CARE HOMES FOR OLDER PEOPLE
Sheldon House Sea View Road Falmouth Cornwall TR11 4EF Lead Inspector
Paul Freeman Unannounced Inspection 29th September 2005 10:00 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.V254738.R01.S.doc Version 5.0 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.V254738.R01.S.doc Version 5.0 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 Mr Charles Barry Libby Mrs Anne Louise Libby, Mr Darren Libby Mrs Judith Alison Libby 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.V254738.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th February 2005 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. The current owners have run the home since November 2000 and have ambitious plans to redevelop the site and create a purpose built care home. One of the providers Mrs J. Libby is currently acting as the Registered Manager. The current accommodation is a former hotel that was initially converted around 1994 and since then has undergone further structural changes. It sits in a quiet residential road close to the town and beaches beach Falmouth. It is easily accessible on foot and by transport from the town and this results in frequent visits to the home by relatives and friends. There is also car parking facilities at the front of the home. The current accommodation is provided over three floors and is accessible to people who experience a disability given two shaft lifts are provided. The building is not the best design to provide the care and support required by residents and the layout does not easily lend itself to meeting the needs of residents. The bedrooms are for both single and shared occupancy and three communal areas are provided on the ground floor. There are currently no dedicated dining facilities but this is currently under consideration. It is therefore constructive that positive plans have been developed to provide quality accommodation that will address the current shortfalls. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A planned unannounced inspection took place on 29 September 2005 and 11 October 2005. Two inspectors undertook the inspection and were at the home for ten hours. The purpose of the inspection was to inspect some of the core standards. Therefore some of the key national minimum standards that were considered include assessment and care planning, health and safety and staffing arrangements. The registered providers, residents and staff were consulted about the services and facilities provided. In addition the Inspectors made a number of observations about the care and support provided to residents. The environment, records and documents were also considered. The Inspectors noted that a number of the residents have complex needs that require a systematic and structured approach. The nature of the residents needs is such that a high level of staff support and guidance is required to provide a safe and meaningful setting. In addition over the three floors there were also a number of vulnerable residents who were confined to their beds due to poor health. The providers have established a reputation for positively caring for individuals that are potentially volatile or have behaviours that challenge the care sector. Therefore a careful balance needs to be established to make sure that the needs of the user group are not compromised. The limitations of the environment do not assist the providers in meeting this goal. The requirements and recommendations set at the last inspection had been worked upon and the provider, staff and residents fully cooperated and were very helpful throughout the inspection period. What the service does well:
There are flexible arrangements in place for prospective residents or their relatives or representatives to visit the care home to help them decide if it is a suitable place to reside. The staff manage the health needs of residents positively. Residents stated they were confidant that medical services are accessed promptly and efficiently when they are required. It is clear that staff closely monitor residents’ health and take positive action when this is required. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 6 General Practitioners regularly visit the home and positive working relationships are in place with health professionals. In addition positive working partnerships have been established with the specialist mental health services and a consultant regularly visits the home. Community Psychiatric Nurses are in regular contact and also regularly visit the home. Flexible visiting arrangements are in place for residents’ and visitors said the staff always positively welcomed them. Community groups also visit the home on occasions to talk with residents and provide entertainment. A satisfactory complaints policy and procedure is in place and the providers are committed to resolving any concerns or complaints at the earliest opportunity. The staff at the home are experienced and skilled in providing the care and support required by the residents. It was evident that staff build and maintain positive relationships with residents and treat each individual with dignity and respect. Residents and relatives said they were very satisfied with the manner in which staff undertook their duties and were clearly confidant about the care and support provided. The Inspectors observations also confirmed that the staff are committed to providing good standards of care and work well as a team in a mutually supportive manner. Additional staff is also employed on occasions to undertake one to one support of residents outside of the home. The evidence indicates this proves to be a positive and enriching experience for the individual concerned. House keeping, maintenance and kitchen staff are employed on a daily basis. The kitchen is viewed as positively contributing to service provided to residents. The providers are reviewing the duties and responsibilities of the house keeping staff in order that the current service can be improved. Equally the maintenance staff has recently been increased to address the outstanding issues in respect of the environment. There are four owners of the home and three take an active role in the operation of the home. The three providers are very experienced in social care and two are qualified nurses. The registered managers post is currently vacant and one of the providers Mrs J Libby is acting as the registered manager in the interim. A manager Mrs A Peters has been appointed and they have applied to the Commission for fitness to be determined. Mrs Peters is currently assisting in the day to day operation of the care home under the close supervision and guidance of the providers. The providers also regularly meet with Mrs Peters to monitor the management of the home but no records are made of these meetings. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 7 There is some good record keeping practise at the home but other records require improvement. This will make sure that a clear record is maintained of the homes events and management to the benefit of residents and staff. The providers have established a range of policies and procedure that promote safe working practices by the staff and manage infection control. The staff is clearly aware of the importance of good standards of hygiene in respect of the care and support they provide to residents. The services and equipment at the home are regularly serviced, maintained and arrangements are in place to make sure the call bell system and the emergency lighting arrangements operate correctly. What has improved since the last inspection?
