Inspection on 19/06/08 for Sheldon House

This inspection was carried out on 19th June 2008.

CSCI found this care home to be providing an Adequate 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 15/01/08

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Sheldon House Sea View Road Falmouth Cornwall TR11 4EF Lead Inspector Melanie Hutton Key Unannounced Inspection 19th June 2008 09:30 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 Sheldon House DS0000008894.V364818.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.V364818.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 Manager post vacant 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.V364818.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th January 2008 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 a shaft lift. 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. However, there is limited scope to improve this within the existing building. 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. Fees charged for the service range form £500 to £850 per week. Sheldon House DS0000008894.V364818.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 one star (1*). This means the people who use this service experience adequate quality outcomes. This was an unannounced key inspection that was undertaken by two inspectors over one day spending a total of twenty hours at the care home. The majority of staff and relatives talked with during the inspection refer to people who use the service as residents. For the purpose of this inspection report this terminology will be respected and used. The inspectors looked at records, care documentation, policies and procedures and inspected the environment. The inspectors met and talked with the residents, registered provider, manager, deputy 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. Ten surveys were received prior to the inspection, one was completed by a resident and the rest by relatives / representatives. We had sent these out before the inspection to seek the views of residents and / or their relatives of the care home An Annual Quality Assurance Assessment (AQAA)) has been completed and returned to the Commission for Social Care Inspection (CSCI). A manager has been appointed for the home and is currently gathering information so that he can complete and forward application to CSCI for the position of registered manager. An improvement plan was submitted following the last Key Unannounced Inspection in January 2008. 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. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 6 The recruitment procedures are robust to safeguard residents. Residents and their relatives / representatives made the following comments regarding their experience of the service provided: “We were given 12 weeks to see how my wife settled in to the home. We were quite satisfied in all aspects, food, sleeping accommodation, and general relaxed and happy feel of the staff”. “The atmosphere of the home is happy and relaxed yet is very efficient. I visit five days a week”. “They are patient and caring – nothing is too much trouble”. “They are very caring and loving” “I am just happy my relative is at Sheldon – he is happy and well care for” “”The carers at Sheldon House are very good and always let me know of anything my relative needs me to bring into her – she is unable to let me know if she needs anything.” What has improved since the last inspection? The last inspection report identified twenty statutory requirements. Of these fifteen are considered to be met. The home has employed an activities co-ordinator and a range and programmed plan of activities has been introduced. Additional domestic staff have been appointed and the home was observed to be clean, hygienic and free from odour during this unannounced inspection. The information provided to residents and their relatives / representatives about the service provided e.g. the service users guide and statement of purpose, has been reviewed and developed. New or prospective residents are now provided with detailed information to help them make a choice about where to live. Care plans have been reviewed and are being transferred into a new system for recording this information. They are now more detailed and informative and provide specific guidance for staff to ensure that individual residents needs are met. Detailed records are held on the food provided to each resident. It is now possible to determine that the diet is satisfactory regarding nutrition, special diets and intake of food for individual residents. Private bedrooms that are being used by residents were observed to have functional furniture and were tidy and clean. Some rooms have been refurbished to a good standard. This has included decoration, replacement of carpets, furniture and curtains. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 7 The training programme has been reviewed and developed. The induction course has been expanded for new staff and additional training provided for staff both internally and from external sources. The home is aware of when update training must take place and has arranged training sessions to ensure that staff are kept up to date. 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. The summary of this inspection report can be made available in other formats on request. Sheldon House DS0000008894.V364818.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.V364818.