Inspection on 09/05/07 for Shotley Park

This inspection was carried out on 9th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Shotley Park 07/12/05

Shotley Park 20/07/05

Shotley Park 28/02/05

Shotley Park 24/06/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Shotley Park Shotley Bridge Consett Durham DH8 OTJ Lead Inspector Mr John Trainor Unannounced Inspection 11:00 9th May 2007 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 Shotley Park DS0000007501.V332700.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. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shotley Park Address Shotley Bridge Consett Durham DH8 OTJ 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) 01207 502052 P/F No e-mail Shotley Park Homes for the Elderly Limited Mrs Vanessa Eccles Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2005 Brief Description of the Service: Shotley Park is a former stately home which was built in the 18th Century. The house stands in a parkland setting of 15 acres of trees and meadows. The home provides lovely views of the surrounding countryside. People living at the home are free to make use of the private grounds around the home. The home is registered to accommodate 45 older people. The majority of bedrooms are single occupancy however a few double rooms are also available. The accommodation has been adapted to meet the needs of the people living at the home whilst still retaining the overall character and many of the original features of the house. Despite the size of the building the accommodation presents and feels homely. There are spacious south-facing lounges and dining rooms which are well furnished and equipped with televisions. All bedrooms are well lit, tastefully furnished and decorated and there is space for people to bring any personal effects with them. Each bedroom has thermostatically controlled heating, a vanity unit, access to toilets and specially adapted bathrooms. A number of the rooms have en-suite facilities. The home has a shaft lift to the first floor and a stair lift to bedroom accommodation on the second floor. The home endeavours to provide a lifestyle for each resident that satisfies his or her social, cultural, religious, and recreational interests and needs. There are regular visits from a hairdresser, and a therapist who offers aromatherapy and reflexology massage. There is an additional fee of £3 - £10 for hairdressing and £3 for the massage. The fees at the time of inspection were £382.50 and were the same as the Durham County Council contracting rate. There were no top up fees and people were not charged any extra if they contracted themselves. The home has its own transport which is made available to people living there on a regular basis. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information was provided to the Commission for Social Care Inspection before a site visit which was unannounced and lasted 10.5 hours over 2 days. We used this information to provide a guide as to what care would be like in the home and inform us what areas we needed to look at to get further evidence. During this visit we inspected records including health and safety records, care plans and recording. We watched how people were looked after to see what life was like for people and spoke to staff, management and people living in the home. What the service does well: What has improved since the last inspection? The home has had plans approved to build a new home on the same site to offer increased environmental standards to people. Rooms are redecorated to a plan and always before someone new moves in. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 6 What they could do better: 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. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People could be assured their needs were able to be met by the home when deciding to move in. EVIDENCE: Pre admission assessments were completed by the manager and those inspected covered all the areas needed to be assessed. Social services care management assessments were also available on file to supplement the manager assessment of need. The home did not currently write to confirm they were able to meet people’s needs following assessment, as required so people have all of the information they may need when making a choice to move into the home. 88 of returns from people living in the home or their relatives reported people had a contract. The contract/statement of terms and conditions was revised to include a statement on fees explaining these were set at the local Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 9 authority level regardless of who had responsibility for paying them. The home did not provide intermediate care. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 10 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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had their health and personal care needs met in a planned way making the most of their independence and ability. EVIDENCE: One relative said of the care. “Excellent, exceedingly high quality of care at all times. It gives personalised high quality care to all residents catering for all their individual needs. It provides a loving and caring atmosphere, excellent meals, superb environment. Residents are clean and dressed smartly.” Care plans and assessments included eating and drinking, focus on food, continence, mobility, expressing sexuality, sleeping, spiritual needs, social, intellectual independence and leisure, there was evidence of risk assessment and risk management . Files showed evidence of the doctor and other health professional involvement in the daily recording though there was no visiting professional record to show easily who had been seen and when. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 11 One relative said, “when I visit my mother she is always clean, well presented and very content.” Another said, “I feel care in Shotley Park is 100 .” People reported they were well looked after happy and content. Staff were seen to treat people with dignity and respect as confirmed by feedback from people who lived at the home and their relatives. Medication storage and administration was safe and people got the medication they were prescribed. Staff completed safe handling of medication training. One persons care file was not available for staff to reference on the day of the site visit so risk management plans were not available. A bed rail was found to be incorrectly fitted creating a potential risk. Other bed rails when checked were all fitted safely and bumpers were in use to minimise risks. Moving and handling practices were a cause for concern, with staff regularly supporting people when assisting them to get up, by holding them under their armpit. This increases risk of injury. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s lifestyle reflected their expectation and individual preference. EVIDENCE: The home provides different activities and events for people. Each person has a social plan outlining what they like to do and plans can be developed from this for activities. On the day of inspection people were completing exercise to promote manual dexterity using a tool designed for this purpose whilst others enjoyed hand massage. The therapists interventions with people were seen to be good. One of the people who lives in the home told us activities did take place. “Always something but I never take part, as I like my own room but activities are there.” There is a reflexologist, manicurist and keep fit instructor and hair dresser 3 times per week. 88 of people and their relatives said they got the activities they wanted. The home is committed to provide good quality varied diet and follows focus on food principles. Fortified diets were provided with real thought about what would be nice for people. Dietary advice was sought from speech and Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 13 language when swallowing was an issue and pureed diets were needed. Pureed diets on the day of inspection were not presented well and were uninspiring being served as an homogenous mush. Discussions were held with the manager about the aesthetic value of food and flavours and how by mixing food into a mush this took away some quality of life if people like particular flavours. Whilst the manager was keen to stress the nutritious value of the food was of a high standard, it was agreed from that day on portions would be individually pureed and served to enable people to benefit from the individual flavours and make mealtimes a more pleasing aesthetic experience. People who could express an opinion said the food was good and that there was a choice of menu, “quite content, not always what I want but always a second choice.” Some people had their own fridges and kettles in their rooms to maximise their abilities all within a risk management framework. The home supports people to carry on their religious beliefs, one person said their relative “…has visitors from her church, such as Eucharistic ministers to give her communion.” One relative did comment, “although the home has very high standards a little more could be done to try to stimulate the older person’s minds.” Another said the home would be better if they could, “provide a lounge where visitors can see their relatives rather than in their own room where there is often no room for visitors to sit.” Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 14 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were protected by the homes policies and procedures on complaints and abuse. EVIDENCE: The home had policies on adult protection and a complaints procedure though here had been no formal complaints recorded since the last inspection. People said the management were approachable and they would feel able to complain if they needed to. One person said they “have not had any major concerns any queries have been dealt with efficiently.” The service user guide included a copy of the complaints procedure. Staff could identify the process to follow in case of adult abuse issues. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 15 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): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People lived in a safe, clean and hygienic home maintained to a high standard. EVIDENCE: The home was grand and well maintained. Communal and private rooms were clean. Dining tables were set with table cloths and serviettes and menus were laminated. All bathrooms and toilets had paper towels and liquid soap to aid infection control though in two of these there were bars of soap left on the bath or sink side. The manager felt this was after someone had been bathed. Bars of soap if used communally can encourage the spread of infection. By providing liquid soap and paper towels the home was encouraging best practice for infection control. People could bring in their own furniture as long as it met current fire resistance standard. The furniture in the home was of good quality. The home had some double rooms and where people were Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 16 sharing they had made a choice. One double room had two sinks the others only had one. There was tracked screening around beds for privacy in double rooms. Electrical appliances were being regularly checked for safety as was the home’s electrical wiring system. The manager confirmed other health and safety checks were taking place. One bed rail was incorrectly fitted which would have posed a risk to the individual had they used it in that condition but this was put right on the day and care plans revised to ensure staff check bedrails are correctly fitted before people use them. Other bed rails when checked were safe. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 17 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): 27, 28, 29 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People were looked after by a staff team deployed in sufficient number and with sufficient skill to meet their needs. EVIDENCE: Staffing hours exceed residential forum guidance and 83 had NVQ level 2 or above. They were seen to treat people with dignity and respect and people seemed to be well cared for. One person said, “The girls are lovely, I wouldn’t be able to pick a bad one out.” One also said, “I can wash myself and go to bed and be as independent as I can, but if I press the buzzer they are up here as quick as anything.” Reports generally confirmed staff were available to people when needed. The home had a robust recruitment and selection process and all files inspected had criminal record checks. When interviewed staff could identify the correct people to go to in case of abuse in the home. Two members of staff interviewed enjoyed working at the home and felt the care they delivered was good. They had recently completed the 1 day first aid course. The manager confirmed senior members of staff completed the three day appointed persons first aid course so there was always a qualified first aid person on each shift. Staff meetings were being held regularly and though there was no formal supervision contract staff were being supervised regularly using a reflective feedback process. Staff felt supported and supervised and Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 18 there was an annual appraisal in addition to this. The home was committed to training. The manager was a trainer and delivered some of the home’s training, though they had used external providers as well. Staff responsible for administering medication had completed the safe handling of medication course. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 19 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): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed in the interests of the people who live in the home. EVIDENCE: The manager was committed to her job and was well qualified. Trained as a nurse SRN RSCN (though registration not maintained) she had the Registered Managers Award as well as a diploma in management and was a member of professional management body. She was also an NVQ assessor and external verifier. The manager understood the principles of criminal record and protection of vulnerable adult checks. There was no formal supervision contract but staff were being supervised regularly using a reflective feedback Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 20 process. Staff felt supported and supervised and there was an annual appraisal in addition to this. The hard wiring electrical certificate was in order as a sample of health and safety checks and at the same time gas was offered though dates for this were in the pre inspection information as were checks on lifts hoists etc. Portable appliance testing was completed annually. The home also had an independent health and safety and fire review. Fire training was not taking place at the required frequency. Moving and handling training refreshers were also not being conducted frequently enough and there were concerns about some observed practice. The home did not handle any money on behalf of service users and worked on the principle of providing things people needed and then sending the bill to the person responsible for looking after their money. Where people couldn’t manage this themselves and did not have relatives to perform this function the local authority did it. Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 21 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 X 3 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 4 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 22 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 OP4 Regulation 14 (d) Requirement For all new admissions confirmation of the ability to meet the needs of people following assessment, must be given in writing, so they can make an informed choice to move into the home. Timescale for action 20/05/07 Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 23 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 OP7 Good Practice Recommendations A visiting professional record sheet included in care plans would enable easy monitoring of health and social care professional visits to people without having to check through daily record sheets. When people need a pureed diet portions should be individually pureed and served to enable people to benefit from the flavours and make mealtimes a more pleasing aesthetic experience. It is recommended staff supervisions are recorded more robustly to ensure all care staff receive a minimum of 6 supervisions per year. Fire training should be provided at more frequent intervals for staff. Current good practice is 6 monthly refreshers for day staff and 3 monthly refreshers for night staff. The registered manager should review moving and handling practice in the home to ensure risks to people are minimised and that care plans include specific detail to outline how people should be moved within a risk management plan. Moving and handling training should be refreshed annually. 2. OP15 3. 4. 5. OP36 OP38 OP38 Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS 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 © 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 Shotley Park DS0000007501.V332700.R01.S.doc Version 5.2 Page 25 - 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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