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Inspection on 22/06/05 for Shouldham Hall Nursing Home

Also see our care home review for Shouldham Hall Nursing Home for more information

This inspection was carried out on 22nd June 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

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

Provides good information to prospective residents and relatives. Provides a high quality of individual and residential care. Provides a good catering services, with meals that are varied , nutritious and interesting. Provides a high quality of accommodation. Has sound polices and practices in regard to recruitment, thus enhancing the safety and care of residents.

What has improved since the last inspection?

The main lounge, and dinning room have been redecorated. The reception area is being upgraded at present and this work is nearing completion. The gardens at the front of the home have undergone a major renovation and improvement and now look more open. The internal decoration in the older part of the home has been improved. A unobtrusive security card system has been installed, which prevents residents from wandering away from their own part of the home.

What the care home could do better:

The care planning needs to be updated. Staff reviews need to be carried out. The home needs to develop and implement a training schedule for all staff. Implement the Quality Assurance system used by the Company.

CARE HOMES FOR OLDER PEOPLE Shouldham Hall Nursing Home Shouldham Norfolk PE33 0DF Lead Inspector Chris Handley Unannounced 22 June 2005 9.30am 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 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. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Shouldham Hall Nursing Home Address Shouldham Norfolk PE33 0DF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01366 347276 01366 347658 ACC (Shouldham Hall) Limited Natasha Obolewicz Care Home 48 Category(ies) of Dementia (1) registration, with number Dementia - over 65 (34) of places Old age (14) Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate forty-eight (48) people in total, all of whom are older people. Of these, thirty-four (34) Service Users will fall in the category of dementia and fourteen (14) Services Users will have needs associated with old age, not falling in any other category. 2. One Service User under the age of 65 years who has dementia and is named in the Commissions records may be accommodated. Total number not to exceed 48. Date of last inspection 16 November 2004 Brief Description of the Service: Shouldham Hall is a 48 bedded care home with nursing for the elderly, and elderly mentally frail. The home consists of two major elements, the original hall, and the new wing. There are 44 single rooms and 2 double rooms on the ground and first floor. The home receives its medical services from the local G.P. centre.There is an enclosed garden and large grounds, the car park is adjacent to the main entrance. There is work in place which will enhance the appearance of the gardens when completed. The home is situated at the edge of the village of Shouldham, which is 10 miles from Kings Lynn. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection commenced at 9.30 taking place over 5 hours, and was carried out as part of the annual inspection programme. The Manager Mrs Obolewicz was present during the inspection and 4 residents 2 visitors and 6 members of staff were spoken to. A total of 21 Standards were inspected What the service does well: What has improved since the last inspection? The main lounge, and dinning room have been redecorated. The reception area is being upgraded at present and this work is nearing completion. The gardens at the front of the home have undergone a major renovation and improvement and now look more open. The internal decoration in the older part of the home has been improved. A unobtrusive security card system has been installed, which prevents residents from wandering away from their own part of the home. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3, &5 The home provides all new residents with a statement of terms and conditions. The home undertakes and records a detailed pre admission assessment. Provides the opportunity for preadmission visits by residents and relatives. EVIDENCE: A copy of the Terms and conditions was seen. The document is neatly set out, and contains all the information required. If needed the Manager will read through the document with the prospective resident. A signed copy is kept in the office and a copy is provided to the resident. Because some of the people who read these documents may have poor sight, it is recommended that the print size be increased. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 9 Pre-admission assessments are carried out by the Manager which are recorded. One such document was read by the Inspector. The Manager is aware of the need to obtain a complete picture of the residents needs, physical, mental and social. This ensures that the Manager will only admit those people who’s needs the home can meet. Pre-admission visits to the home are encouraged. The Manager is aware of the importance to the individual of going to see the home which not only meets their needs, but a home which they like. Prospective residents and relatives are taken on a tour of the home, meeting both staff, and residents, and are informed of the routines of the home. A days stay can also be arranged if wanted. The important factor clearly recognised by the Manager and staff, is that the prospective residents gets a clear a picture of the home as is possible. A visitor told the Inspector that she had visited the home before her relative was admitted. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9, All resident have an individual care plan. The health care needs of residents are met. The home has an effective medicine system. EVIDENCE: Care plans are clearly marked “Confidential Information”. The folders are colour coded . There are dividers in the folders which assist in the management of the documentation. The new directors have also brought new forms with them. Historically the home has had good quality of care plans. The Manager accepts that things have slipped a little in this matter and they are not as comprehensive as was previouly the case i.e. they are not as up to date as they should be. The Manager accepts that a major overhaul now needs to take place. The nurse responsible for the care plans has left, and this has not helped. A positive discussion took place on this matter. It was accepted that there must be ownership of this documentation if it is to work. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 11 There must be a preadmission assessment, an assessment of physical, mental and social well being, The care plan structure must have an assessment - plan, implementation and review, if it is to be effective. Where possible the reviews should involve residents and where appropriate relatives, and this should be recorded. There needs to be a variety of risk assessments to meet the particular needs of the resident groups. The daily record should provide a brief holistic picture of the residents day/night. In order to encourage a positive approach the Inspector suggest the word “problems” should be replaced with “needs” when referring to residents. Once the new format has been completed it is important that they are introduced following a teaching session to ensure that all staff are “ Singing the same song, to the same tune.” The Manager accept her responsibility for the plans and intends to get them back to the previous standard, with the assistance of the newly appointed person. The health care needs of residents are met from a variety of sources. All residents have a G.P, the Manager said, and any additional health care needs would be met by a referral from the G.P. e.g. Physiotherapy, Occupational therapy, and Dietician etc. Dental and optical arrangements are made locally. There are two residents who have pressure sores ,one on the heal, and one in the sacral area, both are being treated appropriately. Since the last inspection one resident cut her head and had to be taken to casualty, following treatment she returned to the home. There are two medicine rooms in Shouldham Hall, both of which were locked, the medicine trolleys inside were locked and locked to the wall. The contents of the medicine rooms and trolleys were neat and tidy. There are no residents who self medicate in the home. Only trained nursing staff administer medicines. The home has a copy of the UKCC guidelines. MAR sheets were seen to be neatly initialled. The home has a list of names and initials of nurses who administer medicines. The are controlled Drugs in the Controlled Drug Cabinet, and one was counted and found to be correct against the Controlled Drug Register. There is a Drug refrigerator which was free from ice. . The home has a good working relationship with the supplying chemist. If staff had concerns about the effects medicines on residents they would contact the prescribing Doctor. The home has a detailed policy on medicines. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,&15 Residents may receive visitors at any reasonable time. The home provides varied, wholesome and nutritious diets. EVIDENCE: The Manager said that residents may have visitors at any reasonable times, and that they may bring children or pets with them as residents look forward to see these visits as they see them as part of the family. Relatives are positively welcomed and are seen as part of a caring team, the Manager said. The Inspector spoke to a visitor explaining his presence in the home, she had nothing but praise for the staff and the quality of care provided. The home has a volunteer who helps with minor but important tasks around the home on a part time basis. She had a CRB check, and was interviewed before she commenced duties. She makes a very useful contribution to the care of the residents. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 13 The Inspector read the menus, they were varied nutritious and interesting. Special diets are provided and recorded. The menu of the day is clearly written in large print on a board in the main corridor. The Cook informed the Inspector that she would see a resident within a few hours of their admission to find out their likes and dislikes. There is always a choice of menu, and if an individual did not like what was prepared and an alternative would be provided. Birthdays and special occasion are celebrated she said. The cook is aware of the importance of food in the daily life of the residents Three of the residents told the Inspector how much they liked the meals as did the visitor whom the Inspector spoke to. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, &18. The home has a well set out complaints procedure. The legal rights of residents are protected. Staff are aware of the home abuse awareness policy. EVIDENCE: The complaints procedure is displayed around the home, which was seen by the Inspector . The name of the new directors of Shouldham Hall Company Limited are clearly visible on the document. The home’s record of complaints showed that there were two complaints made, one relating to furniture, and another dealing with an incidents of care being provided to a residents. Both matters have been effectively dealt with by the Manager. Residents are enabled to exercise their legal rights. A number of residents used their postal votes in the recent elections. Any meeting between the legal representative and the resident would take place in private. The Manager would facilitate legal advice if needed. All allegations and incidents of abuse are followed up promptly and action taken is recorded. The home has polices on this matter. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 15 The staff have had video training on the subject of Adult Abuse Awareness, and this was followed by a questionnaire. Two members of staff briefly told the Inspector what they would do if they suspected abuse was taking place, and they gave firm positive replies as to the action they would take. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26 The residents’ rooms are of a high standard. Residents live in safe comfortable surroundings. The home is clean, pleasant and hygienic. EVIDENCE: The Inspector made a tour of the home accompanied by the Manager, and a wide range of rooms in all parts of the home were seen. There are 44 single, rooms and 2 double rooms. All the rooms seen were neat clean, and odour free. There is a wide range of furniture, some chosen by the resident. There are photographs, pictures and ornaments, and every effort appears to have been made to personalise the rooms. Other residents prefer a plainer look. There are a variety of beds to meet the needs of the residents. There is good natural light in the rooms. Residents spoke highly of their rooms and one visitor told the Inspector that she thought that they were very nice and that they were always clean. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 17 Rooms are individually and naturally ventilated. Rooms are centrally heated and the heating may be controlled in the resident’s own room. Pipe work and radiators are guarded. Lighting meets recognised standards. There is emergency lighting throughout the home which is tested regularly, and the records of this were seen. Water is stored at 60oC and distributed at 50oC and records of the water testing were seen. The Manager is keen to ensure the safety of the environment of the home, and the records seen demonstrate this in practice. The premises were neat, clean, hygienic, and free from offensive odours. The corridors, fire routes and fire doors were free of obstruction. The home has its own laundry which has industrial type machines. There are hand washing facilities in the area. The laundry floor is impermeable and the walls are readily cleanable. The home has polices and procedures for the control of infection and the safe handling of clinical waste, dealing with spillages provision of protective clothing and hand washing. Foul laundry is washed at appropriate temperatures. The washing machines have specified programming to meet disinfection standards. Services and facilities comply with the Water Supply (Water Fittings ) Regulations 1999. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28,29,&30 The home are not in a position to say that service users needs are met by the skill mix of the staff. The recruitment practice of the home is sound. EVIDENCE: The Manager provided the following information. There are 3 members of staff who have NVQ in care, and a further 6 care staff currently undertaking it. This is a very poor level of training as it means that out of a total of 29 people there is only 0.87 of staff who have or are undertaking some recognised training. 2 members of staff have NVQ II in hotel and catering services. It can be seen that the home needs to implement a training programme which addresses this is issue as a matter of urgency. The home previously had a training officer who has recently left and this has resulted in the home not being as far ahead with training as the Manager would like. The home’s recruitment policy and procedure is based on equal opportunities, posts are advertised, references are obtained, CRB and POVA checks are obtained. Completed application forms are required. Applicants are shown around the home and sound preparation for interviews is made. At least two members of staff carry out interviews, which are very carefully prepared for, and notes of the interview are made. Based on the information provided it is clear that the Manager is aware of the significance interviews play in maintaining a good quality of care and safety of residents. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 19 The home has an Induction and Foundation programmes which are recognised by TOPPS. Other training provided includes Moving and Handling, and Fire Prevention training, Health and Safety. On speaking to staff the Inspector became aware the First Aid training is due for renewal. Training for all grades of staff has taken place and the Manager seeks to develop a fully trained workforce. The Manager accepts that training is not at a satisfactory level and intends to increase the training programme. When the new trainer is in post the Inspector recommends that she and the Manager draw up a detailed comprehensive training programme for all staff to ensure that all are appropriately skilled. There are some staff who have had training in caring for the Demented person, and the inspector recommends that that all staff caring for people with Dementia receive training in this matter, and examining areas which may include extending the role of the nurse in areas which would improve residents care. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,36,& 37 The Manager is appropriately trained , skilled and experienced to run this home. The home is commencing to develop a Quality Assurance model. Staff are not supervised at present. Records required are held secure. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 21 EVIDENCE: The Manager is a qualified RGN, ENB 998, Care N11, is also qualified in Reflexology, Spiritual Healing, and has recently obtained The Registered Assessor, and Managers Award. She has been the Manager of the home since 1991. She is experienced and trained to effectively manage this home. Both residents and visitors speak well of her and see her as the person who is in charge of the home, and the individual who can provide advice about “ Important things, Contracts”. Staff view her as the leader of the team. The Manager informed the Inspector that the Company used a Quality Assurance model which was in the very early stages of being implemented at the home. As yet there was some way to go and the Manager undertook to keep the Inspector informed of progress in this matter. The home has employment polices and procedures in place. Supervision of staff previously took place but the member of staff who undertook this has left. Interviews for this post are taking place on 23/6/05. When the newly employed person is in post it is intended that supervision will recommence. The Manager is aware of the importance of supervision and it is her intention that this practice should commence as soon as possible. A wide range of records required by legislation were seen by the Inspector during the process of this inspection. They are held secure and the Manager demonstrated the security system to the Inspector. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION x x x x x 3 3 3 STAFFING Standard No Score 27 x 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 2 x x 1 3 x Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 23 Are there any outstanding requirements from the last inspection? 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. 2. Standard 36 Regulation 18 (2) Requirement It is required that the home carry out of supervision for staff. Timescale for action 30/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. 8. Refer to Standard 2 7 28 30 Good Practice Recommendations It is recommended that the print size of the Terms and Conditions be increased. It is recommended that a major review of the care plans take place, to ensure that the structure and content are of a high quality. It is recommended that NVQ training continue It is recommended that a training programme for all staff be drawn up to ensure that the home has staff who are trained in the area of care/work required. Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection 3rd Floor, Cavell House St Crispins Road Norwich NR3 1YF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Shouldham Hall Nursing Home I55 S15681 Shouldham Hall V234086 220605 Stage 4.doc Version 1.30 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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