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Inspection on 09/08/05 for Sheldon Ridge Nursing Home

Also see our care home review for Sheldon Ridge Nursing Home for more information

This inspection was carried out on 9th August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 11 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Service users receive good health and personal care. Healthcare needs are closely monitored and staff consult other professionals to make sure health needs are met. Staff know individual service users well, and have a good understanding of how to meet their personal care needs. Service users all have their own bedroom which most have decorated with a lot of pictures, photographs, and small items. Staff confirmed they receive regular supervision and attend regular training sessions.

What has improved since the last inspection?

Staff have a better understanding of adult protection; they have covered the subject during formal training and supervision. The home has introduced additional systems to improve infection control and more areas have hand-washing facilities. Administration of medication is monitored more closely, and errors are identified through management checks.

What the care home could do better:

The home must improve the service user plans and assessments to ensure that each service user`s needs are properly identified. They must also improve activities and provide more opportunities for people to go out into the community. Staff are sometimes very busy and at times are not able to spend enough time to provide recreation for service users. The building is generally well maintained but some areas need attention and some furniture and equipment need sorting out. Some repairs have needed attention for over three months. Bradford District Care Trust has not included details of the Commission for Social Care Inspection in it`s complaints procedure, therefore anyone who isunhappy with the service does not know they have a right to make a complaint to the commission. This has been brought to the attention of the trust but they have still not put their procedure right. Although the systems for checking medication records have improved there were still some gaps where staff should have signed to confirm that medication had been administered. Requirements and recommendations identified at this inspection can be found at the end of this report.

