Inspection on 28/08/09 for Shiels Court

This inspection was carried out on 28th August 2009.

CQC found this care home to be providing an Poor service.

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 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shiels Court 22/10/07

Shiels Court 03/01/07

Shiels Court 19/12/05

Shiels Court 24/08/05

Shiels Court 18/05/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Shiels Court Braydeston Avenue Brundall Norwich Norfolk NR13 5JX     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Debra Allen     Date: 0 4 0 9 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Shiels Court Braydeston Avenue Brundall Norwich Norfolk NR13 5JX 01603712029 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): shiels@broadgate-healthcare.co.uk shiels@broadgate-healthcare.co.uk Mr M Afsar Name of registered manager (if applicable) Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 41 The registered person may provide the following categories of service: Care Home only - Code PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - Code DE Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home 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 Care Homes for Older People Page 4 of 38 Over 65 0 41 41 0 Brief description of the care home with en suite WC). 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. The home informed CSCI of its charges in October 2007 and charges from #430 to #434 per week. Residents are expected to pay extra for hairdressing, chiropody newspapers, magazines, manicures and hand massage. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. The fieldwork of this inspection was carried out over two days and approximately twelve hours. As a result of some people with dementia not always being able to tell us about their experiences and what it is like to live in a care home, as part of this inspection process we used a formal way to observe people, to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved observing five people, in Care Homes for Older People Page 6 of 38 the main lounge, who live at Shiels Court for a period of ninety minutes and recording their experiences at regular intervals. This included their state of well being, how they interacted with care staff and others and what they did during this period. The inspection also included a tour of the premises, inspection of staff and residents records and the homes records relating to health and safety. Discussions also took place with the manager, staff, residents and a relative. Five questionnaires were completed or returned to the Commission by members of staff, one from a resident and one from a relative. Some of the additional comments included: ...the home cares for the service users very well... ...Our job is to care and make them feel at home... ...there is always room for improvement but everything is run as well as it could/should be... ...look after the residents well... ...meet the residents needs... ...hoists - lifting is appalling and carers are going to get back problems... ...bathing - I cant remember the last time [name] had a bath and I heard [name] asking for a bath and being refused... ...bathing isnt being done in shifts... ...very good and kind carers... The relatives survey contained additional comments such as: ...consistent and caring environment... ...family feel to the place... ...make all visitors welcome... ...excellent service and cleanliness to rooms and a quick laundry service in a difficult situation... ...friendly answering of the telephone, where messages get passed on and prompt answering of the front door... ...would gladly recommend to others... ...the previous manager and the staff helped me with a very difficult time with [name]s admission. I have only praise for how they deal with [name] and the other residents... Care Homes for Older People Page 7 of 38 ...a menu could be followed... ...there should be an alternative choice on the menu, something different to suit all tastes... ...the two occasions menus have been written have been inspections... ...there could be more activities/things to do for residents at all stages... ...staff could take residents for walks outside the home... ...there could be a choice of more meals... ...the meals are often verging on inedible... ...the display board could be up to date with a daily menu... ...when extra food is brought in, it sometimes gets forgotten about... An Annual Quality Assurance Assessment (AQAA) has also been completed by the manager and returned to the Commission. Seventeen requirements and one recommendation have been made as a result of this inspection. Care Homes for Older People Page 8 of 38 What the care home does well: What has improved since the last inspection? What they could do better: Care plans must be reviewed and updated on a regular basis. Residents wishes must be respected and sufficient opportunities and support provided to enable residents to bathe in accordance with their wishes. Care Homes for Older People Page 9 of 38 Full medical information must be maintained and available for all residents and missing pages in the medication folder must be completed or replaced. Serious consideration must be given in respect of residents having appropriate clothing, crockery and utensils during mealtimes. Care plans must contain