The staff at the home continues to improve and develop the activities and leisure opportunities available to residents. A weekly programme had been established at the home and residents are encouraged to participate in small groups if they wish. The programme is dependant upon the staff having the time to support residents and the providers stated they are establishing plans to improve this situation. Opportunities are also provided for some residents in the local community that have proved to be a valuable experience for the residents concerned. Hobbies, interests and leisure pursuits are not always taken into account when an assessment or residents care plan is completed. Therefore some of the residents said they wanted to participate in a wider range of activities and felt this would improve their quality of life. To assist the development of opportunities a staff member takes the lead role in coordinating and developing activities and leisure pursuits, which has had a positive impact upon the arrangements. The policy for protecting residents against abuse has been reviewed and improved in recent weeks. Any allegations or concerns are reported to the statutory agencies who coordinate the investigations. Staff at the home continues to receive appropriate training in this area and new staff are clearly made aware of their roles and responsibilities during their induction programme. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 8 What they could do better:
Each prospective residents needs are assessed to make sure a suitable care plan is provided and the home are able to meet the needs of the individual concerned. In completing the assessment the staff from the home meet with the person concerned and obtain the views of the individuals relatives or representatives when they are available. In addition the opinions of any professionals that are involved with the person are also taken into account. The current assessment practices need to be improved in order that a detailed comprehensive picture is provided of the person concerned. This will determine the care and support required as well as satisfying the providers they are able to meet the needs identified. Each resident has a care plan that provides guidance about meeting certain areas of assessed need. The plans do not provide a comprehensive picture of the residents needs, preferences and choices. The information provided in the plans need to more detailed in order that appropriate guidance and direction is given to staff about the care and support required. The providers stated they are planning to introduce the person centred approach to care planning which will positively address the current shortfalls. This will promote plans being written in a manner that is user friendly and details the needs, choices and preferences of the person concerned. The documentary evidence indicates that certain aspects of the care plans are reviewed on occasions. There appeared be no arrangements in place to complete a regular comprehensive review and a satisfactory record of the reviews that do occur was also not in place. Medicines are held in secure facilities and the qualified nursing staff manages the arrangements. The medicines were observed to be dispensed safely but a suitable policy and procedure was not available to the staff. A dedicated fridge is provided to store medication when this is required but was not working at the time of the inspection. In addition the providers need to improve the arrangements for the storage of oxygen cylinder to make sure they comply with the required safety guidelines. The home have a whistle blowing policy for staff that allows staff to report any concerns they have about abuse of residents. The policy needs to be developed so that any issues can be reported to a third party. This will provide further protection for residents. The providers recognise that the environment has a number of limitations to providing the quality of services and facilities they wish. Positive plans are at the final stage of agreement to build a new purpose built home on the same site. The building will occur in two phases to make sure that disruption to residents’ is minimal.
