Inspection on 21/09/05 for Shirebrook Fields Nursing Home

This inspection was carried out on 21st September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 27 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Shirebrook Fields Nursing Home 11/05/08

Shirebrook Fields Nursing Home 15/05/07

Shirebrook Fields Nursing Home 17/05/06

Shirebrook Fields Nursing Home 22/04/05

Shirebrook Fields Nursing Home 13/01/05

Shirebrook Fields Nursing Home 05/09/04

Shirebrook Fields Nursing Home 16/06/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood Hall

Muston Road (70)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Shirebrook Fields Nursing Home Spa Lane Woodhouse Sheffield South Yorkshire S13 7PG Lead Inspector Ms Shelagh Murphy Unannounced Inspection 21st September 2005 09:05 Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 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 Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 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 Adults 18-65. 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. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Shirebrook Fields Nursing Home Address Spa Lane Woodhouse Sheffield South Yorkshire S13 7PG 0114 269 1144 0114 269 1133 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) None Shirebrook Nursing Home Ltd Vacant Care Home 44 Category(ies) of Learning disability (44) registration, with number of places Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. There are 25 LD learning disability PC (Personal Care) beds in a self contained unit. There are 19 LD learning disability N (Nursing Care) beds in a self contained unit. 22nd April 2005 Date of last inspection Brief Description of the Service: Shirebrook Fields is a care home providing residential and nursing care for up to forty-four service users who have a learning disability. The home is divided into five units, two of which provide nursing care for up to nineteen service users. Three units provide personal care for up to twenty-five service users. The home is owned by Shirebrook Nursing Homes Ltd. Shirebrook Fields is situated in the village of Woodhouse, Sheffield, and is close to public transport and shops. All the home’s bedrooms are single and the majority of the bedrooms are en-suite. The home is a large single storey modern building, which includes a day centre. The home has individual garden areas for each unit and two car parks. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Shelagh Murphy and Shirley Samuels (Regulation Inspectors) carried out this unannounced inspection over eight hours from 9:15 to 17:25 pm. This made a combined inspection time of sixteen hours. Sharon Radford, manager of the home was present during the inspection. Feedback from the inspection was given to Sharon Radford Manager and Shaun Sunderland, Managing Director. Opportunity was taken to make a tour of the premises, inspect a sample of records and policies and talk to staff and residents. The inspectors had the opportunity to speak to 8 staff on duty, 1 visiting relative and 5 of the residents. Twenty-five staff questionnaires were given out eight of these were returned. The results of the staff survey have been included in the main body of the report. What the service does well: What has improved since the last inspection? Some areas of the existing home had been refurbished and redecorated and this really had made a positive impact on the first impressions of some areas of the home. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 6 Several of the residents had had their bedrooms re-carpeted and refurbished. They reported they had also chosen the colour of paint for their bedrooms. Most of these rooms now need to be personalised. The staff had had two meeting with the management of the home one in May and another one in July 2005. Most of the staff said that they had received some training on a range of topics. The grounds around the home, the gardens and the car-park had all been fenced and the staff said this made them feel safer as they had previously experienced problems from local youths. Some staff said they had had a formal supervision session with a senior member of staff in order to be supported to carry out their jobs with support. Some planned activities had been arranged since the last inspection including a BBQ, to which staff residents and relatives had attended. Several residents and a parent reported they had enjoyed these activities. What they could do better: Many of the previous requirements made at the last two inspections had not been complied with. Assessments of residents were found on two individual care files; however, a requirement to reassess a resident with complex needs had not been carried out. Two residents care plans were checked these had information missing and had not been regularly reviewed. Files were disorganised and care plan formats differed between the units. Communication between staff and relatives needs to improve. Medication procedures were checked and several gaps were found on the drug sheet of one resident where the nurse had not signed for medication including Diazepam and Carbamezapine. There were still some areas of the environment that were in need of urgent attention Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 7 The staffing levels in the Meadows unit were not adequate to meet the agreed minimum staffing levels or the residents 1-1 staffing needs when the inspectors went in to the unit. This is an issue, which has been raised on several previous inspections and resulted in a complaint being made to the CSCI. When the staff rotas were checked they did not correspond with the staff actually on duty. The manager was informed of this and said the problem had arisen as a result of staff phoning in sick. Remedial action was taken to address the issue during the inspection. Three staff recruitment files were checked. None of them contained all the information required by the regulations. Information missing included application forms, gaps in work histories, references from previous employers, CRB checks, copies of identification etc. Two staff spoken to said they felt that staff morale was very low, they said this was due to the fact that they did not consider that the management of the home valued them. Several staff said that the home regularly experienced staffing shortages. Although the owner of the home has tried to improve the organisation and management of the home, at present the residents are not benefiting from a well run home, they are also not benefiting from the ethos, leadership and management approach of the home at this point, even though it is acknowledged that the new manager has introduced some leadership and direction in to the service. Residents’ rights and best interests have not been safeguarded by the homes record keeping policies and procedures as they had not been followed and had placed residents and staff at risk of harm. 