details of how residents health and welfare needs are to be met, particularly in respect of weight and nutrition. Consideration should be given to the times people are given their morning medication, especially in respect of the period between breakfast and lunch. Staff must maintain good and professional relationships with residents. Individuals needs and choices must be respected and serious consideration must be given to ensure the size and layout of rooms occupied by residents are suitable for their needs. Residents must be supported to have access to social activities and pursue their interests and hobbies and care plans must be kept up to date. A menu must be planned and followed, that is nutritionally balanced and has been developed following consultation with the people living at Shiels Court. Sufficient bathing facilities must be available for residents. The entrance to the basement must be made safe and the gates closed at all times that staff are not present. All staff dealing with food at any time must receive training in food hygiene. All care staff must have up to date training in first aid, moving and handling and adult protection. A minimum of 50 of care staff must be trained to at least NVQ 2 or equivalent. Staff must receive formal one-to-one supervision on a regular basis. A formal Quality Assurance process must be carried out on a regular basis. The registered person must ensure that unnecessary risks to the health and safety of residents are identified and eliminated as much as is possible. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our Care Homes for Older People Page 10 of 38 order line 0870 240 7535. Care Homes for Older People Page 11 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 12 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed prior to admission and the information is used as part of the care planning process, which helps to ensure peoples needs are met. Evidence: Five peoples care plans were looked at in detail during this inspection and each was found to be very individual and contained good evidence that comprehensive preadmission assessments were carried out for each person before they moved in to Shiels Court. The completed relatives survey and a brief discussion with a relative confirmed that enough information was provided, from which to make an informed choice about moving to Shiels Court. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The foundations for good care planning are in place but regular reviews have not been happening and some of the information recorded is very sparse. In some cases the information is contrary to peoples needs and choices, which means their health, personal and social needs are not being adequately provided for. Evidence: It was noted from the last inspection, in October 2007, that considerable improvements had been made in respect of individual care planning and these improvements were seen to have been consistently maintained until the beginning of 2009. However, from the records looked at it is evident that certain levels of care provision have declined, peoples needs and choices are not being met and appropriate and up to date records are not being maintained. Specific examples of this are as follows: Care Homes for Older People Page 14 of 38 Evidence: It was noted that care plans were generally being reviewed on a monthly basis. However, all five care plans looked at in detail showed considerable gaps between reviews, with one showing February 2009 as the last. Records of peoples weights were also seen to be inconsistently and inadequately recorded, with no specific care/action plans in place for cases where peoples weight has noticeably changed. i.e. (1) Last weight recorded in February = 10 stone 4 pounds. Previous weight recorded in December 2008 = 10 stone 12 pounds. Showing a loss of 8 pounds. A MUST (Malnutrition Universal Screening Tool) assessment was seen to be dated February 2009 and the outcome was Low Risk. However, there was no indication as to whether this persons weight loss was planned or being supported and monitored. No professional input was evident in the care plan and no diet plan was seen to be in place. (2) Weights not seen to be recorded in care plan - no evidence available. (3) Dates on a Review of Weight sheet were seen, although no actual weights were recorded on it. The dates were March 2008, May 2008 and July 2008. No further information regarding weight was seen to be recorded after July 2008. (4) A Review of Weight sheet was seen, although no actual weights were recorded on it. Comments noted were: March 2008 = Not much change - gained weight since last review. July 2008 = Not much change - has gained 11lb since last review. October 2008 = Not much change - weight has stayed the same. Again, there was no indication as to whether this persons weight change (increase) was planned or being supported and monitored. No professional input was evident in the care plan and no diet plan was seen to be in place. No further information was seen to be available after October 2008. (5) Dates recorded on the review of weight sheet were noted as: March 2008 (gain), April 2008 (loss), May 2008 (obese), July 2008 (down) and October 2008 (same). For this person, it was noted that a speech and language assessment had been completed in February 2008, which