also being replaced. There has been a history of the safety gate at the top of the back staircase being left open. The manager has stated that since her office has been moved up stairs she goes past this gate frequently and checks that it remains closed. The inspectors walked past the gate on various occasions at different times of the day and evening finding it to be appropriately closed. Various bedrooms were noted to have worn carpets, curtains missing or hung incorrectly, vanity units in varying states of disrepair. The manager stated that the maintenance person does go around and make repairs but some furnishings do need replacing. The staff showed the inspectors the home’s maintenance request log and the inspectors were able to speak to the home’s maintenance person who confirmed this. The home has developed a maintenance and replacement programme that it is following to improve the quality of all furnishings. All the residents like their bedrooms. The home’s radiators and pipe work are safe ensuring that potential hot surfaces are kept to low temperature. The manager and maintenance person confirmed that all windows are restricted. One resident has been identified as liking to walk around and has managed since their admission to wander off the premises several times, often found in the country lane by the home. The home has a secure entrance for main doors in and out of the building. However, the individual has wandered out through the patio door in the quiet lounge. The manager and owner stated that they have purchased the necessary buzzer alert system for the patio door and are planning to have it fitted the next day. This will help staff by alerting them if someone is going out that door. All residents’ and staff spoken with felt there were enough toilets and bathrooms. However, on the tour it was noted that none of the communal toilets had disposable hand towels, only some had liquid soap and most had no toilet paper. The manager was surprised at this and asked staff to ensure that supplies were put in each room. When speaking with the cleaners they stated that replacing disposal hand towels and toilet paper was not part of their job and that it was the responsibility of care staff. This was fed back to the manager who stated that she needs to review and enforces staff roles and responsibilities. There were various soap bars seen in communal bathrooms that had been left behind and the manager had them thrown away as it was not possible to identify who’s was whose. The home was found to be general clean and tidy with no clutter or obstacles in corridors. However, the carpet by the lift on the ground floor was frayed and could cause a trip hazard. The manager confirmed that there are basic cleaning schedules and job Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 21 descriptions but they did not go into detailed tasks to be undertaken but she would look into this. It was noted that the bathroom on the first floor had plain glass. A net curtain had previously obscured this window but this hds been removed. The manager stated she would ensure that the window was obscured to ensure privacy before the next resident used it. In two bedrooms the inspectors found a used incontinence pad left lying on top of a soft chair and toilet set. These pads contributed to the offensive odour in the room. The manager explained that some residents do remove their own pad and will leave them lying around. She confirmed that there is a regular checking system in place for staff to look in bedrooms but this could be done more frequently. However, current staffing levels at peak times make this difficult. It was noted that all commode pots seen on the tour were stained, marked and in need of replacing. The manager stated she would look into this. The home’s supply of gloves and aprons are kept in the kitchen in a mounted wall-dispensing unit. Staff confirmed that they collect their gloves and aprons from the kitchen. The residents and relatives stated that the staff do use them. The inspectors observed staff using gloves and aprons appropriately and staff confirmed that they have received regular training on infection control. The laundry room is an L-shaped room accessed from the back corridor and the kitchen. There are two industrial size washing machines and two industrial tumble dryers one was seen working. The manager stated that due to problems experienced with linen coming out stained, the home now send out all linen and towels to an outside agency for laundering. The inspectors checked various beds and found the linen to be slept on but free of stains. The staff and residents stated this had been a great improvement. In the laundry room there is a system of red laundry bags for soiled linen. The home still launders residents clothing and most left that the service was fine. A previous concern raised suggested that clothing was mixed up and not returned to the rightful owners. There was no evidence of individuals wearing other people’s clothes on this visit. The residents spoken with stated that they recognise their own clothing and each article had their name in. Concerns had been raised with Adult Services and at the home about staff smoking in the corridor by the laundry and the smoking coming into the house via the kitchen corridor. The inspectors observed that staff were smoking outside and not in the corridor and the manager confirmed that staff have told not to take smoke breaks together and to smoke out side. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 22 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff at the home are well trained in basic care and supported. The home needs to employ staff in greater numbers at peak times to meet all the residents’ needs and wants. There are satisfactory recruitment procedures that ensure residents are not put at risk. EVIDENCE: The residents spoken with described the staff as ‘caring, friendly, helpful and you can find them if you need them.’ Several residents and relative stated that the staff were polite and had no complaints. Most of the residents spoken with said that they were happy at the home though one resident stated that “as he could not stay at home this would do”. All the residents and relatives spoken with said there was enough staff but sometimes they were so busy they do not like to disturb them. They felt the staff are good at their jobs and knew what they are doing. The rotas showed that a minimum of five carers are on duty during the week day mornings, three in the afternoon and evening, and two waking night staff each night. However, it changes at weekends with numbers of staff available on duty during the busy morning shift can be as low as three. The inspectors looked at the home’s staff rotas for May 2006. It was found that Saturday 6, 27 and 29th May only four staff were on duty for the morning shifts, three for afternoon and evening and two waking night staff. But on Sunday 21st May Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 23 only three staff on in the morning. The manager confirmed that the fourth member of staff did not turn up. The home also employs six part-time domestics, two cooks and one kitchen assistant and thirty carers. The complaints and concerns received by the home, social services and feedback from residents and staff during this visit suggests that quality of social activities and record keeping would be greatly improved by additional staff at peak times such as weekends and evenings. The owner and manager agreed they needed to review staff levels with a view of improving the service they offer. These figures exclude management but the manager and deputy confirmed that they often stand in as carers when there is a shortage of staff. Two of the thirty care staff will come in as needed and are not part of the regular team. The owner and manager confirmed that there is an ethos of no agency staff being used due to previous problems experienced such ineffectiveness due to their lacked of knowledge of the home and residents needs. This was discussed with the owner and manager who agreed it was their responsibility to ensure there are sufficient staff on duty at all times but were not always. They explained that staff did not always inform them of the shortage. If they had know the manager would have stood in until a replacement could be found. The owner and manager agreed to look at empowering staff to past on this information quickly so extra staff can be found. The staff and manager confirmed that there is a good camaraderie within the staff group and many would come in at short notice to help out. The rota shows a mix of experience and new staff. The manager stated that all staff are over eighteen years of age. The staff spoken with felt there was a good skill mix within the staff team and they worked well together as a team. The staff asked had received a copy of the General Social Care Council’s code of practice and extra codes were available in the office. The manager confirmed that they are working towards increasing the number of carers with qualifications in care. Currently the home has 53 of carers who hold or are in the process of undertaking a qualification in care. Out of the thirty carers employed by the home eight have a National Vocational Qualification (NVQ) level two in care and two NVQ three in care. A further five carers are in the process of completing their NVQ level 2 in Care and three are about to start. One carer holds a nursing qualification. The staff spoken with felt that the recruitment process within the home is thorough. The inspector was able to see four different staff records and found that they were detailed with the necessary checks taken to ensure staff are fit to work at the home. However, one file had only one reference but the manager later found the second reference. Other records seen on file include signed contract of employments, job descriptions and criminal record bureau (CRB) and protection of vulnerable adults (POVA) register checks. The POVA Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 24 checks had all been completed and were satisfactory before employing the individual. The manager is responsible for training within the home and she explained the process for identifying training needs of individual workers and planning the training programmes for all staff. The records of training completed and planned throughout the years were seen and reflected information given by the staff. The staff spoken with stated that the induction programme run by the home was useful. The files seen held records of the individual staff induction training covering the key areas with the signatures of the staff member and manager or deputy. The manager was unsure if the home’s induction programme met the recently amended Skill For Care standards for induction and stated that she would check. The home’s training records shows that external and internal training is done, utilising specialist skills