Inspection on 27/05/08 for Shelburne Lodge

This inspection was carried out on 27th May 2008.

CSCI found this care home to be providing an Excellent service.

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

Shelburne Lodge 05/06/07

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shelburne Lodge Rutland Street High Wycombe Bucks HP11 2LJ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Chris Sidwell     Date: 2 7 0 5 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 25 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 25 Information about the care home Name of care home: Address: Shelburne Lodge Rutland Street High Wycombe Bucks HP11 2LJ 01494 440404 01494 449562 shelburne@barchester.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable): Type of registration: Number of places registered: Barchester Healthcare Homes Ltd Mrs Pam Camichel care home 54 Conditions of registration: Category(ies) : Number of places (if applicable): Older People (over 65 years old) who are 54 not covered by any of the other categories Additional conditions: That as of the 21st of October 2005 the home is registered to to admit Service Users over the age of 55 respite care only. That the home is able to admit service users between the ages of 60 and 65 0 5 0 6 2 0 0 7 Date of last inspection Brief description of the care home Shelburne Lodge is a care home providing nursing and personal care up to 54 elderly people. The home is located in a residential area in High Wycombe, a short distance from the local shops, amenities and public transport networks. The home is purpose built and consists of a two-storey building set in small grounds. All the bedrooms, except for two, are single rooms and have en suite facilities.The communal space is pleasant and the gardens are well maintained. There is qualified nursing staff on duty at all times, supported by a team of carers. There is an experienced management team in place overseeing the running of the home.The home has its own mini bus ensuring easy access to local amenities. Care Homes for Older People Page 4 of 25 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was conducted over the course of five days and included an unannounced visit to the home. The key standards for older people’s services were covered. Information received about the home since the last inspection was taken into account in the planning of the visit. Prior to the visit, the manager completed an annual quality assurance self-assessment and questionnaires were distributed to residents, visiting health and social care professionals and staff. Responses from two residents had been received at the time of writing this report. Residents and families were also spoken to on the days of the unannounced visit. Discussions took place with the manager, nursing, care and ancillary staff. Care practice was observed. A tour of the premises and examination of some of the required records was also undertaken. The homes approach to equality and diversity was considered throughout. Care Homes for Older People Page 5 of 25 What the care home does well: What has improved since the last inspection? What they could do better: Barchester Healthcare should review its infection control policies and procedures to ensure that they are line with the latest guidance from the Department of Health. The guidance is available on the departments website www.dh.gov.uk. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk.You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line – 0870 240 7535. Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection care home Page 8 of 25 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is information avalable to residents and their needs are assessed before they move to the home, to help them decide whether the home can meet their needs. Evidence: The home has information available to potential residents in the form of a statement of purpose, service users guide and coloured brochure. These are displayed in the front entrance of the home and are sent to potential residents on request. The manager said that she or her deputy visits potential residents before they move to the home to meet them and to assess their needs with them. The assessment documentation is comprehensive and had been completed in full. Potential residents and their families may visit the home prior to moving to the home, although many move following a stay in hospital. Respite care can also be offered if a room is available. The manager felt that this could be a good way for residents to see whether Care Homes for Older People Page 9 of 25 they liked the home and whether they would like to consider a permanent move at a later stage. One family member was spoken to and she confirmed that they had been given information before moving to the home. She had visited several homes and was happy with their choice. She commented that the ‘staff have worked hard to help my family member settle in’. The home does not offer intermediate care for those in need of rehabilitation. care home Page 10 of 25 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Resident’s personal, healthcare and medication needs are met, promoting their dignity and wellbeing. Evidence: The care of five residents was followed through. All had care plans, which had been updated regularly. Resident’s personal and healthcare needs were identified, risk assessments were undertaken and a plan to address these was documented. Residents had had a nutritional assessment, had been weighed regularly and those who had more that one weight recorded had maintained their weight since moving to the home. One resident was underweight although her weight was stable. This had been recognised and she had been assessed by a dietician and her swallowing reflex had been assessed by a speech and language therapist. Resident’s risk of developing pressure damage was assessed and documented. Two of Care Homes for Older People Page 11 of 25 the residents whose care was followed through were at risk and had been given the appropriate pressure relieving mattress and chair cushion. One resident had severely ulcerated legs due to vascular disease and had been referred to the appropriate Primary Care and hospital professionals. There was evidence in the care plans that they general practitioner visits regularly. There are medication management policies and procedures in place and the staff spoken to were aware of these. Storage facilities are satisfactory. Records are kept of medication entering and leaving the home. The medication administration records are accurately completed. Controlled drugs are stored satisfactorily and