confirmed swallowing problems (dysphagia), following which it was recommended that meals should be pureed and drinks thickened. Evidence of this persons health, weight and nutritional wellbeing was very difficult to establish from the information recorded in the care plan. Bathing records were also looked at for all five people. One persons care plan was Care Homes for Older People Page 15 of 38 Evidence: seen to specifically state that they like to have a bath on a Monday or Tuesday morning each week. However, the records seen indicated that this persons wishes are not being met. Records of baths were seen as follows: (1) May 2009 x 2, June 2009 x 1. No further dates were seen to be recorded and daily notes did not indicate that baths had been provided. (2) November 2008 x 2, December 2008 x 1, January 2009 x 2, February 2009 x 1, March 2009 x 0, April 2009 x 4, May 2009 x 2 and June 2009 x 1. No further dates were seen to be recorded and daily notes did not indicate that baths had been provided. (3) November 2008 x 3, December 2008 x 4, January 2009 x 3, February 2009 x 1, March 2009 x 0, April 2009 x 0, May 2009 x 0, June 2009 x 1, July x 1 and August 2009 x 1. (4) November 2008 x 0, December 2008 x 1 and January 2009 x 1. No further baths were seen to be recorded until September 2009. (5) November 2008 x 2, December 2008 x 3, January 2009 x 1, February 2009 x 3, March 2009 x 0, April 2009 x 1, May 2009 x 1, June 2009 x 1, July 2009 x 1 and August 2009 x 1. In respect of one persons care plan, the information contained within depicted a very mobile and active person, while observations showed somebody very different mostly asleep in one of the communal lounges on both days of the inspection. A discussion with the manager and other staff members confirmed that this was due to a recent change in medication, which was being monitored but had not been appropriately recorded in the care plan. Another residents mobility care assessment clearly stated that they could walk unaided, with no requirements for a frame, walking stick, crutches or care assistant. However two staff were observed assisting this person, using a moving belt. Medication administration, storage and records were looked at during this inspection and, although no errors or omissions were noted, there was some concern around the timing and organisation with regard to when and how medication is administered. It was observed that whilst individuals choices of getting up in the morning was being Care Homes for Older People Page 16 of 38 Evidence: respected, morning medication appeared to be administered on an as and when basis. Medication times were seen to be specified as Morning, Lunch-time, Tea-time and Bed-time but it was observed that morning medication was being administered constantly throughout the morning, with the last person receiving their morning medication at approximately 12:30. Although the staff member responsible for medication confirmed that they knew exactly who had been given their medication and who still needed to take it, it was difficult to evidence the reliability of this. Meanwhile, fridge temperatures were seen to have been consistently recorded, medication due to be returned was stored and recorded appropriately and controlled drugs also stored and recorded appropriately. The information in the medication folders was seen to be generally very good with a medication profile compiled for each person, covering areas such as: Name, photograph, room number, allergies, doctors details, medication and route (i.e. oral, via P.E.G. etc). Signed consent forms were also seen for covert medication administration. However, it was noted that some peoples information pages in the folders were loose or torn, which could lead to their information becoming misplaced, especially as the medication folders contain records for a number of residents. It was also noted that, of six peoples medication records looked at, two were without the front profile sheets. Meanwhile, of the five surveys completed and returned by staff members, three responded always and two responded usually to the question: Are you given up to date information about the needs of people you support or care for (for example in the care plan)? Additional comments from staff, which should be given serious consideration, were noted as: ...the home cares for the service users very well... ...Our job is to care and make them feel at home... Care Homes for Older People Page 17 of 38 Evidence: ...there is always room for improvement but everything is run as well as it could/should be... ...look after the residents well... ...meet the residents needs... ...hoists - lifting is appalling and carers are going to get back problems... ...bathing - I cant remember the last time [name] had a bath and I heard [name] asking for a bath and being refused... ...bathing isnt being done in shifts... ...very good and kind carers... The relatives survey contained additional comments such as: ...consistent and caring environment... ...family feel to the place... ...make all visitors welcome... ...excellent service and cleanliness to rooms and a quick laundry service in a difficult situation... ...friendly answering of the telephone, where messages get passed on and prompt answering of the front door... ...would gladly recommend to others... ...the