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 9 The current accommodation is over three floors and the three communal areas are located on the ground floor. Given the layout of the building the communal areas have limitations and on regular occasions can be very noisy. There is no dedicated dining area at the time of the inspection but the providers are considering creating an area for residents that choose to eat together. The two largest communal areas are reasonably decorated but both have hard floors, which could be a risk to residents in the event of a fall. The third area is part of a corridor that leads to residents’ bedrooms and this can be used as a quiet area or for residents to meet with visitors. Bathrooms and toilets are situated around the home and within a reasonable distance of communal areas. Fifteen of the bedrooms are also provided with ensuite facilities. In certain facilities equipment and other items were being stored that could potentially be a risk to residents, visitors and staff. There are fifteen single bedrooms and nine shared rooms. Some of the rooms are decorated and furnished to an acceptable standard but others require improvement. The providers are planning to update certain rooms in relation to redecoration and the replacement of carpets. There are also other areas in the home that are looking tired and need of redecoration. In certain areas a good standard of hygiene and cleanliness is maintained but other areas were found to have an offensive odour. Prior to the inspection the providers had identified the need to improve the hygiene around the home and were in the process of developing the arrangements to address the current shortfalls. A qualified nurse and care staff are on duty during waking hours and each night. The numbers of staff on duty for waking hours was seen as insufficient to satisfactory meet the needs of residents and provide a safe environment. An immediate requirement was set on 29 September 2005. The providers have subsequently addressed this issue and arrangements are in place for additional staff to be employed during waking hours. The providers are also reviewing the best way to organise the staff on duty to make sure every effort is made to provide consistency of care. The risk management and risk assessment arrangements need to be improved to make sure that every reasonable step is taken to minimise risks to residents, staff and visitors. It is viewed that a high number of accidents and incidence occur at the home. This may partly be accounted for given the volatile and frail nature of some residents but it is viewed that more robust risk management arrangements should improve this situation. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 10 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. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 11 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.V254738.R01.S.doc Version 5.0 Page 12 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 5 The assessment of prospective residents is not satisfactory and requires more detail and information about each persons needs. This will make sure the service is able to provide the care and support required to each person. Prospective residents and their relatives or representatives are able to visit the home to help them decide if it a suitable place to live. EVIDENCE: The assessments of need arrangements for residents that had recently been admitted or where consideration was being given to an admission were considered. The Providers stated that prospective residents are assessed in order to identify their needs and make a determination if the care home is able to provide the care and support the individual requires. Prospective residents are visited in order to complete the assessment and their relatives and representatives are also consulted. In addition the opinions of any professionals that are involved with the individual are also taken into account.
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 13 The records regarding the needs assessments were found to be variable. Some of the assessments were incomplete or did not provide sufficient information or detail to clearly identify the care and support required. The assessments that were currently in the process of completion were more detailed, evidenced multi disciplinary considerations but did not have sufficient information to provide a comprehensive picture of the person concerned. The Inspectors view detailed assessments as essential for this service particularly given the complex, demanding and challenging nature of the needs that many residents and prospective residents present. Prospective residents and their relatives or representatives are able to visit the home if they wish to help them decide if it is a suitable place to reside. The arrangements to visit are flexible and are based upon the prospective residents of their relatives’ choice and preference. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 14 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 9. The care planning arrangements need to be improved in order that staff is provided with adequate information, direction and guidance to meet residents needs. Residents’ health needs are well met and health services are accessed promptly and efficiently when required. The arrangements for administering medication require improvement to make sure they are managed in a safe manner. EVIDENCE: Each resident has a care plan and a number were sampled during the inspection. The providers stated that is the intention to develop the care planning arrangements and adopt the person centred model that is viewed as best practise for people who experience dementia or enduring mental illness. The current care planning arrangements provide a summary of the assessed needs of each resident. The plans concentrate on specific areas that staff need to take account of but do not provide a comprehensive picture of the individual needs, choices or preferences. The plans could be written in a clearer manner
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 15 that provides the staff with the information, guidance and direction they require. This will also assist in more clearly meeting residents’ social and recreational needs and in promoting safe working practices. A resident was admitted the day before the first day of the inspection. It was of concern that a care plan had not been established before the person arrived at the home and was in the process of completion the following day. This arrangement does not assist the staff to help the individual adjust to their new setting or provide the staff with the information they require at the point of admission. There was also no clear evidence that care plans are regularly reviewed. There was some evidence that reviews occur in regard to certain aspect or elements of the plans but no records were found to detail the contents of the review or any conclusion or actions that were agreed or required. The documentary evidence does indicate that residents’ health needs are met. General Practitioners visit the home on regular occasion and some residents commented they had confidence health services were accessed promptly and efficiently whenever they were required. In addition positive working partnerships have been established with specialist mental health services and a consultant regularly visits the home. Community Psychiatric Nurses are in regular contact and also regularly visit the home. A number of staff were consulted and it was evident they are diligent in monitoring residents health and taking positive action where this is required. The qualified staff manage the prescribed medication and the medicines are held in secure facilities. Medicines were observed to be administered safely and a satisfactory partnership has been established with a local pharmacist. The policy and procedure was not available for consideration. This document must be available to guide, direct and inform the staff in the safe administration and storage of medicines. A secure dedicated fridge is provided for medicines that need to be kept at refrigerated temperatures. The fridge was found to be out of commission and it was reported to the Inspectors that it had not worked for sometime. In addition oxygen cylinders were also stored in the secure facilities and suitable signage was not in place. Arrangements need to be made to store the oxygen in a satisfactory manner that meets with the required safety standards. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 16 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 13 The range of activities available continues to develop and there are some good examples of individual opportunities for some of the residents. Regular opportunities need to be provided to residents that reflect their interests, hobbies and leisure pursuits and are detailed in the persons care plan. Positive and flexible visiting arrangements are in place and residents are able to maintain positive links with relatives and friends. EVIDENCE: The documentary evidence indicated that the recommendation set at the last inspection to record activities in residents care plans had been acted upon. However not every care plan detailed the residents interests, hobbies or leisure pursuits. The records and some of the residents indicated they wanted to participate in a wider range of activities and felt this would improve their quality of life. A staff member takes the lead role in coordinating activities on a part time basis. A weekly programme has been established that centres on some group sessions at the home and opportunities for individual residents to participate in community based options. There are also occasions when small groups of
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 17 residents are taken out locally by staff. In addition the staff will initiate other activities spontaneously when sufficient time is available. The environment does not easily lend itself to making activities easily accessible and available to residents as part of their daily experiences. The number and deployment of staff on duty also currently impact upon the opportunities available. Residents evidently welcome the programme that has been established but a higher profile needs to be put in place to identify and coordinate each resident’s preferences and choices. Flexible visiting arrangements are in place and visitors said the staff warmly welcomed them. There is a regular pattern of visitors to the home on a daily basis and residents are able to see their visitors in private. Local community groups also have contact with the residents and on occasion local groups will provide entertainment. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Satisfactory arrangements are in place to deal with complaints and any allegations or concerns of abuse to residents. The whistle blowing policy needs to be developed to make sure that every reasonable step is taken to protect residents. EVIDENCE: The Commission has received one complaint but none have been made to the providers. The complaint received was dealt with in a satisfactory manner by staff at the home and was resolved to the complainant’s satisfaction. A suitable policy and procedure is in place for complaints and the providers are committed to dealing with any complaints or concerns expediently and in a satisfactory manner to all parties concerned. This should state that the complainant is free to contact the Commission for Social Care Inspection at any stage. The arrangements to protect residents against abuse have been improved and developed. A satisfactory policy and procedure is in place and any concerns or allegations are reported to the statutory agencies for investigation. A rolling training programme about the protection of residents is in place for the staff and suitable advice, guidance and direction are provided to new staff during their induction programme.
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 19 A whistle blowing policy is also in place but this relies on staff reporting any concerns to the providers. Arrangements need to be established for staff to have the opportunity to report any issues they feel unable to share with the providers or managers of the home to a third party. This will further protect residents against potential abuse. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24 and 26. The environment has limitations and to address the shortfall plans have been established to build a new home on the same site. In certain areas the standard of décor, furnishings and maintenance within the current home requires improvement to meet the required standard and provide a comfortable setting for residents. The use of communal areas and the excessive noise levels need to be considered in order that residents needs can be met individually and collectively. The standards of cleanliness and hygiene are not acceptable in certain areas and this could constitute a risk a residents. 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
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 21 good quality services and facilities. This has been recognised by the providers and plans have been established to replace the current accommodation with a new building that will be purpose built. The providers have consulted with residents, their relatives or representatives and staff about the plans and it is hoped that building with commence by the end of the year or early in 2006. The building will be undertaken in two phases to make sure that any disruption to residents is minimised. The communal areas at the home are decorated and maintained to a reasonable standard but hard flooring in two of the areas could be a risk to residents if they fell. The two largest areas are most occupied by residents and on regular occasions have a very high noise level that can have an adverse effects upon some of the occupants. In other areas or rooms of the home the decoration, furnishings and carpets are looking tired or in need of replacement. At the time of the inspection there was no dedicated dining areas and residents have meals in their rooms or the two largest communal spaces. The providers are at this time actively considering creating dedicated dining areas for the residents that choose to eat together. Toilets and bathrooms are located throughout the care home and are within a reasonable distance from communal areas. Fifteen of the bedrooms are also provided with ensuite facilities. Some of the facilities were found to be storing equipment and other items which could constitute a risk to service users. There are fifteen single bedrooms and nine shared rooms. Residents’ bedrooms are located on the three floors and some of the rooms have been personalised by the occupants. It was noted that certain rooms would benefit from redecoration and improvement. The rooms are furnished and residents are able to bring their own possessions if they wish. Where possible the furnishings and fittings are domestic in nature and some of the rooms were of a good standard. It was noticeable there were some offensive odours in certain parts of the building. The providers stated that the cleaning arrangements were currently under review to make sure that high standards were maintained. There was also evidence that certain rooms or facilities were maintained to a good standard. The providers stated they were aware of the standard of decor and furnishing and the issues would clearly be addressed when the new accommodation was completed. In the interim plans would be developed to address the areas that fall below an acceptable standard. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 22 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 Staffing arrangements need to be improved to make sure that sufficient numbers of staff are on duty and deployed in a manner that promotes the health, safety and well being of residents. EVIDENCE: The staff group comprises of qualified nurses and carers and a minimum of one qualified nurse in on duty each day and night. In addition one of the providers is on call when they are not at the care home. It was difficult to determine the minimum number of staff required to meet the needs of the residents. The staff rosters indicated that at least seven staff were on duty for waking hours and three waking staff worked each night. In addition staff were employed during waking hours to undertake one to one support of residents outside of the care home. The arrangements to deploy staff result in carers having lead responsibilities for residents throughout the care home which requires the staff to have a presence on all three floors. The staff commented this was not always the case but occurred on regular basis. It was of concern the Inspectors observed a number of occasions when residents in communal areas were unsupported or monitored for several minutes. The Inspectors also found that a high number of accidents and incidents were occurring at the home.
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 23 Given the situation an immediate requirement was set on 29 September 2005 for the providers to provide sufficient numbers of staff on duty during waking hours and that satisfactory number of staff must be on duty to meet the level of supervision and support required by the residents. By the 11 October the provider had reviewed the staffing arrangements and were in the process of increasing the number of staff on duty during waking hours. A part of the review the deployment of staff was also being considered. Residents said they were very satisfied with the manner in which the staff undertook their duties ands found them to be approachable, helpful and flexible. The Inspectors observations confirmed that staff build positive and meaningful relationships with residents and have a wide range of skills, experience and abilities. It was evident the staff work well as a team and are mutually supportive. Staff said they were concerned there was sufficient number to provide a safe experience for residents and were clearly very busy throughout the inspection period. Relative said they were very satisfied with the manner in which staff provided care and undertook their duties. Relatives were also concerned that sufficient numbers of staff were on duty during waking hours. A member of the night staff said there was sufficient number of staff on duty and the on call arrangements were reliable if they were required. Staff are also employed each day to prepare and cook food at the home and this is viewed as reliable and positive contribution. Domestic staff is also employed each day and the duties and responsible are in process of review and development to make sure that a good standard is maintained throughout. Two maintenance staff is employed by the Company to undertake repairs and other duties related to the environment. An additional staff member has recently been appointed in order to address some of the outstanding issues in regard to the environment. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 37 and 38. There are suitably experienced and qualified providers and managers to run the home. The providers actively who encourage residents, visitors and staff to raise concerns and suggestions to improve the services and facilities provided. The current supervision arrangements of the manager elect need to be improved so that a satisfactory record of supervision is maintained to make sure that compliance of the Care Homes Regulations 2001 is not compromised. It was noted by the Inspectors that carers were required to undertake a number of administrative tasks that took them away from providing direct care. It is recommended this arrangement be reviewed. There are some good examples of record keeping at the home but other records require improvement to make sure that residents’ needs are met to a high standard. The risk management arrangements are not satisfactory and potentially place residents and staff at risk.
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 25 EVIDENCE: Three of the four providers taken an active role in the operation of the care home and have substantial experience in the provision of social care. Two providers are qualified nurses. The registered managers post is currently vacant although the Company have appointed a manager who has made an appropriate application to the Commission for fitness to be considered. In the interim one of the providers Mrs J Libby is acting as the registered manager. The manager Mrs Peters is currently coordinating the day to day operation of the care home under the supervision and guidance of the registered persons. One of the providers stated they regularly meet with Mrs Peters each week to supervise the work in progress but no records are maintained of the meetings. However a comprehensive job description has been developed for the registered manager that details their duties and responsibilities. The providers regularly met with the staff group to consider the services and facilities provided and a quarterly newsletter is also produced for residents and their relatives or representatives. The providers are keen to adopt an open style of management and residents, relatives or representatives and staff are encouraged to raise any concerns or make suggestions about how the services and facilities could be improved. Some of the records at the home considered were found to meet a good or satisfactory standard. Other records would benefit from improvement and this includes accident and incident reporting. Certain of these records did not provide sufficient information for managers to make a reasoned decision about the potential risk to the person’s safety. Daily records are also maintained about each resident. The records summarise the events of the day and any incidents or concerns that were noted. The records do not however always detail the action that has been taken to respond to a concern or the outcome that is reached. There are no barriers to residents or their legal representatives accessing the records if they wish to do so and records are held in secure facilities. A range of policies and procedures has been established to promote safe working practices at the home. Staff at the home are clearly aware of the importance of providing care in a suitable manner to promote good standards of hygiene.
Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 26 The equipment and services provided, to the home are regularly serviced, maintained and the emergency lighting and fire equipment is also regularly monitored. Call bell arrangements in each room are also provided and serviced regularly and staff carry intercoms in order that they can easily communicate with colleagues or call for assistance when required. The providers have a locked door policy in order to protect residents from wandering and placing themselves at unreasonable risk. The Inspectors were concerned about the number of reported accidents and incidents that occur and found that the risk management arrangements are not satisfactory. The Inspectors found references in some residents’ records that a risk assessment was required but find no record that an assessment had been completed. There were references in certain residents care plans about the support and care required to minimise an unreasonable risk an individual residents may experience or pose to other residents or staff. However the information, guidance and direction to staff within the document did not provide adequate information. There was no evidence that risk assessments are completed or reviewed following a resident experiencing an accident or incident. This needs to be established to make sure that careful consideration is given to preventing or minimising further occurrences and staff are clear about the care and support required. There was no documentary evidence that a risk assessment of the environment had been undertaken. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 27 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 2 x 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 1 1 2 X X 2 X 2 STAFFING Standard No Score 27 1 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X X X X X 2 1 Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 28 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 2 Standard OP3 OP7 Regulation 14(1) (a-d) 15(1) Requirement A comprehensive and detailed assessment must be completed for all prospective service users. Comprehensive and detailed care plans to meet the needs and preferences of service users must be provided. Care plan must be comprehensively reviewed on a regular basis. A suitable policy and procedure for the storage and administration of medicines must be established and accessible to staff. A dedicated operational fridge must be available to store medication where necessary. Oxygen must be stored and managed at the home in a safe manner. Activities must be offered to each service user that reflects their interests, hobbies and leisure pursuits. A satisfactory whistle blowing policy and procedure must be in place. All parts of the home must be
DS0000008894.V254738.R01.S.doc Timescale for action 30/12/05 28/02/06 3 4 OP7 OP9 15(2)(b) 13(2) 30/01/06 30/11/05 5 6 7 OP9 OP9 OP12 13(2) 13(2) (4)(c) 16(2)(m) 30/11/05 30/11/05 30/03/06 8 9 OP18 OP19 13(6) 23(2)(b) 30/03/06 30/12/05
Page 29 Sheldon House Version 5.0 (d) 10 OP20 11 OP20 12 13 OP26 OP27 14 OP27 15 OP31 16 17 OP37 OP38 reasonably decorated and kept in a good state of repair. 13(4) The use of communal spaces 23(2)(g) must be reviewed in respect of (h) the dining arrangements, noise levels and safety issues. 13(4) Items and equipment at the (a-c) home must be stored in a manner that does not potentially compromise the welfare or well being of residents or staff. 13(3) The home must be clean, 16(2)(k) hygienic and free from offensive odours. 18(1)(a) Sufficient numbers of staff must be on duty during waking hours to meet the needs of residents and to provide and promote service users safety and welfare. 18(1)(a) Sufficient staff must be employed for waking hours to provide sufficient number to be deployed in a manner to provide satisfactory supervision and support and to respond to emergencies. 18(2)(a) A suitable record must be maintained of the regular supervision the manager elect receives. 17 Records required by regulation must be maintained to the standard required. 13(4)(a-c) Satisfactory risk management and risk assessment arrangements must be put in place. 30/11/05 30/11/05 30/11/05 29/09/05 29/09/05 30/11/05 30/03/06 30/11/05 Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 30 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3. Refer to Standard OP16 OP19 OP31 Good Practice Recommendations For the Complaints Procedure to include that the complainant may contact the Commission for Social Care Inspection at anytime. An internal environmental audit should take place to identify areas that require redecoration, repair or replacement of furnishings or carpets. The duties of carers should not include administrative roles that take them away from directly providing care. Sheldon House DS0000008894.V254738.R01.S.doc Version 5.0 Page 31 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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