CARE HOMES FOR OLDER PEOPLE
Sherwood Clifton Street Rishton Nr Blackburn Lancashire BB1 4DW Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 18th October 2006 11:45 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 Sherwood DS0000052306.V312358.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. Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sherwood Address Clifton Street Rishton Nr Blackburn Lancashire BB1 4DW 01254 829816 01254 829816 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) Mr Geoffrey Timmins Mrs Maria Goretti Timmins Care Home 6 Category(ies) of Physical disability (2), Physical disability over 65 registration, with number years of age (6) of places Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. The service should, at all times employ a suitably experienced and qualified manager who is registered with the Commission for Social Care Inspection A maximum of 6 service users requiring personal care who fall into the category of PD(E) Within the total number of 6, a maximum of 2 service users requiring personal care who fall into the category of PD. It is recommended that the registered manager have a job description that clearly outlines their responsibilities and areas of authority in line with the requirements of the Care Homes Regulations 2001. 4th January 2006 Date of last inspection Brief Description of the Service: Sherwood House is a large 2 storey terraced property situated in the small town of Rishton and close to shops and local amenities. The home offers 24hour personal care for up to 6 people who have a physical disability and require intermediate care. Staff at Sherwood House work in partnership with Lancashire Council Social Services and the National Health Service to provide a rehabilitation programme for the residents. Accommodation is provided in single en-suite rooms on both floors of the home. Access to the first floor is via a stair lift. Communal rooms consist of a lounge, dining room and kitchen. Residents usually stay at the home for about 6 weeks. During this time independence is promoted and progress reviewed weekly. Social services are responsible for placing and funding all residents at Sherwood House. Additional charges are payable for hairdressing, newspapers, and toiletries. A statement of purpose and service user guide is available on request. Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Sherwood House on the 18 October 2006. At the time of this inspection two residents were living at the home. No additional visits have been made since the last unannounced inspection. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty and residents were spoken to. Discussions also took place with the senior care assistant on duty and a senior member of staff within the company regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
Following the last inspection information about ‘hip precautions’ for residents recovering form hip replacement operations has been obtained. Members of staff responsible for the administration of medication have received appropriate training. At the time of this inspection door wedges were not in use. All internal doors were closed. This helps to promote the safety of residents in the event of a fire. Records of fridge and freezer temperatures were kept. Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sherwood DS0000052306.V312358.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 Sherwood DS0000052306.V312358.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 at least once during a 12 month period. 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. Admission procedures were thorough. The rehabilitation programme was wellorganised promoting independence for the residents. EVIDENCE: Admission to the home, for all residents, was arranged by social services. Individual records of two residents were inspected. Both files contained a detailed pre-admission assessment, which had been completed by the social worker and other healthcare professionals. This assessment provided useful information for the care plan. The rehabilitation programme lasted for about 6 weeks and was delivered by the multidisciplinary team. This involved frequent visits from healthcare professionals including physiotherapists and occupational therapists. The multidisciplinary team reviewed progress within the rehabilitation programme weekly. The multidisciplinary team provided any necessary equipment. Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 9 Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 10 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, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Privacy and dignity was promoted for all residents. Care plans did not contain detailed information relating to all aspects of care. A procedure relating to the administration medication puts residents at risk. EVIDENCE: The individual care plans of two residents were inspected. However, these plans did not clearly identify and address the care needs of each resident. A risk assessment for nutrition had not been completed for either of these residents. Appropriate risk assessments for falls and pressure sores were in place. Where a risk of falling or developing pressure sores had been identified a care plan was not in place to explain how this risk was to be managed. Risk assessments and care plans were not signed or dated. There was no evidence to suggest that the resident or their relatives had been involved in care planning. A written report about the care given to individual residents was completed during each shift. Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 11 Members of the intermediate care team recorded details of their visits and provided written instructions for the care staff to follow. Residents were involved in the reviews of their progress within the rehabilitation programme. Records for the management of medication were seen to be up to date. However, hand written instructions on the medicines administration records were not signed or witnessed. Medication was stored in a locked drawer in the office. The temperature of this area was checked and recorded daily. Residents were encouraged to accept some responsibility for taking their medication by selecting the correct tablets and removing them from their containers at the appropriate time. Members of staff who had received appropriate training in the management of medication supervised this process. However, poor practice was observed at lunchtime on the day of the inspection when medication was left on the dining table for a resident to take later. This practice increases the risk of error and must cease. Personal care was carried out in private. Members of staff were observed talking to residents in a polite and friendly manner. Three members of staff explained how they promoted privacy and dignity for all residents. One resident said, “The staff are all very good, I’ve had a lot of encouragement.” Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 12 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, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities were well managed and visitors were welcomed into the home at any reasonable time. The daily routine was flexible in order to meet the needs and preferences of residents. Residents were involved in planning the meals. EVIDENCE: Leisure activities included; board games, creative art, pamper sessions and watching TV and videos. Discussion with residents and staff confirmed that the daily routine was flexible. Residents choose when to get up and go to bed. Visitors were welcomed into the home at any reasonable time. Both residents said the meals were very good. Menus were planned on a daily basis when the residents had been asked what they wanted to eat. The meal served at lunchtime was wholesome and looked appetising. Residents were encouraged to prepare light meals e.g. breakfast for themselves as part of the rehabilitation programme.
Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 13 Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 14 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints would be taken seriously and investigated. Members of staff had a clear understanding of adult protection issues. EVIDENCE: A copy of the complaints procedure was displayed in the home and included in the service user guide. No complaints have been made to the home or the commission since the last inspection. Policies and procedures relating to the protection of vulnerable adults were in place. However, the procedure needed amending to clearly state the action to be taken if allegations of abuse were made. This issue was discussed with three members of staff. They were aware of the procedure and said they would report any concerns immediately. Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 15 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 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 clean, comfortable and well maintained. A number of internal doors were wedged open potentially putting residents at risk in the event of a fire. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home was clean, tidy and well maintained. This provided a safe and comfortable environment for the residents. Laundry facilities were located in the kitchen. These were suitable for the size of the home and the needs of the residents. Red alginate bags, which dissolve in the washing machine, were used when necessary to prevent any cross infection from soiled linen. An infection control policy was available. Sherwood DS0000052306.V312358.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were thorough. More than 50 of care assistants had NVQ qualifications in care. Induction training needed further development to ensure consistency in the delivery of care. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts in order to meet the assessed needs of the residents. During the night when one carer was on duty a senior member of staff was on call for emergencies. The files of one recently appointed care assistant and one due to begin working at the home in the next few weeks were inspected. These indicated that all the required pre-employment checks to ensure protection of the residents had been completed. However, one of these care assistants had not given the name of the last employer as a referee. The senior member of staff from the company was advised to discuss this with the care assistant and request a reference from the last employer. Training for all members of staff was encouraged. This included, moving and handling, fire prevention, first aid and basic food hygiene. Five members of staff had an NVQ level 2 in care and one had NVQ level (60 ).
Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 17 Induction training for new employees took place but this did not meet the ‘Skills for Care’ standard. Sherwood DS0000052306.V312358.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was not effectively managed. Residents and their relatives were consulted about the quality of the care and services provided at the home. Appropriate procedures to safeguard the health and safety of residents were in place. EVIDENCE: The home does not currently have a registered manager. Senior care assistants were responsible for the day-to-day running of the home. A senior member of staff within the company provided some management support. The commission must be informed how the home is to be effectively managed until a manager is appointed. Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 19 Feedback from residents and their relatives was actively encouraged at their individual review meetings. Satisfaction questionnaires were also available in each bedroom for residents to complete. Both the residents were able to accept responsibility for their own money. Policies and procedures relating to safe working practices were in place. A fire risk assessment had been carried out. Fire alarms were tested weekly. Fire drills took place regularly and a staff attendance record was kept. Records of the routine servicing of equipment were seen. These included electrical installation and gas safety certificates and the testing of small electrical appliances. Records maintained in the kitchen included fridge and freezer temperatures. Safety procedures were displayed throughout the home. Sherwood DS0000052306.V312358.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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 3 Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 21 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. OP7 Standard Regulation 15(1) Requirement Care plans must give clear guidance about how all the identified needs of the resident are to be met. Residents or their relatives must be involved in planning their care. All care plans must be signed and dated. All residents must have a risk assessment, and if necessary a care plan relating to nutrition. Timescale of 27/01/06 not met. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. Staff must ensure that all medication is not left on the dining table for a resident to take later. Induction training for new employees must meet ‘Skills for Care’ specification. The registered provider shall appoint an individual to manage the care home where – (a) there is no registered manager in respect of the care home.
DS0000052306.V312358.R01.S.doc Timescale for action 24/11/06 2. OP8 3. OP9 12(1)(a) 24/11/06 13(2) 18/10/06 4. OP30 5. OP31 18(1)(c) (i) 8(1)(a) 22/12/06 24/11/06 Sherwood Version 5.2 Page 22 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. OP9 2. OP18 3 OP29 Refer to Standard Good Practice Recommendations All hand written instructions on the medicines administration records should be signed and witnessed. The procedure to follow if allegations of abuse are made should be amended to clearly state what action must be taken. A reference should be requested from the last employer of all prospective employees. Sherwood DS0000052306.V312358.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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