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, 2, 3 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and / or their representatives are 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. This is so that the home can assure them the prospective resident that they are able to meet their individual care needs. EVIDENCE: We have been provided with a copy of the recently developed statement of purpose and service users guide. We were told that all new / prospective resident’s are provided with this information. One relative advised us that they were aware of this information and had received a copy of the service users guide. This provides people with detailed information about the care home and what they can expect to receive from the service. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 10 It is recommended that the manager is not referred to as the registered manager until such times as an application has been made to and approved by CSCI. Each resident is provided with a contract / schedule of terms and conditions on moving into the home. We were shown a copy of the document that was last updated in December 2007. Signed copies were evidenced on clients files. There is evidence that new residents are admitted to the home following a detailed care needs assessment undertaken by a qualified nurse. Additional information is gathered as required. The care needs assessments are now recorded in the newly implemented standex system. This is a tool for recording information relating to assessing and planning care for individual residents. Information is included within the service users guide and the contract regarding trial visits. Relatives were able to tell us that they were welcomed to view the home prior to their relative being admitted. One comment included in a survey from a relative said “we were given twelve weeks to see how my wife settled in”. Another comment made “Carers and nurses go all out to make newcomers welcome” Staff gave examples of residents who have stayed at the home for a short period prior to moving in permanently. Intermediate care is not provided at this home, there are no designated facilities or staff. Sheldon House DS0000008894.V364818.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The detail included in the new system of care planning directs and informs staff of the action they must take to meet individual residents needs. The homes systems and practices regarding medicines protect residents. Some resident’s privacy and dignity is compromised by the practices and systems within the care home. EVIDENCE: A new system of recording information relating to care planning has been introduced into the home – this is known as the standex system. Each resident has an individual plan of care that details the actions staff must take to meet the assessed needs of residents. Not all of the care planning documentation is recorded within the standex system at the time of the inspection. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 12 The deputy manager and manager told us that it is anticipated the trained nurses will complete the re assessment and written process by the end of June 2008. Relatives who completed surveys and spoke with us during the inspection were able to tell us that they were aware of their relatives care plan. One relative said “It is important to me that the care is given in a way that meets my husbands needs. I have seen the care plan and discussed it with the nurses. Some changes are to be made to it so that staff will know about his very individual needs” We were told by one member of staff “‘It is important that the care plan is written with the relatives involvement, if the resident cannot comment”. Some care plans are signed by the resident or their relative / representative to demonstrate this involvement and agreement with the plan. The care planning documentation includes assessments e.g. mental health, skin integrity and nutritional. Further assessment information and care planning should consistently be in place regarding the promotion of continence e.g. the type of incontinence pad required and the specific assistance a person may need regarding toileting arrangements. A qualified mental health nurse is on duty at all times. Daily records and contact sheets inform us of the external professional support provided to residents including the consultant psychiatrist, community psychiatric nurse, community nurse, general practitioners, dentist, optician and chiropodist. We were told by one external professional that in their opinion the home has improved of late and that it is now cleaner and better managed than it has been previously. Further comments made by relatives in surveys relating to the care provided include “The carer’s more than meet the needs of my mum” “My relative has the love and care she needs, is safe and Sheldon House provides that”. “I visit my husband every day and I see that the carers and nursing staff are excellent in any emergencies” “The care is generally very good but staffing levels are low to provide the care that should be provided”. “I have observed that when a patient requests a visit to the toilet they may be kept waiting for anything up to five / ten minutes while the staff member waits for assistance”. “The doctor is called in if they have the slightest doubt of my wife’s health” One specific comment was made within a survey regarding a resident requiring dental treatment for a loose tooth – this was discussed with the manager who told us that he would look into the matter. A qualified nurse administers all medication and a Monitored Dosage system is used – consideration is being given to changing this system by the home. Medication administration records (MAR) were inspected and generally found to be accurate – there were a minority of records that had not been signed following administration of the medication. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 13 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. 