all entries to the controlled drug register are signed. A contract is held for the disposal of unused medication. The registered nurses spoken to said that medication was not administered covertly. If a resident refused medication this would be recorded. If the medication was essential and the resident lacked the capacity to make to the decision, the doctor and family would be informed and a way forward agreed. There is a clinical incident reporting system in place to address any error in medication. The nursing staff wear red tabards to show that they are administering medication to discourage others from interrupting them. None of the residents were managing their own medication on the day of the unannounced visit, although the manager said that there were policies and procedures in place to allow for this. Residents were well groomed and their clothing was in a good state of repair. Staff were observed to be courteous to them and to respond to their wishes promptly. The residents spoken to said that they did not have to wait long for a response to their call bell although they all said ‘they are very busy’. One said I sometimes wait longer at night. All the residents seen had a call bell within reach. Residents said that their care is given in their rooms and that they always see the doctor in their rooms. care home Page 12 of 25 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home offers flexible care, in line with resident’s abilities and supports their autonomy. There is an activities programme to bring interest and activity to the day for residents. The standard of food is good and mealtimes were seen to be a sociable, relaxed time for residents. Evidence: There are two activities coordinator in post, one full time and one part time. They arrange a programme of activities, which include games, quizzes, silk painting, coffee mornings and drama. A minibus is available to take residents shopping. There is regular entertainment, tea parties and individual reminiscence. There is a dedicated hair salon. A social history is undertaken for all residents to support them to remember things that are meaningful for them and to give carers greater understanding of residents likes and dislikes when they cannot articulate them for themselves. One resident hashis own greenhouse, which he said he enjoyed. Residents said that they had a choice and could choose not to participate in organised activities if they preferred. Care Homes for Older People Page 13 of 25 Families said that they could always see their family member in private if they wished and confirmed that they were made welcome at any time. Information about local advocacy services was displayed in the front entrance of the home. There is a varied menu, which is changed to reflect the seasons. There is a choice of breakfast and a choice at supper of a light cooked meal or soup and sandwiches. Late night drinks with biscuits are served. There is a choice of main meal and most food is ‘home cooked’. The assistant chef was aware of residents likes and dislikes and said that he could always offer another alternative if necessary. He said that he could provide meals to meet resident’s cultural and religious needs and endeavoured to provide variety on the menu. There was usually a vegetarian option. The dining room has been recently redecorated and the tables were laid up well with good quality tablecloths, cutlery and crockery. Aids such as plate guards were available to support resident’s independence. A member of the care staff sat at each table to help residents. They were observed to be helping those who could not eat unaided discretely. Residents said that they enjoyed their meals saying ‘the food is very good’, ‘plenty of choice’, ‘they cook what I like’, ‘I have egg and bacon at the weekends’. Residents can choose whether to eat in the dining room or in their rooms. One resident said ‘I like to go downstairs for lunch, I sit at the chatty table’ care home Page 14 of 25 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are complaints, whistle blowing and safeguarding policies and procedures in place to protect residents from harm and to respond to their concerns. Evidence: There are complaints policies and procedures in place. The manager said that she records both verbal and written complaints. The complaints records were seen. Verbal concerns are recorded and clear action plans are described to address the issues. Both families spoken to on the day of the unannounced visit said that they knew who to speak to if they were unhappy. One family member said that the ‘managers and staff are very open and helpful’. Another said I couldn’t fault them they are very responsive to our wishes. The home has an up to date copy of the local multi agency strategy for safeguarding vulnerable adults. Most staff have had safeguarding training and those spoken to said that they would have no hesitation in reporting any concerns about resident’s welfare. The manager and deputy manager are undertaking updated safeguarding training with the local authority. There are whistle blowing policies and procedures in place. The home is secure and the manager said that restraint was not used. None was observed. The Commission for Social Care Inspection has been notified of one complaint since the last inspection and has not been notified of any safeguarding allegations made to Care Homes for Older People Page 15 of 25 the local authority, which is the lead agency in these matters. care home Page 16 of 25 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is modern and provides a clean and comfortable home for residents. They are supported to personalise their own rooms in line with their own tastes and memories. Their clothes are cared for protecting their dignity and self esteem. Barchester Healthcare should review their infection control policies and procedures to ensure that they are in line with the latest guidance from the Department of Health. Evidence: The home is purpose built on two floors. All rooms are single and have ensuite toilets and showers. There is a rolling programme of redecoration and the home is in a good state of repair. Residents are encouraged to personalise their rooms and many had chosen to do so. The handyman is very supportive and is able to put shelves and pictures up to help residents create a homely environment. One resident said ‘this is my space and I enjoy it’. Her room was filled with furniture, pictures and ornaments, which brought her happy memories. There are infection control policies and procedures in place, which have been updated since the Department of Health’s latest guidance, which was