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Inspection on 26/07/07 for Shelton Lock Nursing Home

Also see our care home review for Shelton Lock Nursing Home for more information

This inspection was carried out on 26th July 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

There were positive comments from residents at Shelton Lock, including "I like it here", "I`m happy here", "it`s clean and comfortable". The staff were described as "lovely", "kind", "always willing to help", and "they have a laugh with you". Most of the staff had worked at the home for more than 2 years and there was a group of staff that had worked at the home for 5 years or more. There was a robust quality assurance system in place that included finding out and acting on the views of residents and their representatives.

What has improved since the last inspection?

At the last inspection it was found that 2 bathrooms were cluttered and used as storage. At this inspection the bathrooms the bathrooms were no longer used as storage. Some bedrooms had been redecorated since the last inspection.

What the care home could do better:

Comments were received from residents and staff about staffing levels at the home. It was generally felt by residents that staff were not always available when needed. Staff said they felt they did not always have enough time to spend with residents, although they felt residents` basic needs were met. Staff did not always have training to meet the individual needs of residents, for example, residents with dementia or with specific medical conditions.

CARE HOMES FOR OLDER PEOPLE Shelton Lock Nursing Home 61a Weston Park Avenue Shelton Lock Derby DE24 9ER Lead Inspector Rose Veale Unannounced Inspection 10:00 26th July 2007 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 Shelton Lock Nursing Home DS0000002147.V337794.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. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shelton Lock Nursing Home Address 61a Weston Park Avenue Shelton Lock Derby DE24 9ER 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) 01332 690606 01332 703173 www.bupa.co.uk BUPA Care Homes (CFC Homes) Limited Vacancy Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2006 Brief Description of the Service: Shelton Lock provides care for up to 40 older people with nursing and personal care needs. The home is a purpose built, two-storey building, set back off the road in a residential area of Derby. Shelton Lock has double and single en-suite bedrooms. There are several lounge areas and a large dining room. There is a large, well maintained, accessible garden and a car park. Information about the home, including CSCI inspection reports, is available at the home. Fees at the home range from £550.00 to £726.47 per week. This information was provided in the pre-inspection questionnaire completed in April 2007 and confirmed by the acting manager on 02/08/07. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit was unannounced and took place over 7½ hours. The inspection visit focused on assessing compliance to requirements made at the previous inspection and on assessing all the key standards. There were 30 residents accommodated in the home on the day of the inspection, including 29 residents assessed as needing nursing care. 5 residents and 5 staff were spoken with during the visit. The acting manager and operations manager were available and helpful throughout the inspection visit. Some residents were unable to contribute directly to the inspection process because of communication difficulties, but they were observed during the visit to see how well their needs were met by staff. Records were examined, including care records, staff records, maintenance, and health and safety records. Most areas of the building were seen. A questionnaire and surveys had been completed and returned prior to the inspection and information from this has been included in the body of this report. Since the last inspection, the previous registered manager had left the home and there was an acting manager in place. What the service does well: What has improved since the last inspection? What they could do better: Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 6 Comments were received from residents and staff about staffing levels at the home. It was generally felt by residents that staff were not always available when needed. Staff said they felt they did not always have enough time to spend with residents, although they felt residents’ basic needs were met. Staff did not always have training to meet the individual needs of residents, for example, residents with dementia or with specific medical conditions. 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. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 7 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 Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 8 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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was a satisfactory assessment process so that residents were confident the home was able to meet their needs. EVIDENCE: The care records for 5 residents were examined. All had a range of assessment information, including a pre-admission assessment carried out by staff from the home, and assessment information from social services and / or hospital staff. Specialist advice and support had been sought for residents with specific needs, such as certain medical conditions. Residents spoken with said their needs were met at the home. The survey responses indicated that residents felt they had the care and support they needed most of the time. Standard 6 did not apply to this service. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to this service. There was a consistent and thorough approach to care planning so that residents’ health and personal care needs were well met. EVIDENCE: Each of the care records seen had a care plan produced from the needs assessment. The care plans were detailed and comprehensive, covering all the assessed needs of the residents. Most of the care plans had been reviewed monthly. There was evidence of the involvement of residents and/or their representatives in care planning and review. There were risk assessments in place addressing the risk of falls, the risk of developing pressure sores, the risks associated with manual handling, and a general risk assessment about the environment and equipment in the home. Most of the risk assessment had been reviewed and updated monthly. Some risk assessments had not been signed or dated. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 10 Residents assessed as needing bed rails had a risk assessment and restraint form completed. 2 of these assessments seen had not been signed or dated. Residents spoken with said they were able to see their GP when needed, and that they had access to other healthcare services, such as chiropody, physiotherapy, and optician. The survey responses indicated that residents felt they usually had the medical support they needed. There was evidence in the care records of residents appropriately referred for specialist advice and support. For example, a resident with difficulties in swallowing was seen by the speech and language therapist. The daily records were generally informative about the resident’s daily routine and any changes in their condition. The daily records were generally well kept, although there were blank spaces left at the end of entries. (Current good practice in record keeping is to put a line through any blank space to prevent later additions being made). All of the care plans seen included references to maintaining privacy and dignity for residents. Residents spoken with said staff treated them with respect. Of the 8 survey responses received, 4 said that staff listened and acted upon what residents said. The other 4 said that staff did not always listen as “they haven’t got time” and were “not always available”. There were comments received that residents sometimes had to wait when they needed the toilet. (See staffing section of this report). Staff spoken with were aware of how to ensure privacy and dignity for residents. It was observed that staff were courteous and respectful in their approach to residents. Medication was stored securely. There had been recent problems as the storage room temperature was too warm. Action had been taken using a portable air-conditioning unit and monitoring the temperature daily. The medication administration records seen were correctly completed. There were good records of the receipt and disposal of medication. Medication was only administered by the qualified nurses at the home. It was found that medication prescribed for one resident, (Lactulose), was being used by other residents. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. There was a lack of organised activities so that it was not clear that residents’ social and recreational needs and preferences were fully met. EVIDENCE: The home did not have an activities coordinator in post at the time of the inspection visit. The previous activities coordinator had left recently and the acting manager said that it was planned to recruit to the post. There was no formal programme of activities for residents. Residents spoken with and those surveyed said there were usually activities that they could take part in. One resident commented, “we ought to have more entertainment”, and another resident said “we don’t do much during the day”. Residents spoken with said they could usually follow their preferred routines. One resident gave an example of being assisted to their room after lunch to watch tennis on their own television as they preferred this to watching in the main lounge. One resident said they could get up and go to bed when they wanted. There were comments received that staff were not always available when needed. (See Staffing section of this report). Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 12 Relatives and friends were able to visit at any reasonable time. Residents spoken with said their visitors were made welcome at the home. Residents were able to bring in their own possessions, including items of furniture. The bedrooms seen were personalised with the resident’s own possessions and photographs. Residents spoken with and most of those surveyed said they were satisfied with the meals at the home. One resident commented of the meals, “they could be better”. Residents said they had enjoyed the lunch served on the day of the inspection visit. The menu was displayed in the dining room, though not at a suitable height for people sitting in wheelchairs to see. The home employed an additional assistant from 7.30 to 10.30am every day to help with breakfasts and to help those residents who needed assistance to eat and drink. Staff spoken with said this had improved breakfast times, and that they could do with the same kind of help at teatime. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 13 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 good. This judgement has been made using available evidence including a visit to this service. There were robust policies in place and good staff awareness so that residents were protected and their concerns effectively dealt with. EVIDENCE: The complaints records seen included the action taken and the outcome of the complaint. Complaints and compliments were audited monthly by the providers. A complaint had been received by CSCI in March 2007and had been referred to the providers for investigation and action. There was evidence that this complaint had been appropriately dealt with, although it had not been resolved. Residents spoken with and most of those surveyed said they knew who to go to if they were unhappy or had any concerns. There was evidence that allegations of abuse were dealt with appropriately and promptly. Staff had received training in safeguarding adults awareness, issues and procedures. Staff spoken with were all aware of the correct procedures to follow if abuse was suspected or alleged. The home had policies and procedures in place about safeguarding adults, including the local multi-agency procedures, and about whistle-blowing. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 14 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well equipped and generally well maintained so that residents lived in a safe, clean, comfortable and pleasant environment. EVIDENCE: The home provided equipment and aids to meet the needs of residents, such as lifting hoists, specialist baths, hand-rails, and raised toilet seats. There was a pleasant, well maintained garden that was accessible to residents. The lounge areas were comfortably furnished. There was a ‘quiet’ lounge available for residents. There were areas of the home where redecoration was needed, particularly the corridors and the bathrooms. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 15 Residents spoken with and those surveyed said the home was usually clean and fresh. On the day of the inspection visit, the home appeared clean and was free from offensive odours. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 16 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. Staffing levels and staff training were sufficient to meet residents’ basic needs, but not enough to ensure a holistic, person centred approach to residents care. EVIDENCE: Most of the residents spoken with and those surveyed said that staff were not always available when needed. Comments included, “we have to wait too long to go to the toilet”, “I try not to bother the staff as they are usually very busy”, “I think there is a staff shortage”, “I don’t think there’s enough staff”, and “staff are busy all the time”. Staff spoken with said they often felt “rushed” and that they “can’t always give residents what they need”, when the staffing levels were not as planned. The staff rotas showed that the planned staffing levels were 2 registered nurses with 5 care assistants for the morning shift, plus the breakfast assistant from 7.30 to 10.30am, kitchen, housekeeping and laundry staff, and the acting manager. For the afternoon shift, 1 registered nurse with 4 care assistants, plus the acting manager until about 5pm. The night shift was 1 registered nurse plus 2 or 3 care assistants. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 17 The staff rotas seen showed that actual staffing levels generally met the planned levels, although there had been occasions when there were 4 instead of 5 care assistants in the morning, and 3 instead of 4 in the afternoon. It was observed during the inspection visit that residents were waiting to be transferred from wheelchairs into easy chairs after breakfast and lunch. The staffing levels were discussed with the acting manager and operations manager. The operations manager said there would be a review of staffing levels against the dependency of residents to ensure residents’ needs were properly met. The acting manager said that the home was actively recruiting new staff to work as ‘bank’ care assistants so that there would be more staff to draw on to cover staff sickness and holidays. The acting manager said that out of 20 care assistants, 8 had achieved a National Vocational Qualification (NVQ) at Level 2 or above, and 2 were working towards NVQ. Training records showed that most staff had received all the required training. Staff spoken with confirmed that this. Staff had not had training to meet specific individual needs, such as training about dementia or about conditions such as motor neurone disease. New staff went through an induction programme that met Skills for Care standards and had a period of shadowing an experienced member of staff. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was effectively managed and there were good systems in place so that the health, safety and welfare of residents was promoted and protected. EVIDENCE: Since the last inspection, the registered manager had left and there was an acting manager in place. The acting manager was an experienced nurse who had worked at the home for several years. The acting manager was supported by another manager within the organisation and the operations manager. Staff spoken with were satisfied with the management arrangements and had confidence in the abilities of the acting manager. The operations manager said that the organisation was in the process of recruiting a new permanent manager. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 19 There was a quality assurance system in the home that included surveys sent out to residents and / or their representatives, audits of areas within the home such as catering and housekeeping, audits of documentation, medication audits, and audits of complaints and compliments. The survey responses from residents / their representatives were sent to an independent company for analysis and a report was produced. The report was available to residents / their representatives, staff and visitors. Health and safety records sampled were complete and up to date. Staff had received training in health and safety, manual handling and fire safety. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 20 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) Requirement Medication prescribed for one resident must not be given to others. This will protect residents and ensure medication is given as prescribed. Staff must have training to enable them to understand and meet the needs of residents, such as residents with dementia or specific medical conditions. Timescale for action 31/08/07 2. OP30 18(1)(c) (i) 30/11/07 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 OP7 Good Practice Recommendations Care records should be written in accordance with current good practice, such as not leaving blank spaces between entries in daily records, and ensuring documents are signed and dated. This will help to ensure that information about residents is accurate and current. Following consultation with residents/their representatives, there should be a programme of activities provided to meet the needs and expectations of residents. DS0000002147.V337794.R01.S.doc Version 5.2 Page 22 2. OP12 Shelton Lock Nursing Home 3. OP15 The menus should be displayed where all residents can see them. Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Shelton Lock Nursing Home DS0000002147.V337794.R01.S.doc Version 5.2 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. 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