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 is a Controlled Drugs (CD) cupboard, and a spot check of this medication showed that it was stored and recorded correctly. The room designated for the storage of medicines is very small and difficult to manoeuvre in. We were show that work has progressed well to renovate a room within the home so that the medication / clinical room can be moved. The new clinical room will provide a safe working area for staff and ample storage for medication. Hand washing facilities are in place and the room will be secure. Records show that the home has a pharmacy agreement in place with Boots Chemist and the last visit to the home took place in September 2007. Staff were observed to knock on resident’s doors prior to opening them. One resident and their relative are assured of privacy within their bedroom by the staff as detailed within the plan of care. This was also confirmed to us by the relative and staff. Screening is provided in double rooms. The preferred form of address is recorded within the care planning documentation and staff were observed to use this name when speaking with or about the resident. A number of residents – mainly female residents, were observed to have bare legs on the day of inspection e.g. not wearing tights, stockings or socks. The registered provider and manager suggested that this was probably their personal choice. However this was not recorded within individual care planning. It was noted that in the laundry a large amount of unnamed socks and tights had gathered. In some bedrooms there appeared to be a lack of socks / tights available for use. One relative told us that socks do not always get returned to their relatives bedroom. The laundry assistant told us that un named tights and net pants (for use with incontinence pads) were stored for communal use in the laundry cupboards in the home. This compromises the dignity of residents and must be addressed. The home includes within the service users guide information about the naming of clothing. Staff use radios / walky talkies to liaise with each other in the building. The provider told us this is due to the size and layout of the building and assists staff to locate each other. Some staff were heard to divulge personal information through these. This has improved since the last inspection but further consideration must be given to this issue. The inspector observed that the privacy and dignity of some residents was compromised for unnamed toiletries and named underwear were observed in the bathrooms / toilets. This was also observed at the last inspection. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 14 Call bells are provided in some rooms and in others there are pressure mats linked to the call bell system. A review should take place to show that the current system e.g. call bell or pressure mat is suitable for each resident. We were told that some people would be at risk from having a call bell and many would not be able to ring the bell if it were in place. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 15 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 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 value the activities provided, these have been extended and generally meet the needs of all the residents. Visitors are welcomed to the home at anytime. Choice is available to residents about the time and content of their meals. EVIDENCE: The home has recently appointed a new activities co-ordinator. Detailed records are maintained within the care plan of residents leisure and social interests. Daily records reflect the participation of residents within activities and their level of enjoyment / satisfaction of the activity. A detailed activity sheet is available within the home for residents and their representatives – this is produced on a monthly basis. Planned activities for June included a sing along, floral crafts, crafts with a theme of under the sea, exercise with balloons, basketball and skittles, manicures, birthday celebrations, church services, reminisance and a raffle. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 16 On the day of inspection an external entertainment was booked for the afternoon. This consisted of a two person singing group. Residents and visitors were observed to participate in this and many residents clearly enjoyed the music. Comments received both within survey and during conversations on the day of inspection included: “There is a very good programme of events and activities but unfortunately now my relative spends her time in bed. A member of staff visits her room and reads to her”. “There are a lot of activities for the clients to join in” “Improvements recently but more could be done”. A large number of visitors were at the home on the day of the inspection and the visitors book demonstrates that this is a usual occurrence. Staff were observed to welcome visitors to the home and offer assistance where needed. Some visitors have been given a key / sensor device to access the home. Staff were seen to enable residents to choose when they got up in the morning and helped with personal care. Meal times were also seen to be flexible around the time when a request was made by a relative to delay a meal time. A comment made within a survey said “My relative can have a lie in in the morning if she wants and she can go to bed when she wants”. A record of clothes and property brought into the home is held within the new care plan recording tool. A nutritional assessment is undertaken on admission to the home and notes were recorded about resident’s special diets, likes and dislikes. The menu is a four week rotating menu. Records are held of the menus, the choices available and what meal was provided to each resident. The daily records evidence any issues with food / fluid intake e.g. refusal of meal or small amount eaten. Comments were made within surveys regarding the food provided including “Liquidised food is provided when needed. The various items are put out separately on the plate and look attractive”. “They appear nutritious and adequate” “The diet is good and always plenty to drink offered” The main meal of the day is served to residents either in the dining area, lounge areas or their own rooms. Despite two members of staff being off sick on the day of inspection, the meal was served at the normal time and the meal time was observed to be more relaxed and less hurried than at the previous two inspections. Staff were observed discreetly assisting residents with their food and offering alternatives when one resident did not appear to want the meal given to them. The Chef/cook works from 09.30 until 6pm and is supported by a kitchen assistant. The kitchen staff have cleaning schedules in place and the general appearance of the kitchen was that of a clean and functional kitchen area. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 17 Storage is provided for dried and tinned goods. Fridge and freezer temperatures are recorded as are those of food temperatures (using a probe). Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 18 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 and 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 generally safeguarded by the existing arrangements in the home. EVIDENCE: There is a complaints procedure available in the home. This is also included within the service users guide and has been updated to include the change of contact details of CSCI. A record is kept of any complaints with the investigation details and outcome. We were told within the AQAA and at the inspection that the home has received one complaint within the last twelve months that has been resolved. We have not received any formal complaints since the last inspection. There is a protection of vulnerable adults procedure in place, which includes guidance relating to whistle blowing policy. At this inspection it was not possible to clearly evidence that all staff had been provided with Protection of Vulnerable Adults (POVA) training as the administrative member of staff who operates the data base was not available. The registered provider and manager were able to identify that a minority of staff were due to update their safe guarding training. Certificates were evidenced on staff files relating to POVA training. The POVA training is provided on a rolling programme as part of the company’s training. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 19 One of the directors leads this and is also an external trainer with Cornwall County Council. Recent training had taken place within the home which staff were able to tell us about. Further dates are booked for update training, and this is part of the ongoing training programme within the company. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 20 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, 21, 22, 24,25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a clean home. A programme of refurbishment has started but there are areas of the home, which require tidying up, cleaning or redecoration. Individual accommodation could be made more homely and comfortable. 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. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 21 Observation of all areas of the home identified that since the last inspection, some private bedrooms have been thoroughly cleaned, broken furniture replaced and in three rooms a full refurbishment has taken place. These bedrooms are now attractively decorated, furnished and newly carpeted. Some rooms were observed to be personalised with photographs, pictures and ornaments etc. whilst others were not. There are still parts of the home that would benefit from redecoration and to be made more comfortable or homely. Staff and the registered provider told us that there are plans to address this issue. Some areas of the home would benefit from being tidied. A relative commented that “Sheldon House was once a hotel, it is an old building and a lick of paint would be good” There are two lounge areas, both were seen to be in use throughout the day. Residents are able to move between the two as they choose. Both lounges have dining areas. The lounge to the rear of the home was used for the visiting entertainers on the day of inspection. Both rooms are light and comfortable although the lounge to the rear of the home felt draughty on the day of inspection due to a ceiling fan operating. Despite residents complaining that they felt cold, staff in the lounge did not know how to turn this off and offered a blanket and turned on the electric fire. The outdoor space to the rear of the home is enclosed, it is secluded and provides a safe seating area for residents. On the day of inspection the flower beds were pretty and the grass mown. The bathrooms are clinical in appearance, they would benefit from redecoration and modernisation to make them more welcoming and homely. One bathroom did not appear to be in use – this was due to the condition of the bath. Refurbishment has taken place of one bathroom since the last inspection. The toilet in this bathroom was not accessible due to the storage of a hoist in front of the toilet. Generally the bathrooms and toilets were free from clutter and not being used as storage areas as observed at the last inspection. Some bathrooms / toilets contained communal pads and named toiletries – this was raised at the last inspection. Two bathrooms did not have paper towels and one did not have any liquid soap available. There are limited en suite facilities within this home – this is due to the age of the building and registration as a care home prior to the existing National Minimum Standards. We were told by the registered provider that all hot water outlets that fill baths / showers e.g. where full body immersion takes place have restricted temperature valves in place. The handyman is currently checking that these are all set at the right temperature and is looking to fitting these valves to all areas that residents have access to e.g. hand basins in rooms and toilets. Equipment e.g. hoists and wheelchairs were observed to be stored in corridors and bathrooms. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 22 Specialist equipment is obtained on an individual basis, hospital beds and pressure relieving mattresses are provided for people who need them. This equipment was seen throughout the home. Some 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. It appeared that a significant number of rooms have alarmed mats rather than call bells. This issue was discussed with the manager and registered provider during feedback. We have been told in the improvement plan that a risk assessment referencing the capability of residents using the call bell has been undertaken. This was not evidenced. A large number of rooms appear to have a linoleum type flooring rather than carpet in bedrooms. The manager and registered provider told us that this is dictated by the individual needs of the person occupying the room. The last inspection report stated that this should be based upon risk assessment – we did not see these risk assessments. This issue was discussed with the manager and registered provider during feedback. 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. We were told that one of the residents and their relative has been provided with a key to their room. None of the other residents appear to hold a key, therefore are not able to secure their room, we did not see any evidence to demonstrate if people have been asked if they wished to hold a key for their room. The communal and private bedroom areas were noted to be clean and free form odour on the day of inspection. Additional domestic staff have been appointed since the last inspection and two housekeeping staff were on duty during the inspection. They were observed to clean the communal areas and bedrooms thoroughly. Relatives told us “my husbands room is always spotless”, “the home is always beautifully clean” and “sometimes the floor is not as clean as it may be and feels sticky to walk on”. New carpets were observed through the hall, stairs and landings and in some bedrooms. Some stains were noted on existing carpets and discussion with staff told us that the carpet cleaner is shared between the home and sister home so is not always available and not very efficient. The registered provider informed us that the carpet cleaner is very efficient and is not shared with the other home. It is not clear how infection control is fully managed within the home regarding the cleaning of commodes. Macerators (machines that dispose of used cardboard commode liners and urinals etc) do not appear to be used. These issues were discussed with the manager and registered provider at feedback. We were told that it is planned to remove the macerators from the home. 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 Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 23 flooring and walls in the laundry are permeable and poses an infection control risk. The registered provider told us that he is seeking a solution to this problem. 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. This was also noted at the last inspection. 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.V364818.R01.S.doc Version 5.2 Page 24 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 and 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 always adequate as residents sometimes have to wait a short time for staff to meet their needs. The recruitment procedures are generally robust to safeguard residents. Training is actively encouraged and facilitated. 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 trained nurses, one senior carer and three carers on duty. It was rostered that five carers would be on the morning shift but two had telephoned in sick. An agency was contacted and an agency carer arrived at 11.30 a.m. The trained nurse on duty told us “the numbers of care staff is related to the number of residents, we try to have six carers on duty every day and two trained nurses”. The manager was working on the day of inspection and the deputy manager came in part way through the day. Domestic staff were on duty including two cleaning staff, one laundry worker and the kitchen staff. The activity co-ordinator was also on duty. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 25 Relatives were positive about the staff, comments made included “‘they are very caring”, “They are patient and caring – nothing is too much trouble”, “They are very caring and loving” and “ The carers at Sheldon House are very good and always let me know of anything my relative needs me to bring into her – she is unable to let me know if she needs anything.” The relatives also made comment about the levels of staffing at the home: “The home is very busy and there are not enough staff. The authorities need to look at staffing levels required to give this vulnerable client group the diverse patient centred care” “I feel sometimes the carers are rushed off their feet. I definitely think there should be more carers” “The staff are not always available when my relative needs them – usually I can find someone when I visit” “Staff are usually available but are usually over worked”. Staff also confirmed to us that on some occasions they do feel that the residents and home would benefit from having additional members of staff on duty. These issues were discussed with the registered provider and manager at feedback. They told us that the home is proactive to meet resident’s needs and the staffing is dependent on the complexity of care and the numbers of residents. The manager is developing a staffing