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Inspection on 09/02/09 for Shortwood House Care Home

Also see our care home review for Shortwood House Care Home for more information

This inspection was carried out on 9th February 2009.

CSCI found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides a comfortable and clean environment for the people who live there. They made positive comments about the care and support they receive such as, "this is an excellent home and I am very well cared for and happy". Visitors said they were made to feel welcome and were always offered a drink when they visited. There is a consistent and committed staff team who relatives and people who use the service were complimentary about. For example, "there is a happy staff team with a low staff turnover which is important to mother". The home is being well managed.

What has improved since the last inspection?

A computer, nintendo Wii and Wii fit has been purchased providing people with additional leisure and recreational options. Additionally a programme of activities specifically designed to cater for people with dementia care needs has started. As part of their ongoing programme to ensure a well maintained home some bedrooms have been redecorated and refurbished. There is also an ongoing staff training programme which this year has included topics such as first aid, manual handling, infection control and basic food hygiene. Action has been taken to address the matters raised in the previous key inspection report which related to ensuring people were consulted and involved in the development and review of their care plans, making sure that medication records were well maintained and the repair of garden paths.

What the care home could do better:

They need to ensure that they can show more effectively that they have identified and assessed fully any possible risks to people who live in the home and how they are to be minimised. This will help ensure people`s safety. Care plans need to contain more information about the Mental Capacity Act 2005 to ensure peoples rights to make decisions and choices are protected. Staff also need to have training to ensure they understand the impact this legislation has on their role as carers.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shortwood House Care Home 145 Beardall Street Hucknall Nottinghamshire NG15 7HA     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sue Hayward     Date: 0 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI 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 26 Information about the care home Name of care home: Address: Shortwood House Care Home 145 Beardall Street Hucknall Nottinghamshire NG15 7HA 01159520950 01159539968 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Colette Louise Thomas,Mr Michael Shaun Thomas care home 12 Number of places (if applicable): Under 65 Over 65 2 12 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home 0 0 Shortwood House is situated close to Hucknall town centre. Care and accommodation is provided to a maximum of twelve people over the age of 65 years and up to two people who have needs associated with dementia. Accommodation is on two floors. There are ten single bedrooms and one shared room. All areas are accessible to wheelchair users with a passenger lift providing access to the upper floor. A small garden provides an outdoor sitting area. The current range of fees is from £344 to £380 per week. Chiropody, hairdressing and toiletries are additional costs. Information about the home including a copy of the most recent inspection report can be obtained from the owners, one of who also manages the service. Care Homes for Older People Page 4 of 26 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: two star good 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: This was an unannounced inspection, which focused on key standards which have the potential to affect the health safety and welfare of people who use the service. Throughout this report the terms we and us refer to the Commission for Social Care Inspection (CSCI). The visit lasted five hours and took into account previous information held by us including the previous key inspection report, the history of the service and records of any important events we have been notified of since our last visit. The manager sent us an Annual Quality Assurance Assessment (AQAA) questionnaire before we visited. This gave us information about their own assessment of how well Care Homes for Older People Page 5 of 26 they are meeting standards and their plans to improve aspects of the service. We sent out surveys to people living in the home and included one for them to give to their relatives or friends if they wished. We also sent out surveys to staff. The comments from those we received are included in the report. The main method we used to carry out the inspection is called case tracking. This includes following the care of a sample of people through their records and assessing their care. We spoke to people who use the service and saw the rooms of those who said we could. We also spoke to two members of staff and two sets of relatives. We also spoke to the owner/manager and discussed general outcomes of the visit with her at the end of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: 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 set out 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 order line –0870 240 7535. Care Homes for Older People Page 7 of 26 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 8 of 26 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. People are provided with detailed information about the service. The assessment of people the service supports ensures their needs can be met prior to their admission. Evidence: There is detailed information available which tells people about the service and this was also available in larger print at the home. The manager confirmed it would be provided in other forms if needed. In the services information about the home known as the Statement of Purpose, it was noticed that it contained the incorrect address of where we could be contacted as this has changed, but the manager agreed to ensure it was up dated. There have been no admissions to the home for approximately eighteen months. Both the records of people whose care was followed on this occasion contained information which showed that an assessment of need had taken place prior to their admission. Care Homes for Older People Page 9 of 26 Evidence: This had covered areas such as leisure interests, medication and dietary needs. Comments from relatives and a person who lives in the home confirmed they had had opportunities to visit the home prior to making a decision to stay and felt they had been given sufficient information about the service. They made comments which indicated communication between themselves and staff was good. There were no records seen to show that the manager confirmed to people the outcome of her assessment in writing but she agreed to ensure that in future this was done. We did however, see that people had been issued with a document telling them about their terms and conditions of residency at the home. A relatives comments confirmed that they had regular contact with the staff, had seen inspection reports and been given a full printed pack of information, which has been updated since their admission. An intermediate care service is not currently provided by the home. Care Homes for Older People Page 10 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans contain sufficient information to identify the needs of people and the care required. There are satisfactory procedures in place for staff to follow to ensure medication is administered safely although these are not consistently being followed. Peoples privacy and dignity is well respected. Evidence: We followed the care of two people, one who had dementia care needs. Both had care plans in place. Both contained a statement about their capacity to make decisions, which the manager acknowledged was too general and not decision specific. Not all staff have had training about the Mental Capacity Act 2005 yet. This is an important piece of legislation about how peoples capacity and rights to make decisions and choices is determined. Care records included information about individual risks but they varied in the amount of detail they contained. For example, it was noted that an accident form had been completed for a service user who had stumbled but no risk assessment was in place Care Homes for Older People Page 11 of 26 Evidence: about this. The manager confirmed that in April there is to be a new system for recording care plans and risk assessments and acknowledged more detail was necessary in some instances. Whilst comments from people who use the service varied as to whether they were aware of their personal records, both sets of relatives seen confirmed that that they knew about them and staff discussed the content regularly with them and their relatives. Comments from people who were spoken to on the day including relatives and from the questionnaires we received were very positive about the care and services received for example, I wouldnt move from here you can be sure of that and this is an excellent home and I am very well cared for and happy. We were told before we visited that they have policies and procedures about how to administer medication safely. We observed a member of staff administering part of the lunchtime medications. Records and comments from staff showed that they are trained to do this. They use a system which is pre-packed by a pharmacist. The storage arrangements are satisfactory. Records are well maintained, however it was noticed that there were occasions when records were completed prior to people who use the service taking the medication, although the staff member did ensure medications were taken. It was also noticed that gloves were not worn when a specific medication was handled by a staff member. Both these issues were discussed with the manager who agreed that they would be addressed. They do have a contract with a local pharmacist who advises on the medication systems in place. The records we checked showed that peoples health is monitored regularly, for example they showed when doctors had visited, that weight is monitored and of other health professionals visits. People made comments indicating they felt their privacy and dignity was well respected. Staff were observed to be discreet when speaking with people who use the service in communal places. Care Homes for Older People Page 12 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are opportunities for people to be involved in various social and leisure activities and they have choice of whether they do. Visitors are made welcomed. Meals are well balanced and take in to account peoples individual needs and preferences. Evidence: In the information they provided us with prior to the site visit they told us they had purchased a computer and Nintendo Wii and Wii fit for the use of people who live in the home. The computer was seen available for people to use in the dining room. Records are kept to show when people have participated in activities and a service user confirmed that they are given a choice of whether or not they join in with activities, entertainment or outings. The registered manager and care manager have since the last inspection visit, completed some training and are implementing a programme of activities designed specifically for people who have dementia care needs. On the day of the visit people were observed participating in activities. Visitors were noticed to come and go throughout the day and their comments and observations we made showed they were made to feel welcome and were offered drinks during their visit. Care Homes for Older People Page 13 of 26 Evidence: A comment from a service user was that they could get up and go to bed at a time that suited their lifestyle and indicated that their individual preferences and choices are respected by staff. Staff told us that there are regular twice weekly visits from members of the clergy. We were told they have altered menus and mealtimes as a result of listening to the views of people. People made positive comments about the meals. There are records kept of the meal options and these showed that people have a choice and their specific dietary needs and preferences are catered for. The lunch menu was on the noticeboard in the dining room and a service user who has a visual impairment said that staff always told her what the meal options were so that she could choose. The kitchen area was clean and tidy and records showed that basic food hygiene is part of the staff training programme. Care Homes for Older People Page 14 of 26 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. People are protected by satisfactory policies and procedures relating to complaints and the protection of people and feel confident any concerns will be listened to and acted on. Evidence: We saw that copies of the complaints procedure are available in the home and in larger print. Comments from the people we spoke to and from the surveys we received confirmed that they knew who to complain to and would feel comfortable to raise a concern with staff. Comments also indicated that people were of the opinion that staff would listen and act if a concern was raised. There is a record in place where any issues can be noted should they arise but the manager confirmed none had been received in the past twelve months. Staff demonstrated a satisfactory knowledge of the complaints and protection of vulnerable adults procedures and have had training about the latter. As well as their own, they also had a copy of the Local Authority Safeguarding Adults policy in place to refer to if needed. One person said they felt safe in the home another said, I am very well cared for and happy. Care Homes for Older People Page 15 of 26 Care Homes for Older People Page 16 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, clean and tidy home, which helps to keep them safe. Evidence: People were complimentary about the comfort and cleanliness that the home provided. The bedrooms seen were well personalised with peoples own personal affects and in some instances furniture. The manager said it had not been the custom to keep an inventory of peoples personal belongings but agreed to do so. All areas of the home seen were well decorated, well maintained and smelt fresh. We saw that a bedroom was in the process of being redecorated during our visit. There were no obvious safety issues noted of the areas seen