CARE HOMES FOR OLDER PEOPLE
Shirley View Nursing Home 23 Shirley Avenue South Cheam Surrey SM2 7QS Lead Inspector
Alison Ford Key Unannounced Inspection 15th May 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Shirley View Nursing Home Address 23 Shirley Avenue South Cheam Surrey SM2 7QS 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) 020 8643 5680 020 8642 7313 Family Star Limited Alan Laximan Madoo Care Home 29 Category(ies) of Past or present drug dependence (29), Past or registration, with number present drug dependence over 65 years of age of places (29), Mental Disorder, excluding learning disability or dementia - over 65 years of age (29) Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection Brief Description of the Service: Shirley View Nursing Home is a detached building in keeping with other houses on the avenue. The home is registered as a care home with nursing for up to 29 people with dementia or other mental disorder. Accommodation in the home includes bedrooms on the ground and first floors. There are five single bedrooms and twelve double all of which have wash hand basins. In addition to a shaft lift there is a stair lift. All baths, showers and basins have thermostatic controls and radiators have protective covers. The front door is kept locked to ensure the safety of residents. The communal areas include a through lounge laid out in two areas for different uses and an adjoining dining area. The well maintained rear garden includes a patio, which is accessible to users via a ramp and a lawn, flowerbeds and trees. There are off street parking facilities at the front of the building. At the time of this inspection fees range from £555 - £650 per week and any extra charges would discussed prior to admission. Copies of the homes Statement of Purpose and their latest inspection report can be obtained from them and the latter can also be obtained from The Commission for Social Care Inspection via the internet. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced visit to the home was undertaken as a part of the inspection process for the year 2007/2008. In writing the report consideration has also been given to information received throughout the year such as comments from people who use the service and reports of incidents and complaints. Since the last inspection there has been a change of Registered Provider for this service however, the Registered Manager and the majority of the staff have remained. Several relatives of the people living in the home had been met, and spoken with, at an event recently held by the previous providers as a thank you to all of the staff and to introduce their successors to them and the residents and their relatives. They had all spoken highly of the staff in the home and were pleased with the care that was being given. The inspection visit was undertaken with help from the Registered Manager and his deputy and they were helpful, knowledgeable and very receptive to the inspection process. Prior to the inspection visit comment cards, routinely sent out by The Commission for Social Care Inspection, had been returned by six relatives of people living in the home. All of the feedback received from them was positive, reflecting their satisfaction with the home. A tour of the premises was undertaken; many of the twenty-six residents currently living in the home and several members of staff were spoken with. A visitor to the home, and a healthcare professional there on the day also offered their opinions of the home and the care that residents receive. Various records that the home is required to keep, as evidence of its commitment to the protection and health and safety of its residents, were seen and also a sample of care plans which identify the help and support that residents need and show how their assessed health care needs are met. Personnel files of new members staff were checked to make sure that they contained all of the necessary documentation that helps to ensure the protection of residents and staff training schedules were looked at to evaluate whether the training that is provided is relevant to their needs. Menus and kitchen records were seen although the lunchtime meal was not observed during this visit. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 6 What the service does well:
This home provides care for up to twenty-nine older people with dementia or mental health problems many of whom are extremely confused. The atmosphere in the home is homely, friendly and welcoming and those residents that were able to express an opinion agreed that they were well looked after. They all appeared clean and well cared for and on the day of the inspection a chiropodist was visiting. The homes manager and his deputy have worked there for some time and have built up a strong staff team. The majority of them have undertaken training in dementia awareness to help them understand the needs of the people that they care for. Staff turnover is generally quite low and there are very few complaints received about the service. During the inspection, despite less staff than usual due to sickness, nurses and carers were observed to have time to spend talking with residents as they cared for them and they treated them with respect and kindness. Prior to the admission of any new resident an assessment is undertaken in order to ensure that the home can meet their needs and then care plans are based on these, setting out the help and support that is required. These are reviewed regularly so that any changes can be identified. Residents also have access to other members of the primary healthcare team such as doctors and specialist nurses, as necessary. A key worker system is in operation in the home, and staff are expected to spend time with “their residents” so that they can get to know them better and understand their needs. Staff training is ongoing and all staff have undertaken training, which helps them with the work that they do. There was evidence that robust recruitment policies are in place, with appropriate checks being undertaken to help to ensure the protection of the people in the home. Residents were complimentary about the food served in the home, there is always an alternative dish available and there is a hot snack supper if they would like it. Daily menus are put up on the wall in the dining room on a large board for them and weekly ones on the wall, so that their relatives can see what food will be served during the week. Activities are provided which suit the remaining abilities of residents both by the carers and visiting helpers and all of the residents are encouraged to join in.
Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 7 There is an ongoing redecoration programme in place and in order to make residents feel more at home, they have been able to bring some of their possessions with them to personalise their bedrooms which are all very pleasantly decorated. Records kept by the home and relating to ensuring the health and safety of residents and staff were generally in good order. What has improved since the last inspection? What they could do better:
Very few issues of concern were raised at this inspection. In order to ensure that potential residents and their families have access to all of the information that they need, when they are deciding if the home will suit them, the Statement of Purpose and Service User Guide need to be updated. The Service User Guide acts as a “ guide book” to the service and must be given to all of the people who live in the home. Residents care plans that were seen showed that careful thought is given to their healthcare needs however; there is limited information available regarding their social preferences and past achievements. This information is
Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 8 essential when trying to understand resident’s current behaviour and also in order arrange activities, which will suit their interests. The Registered Providers apparently visit the home on a regular basis although there is no documentary evidence of this. Records must be available to show that they are satisfied with the way that things are being run and that they have spoken to people using the service and working in the home in order to gain their views. 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. The summary of this inspection report can be made available in other formats on request. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1,3,6 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The people who use this service can expect that an assessment will be undertaken prior to them moving into the home to ensure that their healthcare needs can be met however, the information that they receive about the home is limited. This home does not offer intermediate care. EVIDENCE: There is a Statement of Purpose for the home, which sets out the aims and objectives of the service. This now needs to be updated to reflect the current situation in the home and in line with regulations. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 11 There is one copy of the Service User Guide available and this too must now be updated to provide information for residents and their relatives about life within the home. There must be one copy available for each resident and it was suggested that this could be left in resident’s bedrooms. The majority of residents would be too frail to visit prior to their moving in and although there is a very nice brochure of the home available it was suggested that an album of photographs could be complied which would reflect life in the home. This could them be shown to residents as a part f the pre-admission process to help them decide whether they would like living there. Five care plans of residents who had been admitted since the last inspection were looked at and there was evidence that pre-admission assessments had been undertaken in order to ensure that the home would be able to meet their healthcare needs. Care Managers reviews were also available. This assessment then forms the basis for subsequent care planning. Regular reviews of any changes in the needs of residents take place throughout the year. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The people who use this service all have an individual care plan, documenting the help and support that they require, so that all members of staff are aware of how they prefer to be cared for and that their assessed health care needs remain met even though they may change. Residents can be confident that they will be treated with respect and dignity and medication policies and procedures are in place to ensure their safety. EVIDENCE: All residents have a comprehensive care plan and five of these were examined at this inspection. They all contained assessments of physical and mental health, risk assessments, continence and tissue viability assessments. There was evidence available to show that other healthcare professionals are consulted as required. Risk factors, which could lead to the development of
Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 13 pressure sores, are monitored regularly and appropriate interventions and equipment are used. Some of the recommendations of the National Minimum Standards, such as locks on bedroom doors and lockable drawers are thought not to be entirely appropriate for these residents however; there is evidence that these facilities have been offered. There is evidence that relatives are being asked to contribute to the care planning process, where possible, and they are made aware of the support currently being given. Although healthcare needs are well met there must be more emphasis placed on the social care needs of residents. Recognition of their past lives and previous achievements would help staff to understand them more and provide activities which suit their individual preferences. There must also be a record of the wishes of residents and their relatives in the event of them becoming unwell or their death so that everyone is aware of the necessary procedures to be followed. Personal care is given in resident’s own rooms and visitors could be received there if they wished. Staff were observed treating residents respectfully and comments were made about how kind they all were. Medication rerecords and storage were seen to be in order and procedures for disposal of unwanted drugs are in line with current legislation. Trained nurses administer all of the medication; no resident currently in the home is able to manage this for themselves. A pharmacy audit has occurred recently and no problems were found then. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. People who use this service are offered the opportunity to join in with activities, which suit their capabilities, and they are encouraged to exercise choices within their daily lives as much as they are able. Their relatives and friends are welcome to visit. They enjoy the food served in the home and meals, which suit their preferences, are prepared for them. EVIDENCE: The advanced stages of dementia of many of the residents, limits the amount of choices that they are able to make and the activities that they can participate in. Care staff encourage residents to maintain a degree of independence and were seen sitting helping them or chatting. An activity professional visits weekly and musical events are always popular. Since the new Registered Providers have taken over the home there are more social events and pictures `around the home illustrate some of the celebrations that there have been.
Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 15 Visitors are encouraged and always made welcome in the home. Many of them talk to all of the residents in the home and they had previously asked about a photograph board with resident’s names on so that they knew who everyone was. Photographs of those, whose representatives gave their permission, are now on display on the wall. The lunchtime meal was not observed during this inspection although all of those spoken with said that they enjoyed the food that was served. The daily menu is displayed on a board in the dining area. There is always a choice available although it was recommended that the introduction of picture menus could be compiled to help those residents with cognitive impairment. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 16 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who use this service are confident that any complaints that they might have would be dealt with promptly and appropriately and that measures are in place to ensure that they are protected from abuse. EVIDENCE: Residents in the home would probably find it difficult to raise any concerns that they might have however relatives spoken with during the inspection process were confident that any issues would be dealt with promptly and resolved appropriately. Given the lack of capabilities of many of the residents it is important that all staff have up to date training in adult abuse and the protection of vulnerable adults and this has been undertaken. No complaints have been recorded during the last year. All necessary pre-employment checks are carried out on new staff prior to them starting work and staff files provided evidence of this. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The People who use this service live in a comfortable, clean and safe environment, which suits their needs, and they have been encouraged to bring in their own possessions to enable them to personalise their rooms and feel at home EVIDENCE: The home is in a pleasant residential area in keeping with surrounding properties and there is a well-maintained rear garden that is accessible to all the residents. A tour of the premises was undertaken. Both communal areas and resident’s bedrooms are pleasant; the latter have been personalised by their occupants with items from home. Nursing beds have been provided for those who need them and residents have been offered locks on their bedroom doors and a
Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 18 lockable space for their personal items. All radiators are covered and windows have been fitted with restrictors. Laundry facilities are small but adequate and kept extremely neat and tidy. The home is generally odour free. Some areas of the home would benefit from redecoration however; it is acknowledged that there is an ongoing redecoration plan in place. There is a fire door at the top of the stairs, which remains closed however some residents wander at night. An alarm to alert staff when this door has been opened has now been fitted. Closed Circuit Television cameras are about to be fitted to outside entrances as a security measure. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use this service can be sure that sufficient numbers of appropriately trained staff will be on duty in the home to meet their needs and that recruitment policies and procedures are in place to protect them. EVIDENCE: The home is always staffed by a mixture of trained nurses and carers and a range of ancillary staff supports them. All staff have been able to access training relevant to the work that they do over the last year and more sessions are planned. 50 of the care staff have undertaken NVQ training to at least level 2 and five have now progressed to level 3. The majority have completed additional training in dementia awareness. Three staff files of employees recruited since the last inspection were seen. They all contained evidence that appropriate pre-employment checks are completed to help protect the residents in the home. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,35,38 Quality in this outcome area is good, This judgement has been made using available evidence including a visit to this service. The people who use this service can be sure that the home is managed by a person who is fit to be in charge and that it is run in their best interests Policies and procedures are in place to show that health and safety of staff and residents is generally protected. EVIDENCE: The Registered Manager has been in post for some time and displays an understanding of the needs of this client group. He has completed The
Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 21 Registered Managers Award and his deputy is currently undertaking the same qualification. Communication within the home is good. Staff meetings are held regularly to ensure that all staff are aware of any developments within the home and able to contribute their views and management meetings take place weekly. Meetings are held for residents and their relatives yearly in addition to social events that they are invited to. This allows them to establish a relationship with the staff and influence that way that the home is run. Questionnaires are distributed to relatives twice a year to gain their views of the service and the Registered Providers are frequently in the home. Records of these visits made under Regulation 26 must be made available for inspection in the future. Residents are not able to manage their own finances and all have relatives or representatives who do this on their behalf. Staff supervision is now in place for care staff and records of these sessions were seen. Maintenance and safety certificates were seen and were in order. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 4 Requirement The statement of purpose and Service user Guide must be update to reflect the current situation in the home and contain all of the information required by the regulations. A copy of the Service User Guide must be made available to all of the residents. Care plans must contain more information about the social preferences of the people who live in the home in order that staff can have a greater understanding of their needs. Care plans must contain information regarding the wishes of residents and their relatives in the event of them becoming unwell or their death so that everyone is aware of the procedures to be followed. There must be documented evidence that The Registered Provider has visited the home and satisfied himself as to the situation therein in accordance with Regulation 26. Timescale for action 30/08/07 2 OP7 5 30/08/07 3 OP7 15 (1) 30/08/07 4 OP33 26 30/08/07 Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 24 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 2 Refer to Standard OP1 OP15 Good Practice Recommendations It is recommended that a copy of the Service User Guide should be available in each resident’s bedroom for future reference. It is recommended that picture menus should be introduced to help residents choose what they would prefer to eat. Shirley View Nursing Home DS0000068641.V340777.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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