previous manager and the staff helped me with a very difficult time with [name]s admission. I have only praise for how they deal with [name] and the other residents... Although observations showed residents generally being treated with respect by staff members, it was very disappointing to observe, during meal times, that a number of residents were given somewhat tatty and threadbare yellow pinafores to wear over Care Homes for Older People Page 18 of 38 Evidence: their clothing and everybody, in both dining rooms, were seen to have their meals served on melamine/plastic dishes and their drinks in coloured plastic beakers. This does not promote peoples dignity or provide them with their right to enjoy a sociable and dignified mealtime. Care Homes for Older People Page 19 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to maintain contact with family, and friends, according to their wishes. Activities and entertainment are provided for people living at Shiels Court but 1:1 time with staff has declined over the past months and meal choices are limited. Evidence: As a result of some people with dementia not always being able to tell us about their experiences and what it is like to live in a care home, as part of this inspection process we have used a formal way to observe people, to help us understand. We call this a Short Observational Framework for Inspection (SOFI). This involved us observing five people, in the main lounge, who live at Shiels Court for a period of ninety minutes and recording their experiences at regular intervals. This included their state of well being, how they interacted with care staff and others and what they did during this period. The observation highlighted that interaction was very limited for the five people who were being observed. One person was observed to sleep throughout the majority of the observational period, being woken once by staff and supported to have a drink. Although staff were Care Homes for Older People Page 20 of 38 Evidence: gentle and caring during this period, the resident drank with their eyes closed and remained in a semi reclined position, which resulted in bouts of coughing. Another person was observed falling asleep with a bottle of drink in her hand which they appeared to be comfortable holding, with no risk of spillage or harm. A staff member was noted to walk over to the resident and remove the bottle from them, which seemed to cause confusion for the resident when they awoke - they appeared to know something was missing or different. This is not appropriate or considerate behaviour for people with dementia. It was also noted on a number of occasions that staff failed to acknowledge residents when in their presence. On one occasion, a staff member was observed stepping over one persons feet and standing in front of them and, although the resident was alert and communicative staff failed to acknowledge them in any way. Another example was while in the Royal lounge, a staff member came in, cleared empty crockery away and wiped the table, without any acknowledgement of the person still sitting at the table or any of the other residents sitting elsewhere in the lounge. Various entertainment was noted on both days of the inspection; on one day, some of the residents were having a ball game in the main lounge on another, a man was singing and playing the piano, encouraging a sing-along and on both days some residents were observed having one-to-one interaction - which included time with family or friends that were visiting. From observations it appeared that the people who were more able to communicate and were active received more interaction from staff, whereas other people who were quieter and less physically able, mostly only had interaction for essential purposes such as being assisted to eat, drink, have medication, go to the toilet etc. Other observations while sitting in the smaller part of the main communal area were as follows: * The flat screen television on the wall in the small lounge was turned on but the volume was barely audible. * The television was also on in the larger lounge directly beside the smaller one, which was more audible. * Music was playing in the dining area, which was also audible throughout the dining room, large lounge and smaller one. Care Homes for Older People Page 21 of 38 Evidence: * The kitchenette door was regularly banging loudly with staff entering and leaving. The whole environment - whilst a generally cheerful, was a cacophony of noise, which can cause confusion for people who have dementia or sensory impairment. In respect of the five people who were observed, their care plans indicated a number of hobbies, interests and activities that are enjoyed such as: going for a walk, playing the organ, playing bingo, watching/playing darts, reading books and reading the newspaper. However, there was no evidence of any of the five people undertaking any of these activities on either day of the inspection and observations noted gave reason to believe that the care plans are not providing up to date information, which will inevitably cause consistency of care to be compromised. In respect of mealtimes, it was disappointing to note that, as with the previous inspection in October 2007, the home is failing to keep to planned menus and people did not appear to be consulted about