however the manager told us that the service had had a visit from an Environmental Health Officer on 22/01/09 who had raised a number of issues that needed attention and have been given a timescale of the end of April 2009 to carry out some of the issues. For example, in relation to ensuring risk assessments of the environment are carried out and documented. The manager provided us with information to show she was in the process of addressing them. For example, she has obtained quotations for thermostatic mixer valves for hot water taps to control hot water temperatures. She has also made arrangements for some pipework to be boxed in. Care Homes for Older People Page 17 of 26 Evidence: Staff told us that any maintenance issues were addressed promptly and they were provided with equipment to ensure good standards of hygiene. Staff were observed to wear disposable gloves and also attended quickly to clean up food debris on the floor in the dining room to ensure it did not pose a risk to people who use the service. People who had completed the surveys we sent out told us that the home was always fresh and clean. Care Homes for Older People Page 18 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People receive care from a consistent staff team who are trained to ensure they have the knowledge and skills to care for people properly. The staff recruitment procedure helps to ensure people are protected. Evidence: There has been little staff turnover in the past twelve months helping to ensure a consistent staff team. Comments from a person who uses the service and a relative were continuity of staff makes a big difference and the little turnover of staff is good for mum as she cant see or hear very well. Rotas showed that there are always two staff on duty during the day and at night there is one wakeful staff member and one who is on call on the premises. The manager works additionally to the staff rota. In addition there is a house keeper. Comments from people who use the service and their relatives were positive about their relationships with staff indicating they felt staff would listen and act on what they said, they were always available when needed and one person said if she told staff she had a problem I dare say they would do something about it. We checked the recruitment records of two people who had been employed since the last inspection. They showed that important checks such as criminal records and Care Homes for Older People Page 19 of 26 Evidence: protection of vulnerable adults register checks had been made. One application form had been fully completed the other had some gaps which the manager said were checked during the interview. In one instance whilst the manager confirmed two references had been obtained only one could be found. Staff confirmed that they felt well supported in their work. Comments from them and training records checked showed that they have a range of training some, which is updated regularly and other training, which is more specific to meet the needs of the people the service supports. For example dementia care awareness training. We were told prior to the site visit that eleven staff had now achieved a nationally recognised vocational award in care at level two and a further staff member was registered to start the award. Discussion with the manager indicated that training for staff about the Mental Capacity Act 2005 is to be arranged. Care Homes for Older People Page 20 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and led and there are systems in place to ensure the views of people who use the service are obtained and acted on. Action is being taken to address matters raised by the environmental health officer which will help to ensure peoples health and safety is promoted. Evidence: There have been no changes to the ownership or management of the service since the last inspection. The manager, also one of the owners has achieved a nationally recognised vocational award in care at level IV and is enrolled on a registered managers course due to commence in April 2009. Comments from people who use the service and their relatives indicated there were good management systems in place. For example, all knew who was in charge and said would feel comfortable to raise any matters of concern if they had any. One of the people spoken to said I wish all homes were like this. Another said its excellent here Care Homes for Older People Page 21 of 26 Evidence: and mum settled in from day one. Records checked showed that there are quality monitoring systems in place such as staff meetings, staff supervision and residents meetings. They also have a quality audit manual which showed that questionnaires are used periodically with people. There are a range of policies and procedures in place to ensure the health and safety of the people the service supports and the sample of records checked relating to the maintenance of equipment such as the boiler showed that they had been serviced. Training records included information to show that health and safety training is provided for staff about matters such as manual handling and infection control and there is an induction training programme in place which new employees complete. Staff commented positively about the training opportunities and the management support they receive. There are satisfactory arrangements in place to ensure that any money or valuables of people the service supports are stored securely. Of the sample checked on the day of the visit records reflected accurately money held in safe keeping. Fire risk assessments have been completed and fire extinguishers were last checked on the 24th November 2008. Records were not in place to show that all areas of the premises had been risk assessed. The most recent environmental health officers visit raised some issues and areas within the environment that need addressing and gave a timescale of April 2009 in which two of the areas raised must be addressed. The manager discussed and was able to provide information to show the action being taken to resolve the matters which are outstanding. Care Homes for Older People Page 22 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 23 of 26 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 3 14 Records must be in place in 31/03/2009 order to demonstrate that people have received written confirmation of the outcome of assessments. This will ensure that people who use the service or their advocates can be sure that the service is able to meet their need . 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 1 7 Care plans should include more detailed reference to the Mental Capacity Act 2005 and the effects it has upon the lives of people who use the service. This is to ensure that their rights and choices are protected. Records of the recruitment procedure should show consistently that two satisfactory references have been obtained. Training should be arranged to ensure that all staff are fully aware of the assessment and recording of peoples capacity as outlined in the Mental Capacity Act 2005 to ensure that Page 24 of 26 2 29 3 30 Care Homes for Older People peoples rights, decisions and choices are respected. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or 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) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!