and qualifications of the manager. The staff confirmed that they undertake training regularly and the inspector viewed copies of individual staff training certificates and other records of instructions. The staff have received training in the necessary health and safety subjects such as fire safety, first aid, moving and handling, health and safety, infection control and elder abuse. Other training courses attended by staff include dementia, death and dying, safe handling of medicines, eye care, key worker, induction and foundation. The manager confirmed that the following subjects will be covered over the next few months further dementia and elder abuse training and food hygiene refreshers and full courses. It was noted that one resident had a specialist mental health care needs that the staff have not been trained in yet. The manager has put an information sheet on the mental health condition in the individual’s file and agrees that training needs to be arranged as a matter of priority. However, having arranged training with the community psychiatric nurse for the staff she was latter told that Shedfield were not a priority home and would have to wait for the second phase of training schedules. The manager confirmed that staff are now taking their breaks separately so there is always staff around the home. However, there had been comments raised from previous concerns that staff congregate in the kitchen together. The inspectors observed a number of staff were in the kitchen at the same time mainly during shift changes. The manager and staff explained that the kitchen was also the central place were medicines, personal care equipment like gloves and aprons are kept and where handovers take place. Staff were seen taking separate smoking breaks outside and no cigarette smells were noted in the corridor not kitchen. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 25 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is being run well by a capable manager. There is a good system for involving residents in the day-to-day running of the home and a quality assurance system that is to be expanded to included all aspects of the service provided. There is a satisfactory system in place for the safe storage and monitoring of residents money. The residents’ health, safety and welfare are promoted by the home with systems that ensure individuals are protected. EVIDENCE: The manager has been at the home for eighteen months and has made noticeable improvements to the management of the home. The residents confirmed this, relatives and staff stated that she was very approachable, fair, listened and tried to improve things. The manager holds a national vocational qualification in care level 4 and registered manager’s award. The staff spoken Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 26 with stated that since the manager’s arrival the home has felt more settled, they feel supported and things are getting done. However, the manager and owner confirmed that it is the manager’s intention to move on within the near future and has agreed with the owner that she would stay to handover to a new manager. The staff spoken with confirmed that there is a clear line of authority within the home. The home has a positive supportive ethos and staff training with a programme of regular monitoring supervisions. These look at individual staffs performance and identify training needs but have yet to include one to one comments, aspirations and personal development. The manager felt this would be a simple process to include in the supervision process and make necessary records. Within the staff files seen there were copies of monitoring supervisions and annual appraisals. The staff felt they found the process a little daunting but useful. They also confirmed that they attend regular meetings and the inspectors saw minutes of the staff meetings. They covered many of the issues for improvement raised during this visit, discussions and actions. The home also hold regular residents meetings the minutes for the meetings of the 25th October 2005 and 9th February 2006 were seen and covered consultation issues around décor of the home meal planning and choices and other evidence of residents being involved in the day to day running of the home. The residents stated that their family or financial appointees rather than the home look after their money. However, the manager confirmed they do hold for safe keeping some of the residents’ spending money in the homes safe. The home has records of the money in, out, receipts and balances for each resident whose money they look after. The money is separately stored in individual envelopes. The deputy manager counted the money for two residents out in front of the inspector and the balance was found to be accurate including receipts and records. Regular risk assessments are undertaken and recorded to ensure that the safety within the home room by room. These were sampled and found to be satisfactory. The manager completes these with the assistance of the maintenance person. Policies and procedures within the home are looked at annually. However, there is no formal system in place for auditing all aspects of the service provided. The manager stated that she would be looking to formalise this process but many tasks are monitored regularly or as necessary but not always recorded. The staff and residents spoken with stated that they felt their opinions were valued. However, one resident felt that their opinions