CARE HOMES FOR OLDER PEOPLE
Shiels Court Braydeston Avenue Brundall Norwich Norfolk NR13 5JX Lead Inspector
Hilary Shephard Unannounced Inspection 2 pm 19 December 2005
th 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 Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 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. Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Shiels Court Address Braydeston Avenue Brundall Norwich Norfolk NR13 5JX 01603 712029 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) shiels@broadgate-healthcare.co.uk Mr M Afsar Care Home 40 Category(ies) of Dementia - over 65 years of age (40) registration, with number of places Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One (1) Service User under the age of 65 may be accommodated. A manager must be put forward for registration within six months Date of last inspection 24th August 2005 Brief Description of the Service: Shiels Court is a large Victorian house situated in the village of Brundall. The original house has been altered and extended over the years and now provides care and accommodation for up to 40 older people with dementia. The bedroom accommodation for residents is on three floors and consists of 26 single and 7 shared bedrooms (all with ensuite w.c.)The communal space consists of one very large lounge with a partition across separating the dining room, a separate smaller lounge and at the rear of the building a further small lounge, which is often used by staff for training purposes, and by visitors as an area to meet residents in private. The home also has extensive gardens currently being altered to meet the needs of the residents. Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over 5 ¼ hours during which time the inspector spoke with 9 residents and 1 member of staff. The views of residents and staff, where appropriate, are reflected in the findings in the report. This is the third inspection undertaken this year and the focus of this inspection was on activities, daily life and care plans. An inspection was made on 7th December 2005 of the homes medication by the Commission’s specialist Pharmacist Inspector who followed up requirements made at previous inspections. At the end of the inspection feedback was given to the manager and deputy manager. One requirement and one recommendation have been made as a result of this inspection. What the service does well: What has improved since the last inspection?
Recruitment practices have improved and the manager is careful not to employ new staff without making sure proper checks are done. Training continues to be provided and staff are undertaking NVQ Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 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. Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 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 Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 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): Standards not assessed at this inspection. EVIDENCE: Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 and 9 Care plans continue to improve, but due to illness the completion of all care plans has been delayed. Medication management has improved significantly, however some medicines are not being administered in line with prescribed instructions. EVIDENCE: Care plans contained a little more information about residents social and emotional care needs, and a brief life history. The recording of the residents’ life story has improved, but is still too brief and not always reflected in care plan guidelines. One newly admitted resident has specific interests that have been identified in his life story, but the guidelines for staff as to how they are to promote theses interests with the resident were omitted. Other general care needs have been identified, but again, guidelines for staff were omitted. Some care plans are more focussed on the residents’ individual needs and abilities than others and further work is needed to make the care is truly person centred. The home uses a standard computer programme, which has limitations when trying to write person centred care plans. The manager felt that at least six months were needed to get all care plans up to date, accurate and person centred. A requirement has been repeated from the previous two inspections.
Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 10 The Commissions specialist Pharmacist Inspector reviewed the medication on 7th December and found that the management of medicines has improved considerably since the previous inspection. Some recording and administration errors were noted, two requirements and one recommendation were made which the manager advised have been addressed. Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13 and 14 The lifestyle experienced by the residents was generally positive and enjoyable, family contact is encouraged and maintained, but residents are not always enabled to make choices. EVIDENCE: Residents said they thought living in the home was what they expected it to be like and said they were quite happy and settled. Residents were observed and most appeared to be relaxed and content and happy to be with the care staff. The manager has reviewed the activities provided in the home and has introduced new ones for the residents to participate in. Staff were seen to be interacting well with residents throughout the inspection and said that someone comes in weekly to organise activities and entertain the residents and that for those residents who can’t join in, the staff work with them on a one to one basis. This was seen to be the case throughout the inspection. Residents said they are able to make choices about the clothes they wear and how they have their hair, but they were not always given a choice about which meal they would like, although categorically stated the food was nice. A recommendation has been made regarding choices. Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 12 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): Standards not assessed at this inspection. EVIDENCE: Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 13 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): Standards not assessed at this inspection. EVIDENCE: Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 14 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): Standards 28 and 29 The knowledge of basic care practice has improved through better training. The home makes every effort to protect residents from harm by completing proper recruitment checks. EVIDENCE: Out of 24 care staff employed at the home, 5 are working towards NVQ level 3 and 3 towards NVQ level 2. The manager aims to introduce a continual NVQ training programme until at least 80 of care staff are qualified. Interaction seen between staff and residents continues to improve showing that staff are benefiting from their training. Staff files were inspected and showed that pre-employment checks are being made before staff commence. Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 15 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): Standards 31 and 33 Significant improvements have been made to the home since the appointment of the current manager and since the home was taken over in April 2005. Formal quality surveys are not being completed, but informal quality monitoring is undertaken constantly. EVIDENCE: The current manager is not yet registered with the Commission, but is working towards NVQ level 4 and has undertaken other training courses to improve care practices within the home. Care practice within the home has improved consistently since April 2005 and continues to do so. The manager is proactive and frequently assesses and monitors the service provided. Formal quality monitoring is planned for the New Year, however regular checks are made on the standards of cleanliness throughout the building, and improvements are put into place as required. The manager noted that the bedrooms weren’t being cleaned to her satisfaction after a weekend, so extra domestic staff were employed on Saturdays to address this.
Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 16 Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 17 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x x STAFFING Standard No Score 27 x 28 2 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x x x x x Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 18 Are there any outstanding requirements from the last inspection? One 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 OP7 Regulation 15 Requirement The Registered person must ensure that all care plans contain a life history, and provide full and detailed guidelines covering residents’ physical, social, emotional and psychological needs. Previous deadlines of 6.12.04 and 8.04.05 not met. Timescale for action 30/06/06 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 OP14 Good Practice Recommendations The Registered person is recommended to consider how to give residents a choice about meals and food. Shiels Court DS0000063180.V276826.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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