what is provided for the main course. On the first day of the inspection the main meal was noted to be either turkey with suet dumplings and mixed vegetables or chicken in bacon with a jacket potato. Dessert was either ice cream or Angel Delight. It was commented on by some staff members that meals and snacks used to be available and offered to residents four to five times during the course of a day but in the last few months this has reduced to an average of three times per day only. From the surveys completed by staff, resident and relative, additional comments included: ...a menu could be followed... ...there should be an alternative choice on the menu, something different to suit all tastes... ...the two occasions menus have been written have been inspections... ...there could be more activities/things to do for residents at all stages... ...staff could take residents for walks outside the home... Care Homes for Older People Page 22 of 38 Evidence: ...there could be a choice of more meals... ...the meals are often verging on inedible... ...the display board could be up to date with a daily menu... ...when extra food is brought in, it sometimes gets forgotten about... Care Homes for Older People Page 23 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents, their families and friends know their complaints will be listened to, taken seriously and acted upon. Procedures are in place that help protect residents from abuse, although it is not evident from the records that all staff have received up to date training in adult protection. Evidence: The surveys completed by one resident and a relative both confirmed that they knew how to make a complaint and who to talk to if they had any concerns. Four out of the five staff surveys responded yes that they know what to do if someone has concerns about the home. Although the manager confirmed that all staff have received training in adult protection, training records did not clearly confirm this and of the staff files looked at, only one had clearly received this training in 2008. The manager did confirm that herself and the deputy were booked on a safeguarding course in October. Shiels Court do keep the Commission informed of any notifiable incidents and it was stated in the AQAA that complaints are looked into very quickly, thoroughly and usually well within the mandatory timescale. All staff were confirmed as being Care Homes for Older People Page 24 of 38 Evidence: informed and aware of the whistle-blowing policy and have been given copy of the policy. The manager also confirmed that no money is managed by the home on behalf of any of the residents, although small amounts of money are occasionally kept for some residents, but the usual practice is for the Home to pay for items/services and be reimbursed by peoples relatives. It was noted that written records and receipts are kept in this respect. Care Homes for Older People Page 25 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to provide a clean and generally safe and well maintained environment for residents, with further and ongoing improvements having been made to some of the tired areas. However, bathing facilities are currently inadequate to meet the needs of the residents. Evidence: A tour of the premises showed the premises to be clean and hygienic, with no unpleasant odours noted during either days of this visit. Refurbishment and improvements to the home have continued since the last inspection and remain ongoing. From information in the AQAA, and observations during the inspection, some of the improvements in the last year have included new carpeting throughout the large lounge/communal area, new curtains and the walls repainted. Half of the ornamental brick wall has been plastered and the kitchen access area has been re-tiled. Additionally, a new Nurse Call System has been installed, new gas pipes laid and a new gas meter fitted. The re-wiring programme is ongoing throughout the home and new television and Digital Audio Broadcasting aerials are also in the process of being fitted. Care Homes for Older People Page 26 of 38 Evidence: A new, larger, concrete pad has been laid in order to maintain and manage the area where rubbish and clinical waste is stored. The Coach-House has been repainted, windows repaired and brick work made good. There is an ongoing programme to improve the front and rear garden areas and it was stated that the residents are getting a lot of enjoyment from them now. A new awning, to provide shade on the patio, is also in the process of being purchased. Two areas of concern however were the fact that there are currently only two communal bathrooms in use, one of which has a broken lock on the door and it was confirmed by more than one staff member that this bathroom is hardly ever used, the one near the Coach-House is used more often. A third bathroom on the middle floor is currently out of action due to the bath-hoist having been condemned. Staff stated that this has been the case for some considerable time and there are no immediate plans to have the hoist repaired or replaced. Whilst touring the garden area, the entrance to the basement was noted to be a very steep slope. This slope is guarded only by very flimsy gates and on the second visit the gates were open without any staff present. As some of the residents enjoy