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Inspection on 28/06/06 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 28th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Staff show a commitment to their work and a desire to improve their practice through training. On the day of inspection the home was clean and free from offensive odours. The home operates a training resource for student nurses.

What has improved since the last inspection?

The home has made some minor improvements to the information in residents care plans. A training officer has been appointed and has made progress with staff training plans An activities coordinator has been appointed. Some minor improvement can be seen in the interaction between staff and residents. The environment is improving and progress is being made in the dementia unit to make it more homely.

What the care home could do better:

Whilst some improvement can be seen, progress is very slow. Nine of the fifteen requirements made at the last inspection have not been met within the stated timescales and this is disappointing. Fourteen of the requirements are made for the second, third and fourth time and the management must be more proactive in ensuring the requirements made in this report are met to avoid enforcement action being taken by the Commission. Care plans need to be developed in line with a person centred approach to care planning. Those in use in the home are not suitable for people with advanced care needs. Care plans must include social and emotional needs. There are insufficient risk assessments to cover all aspects of the service users daily lives. The plans focus on the physical rather than the holistic care. Care plans should be made accessible to staff and staff must be aware of the content of risk assessments. Records kept in service users rooms must be developed to provide meaningful information about how staff are to meet individuals care needs. Staff must be encouraged to communicate with residents and to be educated as to the importance of positive interaction with residents. Specialist equipment must be provided communication between residents and others. to promote effectiveThe home must promote the dignity, privacy and independence of residents. The home must ensure that the medication arrangements are improved to protect the health and welfare of residents. The home must ensure that they gather information about people`s life history, hobbies and interests so that meaningful activities can be provided.The home needs to find a way to monitor contact time with residents, so that they ensure that stimulation is offered to people at regular intervals. Staff should be encouraged to engage residents in the activities of daily living. Meals must be presented in an appealing, appetising manner and in a way that promotes dignity and independence. The practice of changing over who is assisting a resident to eat their meal should also stop (once again this happened midway through a meal). Nutritional needs assessments must be completed to identify those people who would benefit from finger foods and to ensure that food is presented in a way that meets individual needs. The home should make efforts to make the mealtime experience less chaotic. Environment risk assessments must be completed and potential hazards identified and eliminated e.g. communal toiletries and those stored in peoples rooms. The management must continue to make improvements to the physical environment in the Dementia unit to make it more appropriate to the needs of people with dementia. The lighting in the corridors of the Dementia unit must still be improved. Staffing levels need to be assessed and the home should complete a dependency assessment and staff according to the individual needs. The home does not have any staff who are trained to NVQ 2 or above and this must be addressed. Training for staff in the Dementia unit, needs to be widened, so that staff are encouraged to look at the reasons for certain behaviours and try to deal with that rather than the outcomes. The Induction training for those in Dementia Unit needs to include the Skills for Care Dementia elements. Recruitment practice must be improved to ensure that it is robust. The manager of the home has completed her RMA award, but could benefit from some external training input about dementia care or shouldShouldham Hall Nursing HomeDS0000015681.V303230.R01.S.docVersion 5.2Page 8delegate the management of the dementia unit to someone with the skills and experience necessary . The manager should also explore ways management tasks could be delegated. in which some of theThe home urgently needs to carry out a quality assurance survey to explore ways in which the stakeholders feel the service could be developed and improved. Outcomes must be shared with stakeholders and the Commission.

CARE HOMES FOR OLDER PEOPLE Shouldham Hall Nursing Home Shouldham Norfolk PE33 0DF Lead Inspector Kim Patience Unannounced Inspection 28th June 2006 10:30 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 Shouldham Hall Nursing Home DS0000015681.V303230.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. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shouldham Hall Nursing Home Address Shouldham Norfolk PE33 0DF 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) 01366 347276 01366 347658 shouldhamhall@tiscali.co.uk Shouldham Hall (Registration) Limited Natasha Obolewicz Care Home 48 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (34), Old age, not falling within any other of places category (14) Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate forty-eight (48) people in total, all of who are older people. Of these, thirty-four (34) Service Users will fall in the category of dementia and fourteen (14) Service Users will have needs associated with old age, not falling in any other category. One Service User under the age of 65 years who has dementia and is named in the Commission`s records may be accommodated. 23rd February 2006 2. Date of last inspection 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 wings, the original hall, and the new wing. There are a total of 44 single rooms and 2 double rooms on the ground and first floors. The home receives its medical services from the local G.P. centre. There is an enclosed garden and large grounds, and ample car parking on the front drive to the home. The home is situated at the edge of the village of Shouldham, which is 10 miles from Kings Lynn. The fees charged at this home range from £393 - £525 Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out by an unannounced vbisit to the home an examination of the information submitted by the home. There was a disappointing response to the comment cards sent to the home for use by service users and relatives. The Visit was over two days and lasted approximately 12.5 hrs, this included the feedback session held on day two. In order to assess the key standards, records relating to residents and staff were inspected, observations of staff and residents engaged in daily routines were made and staff and residents were spoken with. The home was asked to complete a pre-inspection questionnaire and residents and relatives were provided with surveys so that they could comment on the quality of the service. The pre-inspection questionnaire was completed and returned within the given timescale, however, there was a poor response to the surveys and only three were returned. The manager and operations manager were available for consultation throughout the visit and helpful in facilitating the process. Feedback was given at the end of the visit, at which time Mr Akash Soni, the company director was present. What the service does well: What has improved since the last inspection? The home has made some minor improvements to the information in residents care plans. A training officer has been appointed and has made progress with staff training plans An activities coordinator has been appointed. Some minor improvement can be seen in the interaction between staff and residents. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 6 The environment is improving and progress is being made in the dementia unit to make it more homely. What they could do better: Whilst some improvement can be seen, progress is very slow. Nine of the fifteen requirements made at the last inspection have not been met within the stated timescales and this is disappointing. Fourteen of the requirements are made for the second, third and fourth time and the management must be more proactive in ensuring the requirements made in this report are met to avoid enforcement action being taken by the Commission. Care plans need to be developed in line with a person centred approach to care planning. Those in use in the home are not suitable for people with advanced care needs. Care plans must include social and emotional needs. There are insufficient risk assessments to cover all aspects of the service users daily lives. The plans focus on the physical rather than the holistic care. Care plans should be made accessible to staff and staff must be aware of the content of risk assessments. Records kept in service users rooms must be developed to provide meaningful information about how staff are to meet individuals care needs. Staff must be encouraged to communicate with residents and to be educated as to the importance of positive interaction with residents. Specialist equipment must be provided communication between residents and others. to promote effective The home must promote the dignity, privacy and independence of residents. The home must ensure that the medication arrangements are improved to protect the health and welfare of residents. The home must ensure that they gather information about people’s life history, hobbies and interests so that meaningful activities can be provided. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 7 The home needs to find a way to monitor contact time with residents, so that they ensure that stimulation is offered to people at regular intervals. Staff should be encouraged to engage residents in the activities of daily living. Meals must be presented in an appealing, appetising manner and in a way that promotes dignity and independence. The practice of changing over who is assisting a resident to eat their meal should also stop (once again this happened midway through a meal). Nutritional needs assessments must be completed to identify those people who would benefit from finger foods and to ensure that food is presented in a way that meets individual needs. The home should make efforts to make the mealtime experience less chaotic. Environment risk assessments must be completed and potential hazards identified and eliminated e.g. communal toiletries and those stored in peoples rooms. The management must continue to make improvements to the physical environment in the Dementia unit to make it more appropriate to the needs of people with dementia. The lighting in the corridors of the Dementia unit must still be improved. Staffing levels need to be assessed and the home should complete a dependency assessment and staff according to the individual needs. The home does not have any staff who are trained to NVQ 2 or above and this must be addressed. Training for staff in the Dementia unit, needs to be widened, so that staff are encouraged to look at the reasons for certain behaviours and try to deal with that rather than the outcomes. The Induction training for those in Dementia Unit needs to include the Skills for Care Dementia elements. Recruitment practice must be improved to ensure that it is robust. The manager of the home has completed her RMA award, but could benefit from some external training input about dementia care or should Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 8 delegate the management of the dementia unit to someone with the skills and experience necessary . The manager should also explore ways management tasks could be delegated. in which some of the The home urgently needs to carry out a quality assurance survey to explore ways in which the stakeholders feel the service could be developed and improved. Outcomes must be shared with stakeholders and the Commission. 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 DS0000015681.V303230.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 6 The quality outcome in this area is adequate as the home can demonstrate that the pre-admission procedure provides sufficient information from which to meet people’s needs on admission to the home. EVIDENCE: The pre-admission process was assessed by looking at the records relating to only one new resident and through discussion with the manager. The home has a pre-admission procedure that includes the completion of a pre-admission assessment and a visit by the resident and representatives to the home to view the accommodation. Either the manager or the deputy will complete the assessment. The pre-admission assessment contains basic information from which care plans can be written. Family or advocates are invited to take part in the planning process and to view accommodation. The home has a brochure that contains the service users guide and this is sent to all prospective residents or given to them when coming to view the home. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 11 All personal items are listed on admission and people have a six-week trial period of stay at the end of which a placement meeting is held to review whether a permanent placement is appropriate. Full care plans are developed during the first two weeks, during which time information can be gathered. Any immediate care plans and risk assessments are written within a few days of admission. For instance, moving and handling assessments and risk assessments relating to any special requirements. The home does not provide intermediate care services. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The quality rating for these standards is poor as the home is still not able to demonstrate that they can meet people’s holistic needs and that care is delivered in accordance with care plans. Observation shows a continuation of poor practice, a lack of understanding of peoples needs and how they should be met. EVIDENCE: Whilst some improvements can be seen, it is not sufficient. Care plans still do not provide adequate information to meet individual’s holistic needs. They are still very clinical and do not consider peoples social, emotional and psychological needs. See requirements. Observations of care staff engaged in the delivery of care show that staff do not have sufficient knowledge of peoples needs and how they should be met. This could indicate that they do not have access to up to date information. The recommendation made at the last inspection to introduce care plan summaries has not been taken up. However, this would provide staff with easy access to a Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 13 summary of peoples needs and could provide pointers to the main care plan where necessary. See requirements. Some improvements have been made to risk assessments, for instance, information has been added to those in relation to behaviours. However, again the improvement is not sufficient to meet the standard. There was still evidence that risk assessments were not adequately completed. In one case a falls risk assessment stated that the person should mobilise in a safe environment, but did not say how to make it safe. Nor did it look at any other measures that should be taken to reduce risk, such as appropriate footwear or equipment. See requirements. There is some evidence that the home is making efforts to meet people’s health needs, but again is not sufficient to meet the standard. Records of visits made by health professionals are maintained, but do not show the outcome of the visit so it is not possible to assess whether needs have been appropriately met. In addition, people’s nutritional needs are not properly assessed and some weight loss is occurring. There is no evidence that action is being taken in response to this. See requirements The medication standard was assessed by the pharmacist inspector on day two. The inspection showed that there are still concerns in relation to the safe administration of medicines. This is the forth medication inspection where requirements have been made and have not been met. The home must meet the requirements within the given timescales. See requirements. The findings of the Pharmacy Inspection will be produced in a separate report available on request. Issues around dignity, privacy and respect remain. Staff were seen to treat people in a condescending way. For instance, when the resident said she was vegetarian staff laughed and told her she wasn’t, another resident stated that the food was ‘crap’ and they laughed not asking him why. A GP was seen to consult a resident in the dining room and talk about her condition and diagnosis. