Inspection on 15/01/08 for Sheldon House

This inspection was carried out on 15th January 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sheldon House 02/06/09

Sheldon House 19/06/08

Sheldon House 11/09/07

Sheldon House 20/09/06

Sheldon House 20/03/06

Sheldon House 29/09/05

Sheldon House 08/02/05

Sheldon House 09/09/04

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

CARE HOMES FOR OLDER PEOPLE Sheldon House Sea View Road Falmouth Cornwall TR11 4EF Lead Inspector Kerensa Livingstone Unannounced Inspection 15th January 2008 09:00 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 Sheldon House DS0000008894.V356825.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. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sheldon House Address Sea View Road Falmouth Cornwall TR11 4EF 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) 01326 313411 01326 317902 sheldon@comfortcaregroup.co.uk Mr Charles Barry Libby Mrs Anne Louise Libby, Mr Darren Libby Mrs Doreen Ann Peters Care Home 34 Category(ies) of Dementia - over 65 years of age (34), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (34) Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th September 2007 Brief Description of the Service: Sheldon House is a long established care home and is registered to provide nursing care for up to 34 people who experience dementia or enduring mental illness who are over the age of sixty-five years of age. The current owners have run the home since November 2000. The accommodation is a former hotel that was initially converted around 1994 and since then has undergone further structural changes. It is located on a quiet residential road close to the town and beaches of Falmouth. It is easily accessible on foot and by transport from the town, this results in frequent visits to the home by relatives and friends. There is a car park at the front of the home and an attractive garden area. The accommodation is provided over three floors and is accessible to people who experience a disability by two shaft lifts. The building is not the best design to provide the care and support required by residents. The layout does not easily lend itself to meeting the needs of residents. The bedrooms are for both single and shared occupancy. There are three communal areas are provided on the ground floor. One of these areas is used as a dining room. There is a small patio area to the rear of the home, which is accessible to residents. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. This was an unannounced key inspection that was undertaken by two inspectors over one day. The inspectors looked at records, care documentation, Policies and Procedures and inspected the environment. The inspectors met and talked with the residents, Manager, staff and relatives visiting the home. The inspectors made direct observations of the care and support and the manner in which the staff interacted with residents. An Annual Quality Assurance Assessment (AQAA)) was completed prior to the previous Key inspection which was conducted on the 11th and 12th of September. Residents and relatives information was gathered using questionnaires at this time. The Registered Manager has left the home since the last inspection. A new Manager has been appointed. The Commission for Social Care Inspection is awaiting confirmation of the interim management arrangements from the registered persons. An improvement plan was submitted following the last Key Unannounced Inspection in September. This report contains requirements that were set at the previous inspection, where the requirements have not been met they are renotified and a new date set. Where the dates set are still current, these dates have been carried over to enable compliance within the timescales. Additional requirements have been added from this inspection. The timescales for the improvement plan have been discussed and agreed with the registered persons. What the service does well: Residents have their needs assessed prior to moving into the home. Visitors are welcomed to the home at anytime. Complaints are listened to and acted upon. Feedback is sought from people who use the service. Staff and residents or their representatives have opportunities to contribute to the running of the home. A high percentage of staff have achieved their National Vocational Qualification level 2 and/or 3. The recruitment procedures are generally robust to safeguard residents. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Prospective residents are not provided with comprehensive information to enable them to make an informed choice of home. The residents value the activities provided, these are being extended and must meet the needs of all the residents. Mealtimes are not conducive to a relaxed and social occasion where independence is encouraged. Residents are not consistently safeguarded by the existing arrangements in the home. The plan of care is not adequate to lead and direct the care to meet individual needs. Residents and/or their representatives must be enabled to make decisions about their lives. Medicines must be administered safely, as per the home’s policies and procedures. Some individual’s right to privacy and dignity is compromised. There is no registered manager for this home. Residents do not have direct access to their own money. Risk assessment practices require improvement. The current environment is unsuitable and does not meet the needs of the resident. Individual accommodation could be made more homely and comfortable. There is not adequate storage for equipment. There are areas of the home, which require tidying up, cleaning or redecoration. The numbers of staff on duty are not adequate to meet the needs of the residents. Training is actively encouraged and facilitated; this must incorporate induction, post registration training and training specific to the people who live at Sheldon House. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prospective residents are not provided with comprehensive information to enable them to make an informed choice of home. Residents have their needs assessed prior to moving into the home. EVIDENCE: At the inspection in September the inspector was informed that the Service User’s Guide was not being provided to new residents and had not been for a considerable period of time. The Statement of Purpose was out of date. A draft Service user’s guide and Statement of Purpose were provided following the last inspection, this document is due to be finalised and made more user friendly. The Service User’s Guide must include a copy of the most recent inspection report and details of the qualifications of the Manager and staff. Service user’s views of the home have been included to the Service user’s Guide. All prospective residents must be provided with a Resident’s Guide that includes Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 10 the required information. The Statement of Purpose must include all the required information e.g. physical environmental information. At the last inspection there were concerns that the collective needs of the existing residents need greater consideration when assessing a prospective resident. There is evidence that new residents are being admitted to the home following a detailed assessment by a qualified nurse. Additional information is gathered as required. Intermediate care is not provided at this home, there are no designated facilities or staff. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The plan of care is not adequate to lead and direct the care to meet individual needs. Residents and/or their representatives must be enabled to make decisions about their lives. Medicines must be administered safely, as per the home’s policies and procedures. Some individual’s right to privacy and dignity is compromised. EVIDENCE: The resident’s plans are currently being reviewed, they are more person centred than at the last inspection. More detailed information is being included to ensure that staff are aware of the action to be taken, however there were areas such as promoting personal hygiene and mental health where the action required was not recorded. All aspects of the health, personal, psychological and social care needs of the person must be included. There is little evidence of resident and/or representative involvement in the planning or reviewing of the care plans. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 12 All residents are registered with a General Practitioner. There is clear evidence that advice is sought from the General Practitioner and Mental Health Services as required. Nutritional screening is being undertaken and there was evidence that action is taken where there is concern about weight loss. A qualified mental health nurse is on duty at all times. Advice is sought from the District Nurse team on general health issues. No continence assessments are undertaken, evidence should demonstrate how continence is promoted. Staff are not always guided as to which type of continence pad residents use and it was observed during the inspection that communal pads are stored in some areas. In one person’s wardrobe, a list was inside the door detailing the type of pad required and how often – this was different to the pads stored within the room. All medication is administered by a qualified nurse and a Monitored Dosage system is used. At this inspection, the administration of morning medication was observed. It was noted that the morning medicines took until lunchtime to be administered to all people who required them, this could have consequences for people who require their medication at regular intervals. The trained nurse on duty must administer named medication directly to the person for whom it is prescribed to avoid risk of error. Medication administration records (MAR) were inspected and found to be accurate. However, it was not possible to audit some medicines which had not been administered, as the previous months MAR sheets were not readily available. A record of staff signatures are kept and a photograph of each resident is kept on the medication sheets. Records of medication received and disposed of are being kept. The room designated for the storage of medicines is very small and difficult to manoeuvre in. There is a designated member of staff responsible for ordering the medicines. There are policies and procedures in place; these were not inspected in detail at this inspection. There is a designated fridge to store medication that requires this facility, temperatures are checked daily. There are two Controlled Drugs (CD) cupboards, and a spot check of this medication showed that it was stored and recorded correctly. The Controlled Drugs Register index was full and it was unclear which medicines were recorded in the register. It was noted at the last inspection some items were overstocked and medicines were kept for sometime whilst waiting to be destroyed, this remains the same. Staff were observed to knock on resident’s doors prior to opening them. Screening is provided in double rooms. In shared rooms residents also share wardrobe space with the wardrobe being divided by a piece of wood – this does not give the person privacy or personal space. Some staff were observed to talk over or use their radios whilst assisting the resident. Some staff used the terms ‘darling’ ‘love’ and ‘mate’ in preference to the resident’s preferred name. The inspector observed that the privacy and dignity of some residents was compromised for unnamed toiletries were observed in the bathrooms. No lockable facility is provided in each resident’s room and residents are actively discouraged from having any money or Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 13 valuables in the home. A review of the call bell provision must be conducted to ensure that residents are able to call for assistance when they need it. Sheldon House DS0000008894.V356825.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents value the activities provided, these are being extended and must meet the needs of all the residents. Visitors are welcomed to the home at anytime. Mealtimes are not conducive to a relaxed and social occasion where independence is encouraged. EVIDENCE: There is a part time (18 hours) activities coordinator who works hard to meet the needs of the residents. Resident’s interests are recorded and a record is kept of the activities undertaken. In the last month the activities included bingo, doing jigsaws, having a manicure, spending time reading/ writing/talking one to one. On the day prior to the inspection a church service was held with thirteen residents attending. At the last inspection there were plans to commence a physical activity group, this is yet to take place. Some individuals are given opportunities for stimulation through leisure and recreational activities in the home; this must be extended to include all residents. Due to the complexity of needs of the individuals, the current staffing hours for this area are not adequate to meet the resident’s needs, we were informed that this is under review. Life stories are available for some residents to provide staff with information about past interests and history – Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 15 these are not all completed at the time of inspection. Residents and relatives have commented that they would like to go out of the home on outings. Care staff organise themed days, where staff dress up in costume and activities are arranged. Visitors are able to visit at anytime. The main door to the home is locked, however regular visitors are provided with a pass key to enable them to enter the home. One relative commented how they were able to visit at anytime and often had a cup of tea. No written information is being given to relatives currently about the home’s policy on maintaining relatives involvement with residents at the time of moving into the home. This is due to be addressed when the Resident’s guide is finalised. Residents are able to bring in personal affects to the home. No advocates are utilised regularly. Staff are due to attend Mental Capacity Act training, which may help clarify some issues where due to capacity, consent is being obtained from a third party. Some individual accommodation was observed to be impersonal. The menu on the day of the inspection was Beef and vegetable stew with dumplings or Cornish pasty followed by Forest fruit ripple. The Chef/cook works from 09.30 until 6pm and is supported by a kitchen assistant. Breakfast is provided by the care staff, which is porridge, boiled egg, cereals or toast. The menus operate a three-week rotation. Since the last inspection the menu has been reviewed and offers a varied diet of wholesome and nutritious food. Residents are offered a clear choice of main course, the menu for the day is written on the board in the lounge for the residents and their visitors to see, all the choices that are available should be written up to enable residents to have a clear choice of pudding. Fresh fruit is readily available and a fruit salad is offered at teatime mid afternoon. Special diets are provided as required. Food records have been commenced since the last inspection and must be kept for all residents including special diets. One of the communal rooms is being used as a dining room, however on the day of the inspection there were only three people sat at the table for lunch. The care staff continue to serve lunch to residents in their individual rooms and the other two lounges as well as assist individuals to eat their lunch. The lunchtime was observed to be noisy, residents eating at different times and without a drink. Staff were observed to be having conversations on their radios whilst assisting an individual with their lunch. The lunchtime did appear less hectic and rushed in comparison to the last inspection. The current arrangements are not conducive to a relaxed and social occasion where independence is encouraged. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are listened to and acted upon. Residents are not consistently safeguarded by the existing arrangements in the home. EVIDENCE: There is a complaints procedure, this should state that the complainant can contact the Commission for Social Care Inspection or Department of Adult Social Care at anytime. A record is kept of any complaints with the investigation details and outcome. The inspector was informed that the home has not received any complaints since the inspection in September. At the last inspection one complaint had been received and been resolved. The Commission has not received any formal complaints since the last inspection. Records informed us that a relative had raised a concern and was reassured by a member of staff – this was not recorded within the complaints log. There is a protection of vulnerable adults procedure in place. All concerns must be reported to the Department of Adult Social Care as required by the Safeguarding procedures operating nationally. There is a whistle blowing policy. At this inspection it was not possible to evidence that all staff had been provided with Protection of Vulnerable Adults training, this is provided on a rolling programme as part of the company’s training. The Manager plans to reorganise training records to enable this information to be readily available and forward this to the Commission for Social Care Inspection. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26.Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The current environment is unsuitable and does not meet the needs of the resident. Individual accommodation could be made more homely and comfortable. There is not adequate storage for equipment. There are areas of the home, which require tidying up, cleaning or redecoration. Specialist equipment is provided based on individual need. EVIDENCE: The home is a three storey building with the communal areas located on the ground floor. The layout of the home has significant limitations in providing good quality services and facilities. This has been recognised by the providers who are also aware that the layout of the building does present certain limitations and challenges in creating a homely and comfortable setting for residents. Previous timescales to address the unsuitable environment have not been met and no immediate work is due to start. Several relatives have Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 18 concerns about the suitability of the environment, one commented that a ‘purpose build premises would help the home improve’. The outside areas to the rear of the building require tidying up. A window frame was observed to be in a poor state to the rear of the home. An open garage was observed to be full of equipment including commodes, toilet, wash hand basin, hoists and wheelchairs. At the rear of the home next to the laundry, there were five large bins, empty vegetable oil container and a skip full of rubbish. There are parts of the home that would benefit from redecoration and to be made more comfortable or homely. Since the last inspection one of the lounge areas has become a dining room. There are two lounge areas, on the day of the inspection one lounge only was used until lunchtime. The inspector was informed this has been initially due to staff shortages, this was remedied. These areas are light and comfortable although the laminate flooring echoes any sounds. The outdoor space to the rear of the home is enclosed, it is small and requires some attention to make it pleasant for the residents. The bathrooms are clinical, they would benefit from redecoration and modernisation to make them more welcoming and homely. Bathrooms were observed to house communal toiletries, mattresses, zimmer frames, commodes and pads. Several bathrooms were unusable due to the items that are stored in them. One toilet was inaccessible due to mattresses being stored inside, one of which had blocked the doorway. Toilets were noted to be dirty, with severe staining to the toilet bowl in some. Odours were noted in many of the toilets. Some toilets that do not have natural ventilation require the ventaxia to be cleaned and checked to make sure they are working properly. There are only a small number of rooms that have ensuite facilities – it was noted that generally these were locked and not accessible by the people using the rooms. One ensuite bath was filled with equipment, clothing and old suitcases belonging to people who no longer live at the home. Furniture and equipment was observed stored in corridors and bathrooms. Some chairs and mats were soiled and required washing. Specialist equipment is obtained on an individual basis, hospital beds and pressure relieving mattresses are provided for people who need them. Some resident’s rooms were observed to need repairs or redecoration e.g. curtains rehanging and furniture mending or replacing. One room had a sink unit that was in a state of disrepair with rough edges and doors that do not close properly – this could be a risk to both staff and residents. Residents who choose to remain in their own room were observed to be unable to call for assistance if they required it, due to not having a call bell. At the last inspection it was identified that the call bells did not have extension leads to enable residents to use them, as they are used for plugging in alarmed mats to alert staff. It was identified that this practice should be reviewed and based upon a risk assessment. This has not been done. The use of linoleum rather Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 19 than carpet in bedrooms should be based upon risk assessment and dependant on individual need. No lockable storage is provided within individual rooms. Some rooms have a locking facility on the door, the key to these locks is the same as the general one carried by all staff to access all areas of the home. None of the residents currently holds a key, therefore are not able to secure their room, no evidence was available to demonstrate if people have been asked if they wished to hold a key for their room. The manager told the inspectors that these locks are not used by staff. One room was observed to have an external lock, the manager stated this would be removed as it was obsolete. Reference was made within daily records to a concern about a person not being able to leave the room if they wished to at night, this was not reflected in the complaints log and the manager told us that the door would not be locked at any time. At the last inspection it was recommended that an audit of the furniture in each room be audited as some rooms are very basic, this has not been done. Some areas were observed to need cleaning and dusting in the home. The hall carpet is stained and needs to be replaced. It is not clear how infection control is fully managed within the home regarding the cleaning of commodes. Macerators do not appear to be used and staff told us that they had not had clear instruction on how or where to clean commodes. Some clothing was noted within resident’s wardrobes that was soiled and personal clothing was observed to be untidily stored in their wardrobes and chests of drawers leaving it creased. The laundry is a large room separate from the main building. There are two industrial washing machines and two dryers. Red disposable bags are used for soiled laundry. All bed linen and towels are sent out to be laundered. The flooring and walls in the laundry are permeable and poses an infection control risk. Systems in place within the laundry do not always help to reduce the risk of infection e.g. dirty washing being sorted on the floor and wet laundry that has been sluiced put on the floor until bagged for external laundering. There is a designated member of staff working in the laundry every day of the week. It was observed that a number of slippers were in the laundry having been laundered and not returned to their owners – some did not appear to have a name inside to identify their owner. Clean washing is sorted into named baskets to return to individual bedrooms for storage, some personal clothing is hung directly onto hangers within the laundry e.g. cardigans and ironing is carried out within the laundry. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 &30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty are not adequate to meet the needs of the residents. The recruitment procedures are generally robust to safeguard residents. Training is actively encouraged and facilitated, this must incorporate induction, post registration training and training specific to the people who live at Sheldon House. A high percentage of staff have achieved their National Vocational Qualification level 2 and/or 3. EVIDENCE: There were twenty eight residents at the home on the day of the inspection. On the day of the inspection there were two nurses and five carers on duty in the morning, the inspector was informed this was due to sickness. Another carer came on duty to increase the numbers to six. Senior carers have been appointed and were observed to be left on the floor in charge of the delivery of care and allocation of staff resources. There was one housekeeper on duty from 08.00 –12.00 and another from 3.30. The minimal housekeeping cover was raised at the last two inspections. The care staff were observed to be under considerable pressure during the inspection to complete the work required. The inspectors were concerned that there were inadequate housekeeping or catering hours to meet the needs of the residents. This placed an additional unreasonable burden on the care staff. The maintenance person and activity person are shared between this home and the sister home. Relatives were very positive about the staff, one stated ‘they really do care Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 21 about the residents’ and another relative said ‘the staff are really good’. The catering and laundry staff must be clearly included on the rota, as well as the Registered Manager. Fourteen night shifts were available as extra hours over two week period. All staff are encouraged to participate in training including their National Vocational Qualification (NVQ) level 2 or level 3 training. Eight staff have achieved their NVQ level 3 and seven have NVQ level 2. A thorough recruitment procedure was evident at the home, all files examined contained a completed application, health declaration, at least two written references, Criminal Records Bureau checks and a record of the interview, with the exception of one who had only one reference. The Manager undertook to chase this up as a priority. All staff receive a contract. No volunteers work in the home. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is no registered manager for this home. Feedback is sought from people who use the service. Staff and residents or their representatives have opportunities to contribute to the running of the home. Residents do not have direct access to their own money. Risk assessment practices require improvement. EVIDENCE: The Registered Manager has left the home since the last inspection. A new Manager has been appointed, this is an existing member of staff who has been promoted internally. Staff meetings are held. There are regular senior management meetings. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 23 A comprehensive quality assurance audit took place in May of this year taking account of the views of staff, relatives or representatives, residents and professionals visiting the home. This information has been analysed, opportunities for improvement identified and a suitable action plan established. At the last inspection the inspector was informed that three monthly residents forums are held. The Registered persons conduct regular visits to the home; one report has been forwarded to the Commission for Social Care Inspection since the last inspection, this was in November. During this inspection, it was observed that personal information relating to residents are not always stored securely. An unlocked filing cabinet is stored in the reception area which holds personal records of residents. An empty bedroom was observed to have residents personal files on the bed, with no member of staff in the area. The office was left unlocked on several occasions throughout the day with no member of staff in the room. Labels inside wardrobes named residents who no longer lived at the home. A Fireboard listing resident’s names is visible in the reception area. The inspector was informed that resident’s monies are not held in the home and that no monies are received on behalf of the resident. There is no lockable facility for residents to keep money. Since the last inspection notifications of any event, which adversely affects the wellbeing, or safety of any resident have been forwarded to the Commission as required. The Manager stated that he would be the lead for health and safety within the home, with other member of staff having specific roles e.g. fire safety is managed by a senior carer. The emergency lighting in the home is tested monthly and a record kept. It was observed that the external covered fire escape is dimly lit in places and the manager told the inspectors that he would check on this. The fire alarms are tested weekly with a record kept. A record is kept of fire training for all staff. Evidence of maintenance and servicing were not readily available for inspection for example hot water valve restrictors were being checked however records were not available to show this and a legionella check has been made, no results were available from the sample taken in November 2007. The manager was aware of this. While most radiators appeared to be covered, several portable heaters of varying types were seen throughout the home – these pose a significant risk to residents from trailing leads and the possibility of burns. Window restrictors were observed throughout the home, the manager said that there was no written risk assessment around the use of restrictors or where they were located. The manager agreed to forward written evidence of Portable Appliance Testing (PAT) as it was not available at the time of the inspection. No evidence was available to show that gas appliance checks have been made or that electrical hardwiring has been carried out in the last five Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 24 years. There is one maintenance staff member, who also provides maintenance cover for the sister home. There are two designated moving and handling trainers, the Manager believed all staff were up to date with their moving and handling training and plans to coordinate records to demonstrate this. During the inspection some moving and handling practices were observed caused some concern as they may place the resident and staff members at risk of injury – these were discussed with the manager who stated he would address this. Individual records are kept of health and safety training; this is provided to staff by the manager as part of the rolling programme of training and followed up with a questionnaire for staff to complete. At the last inspection there were concerns regarding the number of incidents, these are being reviewed. The manager told us that COSHH assessments are completed and kept under review; these were not inspected on the day of inspection. It was observed that a cupboard containing COSHH material was left unlocked and unattended during the day – this was raised with the manager. Environmental risk assessments are being compiled, however when the risks are identified, there is no evidence that the actions needed to minimise the risk are taken and subsequently that they are reviewed on the date identified as the review date. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 25 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 1 2 1 2 X 1 X 1 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X 1 1 Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 5 Requirement The registered person shall produce a written guide to the care home, which shall include the information detailed in this regulation. A copy of this document must be supplied to the Commission and each resident. Previous timescales not met 01/12/07 Timescale for action 01/05/08 2. OP1 4, Sch.1 The registered person shall compile in relation to the care home a written statement which shall consist of the matters listed in Schedule 1. A copy of this document must be supplied to the Commission. Previous timescales not met 01/12/07 01/05/08 3. OP7 15(1) The registered person shall after consultation with the resident or representative prepare a written