issued in June 2006. Staff were observed to be wearing protective clothing and were observed to wash their hands and had had training in infection control. The manager said that residents Care Homes for Older People Page 17 of 25 had their own sliding sheets where they needed them. She said that residents who had an infection would have their own hoist sling although other residents might share a sling. Hoist slings are washed regularly. The manager also said that it was Barchester Healthcare’s policy not to issue staff with alcohol hand gel on a routine basis. Barchester healthcare should review the application of their infection control policies to ensure that they are in line with the latest guidance from the Department of Health, which states is available on their website www.dh.gov.uk. This states that ‘alcohol hand rubs should be used at the point of care’ (page 13) and that ‘residents should not share hoist slings’ (page 18). The laundry is well managed and staff said that residents had their own clothes. The laundress has an excellent system for separating laundry to ensure that it is washed at the correct temperatures. She was supportive of residents and said that it was important to them that they were able to dress well. The home was clean and tidy on the day of the unannounced visit. There were no offensive odours. care home Page 18 of 25 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels are good and there are sufficient well-trained staff to meet resident’s needs. The recruitment procedures are thorough and should protect residents from potentially unsuitable carers. Evidence: There is a consistent staff team who know the residents well. The manager said that she had a full staff complement at the moment. There were three registered nurses on duty and eight carers on the day of the unannounced visit to the home. The rota showed that the home does not use many agency staff. The residents spoken to were very complimentary about the staff saying’ they can’t do enough for you’, ‘they are very kind’ and ‘they always come when I ring the bell’. One family member said that ‘they support both of us’. The care staff are supported by a team of ancillary staff, all of whom were able to describe their role in supporting residents and took pride in doing so. The recruitment files of four recently recruited members of staff were reviewed. All had the required documentation to show that checks as to the potential staff member’s identity and suitability to work with vulnerable people had been undertaken. All had submitted an application form, which showed their work history. Criminal Care Homes for Older People Page 19 of 25 Records Bureau checks had been undertaken and references had been sought before the staff member commenced work. Interview records had been kept. Copies of the staff member’s passport and work permit were on file. There are comprehensive training programmes for staff. The training matrix showed that all staff have had the mandatory training in safe working practices and that staff undertake an induction programme on appointment to the home. The manager said that staff were signed up to the skills for life programme to improve their command of English where necessary. Most of the carers, who had been recruited from overseas, were qualified nurses in their own country, which is seen as the equivalent to the National Vocational Qualification in Care at level 3. They were employed as senior carers. Five of the other carers held the National Vocational Qualifications in Care at level 2. care home Page 20 of 25 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed by an experienced manager who takes the views of residents and their families into account in the running of the home. There are quality assurance systems in place to ensure that the care residents receive is safe and of a good standard and that action is taken when deficits in care are noted. Evidence: There is an experienced manager in post. She is a registered nurse and holds the National Vocational Qualifications in Management at level 4. There is an experienced deputy manager who is also a registered Nurse. The lines of accountability within the organisation are clear. The residents and staff spoken to say that the management team are approachable and responsive to their needs. Families and staff spoke highly Care Homes for Older People Page 21 of 25 of the manager and said that she was approachable and listened to their views. The home has a quality assurance system in place. Regular resident, family and staff meetings are held. The manager and her deputy regularly audit processes in the home. The audits show month on month improvement in care planning and medication management. The organisation also monitors the quality of care by means of regular visits. Residents are spoken to and reports of these visits, with action points are kept. The recommendations made following the previous inspection have been addressed. The home does not manage residents’ financial affairs and there is no facility for residents to hold a personal allowance in the home, unless they keep it in the locked drawer in their rooms. Residents are able to make purchases and to go out and relatives would be invoiced afterwards. There are health and safety policies and procedures in place. Regular health and safety meetings are held with key staff. The information sent prior to the visit showed that service and maintenance records are up to date. Most staff have had moving and handling training, health and safety, food hygiene, infection control and fire safety training. Fire safety records are kept and were up to date. The staff spoken to were aware of the fire evacuation procedures. Risk assessments for safe working practices have also been undertaken. Records are kept of safety checks of hot water temperatures, particularly baths and showers. Accidents are recorded and regular visual hazard checks are undertaken. The maintenance man is very organised and has put in place robust systems to ensure that checks are carried out at the required frequencies and that external contractors visit when required. care home Page 22 of 25 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 23 of 25 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 14 26 Barchester Healthcare should review their infection control policies and procedures to ensure that are in line with the latest guidance from the Department of Health, available from them on their website www.dh.gov.uk Care Homes for Older People Page 24 of 25 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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