are valued to differing degrees depending on whom they were talking with. This was feedback to the manager who agreed that she would investigate this statement with the individual. The staff felt they were included in the day-to- Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 27 day decision making within the home, stating that changes and or issues are discussed and actions agreed at regular staff meetings. The owners have regularly sent Care Homes Regulations 2001, regulation 26 monitoring reports. These have been very brief and repetitive. The owner Mr Geach asked the inspectors advise on how these reports may be improved. Since the visit, Mr Geach has sent in a much improved regulation 26 report that details many of the issues raised at the visit and how the home is going to resolve them. The manager shared with the inspectors the quality survey questionnaires completed by residents, relatives and friends. These were found to be positive in the main; issues identified were followed through and resolved. The inspectors discussed with the manager the advantages of including health professional, staff and other stakeholders in the surveys, and completing a brief summary of the outcomes giving a copy to residents, relatives and representatives. The residents commented on the comings and goings of the home’s maintenance man. Records were sampled of maintenance undertaken on all equipment within the home. The maintenance person explained the home’s procedures for monitoring safety and maintenance within the home. All the residents and relatives spoken with stated that they felt safe at the home and some confirmed that the fire alarms are regularly tested. The maintenance person explained the recording system for fires safety maintenance, evacuation and visual checks. The visual checks of fire alarm points and emergency lighting equipment has been recorded and undertaken at appropriate intervals to ensure the safety of the residents. However, the home’s fire extinguishers had been visual checked monthly until November 2005 and then records had stopped. The maintenance person and manager stated that they had been told these visual checks were not necessary anymore. The inspector strongly advised them to seek clarification from Hampshire Fire And Rescue Service regarding the correct frequency for visual checking equipment. The manager organises and undertakes ‘in house’ training on fire safety and records were seen showed that most staff had received the necessary training but not all staff have participate in a drill. It was noted that three of the ‘in house’ training sessions had not been dated. The manager stated that twice a year staff attend the external fire safety officers training that in January 2006 when the officer filled a corridor full of smoke and staff complete a series of fire safety related tasks. The home has a satisfactory reference file for the Control of Substances Hazardous to Health (COSHH) information leaflets for each chemical being utilised within the home. However, on the tour of the home a simple detergent used for cleaning toilets was found in a resident’s en-suite. The manager removed this and confirmed that the cleaner had recently been in cleaning. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 28 The home’s records for reporting injuries and incidents were appropriate. The incident records matched the Care Homes Regulation, regulation 37 reports. The trend of higher number of residents’ falls occurred during period (mainly the evening) when staffing levels were low. This was discussed with manager and owner who agreed that they would review this as part of the staffing level review. It was noted that one new member of staff was moving two residents with one or both foot plates not being used. Other staff were seen moving residents in wheelchairs appropriately with the foot plates. This observation was pointed out to the manager who stated she would instruct the new member of staff in the correct use of wheelchair footplates. Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 OP19 Regulation 23(2) (b)(d) 13(4) (a)(c) Requirement The home must ensure that the environment is with in reason free of hazards and kept in a good state of repair with quality furnishings. This includes repair or replacement of broken and damaged future and fixings, replacement of warn and damaged furnishings. The home must ensure that practices within the home prevent the spread of infection. Timescale for action 01/09/06 2 OP26 23(2)(d) 13(3) 30/06/06 3 OP27 18(1)(a) Communal hand washing facilities must have disposal had drying system and liquid soaps. Each toilet must have a supply of toilet paper. There is a system in the home to eliminate offensive odours and manage residents’ behaviour regarding poor hygiene practices. The home must ensure that 30/06/06 there are sufficient numbers of staff on duty at anyone time to meet the needs and promote the dignity of residents. DS0000012320.V296637.R01.S.doc Version 5.2 Page 31 Shedfield Lodge 4 OP38 13(4) (a)(c) The home must ensure that all service users are kept safe and unnecessary risks are eliminated. The premises must be made safe and secure to ensure that the named service user is not put at risk through their wandering. 30/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Shedfield Lodge DS0000012320.V296637.R01.S.doc Version 5.2 Page 33 - 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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