level tool to assist with the rostering of staff. All staff are encouraged to participate in training including their National Vocational Qualification (NVQ) level 2 or level 3 training. The AQAA told us that twenty staff (out of twenty eight) have achieved their NVQ level 2, with four working towards this qualification. This document also advised us that all catering staff have received training in safe food handling with 82 of care staff provided with this. Induction training is provided to all staff and includes: introduction to the company, health & safety, fire training, moving & handling, safeguarding adults, infection control, food handling & hygiene, person centred care planning, introduction to dementia care, safe administration of medicines and basic life support and First Aid Staff training is provided both in house and through external providers. A programme of core training is in place plus additional training relating to residents individual needs e.g. aggression, challenging behaviours, sexuality. The core training includes initial induction training and then updates for the following topics - moving and handling, health and safety, infection control, POVA, dementia care, fire training. Training certificates are held on individual staff files and also on a data base. The administrator was not available on the day of inspection to demonstrate this data base fully but the manager and registered provider advised us that all staff are made aware of training needs and when to attend. It was noted that whilst there are some gaps in update training, we were told that staff have been advised of this and the dates for them to attend. Staff files evidenced certificates for training attended. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 26 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. All staff receive a contract. No volunteers work in the home. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 27 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, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has yet to register with CSCI therefore the legal responsibilities are with the registered provider at this time. The residents benefit from the ethos and leadership of the manager and the deputy manager. Feedback is sought from residents and / or their relatives regarding the way in which the home is run. Residents do not have direct access to their own money. Risk assessment practices require improvement. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 28 EVIDENCE: A manager has been appointed, this is an existing member of staff who has been promoted internally. The manager told us that information for his application e.g. CRB check and references is being gathered prior to submitting this to CSCI. Staff, relatives and external professionals were positive in their comments about the manager and the influence he has had on the care home since being appointed as manager. Staff meetings are held. There are regular senior management meetings. The manger told us that this year’s quality assurance process has recently started, seeking the views of staff, residents and or relatives or representatives and professionals visiting the home through surveys. The information from these surveys is yet to be audited and the findings published. The Registered persons conduct regular visits to the home. Resident’s personal information was observed to generally be stored securely in lockable filing cabinets in locked offices. Consideration should be given to the use of a diary / communication book as resident’s names and personal information is included within this. On one occasion the lower door to the managers office was left unlocked and open and at the top of the stairs data relating to residents was stored. A Fireboard listing resident’s names is held within the reception area – this is not easily accessible to people other than staff. The accident record book should comply with data protection in that when completed the records are stored within individual resident or staff files. We were told 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. Staff records identify that supervision takes place regularly by the written evidence of the date on which it happened – no further detail is recorded in staff records. Staff confirmed to us that an allocated supervisor regularly supervises them. The trained nurses supervise the carers and the manager the trained nurses. Each supervisor and staff member hold their own supervision records. This was discussed at length during the inspection with the manager, deputy manager and the trained nurse on duty. It was agreed that further records would be held on the staff files in future. The Manager told us that he is the lead for health and safety within the home, with other members 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. The fire alarms are tested weekly with a record kept. A record is kept of fire training for all staff, which is provided by the manager. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 29 All staff are provided with internal moving and handling training – the deputy manager is a trained moving and handling trainer. One of the directors is a trained first aid trainer and provides this training for all staff. Infection control training is provided initially at induction and updated annually. This is carried out by the manager at the sister home. Food hygiene is also provided annually and internally. Evidence of maintenance and servicing were available for inspection. Records evidenced servicing for the gas boilers, lifts, hoists and fire extinguishers. Portable appliance testing records were in place and the registered provider obtained evidence of the five yearly hard wiring checks that have been made. The water has been tested for legionella and the environmental health officer visited in October 2007. It is not always clear to see that recommended work has been undertaken following visits. The registered provider and manager told us that all issues raised by external maintenance / servicing people are addressed. 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. It was not clear that a formal risk assessment process has taken place prior to the use of these portable heaters. Window restrictors were observed throughout the home, again it was not clear that environmental risk assessments in place around the use of restrictors or where they were located. 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 told us that all staff are up to date with their moving and handling training, all staff spoken with during the inspection have undertaken this training and were confident with providing care to the current residents. Incidents concerning residents associated with mobility or moving and handling issues are recorded and monitored by the manager. We have received a number of reported incidents e.g. falls, in accordance with regulation 37, detailing what happened and the action taken by staff. 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. The manager told us that COSHH assessments are completed and available to all staff including the domestic staff. It was observed that a cupboard containing COSHH material was left unlocked and unattended during the day – this was observed to happen at the last inspection as well. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 30 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 3 3 X 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 1 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 3 2 2 X 2 3 1 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 3 3 X 2 2 2 2 Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 31 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 OP10 Regulation 12(4) Timescale for action The registered person shall make 14/08/08 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 01/03/08 01/12/07 Specifically to this inspection consideration must be given to ensuring residents are able to wear their own clothes at all times e.g. tights, socks and net pants. Communal toiletries must not be used and underwear should not be left within bathrooms and toilets. Care must be given when using radios throughout the home that personal information e.g. names of residents, room number relating to personal care etc as this may compromise residents privacy and / or dignity. 2. OP19 23(2)(b) (d) The registered person shall ensure that all parts of the care home are reasonably decorated. DS0000008894.V364818.R01.S.doc Requirement 14/08/08 Sheldon House Version 5.2 Page 32 3. OP22 23(2)(l) The registered person shall provide suitable storage for the purposes of the care home. Previous timescales not met 01/12/07 01/04/08 It is required that the registered person shall make suitable arrangements to prevent infection, toxic conditions and the spread of infection at the care home. E.g. and that clear guidelines are in place to identify how infection control is promoted when disposing of used commode inserts. 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 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 01/04/08 14/08/08 4. OP26 13(3) 14/08/08 5. OP27 18(1)(a), 17, Sch.4 14/08/08 6. OP38 13(4)(a-c) Satisfactory risk management 13(4)23 and risk assessment (2) arrangements must be provided to CSCI by the time scale specified. E.g. window restrictors and portable heaters It is required that areas used to store COSHH materials are consistently secure and not accessible to residents at any time. 14/08/08 Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP1 Good Practice Recommendations It is recommended that the manager is not referred to as the registered manager until such times as their application has been submitted to and approved by CSCI. It is recommended that assessments to be undertaken and recorded, by a suitably qualified person to promote continence. It is recommended that written evidence is available that shows that an assessment has taken place to establish the best form of call bell / alarm system for each resident and why the system in place is being used. It is recommended that the bathrooms be updated and made more homely and comfortable. It is recommended that where residents and / or their relatives have not personalised their rooms the home makes more effort to make the room homely unless it is the expressed wish of the resident that this does not happen. It is recommended that clear written evidence identifies that a hard linoleum type flooring is required by the resident as oppose to carpeting in their bedroom. It is recommended that the floor and walls of the laundry to be impermeable and that systems are in place to promote infection control. It is recommended that equipment for cleaning carpets is reviewed to ensure that it is fit for purpose and available when required. It is recommended that secure facilities are provided for residents for the safe keeping of their money and valuables. It is recommended that the recording of supervision is reviewed to ensure that supervision records are available DS0000008894.V364818.R01.S.doc Version 5.2 Page 34 2. OP8 3. OP10 4. 5. OP21 OP24 6. OP26 7. OP35 8. OP36 Sheldon House at all times for people who need to review this. 9. OP37 It is recommended that consideration is given to the storing of confidential information e.g. within the communication book and outside of the managers office. Sheldon House DS0000008894.V364818.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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.V364818.R01.S.doc Version 5.2 Page 36 - 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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