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. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2. The home had an up to date statement of purpose, the service users guide still did not meet the regulations and had not been updated for some time. The manager stated that both of these documents were presently under review. Residents had, had their needs assessed this ensured the home was suitable to meet their care needs. One resident needed to have a reassessment of her needs carried out by professionals with learning disability and sensory impairment assessment expertise. EVIDENCE: The manager stated that the statement of purpose and the service users guide were both under review. Copies of these will need to be sent in to the CSCI. Copies of full needs assessments were contained in resident care plans. The information from the full needs assessment had been incorporated into two of the three resident care plans. One resident needs to be re-assessed, as the present assessment does not adequately reflect her present care needs adequately. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 8. The contents of the residents care plans checked were inadequate to meet the regulations and to ensure the staff knew how to support the individuals. One care plan needed reviewing to ensure the residents present needs were being met. Several residents said they were happy at the home one resident said he was not. This person will need support to find out what issues are affecting his perception. There was very little evidence to show that the residents are consulted on and participate in all aspects of life in the home. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 11 EVIDENCE: Information on two residents care plans was inadequate to ensure that the resident’s needs could be met, the manager agreed that the care plans were not adequate to ensure staff knew how to meet the residents needs. Records were incomplete, the care plans had information missing, behavioural management plans were not available for residents who present challenges and inapprorpiate remarks had bee written on incident records.The experienced staff could not find even basic information as in each unit the care plan formats were different. One care plan had not been regularly reviewed by the staff. There was evidence that residents and their relatives were not involved in drawing up their care plans as there was no record of their attendance and one relative who visited regularly did not know which activities his son took part in on a regular basis or why he had not been on a holiday this year. There is one residents who was identified as needing a reassessment of their needs at the inspection in January 2005 who has still not been reassessed. The manager was notified that a request for this reassment must now be made as a priority. Following this a more detailed care plan must be drawn up to ensure staff knew how to support the resident effectively. Three of the residents said that they were happy in the home one resident said, “I like the staff, and I’ve been on holiday with some of them”. One resident said he was not happy at the home. This person will need support to find out what issues are affecting his perception. The staff reported that the residents do not have any formal inclusion in the decision-making processes in the home. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 and 15. Overall, the opportunities for some service users to participate in and to develop independent living skills are limited. There were limited opportunities for residents to continue with education and or training/employment. Some residents said they are able to attend and take part in appropriate activities in the local community. There was evidence that some daily activities and leisure opportunities had been made available to some residents. Residents were able to maintain contact with family and friends. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 13 EVIDENCE: The staff told the inspectors that the residents’ opportunities to participate in and to develop independent living skills are limited as residents did not shop for food or prepare meals on a regular basis. The meals are prepared by the kitchen staff. Staff said the residents did not do their laundry or clean their rooms as, this was all done by ancillary staff. This greatly limited the service users opportunities to develop independent living skills. There was no evidence found on the residents care files that they had regular planned activity rotas, the staff were not aware of any residents at the home who were supported to continue with education or training services in the community and none of the residents had been supported to find employment opportunities, even though there were some residents capable of this. Several staff said they supported residents to use community facilities such as local shops, pubs and parks. Some activities were occurring during this inspection. Some residents were involved in a music group whilst others were seen drawing and playing games. One relative said that their son had very few opportunities to attend the swimming pool or other activities within the day service but did not know why this was. He also advised that his son had not had an annual holiday away from the service and had not been informed of the reasons for this. This was reported to the manager. Residents, a relative and the staff all confirmed that visitors were welcome at the home at any time. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 Staffing levels and gender balance at the home have at times been inadequate to enable service users to receive personal care from staff of the same gender, as they would prefer. None of the residents in the home administer their own medication. The current medication practices posed a possible risk to the residents’ as medication administered was not always signed for. EVIDENCE: Staffing levels and gender balance at the home have at times been inadequate to enable service users to receive personal care from staff of the same gender at all times, as they would prefer. An example of this was found on the Meadows Unit, where six male residents were being supported by predominantly female staff. The care plans checked did not identify whether male or female staff should support the individual resident with intimate personal care. This information must be added to ensure the residents choices and dignity, are respected. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 15 Medication was checked. Staff said no service users self-medicated and risk assessments identifying why this was were in place on the files checked. Some drug sheets showed that medication, which appeared to have been administered, had not been signed for on more than one occasion. Immediate requirements were issued on the day of the inspection to ensure that medication is administered appropriately to protect the residents. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. A complaints procedure was in place in the home. The inspector has serious concerns regarding the number and nature of five complaints recently made about the home. As a result of these concerns an adult protection service strategy meeting is to be called to oversee their investigation. The home had an adult protection procedure, which met the regulations, however, procedures to record serious incidents and to complete body maps had not been followed appropriately during some recent incidents. These practices potentially placed the resident and staff at serious risk. Some staff said they had completed training and had an understanding of the procedures to be followed should they suspect any abuse at the home. Notification of incidents which affect the residents well being had either not been reported to the CSCI office at all or had not been in the timescales required. This is an issue, which has arisen at the last three inspections. EVIDENCE: Three complaints have recently been made to the manager of the home, two from relatives regarding their relatives care and safety whilst in the respite service and one from a resident and several staff about the behaviour of a member of staff. Two other anonymous complaints were made to the CSCI over the last few months. All five of these complaints are presently being investigated through the adult protection procedures. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 17 Initial investigations in to one complaint made by a relative and investigated by the manager of the home found serious omissions in record keeping and other poor communication issues and as a result requirements to address the problems were issued by CSCI and are listed at the back of this report. Two anonymous complaints that were made to the CSCI the first alleged that staff had been employed without adequate CRB checks and adequate verbal and written communication skills to carry out the work. The second complaint was more vague but listed a whole range of allegations including poor living environment for the residents, neglect and allegations of abuse. The new manager of the home initially investigated both of these complaints. She reported back to the CSCI that she could find no evidence to substantiate the complaints. Some of the findings from this inspection would question those outcomes and at least partially uphold both complaints. There was some evidence that staff listen to residents complaints and protect them from abuse as staff had supported a resident who had made a complaint about a member of staff and this was being followed up by the manager. As a result of this complaint another adult protection investigation is underway regarding a member of staff who is presently suspended by the home. All of these complaints have been referred to an adult protection service strategy meeting for further investigation. The procedures in place to protect residents from abuse had not been followed as records of challenging behaviour incidents and body maps were incomplete when checked by the manager. Several, notification of incidents which affect the residents well being had either not been reported to the CSCI office at all or had not been reported in the timescales required. This is an issue, which had arisen at previous inspections. This could potentially have placed the residents and staff at risk. Staff had received information on adult abuse and the staff said they had been trained in adult protection procedures and managing challenging behaviour. Training records confirmed this training was accredited to BILD. The value of this training must be questioned though as the managing director re-stated that the service has a, “no restraints policy”, however, restraint had clearly been used with some residents as it is recorded in incident reports. This confusion potentially places residents and staff at risk and needs to be addressed as a matter of urgency. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. The grounds, gardens and car parks had been fenced off and this improved security of the home. The environment within the home had improved in some areas since the last inspection, these areas included lounges, dining areas and some residents’ bedrooms, where decoration and new flooring had been supplied the home looks clean and fresh. However, some areas of the home in which the residents are living are not of an acceptable standard. Including communal areas and residents bedrooms. There is still a lot of old, stained and dirty furniture, décor and carpets in these areas. Most of the service users bedrooms in these areas required redecoration, most were not personalised and many did not contain adequate fittings or furnishings. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 19 EVIDENCE: Some areas of the home including resident’s bedrooms, corridors and kitchen areas had been redecorated since the last inspection. Some new carpets and floor coverings had been laid. These areas of the home appeared clean, fresh and homely. Some staff reported that the new floor covering was slippy when wet and potentially posed a risk of slipping. This was reported to the manager for action to be taken. Overall, the home has been in need of general refurbishment for over the last year. It is acknowledged that improvements have been made to some areas; primarily new extensions have been built to meet the new regulations but as yet are not opened as they are still in the process of registration. However, there are still areas of the home which the residents are living in which were bare and institutional. Many carpets and furnishings were faded, dirty and stained. This created a neglected, unwelcoming and uncared for environment in these areas. There are areas of the residents’ living space, which do not meet the required standards of cleanliness or homeliness and will need immediate action to be taken. The Meadows, is a house for seven male service users who present behaviour which challenges. The walls of the corridor areas were stained and bare. The ceiling coverings had been removed in some areas and wires were hanging down. Bare wires were also visible in the walls. The manager reported that none of the wires were, “live”. The lounge and dining rooms were drab, walls were scuffed and stained and the carpet and furniture were dirty with food debris and appeared very worn and stained. The bedroom carpets were stained and some of the bedding was faded, dirty and pillows were lumpy and smelly. An unpleasant odour pervaded in the unit. The standards of the environment in these rooms were wholly inadequate to meet the residents’ needs or the standards required in a care home. The inspectors issued immediate requirements for some of these rooms to be deep cleaned and made fit for purpose within two weeks. As a temporary solution the new lounge and dining area will be opened for two weeks to allow remedial work on these areas to take place. There were other numerous problems found in the other units inspected and these issues included: - in the 12 bed nursing unit and the Ferns residential unit for example, stained lounge chairs, bare wires sticking out of the wall behind the TV, stained and dirty dining room furniture. Dirty and soiled bedding was found on a resident’s bed. The roof had been leaking on these units and therefore the ceiling panels and walls had become stained. There were no shower curtains in one of the shower rooms, which did not protect the resident’s dignity. The flooring in one bathroom was not sealed appropriately and therefore could not be cleaned appropriately. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 20 The inspectors spoke to the domestic staff to find out why some areas of the home were in this state. One of the cleaners reported that some of the equipment they used was inadequate to carry out their tasks appropriately they reported that the carpet shampooing machines were 8 years old and did not work adequately, that there were only two vacuum cleaners in the home and they had been refused bags’ for these and this and this meant that they were constantly being blocked and not working appropriately. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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, 32, 33, 34, 35 and 36. Overall staff understood their general roles and responsibilities, although there had been some recent incidents in the home where line management had not been informed and this meant that correct procedures had not been followed and which placed residents and staff at risk of harm. Residents were being supported by staff who had qualifications and who had received some of the training to carry out the majority of the tasks they are required to attend to. There was no provision for new staff to complete the Learning Disability Award Framework (LDAF) induction and foundation awards. The staff team at present is not working effectively as a team, at one point there were inadequate numbers of staff on duty in one unit, staff said morale was low and communication was poor, all of these issues are to the detriment of the residents, staff and the service. Staff recruitment policy and practices had not been followed and this potentially placed residents at risk from the home employing unsuitable staff. Not all of the residents needs were being met as although staff had received appropriate training in some areas they had not followed correct procedures, this had potentially placed the residents at unnecessary risk of harm. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 22 Staff reported that they had started to be formally supervised but generally staff had not been receiving appropriate supervision for some time and this resulted in residents not receiving the appropriate support they required in a consistent manner. EVIDENCE: During a recent series of incidents with a resident, there was evidence that staff including senior staff had not followed the homes procedures and policies even though they had been appropriately trained in the management of challenging behaviour. This had led to the incidents escalating and inappropriate practices being carried out. This has been referred to adult protection, and is currently being investigated via these procedures. Immediate requirements to address the issues were made by CSCI prior to the inspection. There was evidence that registered nurses are employed at the home and several care staff reported they had completed the NVQ2 care awards. The manager reported that there was no provision for new staff to complete the Learning Disability Award Framework (LDAF) induction and foundation awards, which does not meet the sector skills council training requirements. The staffing levels in the Meadows Unit were not adequate to meet the agreed minimum staffing levels or the residents 1-1 staffing needs when the inspectors went in to the unit. This is an issue, which has been raised on several previous inspections and resulted in a complaint being made to the CSCI. The staff reported to the inspectors that the unit had been understaffed all morning. The staff rotas were checked and did not correspond with the staff on duty when the inspectors went in to the unit. They were showing that two staff were on duty, when one of the two staff was a 1-1 worker. The other issue of concern was that the two members of staff who were on duty in the unit at the time the inspectors went in were not experienced workers and therefore should not have been left alone with residents whose needs are so challenging. The manager was informed of this straight away and had taken action to remedy the problem, which she said had occurred due to staff sickness. Several staff described morale as very low and said that communication, within the teams were poor. There were staffing problems with staff not turning up for duty or phoning in sick. Staff turnover was also described as high by the staff and they said that there was a high level of the use of bank staff. The inspectors observed all of these issues during the inspection. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 23 The manager had begun to try to improve communication within the staff team and had introduced staff meetings in to the home one had been held in July 2005. Three staff recruitment files were checked and did not contain all of the information required by the regulations including CRB checks, (although the manager said these had been sent for), lack of references from the last employer, incomplete work histories and the appropriate lack of identification. These practices did not protect the residents. An immediate requirement to address the problems was issued and the manager was told these staff must not work unsupervised with the residents until all the appropriate checks and information are in place. Staff said that they had undertaken relevant training to assist them in caring for the specific client group at Shirebrook Fields; this included managing challenging behaviour and the protection of vulnerable adults. However, although staff had been trained there was evidence that the policy had not been followed and procedures to protect residents and staff had not been completed. This issue has been referred to earlier in this report. Several staff reported that they had had one formal supervision since the new manager had been employed; this was the first one for some time, for the majority of the staff who welcomed this. Up until recently the staff had not been accountable for their performance at work to one line manager. This frustrated the staff and resulted in residents not receiving adequate support and consistent approaches from staff. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40 and 42. Although the owner of the home has tried to improve the organisation and management of the home, at present the residents are not benefiting from a well run home. Residents are not overall, benefiting from the ethos, leadership and management approach of the home at this point, even though it is acknowledged that the new manager has introduced leadership and direction in to the service. The residents’ views do not presently underpin the self-monitoring, review and development by the home in any meaningful way. Residents’ rights and best interests have not been safeguarded by the homes record keeping policies and procedures as they had not been followed and had placed residents and staff at risk of harm. The residents health and safety had not been promoted and protected in several areas and had placed residents at risk. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 25 EVIDENCE: It is fair to say that the management arrangements have improved since the last inspection; a qualified and experienced manager has been recruited to run the home since the last inspection. However, the home is still not what can be described as well run. The new manager is a registered nurse who has a lot of previous management experience in residential care settings, but no previous experience in managing a learning disability service. She stated she was keen to develop skills and knowledge in this area. The manager is presently going through the process to become the registered manager of the service and has already achieved NVQ 4 in management. Most of the staff spoke positively about the new manager, they felt her role was clear and staff knew who were their line manager was. The current management arrangements appeared to be more organised than at previous inspections. There was evidence of leadership and more direction. The manager was co-operative with inspectors and has responded to all requests for information and investigations in a professional manner. The management approach at the home is not seen as appropriate by staff. It did not create an open, positive or inclusive atmosphere to meet the residents’ needs or to appropriately support the staff team. This is an area, which will need attention, as several staff described not feeling valued or supported. There was overwhelming evidence from recent incidents, complaints and this inspection that the home is not running at an acceptable, safe level at present. The care given to some residents meets some basic primary needs, but does not meet the full range of social, emotional, cultural and spiritual needs. At present the home is not meeting the residents needs in an acceptable manner for the following reasons. Areas of the environment are not adequate to meet the residents’ need for a homely, safe and clean environment. The nature and number of incidents and complaints at the home are very concerning, the fact that numerous procedures and polices have not been followed even where staff have been trained do not inspire confidence. The staffing arrangements are not adequate to meet the residents needs at times and appropriate recruitment practices are not being followed. Medication is not being managed appropriately and the general levels of record keeping in many areas are wholly inadequate if not dangerous. All of these practices are placing staff and service users at risk from harm and are not acceptable in a registered care home. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 26 There was no evidence that the residents views are sought in any meaningful manner, they are not involved in the development and review of the service at present. A lot of work needs to be done to introduce quality assurance systems within the home, which enable the service users views to be included in how the home is run and the future development of the service. Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 X X X Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 X 1 x x Standard No 24 25 26 27 28 29 30 STAFFING Score 1 X x x x x 1 LIFESTYLES Standard No Score 11 2 12 1 13 3 14 2 15 3 16 x 17 Standard No 31 32 33 34 35 36 Score 1 2 1 1 1 2 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Shirebrook Fields Nursing Home Score 2 x 1 x Standard No 37 38 39 40 41 42 43 Score 1 1 1 1 1 1 x DS0000021807.V252157.R01.S.doc Version 5.0 Page 28 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. Standard YA1 Regulation 6 Requirement Timescale for action 31/01/06 2. YA2 12, 14 3. YA6 13, 15 4. YA8 24 The service users guide must include all of the information required by the regulations. (Requirement first made on 16/6/04) The service user identified must 31/12/05 have their needs reassessed. (Requirement first made on 13/1/05. The service users plan must 31/12/05 contain all of the information required by the regulations. Including physical intervention stratergies or behaviour management plans. (Requirement first made on 13.1.05 ) The service user plans must be reviewed on a six monthly basis.( Requirement first made on 22/4/05) Service users and relatives must be offered the opportunity to attend care plans. Service users must be consulted 31/01/06 on and participate in all aspects of life in the home. Service users must be offered opportunities for personal DS0000021807.V252157.R01.S.doc 5. YA11 16 31/01/06 Shirebrook Fields Nursing Home Version 5.0 Page 29 6. YA12 12 7. YA14 12,16 8. YA18 12, 18 development including independent living skills. Arrangements must be made to 31/03/06 ensure service users can take part in educational/training and employment activities as appropriate to meet their needs. All service users in long-term 31/03/06 placements must be offered an annual holiday outside the home. If this is not possible their representatives should be informed of this decision. Appropriate numbers of 31/12/05 male/female staff must be available to support service users with personal care tasks to meet their individual needs. 21/09/05 9. YA20 13 10. YA23 Arrangements must be improved for the safe recording, safekeeping and safe administration of medication received in to the home. (Requirement first made on 13/1/05). 13, 15, 17 Records of any restraints or breakaway techniques used at the home must be recorded as appropriate. Records of injuries or marks to service users must be completed as per the homes procedures. Records of any personal care for service users including any changes in condition must be recorded as per the homes procedures. 13, 15, 17 Care plans, which specify how service users who present challenges should be supported, must be devised with support from multi-disciplinary professionals. 37 All notifiable incidents must be DS0000021807.V252157.R01.S.doc 21/09/05 11. YA6YA23 21/09/05 12. YA23 21/09/05 Page 30 Shirebrook Fields Nursing Home Version 5.0 13. YA24 12, 23 reported to the CSCI. Therefore all adult protection issues must be notified to the local CSCI office without delay. The meadows lounge and dining room must be cleaned and be made fit for purpose. The premises must be kept well maintained and safe. Therefore the environment must be kept safe, carpets, beds, bedding, décor, furniture, fixtures and fittings must be kept clean and in good condition/well maintained. (Requirement first made on 16/6/04). Agreed staffing levels must be maintained at all times. Residents receiving funding for 1-1 staff support and must recieve this level of support. Service users must be supported by an effective staff team. Team building opportunities must be offered within the teams. Staff recruitment files must contain all of the information required by the regulations. Staff who have not got a CRB check must not work unsupervised. All appropriate staff must be offered the opportunity to complete the LDAF induction and foundation training (Requirement first made on 16/6/04). The staff must be appropriately supervised to carry out their duties (Requirement first made on 16/6/04). Improvements must be made in how the home is run, therefore the manager must :DS0000021807.V252157.R01.S.doc 05/10/05 13. YA24YA30 12, 13, 16, 23 30/11/05 14. YA32 18 05/10/05 15. YA33 12, 18 31/12/05 16. YA34 19 05/10/05 17. YA35 18 31/12/05 18. YA36 18 31/12/05 19. YA37 9, 12, 21 31/12/05 Shirebrook Fields Nursing Home Version 5.0 Page 31 1)investigate the staff concerns and perceptions of management within the home. 2)take up periodic training on the current good practice issues to meet the needs of adults with learning disabilities. 30/06/05 Appropriate action must be taken to address the poor morale and poor communication issues raised by the staff. An effective quality assurance/ quality audit system must be developed and maintained. They must be based on seeking the views of service users and relatives (Requirement first made on 16/6/04). Action must be taken to ensure the homes policies and procedures are followed in order to protect the service users rights and best interests. Record keeping in general must be improved to safeguard the service users rights and best interests. 23 Appropriate action must be taken to ensure the service users health, safety and welfare is promoted and protected. 20. YA38 12, 21 31/12/05 21. YA39 24 31/03/06 22. YA40 13, 17 31/10/05 23. YA41 13, 17 31/10/05 24. YA42 12, 13, 21/09/05 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 NA Good Practice Recommendations NONE Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 32 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Shirebrook Fields Nursing Home DS0000021807.V252157.R01.S.doc Version 5.0 Page 33 - 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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