going into the garden without assistance, this area is deemed a high risk area and was highlighted to staff on the second day of the inspection. Care Homes for Older People Page 27 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shiels Court has safe recruitment practices and appropriate staffing levels but some staff are lacking in training for certain areas and the Home still hasnt achieved the required NVQ target. Evidence: Personnel files were looked at in detail for three staff members and discussions were held individually with two. The personnel files were found to contain copies of documentation or confirmation details for things such as application forms, references, identification and clear, enhanced Criminal Records Bureau (CRB) disclosures, therefore confirming that robust recruitment procedures are followed, which helps to protect the residents living at Shiels Court. Training records were looked at and evidence was seen for some staff in areas such as first aid, medication administration, infection control, fire safety, health & safety, moving & handling and dementia. However, there was a significant lack of evidence that general care staff have received training in areas such as first aid, adult protection and food hygiene. Care Homes for Older People Page 28 of 38 Evidence: A discussion with a senior staff member confirmed that generally only the chefs and allocated kitchen staff receive training in food hygiene but, given the fact that there are times when a chef is not on duty, virtually all staff are frequently required to prepare, handle and store food at certain times. It was confirmed that the manager and deputy were due to attend an adult protection course in October 2009 but there was no evidence of any training having been arranged for the rest of the staff team in this area. In respect of NVQ trained staff, it was confirmed that in excess of thirty five staff are currently employed and only seven have their NVQ level two or three. A further five have commenced their training for NVQ level three. From the staff files looked at, there was evidence of a good induction process and early days supervision plus a buddy system with experienced carers. It was commented on by a few staff members that a number of ancillary hours have recently been cut, which means that more pressure is being put on kitchen and cleaning staff. The rota was examined for the four weeks prior to the inspection, which showed appropriate staffing levels and there appeared to be sufficient numbers of staff on duty during both days of the inspection. Meanwhile, from the surveys received, the relative responded usually to the question: Do you feel that the care service meets the needs of your relative? In the staff surveys, one person responded always, three responded usually and one responded sometimes to the question: Are there enough staff to meet the individual needs of all the people who use the service? Care Homes for Older People Page 29 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The absence of the previous manager and recent management changes at Shiels Court have resulted in a decline in respect of staff and residents health, safety and wellbeing being promoted and protected, record keeping is not up to date and staff have not been receiving regular supervision. Evidence: The previous manager was absent from Shiels Court for a number of months prior to the acting manager being appointed in August 2009. The new manager has been working at Shiels Court for thirteen years and has been the deputy for a considerable period of time. It is acknowledged that the new manager has a great deal of work to do in order to catch up but it is disappointing, given the fact that additional senior staff have been in post since the last inspection and the previous managers long term absence was not unexpected, that the previously noted high standards have declined in so many areas of basic care, support and record keeping for staff and residents. Care Homes for Older People Page 30 of 38 Evidence: In respect of the most recent Quality Assurance Audit, records and feedback were only available from the one carried out in 2007, although the manager has stated that she intends to get this organised again, for completion this year. As mentioned in a previous section, the manager confirmed that no money is managed by the home on behalf of any of the residents, although small amounts of money are occasionally kept for some residents. The usual practice is for the Home to pay for items/services and be reimbursed by peoples relatives. It was noted that written records and receipts are kept in this respect. Staff records looked at and a discussion with the manager acknowledged that staff one-to-one supervisions have fallen behind due to the recent management changes but the new manager has confirmed that she is currently in the process of catching up and is confident that these will be up to date again within a few months. A new maintenance person has recently been appointed and where it was noted that certain areas in respect of health and safety had not been kept up to date, such as fire safety tests etc. these were seen to have been carried out on a regular basis for the last four-five months. The general practice during fire drills is for staff and visitors only to evacuate but