plan as to how the resident’s needs in respect of his health and welfare are to be met. The resident’s plan must be made available to the resident and kept under review. Previous timescales not met 30/12/06 DS0000008894.V356825.R01.S.doc 01/03/08 Sheldon House Version 5.2 Page 27 4. OP9 13(2) 5. OP10 12(4) The registered person shall make 01/05/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. The registered person shall make 01/03/08 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of residents. Previous timescales not met 01/12/07 6 OP12 16(2) The registered persons shall 15/04/08 make arrangements for residents to engage in local, social and community activities. They will provide facilities for recreation and activities, having regard to the needs of the resident. Previous timescales not met 01/12/07 7. OP15 17(2) Sch.4 The registered person is required to keep records of food in sufficient detail to enable any person inspecting the record to determine that the diet is satisfactory, in relation to nutrition or otherwise and any special diets. Previous timescales not met 01/10/07 01/03/08 8. OP18 13(6) The registered persons shall make arrangements to prevent residents being placed at risk of harm or abuse. Previous timescales not met 01/10/07 01/04/08 9. OP19 23(2) 10. OP19 23(2)(b)( d) The registered person shall not use the premises for the purposes of a care home unless the physical design and layout of the premises to be used as the care home meet the need of the residents. The registered person shall ensure that the premises used are of sound construction and all DS0000008894.V356825.R01.S.doc 01/04/08 01/04/08 Sheldon House Version 5.2 Page 28 11. OP20 13(4) 23(2) 12. OP21 23 13. OP22 23(2l) parts of the care home are kept clean and reasonably decorated. Previous timescales not met 30/03/07 The physical design and layout of 01/04/08 the premises to be used as the care home meet the needs of the residents and activities that residents participate in are so far as practicable free from avoidable risks. Previous timescales not met 30/03/07 The registered person shall 01/04/08 having regard to the number and needs of the residents ensure that there are provided at appropriate places in the premises sufficient number of lavatories and of wash hand basins, baths and showers fitted with a hot and cold water supply. This information is to be provided to the Commission. 01/04/08 The registered person shall provide suitable storage for the purposes of the care home. Previous timescales not met 01/12/07 14. OP24 16 15. OP26 16(2k) The registered person shall provide rooms occupied by residents with adequate furniture, bedding and furnishings and equipment suitable to the need of the residents. The registered person shall keep the care home free from offensive odours. Previous timescales not met 01/12/07 01/04/08 01/04/08 16. OP27 18(1a), 17, Sch.4 The registered person shall having regard to the size of the home, the number and needs of the resident ensure that at all times suitably qualified, competent and experienced persons are working at the care DS0000008894.V356825.R01.S.doc 01/04/08 Sheldon House Version 5.2 Page 29 17. OP30 18(1c) home in such numbers as are appropriate for the health and welfare of the residents. These must be recorded on the duty rota. Previous timescales not met 01/10/07 The registered person shall ensure that staff are provided with the training appropriate to the work they are to perform e.g. Skills for care induction, post registration training, specific role training. Previous timescales not met 01/12/07 01/06/08 18. OP31 8 19. OP37 20. OP38 The registered provider shall 01/03/08 appoint an individual to manage the care home where he is not in full time day to day charge of the care home. The registered persons shall inform the Commission for Social Care Inspection of the interim management arrangements. Data States that anyone who 01/03/08 Protection processes personal information Act 1998 must comply with eight principles, for example make sure that personal information is secure. Confidential information must be locked away securely. 13(4)(a-c) Satisfactory risk management 01/03/08 and risk assessment arrangements must be put in place. Previous timescales not met 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 30 No. 1. 2. 3. 4. 5. Refer to Standard OP8 OP9 OP15 OP21 OP24 Good Practice Recommendations For assessments to be undertaken by a suitably qualified person to promote continence. For the room used for the storage of medicines to be rearranged or reprovided to meet the needs of the staff. For residents to be offered a clear choice of pudding at mealtimes. For the bathrooms to be updated and made more homely and comfortable. For an audit of each room to be conducted to ensure that they are provided with the fittings and furnishings that the resident requires as detailed in NMS 24 including a call bell. For the floor and walls of the laundry to be impermeable. For evidence that the portable appliance testing has been completed to be forwarded to the Commission on completion. 6. 7. OP26 OP38 Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 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 © 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 Sheldon House DS0000008894.V356825.R01.S.doc Version 5.2 Page 32 - 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. 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