CARE HOME ADULTS 18-65 Sheldon Ridge 1-3- Bierley Lane Bradford BD4 6AB Lead Inspector Carol Haj-Najafi Unannounced 9th August 2005 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Sheldon Ridge Address 1-3 Bierley Lane Bradford BD4 6AB Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01274 688029 01274 684320 Brunel & Family Housing Association Ltd Ms Susan Linda Roberts Care Home with Nursing 13 Category(ies) of Learning Disability (13) registration, with number of places Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 9th February 2005 Brief Description of the Service: Sheldon Ridge is registered to provide long term nursing care for thirteen adults with a learning disability. The home is situated in the village of Bierley and is close to local amenities and a bus route.The home was originally two purpose built bungalows; an extension has linked the bungalows, and created additional communal space. All bedrooms provided are single accommodation. Spacious communal areas include lounges, dining areas, a multi-sensory room, and an activity room. The home has an attractive enclosed rear garden, with level access from the lounges. Specified parking areas are available for visitors to the home.Nursing staff, health care assistants, and domiciliary staff are employed at the home. The home is a joint venture between Brunel Support Works and Bradford District Health Trust. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection between 9.45am and 5.00pm. The purpose of the inspection was to ensure the home was operating and being managed to a satisfactory standard. The inspector looked around the home, observed practice and spoke to four staff and the registered manager. Service users living at the home have very complex needs, and discussions with service users are very limited. Records were inspected including service user plans, risk assessments, daily records, staff training and health and safety certificates. What the service does well: What has improved since the last inspection? What they could do better: The home must improve the service user plans and assessments to ensure that each service user’s needs are properly identified. They must also improve activities and provide more opportunities for people to go out into the community. Staff are sometimes very busy and at times are not able to spend enough time to provide recreation for service users. The building is generally well maintained but some areas need attention and some furniture and equipment need sorting out. Some repairs have needed attention for over three months. Bradford District Care Trust has not included details of the Commission for Social Care Inspection in it’s complaints procedure, therefore anyone who is Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 6 unhappy with the service does not know they have a right to make a complaint to the commission. This has been brought to the attention of the trust but they have still not put their procedure right. Although the systems for checking medication records have improved there were still some gaps where staff should have signed to confirm that medication had been administered. Requirements and recommendations identified at this inspection can be found at the end of this report. 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 Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None Standards from this section were not assessed at this inspection. EVIDENCE: Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Service user plans must improve. Some information is good and provides specific guidance but other information is incorrect and does not identify how some needs should be met. Programmes that help service users to develop are not followed consistently. Individual risk assessments have been completed although not all identified risks are recorded. EVIDENCE: Care records for two service users were looked at. Each service user had a care plan and risk assessments but these did not cover all their needs. Some elements of care plans and risk assessments gave good information but others were general and applied to general care, for example ‘respect privacy and dignity and service user’s wishes’ and ‘ensure the temperature of the bath water is not too hot’. It is not necessary to record this information in individual records and this practice should be automatically applied throughout the home. Staff were able to describe specific care needs for individual service users but the relevant care plan gave different information, for example one service user always had a shower but the care plan stated they had a bath. An occupational therapist had made recommendations for one service user but these had not been recorded or implemented. An eating programme for one service user had Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 10 been devised to assist with an eating problem; this programme was not being followed. Care plans had not been updated for some time, and even though one care plan had been signed to confirm it had been reviewed the information had not been correct at the time of the review. Care staff have limited involvement in the care planning process, and the plans are not used by the staff team on a regular basis. The manager is introducing a new care plan format and it is hoped this will address the shortfalls in the care planning process. Each service user has a range of risk assessments. However, some risks had been identified and appropriate action had been taken to minimise these risks but these had not been recorded. Sinks had been removed from two service users rooms; this was to prevent them from harming themselves but this resulted in them not being able to have a wash in the privacy of their room. Any decision that is made on behalf of service users must be carried out through a formal assessment process. Some service users have monitors (listening devices) in their bedroom; this is to alert staff if they have an accident or a seizure. The manager said two of the service users had risk assessments for the use of monitors but one service user did not. A formal assessment should be completed to make sure a monitor is required, and then clear guidance on the use of monitors should be formalised to make sure the privacy and dignity of service users is not compromised. Staff talked about involving different people and using knowledge and experience in decision-making processes. For example staff observe service users responses and body language to determine what they like and make sure relatives are consulted before decisions are made. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 14, & 17 The range and frequency of activities provided in the home and community are inadequate, which has resulted in lack of stimulation and motivation. Service users get a choice of meals, and these are satisfactory. EVIDENCE: The inspector spoke to five staff, all of who agreed that activities and opportunities to go out should improve. Four weeks of daily records were looked at for two service users. Throughout this period there was no evidence that the service users had been involved in any regular activity. Both service users pay for a twenty minute massage session once a month. The lack of activities and outings had been raised at the last inspection; staff and the manager confirmed that improvements had been made but these had since lapsed. Some service users attend day care services on a part time basis. There has been a reduction in day care provision within Bradford, therefore most service users do not receive an external day care service. This has resulted in service users spending more time at the home; staff thought this had contributed to the noticeable lack of activities. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 12 Staff said the meals were generally good. The home has a four week menu and any variation to the menu is recorded. Service users have a choice of meals. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 & 19 The home has good systems in place to make sure service users’ health and personal care needs are met. Service user’s privacy and dignity is respected. EVIDENCE: Staff spoke about privacy and dignity and had a good understanding of service user’s needs in relation to personal care and support. Each service user has a daily bath or shower. Records confirmed that service users attend regular healthcare appointments and advice is sought from other professionals. Details of contacts and appointments are well recorded. Staff generally felt that the home performs well in meeting health and personal care needs. The standard relating to medication administration was checked to establish that the requirement from the last inspection had been met. Gaps were again noted in medication administration records at this inspection. The manager said additional training had been provided to one staff, and the medication records are monitored by the manager and during senior management visits. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Although service users are generally unable to say how they are feeling, staff try hard to interpret their wishes through other methods. Service users are safeguarded from abuse. EVIDENCE: Service users are generally not able to say if they are satisfied with the service. Staff spoke about observing service users, and using knowledge and experience to identify when service users are unhappy. Service user plans have information which indicates when someone is unhappy or in pain. The home has a complaints procedure but details of the Commission for Social Care Inspection must be included. This has previously been brought to the attention of Bradford District Care Trust. The home has adult protection policies and procedures. Staff had a good understanding of adult protection and confirmed they have covered adult abuse through various training courses. Applications have been submitted for staff to attend additional adult protection training. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29, 30. The home is generally well maintained but there are a number of jobs which need addressing. Repairs and works are not carried out promptly, and this has had adverse affects on service users. Specialist equipment has been obtained to meet individual needs. Service users’ bedrooms are personal and are nicely decorated and furnished. EVIDENCE: The inspector visited all areas of the home. It was tidy and well organised. Moving and handling equipment is provided, and some specialised equipment has been provided for individual service users. Service users enjoy spending time in the enclosed garden. Bedrooms are very personal, and careful consideration has been given to the décor to ensure it reflects the preferences of service users. The home is reasonably well maintained but there are a number of repairs and works that must be addressed; some of these have been outstanding since May. This includes, damaged paintwork, broken and missing tiles, cracked plaster, loose flooring, and broken window blinds. Sandbags were laid in front Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 16 of a fire exit to stop leaks when it is raining. Some equipment/furniture needs fixing to walls and some furniture needs removing. One service user has had a wardrobe in their bedroom since May, which is still wrapped in cellophane. One service user had a mobile hoist stored in their bedroom, even though the hoist belonged to another service user. Some service users have not been able to watch television for several months because they are waiting for the new one to be set up; this is unacceptable. Service users or staff cannot use the activity room because it is being used to store equipment that is waiting to be installed. The shower attached to one of the assisted baths is broken, which makes hair washing and rinsing very difficult. Two industrial washing machines, with sluicing facility and two dryers are provided but one washing machine and one dryer is broken. Procedures are in place for control of infection. Hand washing facilities have been situated throughout the home. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 &36 The staff team generally work well together but there are some issues that need sorting out to enable the team to work more effectively. Staffing levels must be closely monitored to ensure staff have sufficient time with service users. Staff have opportunities to attend varied training courses and receive regular supervision. Training records must be maintained. EVIDENCE: The inspector spoke individually to five staff. Staff spoke of the daily routines and had a clear understanding of their roles. Staff generally felt that they worked well together but some aspects of teamwork could improve. The positive teamwork related to knowledge of service users and supporting each other in daily tasks. The areas to develop related to communication and inconsistencies in staff approaches. It was also felt that it would be beneficial for the manager to spend more time in the units. The manager was aware of the team issues, and agreed that to spend more time in the units could be beneficial. Staff are responsible for accompanying service users to appointments and one service user to day care. Staff and the manager said the workload can be very demanding, and staff said it is sometimes not possible to organise group or individual activities. They also said service users are sometimes left for long periods of time, without having staff input. For the past two weeks, staff have Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 18 had to cook meals because the cook has not been on duty. Extra staff have not been brought in to cover the extra workload. Staff that are cooking are also assisting service users with continence care and dealing with soiled laundry. Staff said they have a lot of opportunities to attend various training courses and the manager encourages this. All new staff complete an induction programme that includes LDAF (Learning Disability Award Framework) training. It was not possible to verify what courses had been attended as training records and training plans were not up to date. Staff said they have regular supervision. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) None EVIDENCE: These standards were not checked other than establishing that the requirements from the last inspection had been met. These were about gas and electrical safety checks. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score 2 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 x 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x 2 1 1 x x 3 Standard No 31 32 33 34 35 36 Score 3 x 2 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sheldon Ridge Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x x x 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 21 Yes Are there any outstanding requirements from the last inspection? 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 YA6 Regulation 15 Requirement The registered manager must ensure service users have an up to date plan that covers social, personal and health care needs. The registered manager must ensure formal risk assessments are completed; this relates to the use of monitors and sinks in service users rooms. The registered provider must ensure service users are given opportunities to access the community. The registered manager must ensure service users have oportunities to engage in recreational activities. The registered manager must ensure medication records are appropriately maintained. The registered provider must ensure details of the CSCI are included in the complaints procedure (Timescale of 31/10/05 & 31/03/05 not met) The registered provider must ensure maintenance work that is in the main body of the report is completed. The registered provider must repair the laundry equipment to Timescale for action 31st December 2005 30th September 2005 30th September 2005 30th September 2005 30th September 2005 31st October 2005 31st October 2005 30th September Page 22 2. YA9 13 3. YA13 16 4. YA14 16 5. 6. YA20 YA22 13 22 7. YA24 13 & 23 8. YA30 16 Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 9. YA33 18 10. YA33 16 11. YA35 18 ensure there is adequate facilities to wash and dry service users clothes. The registered provider must ensure there are adequate staff on shift to meet the needs of service users; this must include appropriate cover for domicilairy duties. The registered manager must ensure suitable arrangements are in place when staff are supporting service users with personal care and handling food. The registered manager must ensure training records are maintained. 2005 30th September 2005 30th September 2005 31st October 2005 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 YA33 Good Practice Recommendations The registered manager should develop strategies for dealing with some of the team issues. Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 23 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sheldon Ridge 20050809 Sheldon Ridge UN S19895 V225285 J52.doc Version 1.30 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!