full evacuations have been carried out on two occasions. A fire safety audit was completed in May 2009 All the health and safety policies looked at during the inspection were seen to be up to date and in order, again since the appointment of the new maintenance person. However, as highlighted in previous sections there are concerns around the safety and welfare of staff and residents in respect of the lack of training in food hygiene and the lack of evidence of training for all care staff in areas such as first aid, moving and handling and adult protection. The other safety concern is the entrance to the basement in the garden (see Environment). Care Homes for Older People Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 15 16.i12.3 A comprehensive list of dietary likes, dislikes and nutritional needs must be compiled and used in the preparation of peoples individual meals. A menu must be followed that is nutritionally balanced and has been developed following consultation with people living at the home. 30/11/2007 2 15 16 I12.3 30/11/2007 Care Homes for Older People Page 32 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 17 Care plans must contain 08/12/2009 details of how residents health and welfare needs are to be met, particularly in respect of weight and nutrition. To ensure residents needs continue to be met and that there is consistency in care provision. 2 7 15 Care plans must be reviewed 08/12/2009 and updated on a regular basis. To ensure residents needs continue to be met and that there is consistency in care provision. 3 8 12 Residents wishes must be respected and sufficient opportunities and support provided to enable residents to bathe in accordance with their wishes. 08/12/2009 Care Homes for Older People Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure individuals maintain their dignity and rights. 4 9 17 Full medical information must be maintained and available for all residents and missing pages in the medication folder must be completed or replaced. To ensure consistency of care and reduce the risk of errors and omissions. 5 10 12 Serious consideration must 08/12/2009 be given in respect of residents having appropriate clothing, crockery and utensils during mealtimes. To ensure residents dignity is respected and maintained at all times. 6 12 15 Residents must be 08/12/2009 supported to have access to social activities and pursue their interests and hobbies and care plans must be kept up to date. To ensure residents needs continue to be met and there is consistency in care provision. 08/12/2009 Care Homes for Older People Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 7 12 23 Individuals needs and choices must be respected and serious consideration must be given to ensure the size and layout of rooms occupied by residents are suitable for their needs. 08/12/2009 8 12 12 Staff must maintain good and professional relationships with residents. To ensure people are treated with respect at all times. 08/12/2009 9 15 16 A menu must be planned and followed, that is nutritionally balanced and has been developed following consultation with the people living at Shiels Court. To ensure residents dietary needs are met and mealtimes are a pleasurable experience. 08/12/2009 10 20 23 The entrance to the basement must be made safe and the gates closed at all times that staff are not present. To ensure residents safety is maintained. 08/12/2009 Care Homes for Older People Page 35 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 11 21 23 Sufficient bathing facilities must be available for residents. To ensure their needs and choices are respected and their dignity is maintained. 08/12/2009 12 30 18 A minimum of 50 of care staff must be trained to at least NVQ 2 or equivalent. To ensure staff have the necessary skills to carry out their duties and that residents are consistently supported by competent staff. 27/08/2010 13 30 18 All care staff must have up to date training in first aid, moving and handling and adult protection. To ensure residents health, safety and welfare is protected and maintained at all times. 31/12/2009 14 30 18 All staff dealing with food at any time must receive training in food hygiene. To ensure residents health, safety and welfare is protected and maintained at all times. 31/12/2009 15 33 24 A formal Quality Assurance process must be carried out on a regular basis. 31/12/2009 Care Homes for Older People Page 36 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action To ensure the service continues to meet residents needs. 16 36 18 Staff must receive formal one-to-one supervision on a regular basis. To ensure staff are supported and any concerns or issues can be discussed and addressed. 17 38 13 The registered person must ensure that unnecessary risks to the health and safety of residents are identified and eliminated as much as is possible. To ensure residents are able to live in a safe environment at all times. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 31/12/2009 08/12/2009 1 9 Consideration should be given to the times people are given their morning medication, especially in respect of the period between breakfast and lunch. Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 38 of 38 - 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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