CARE HOMES FOR OLDER PEOPLE
Shiels Court 4 Braydeston Avenue Brundall Norwich NR13 5JX Lead Inspector
Hilary Shephard Unannounced 24 August 2005 08.15 am
th 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 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 I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Shiels Court Address 4 Braydeston Avenue, Brundall, Norwich, NR13 5JX 01603 712029 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) Mr M Afsar Care Home 40 Category(ies) of Dementia (40) registration, with number of places Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: One (1) Service User under the age of 65 may be accommodated. All outstanding inspection requirements must be complied with within six months of the purchase completion date. A manager must be put forward for registration within six months The following areas of concern must be addressed immediately upon registration: Two written references and Criminal Records Bureau checks must be obtained on all new staff prior to their commencement Date of last inspection 18th May 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 I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over 5 hours and the purpose was to follow up requirements made at the previous inspection (18.5.05) and look into concerns highlighted to CSCI following a recent strategy meeting. The inspector spoke with six residents and four staff and looked at care plans and training records. What the service does well: What has improved since the last inspection? What they could do better:
Although the care plans have improved significantly, there is a need for the new format to be completed for all residents in order for their needs to be fully assessed, identified and met. Recruitment practices are poor, and the home is not following proper procedures and is not checking staff thoroughly before they start work.
Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 6 Enforcement procedings will commence if this requirement has not been met by the time of the next inspection. 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 I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 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 standard(s) Not assessed at this inspection. EVIDENCE: Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 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 standard(s) 7, 8 and 10 Further improvements have been made to the residents care plans and the care of their health needs, residents were satisfied they were treated with respect. EVIDENCE: Care plans were inspected and over the past three months the manager has been implementing a new care plan format. The manager is gradually introducing these for all residents and is to start with the residents whose needs are the greatest, however currently only the newly admitted residents have these. The new style care plans were good, contained lots of information about the residents social and medical history and had clear guidelines enabling staff to meet the residents identified needs. These care plans also contained reference to the residents social and emotional needs and need further work to enable information gathered in the residents life history to be reflected here. Risk assessments have been developed for all new residents and these were comprehensive with easy to follow guidance for staff. There is an urgent need for all care plans to be updated to the new format as soon as possible and the requirement made at the last inspection has been repeated.
Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 10 District nurses have been involved with the care of some residents for some time and advised that concerns highlighted to CSCI about pressure sores have improved and in some cases resolved. District nurses have been working closely with care staff and the manager providing training and guidance in care practice which has helped care staff to improve their knowledge and skills regarding care provision. Residents said they thought the staff were good, and observation showed that staff were providing appropriate care. Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 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 standard(s) Not assessed at this inspection. EVIDENCE: Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 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 standard(s) Not assessed at this inspection. EVIDENCE: Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 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 standard(s) 26 Residents benefit from living in a clean and pleasant smelling home. EVIDENCE: The home was clean with no unpleasant odour. The manager advised that there are further plans to replace carpets on the ground floor and to improve the décor. Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 Staffing levels are meeting the needs of the current residents, but by not following proper recruitment procedures the home is placing residents at risk from harm. Significant improvements have been made to staffs skills and knowledge by the provision of training relevant to the residents needs. EVIDENCE: The files of newly appointed staff were checked and did not contain Criminal Records Bureau checks (CRB) or a check on the Protection of Vulnerable Adult register (POVA). Two files only contained one written reference and no copies of identification (ID), two files did not contain adequate detail regarding the applicant’s previous employment and one file had no application form, references, CRB or ID. As the level of concern was so serious, an immediate requirement was issued at the time of the inspection. The home is still experiencing difficulties obtaining checks in a timely fashion from the CRB and are still not obtaining POVA first checks whilst they are waiting for the CRB check to be done despite a requirement being made at the previous inspection. The manager advised that staff are working under supervision until the CRB check is received, but the home could protect residents further by ensuring a POVA fist check is completed before staff commence and the requirement from the previous inspection has been repeated. Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 15 Staff have received training in basic care practice, induction and foundation, dementia care, adult protection, moving and handling and pressure area care. Nine staff have also commenced NVQ training, four at level 2 and five at level 3. Staff advised that they have benefited from all the training they have had recently and that training opportunities are much better since the new owner took over the home. Staff said they had started NVQ training, which they were enjoying and learning from. The interaction seen between staff and residents was much better showing that staff had benefited from their recent dementia care training. A new hoist had been purchased and staff are being much more careful about how they move residents. Staffing levels were adequate, staff were seen to be able to care for the residents without rushing, and were able to spend a little time with them during the morning. Staff advised that they were a bit short staffed that morning but they appeared to be managing well. The manager advised that some young staff have been appointed to undertake ancillary duties in the kitchen and laundry and one of these staff was seen to interact very well with the residents throughout the morning. Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 16 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Not assessed at this inspection. EVIDENCE: Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x x x Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 18 Are there any outstanding requirements from the last inspection? Two are repeated from the inspection of 18.5.05 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 7 Regulation 15 Timescale for action The Registered person must complete ensure that all care plans contain all by 30th a life history wherever possible November and provide full and detailed 2005. guidelines covering residents physical, social, emotional and psychological needs. (Previous deadline of 18.5.05 not met.) The Registered person must Prior to ensure that POVA first checks commence are obtained whilst waiting for ment of new staff CRB checks and PRIOR to staff commencement and that staff continue to be supervised until the CRB is received. (Previous deadline of 18.5.05 not met.) Requirement 2. 29 19 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 Good Practice Recommendations Shiels Court I55 s63180 shielscourt v244153 240805 stage 4.doc Version 1.40 Page 19 Commission for Social Care Inspection 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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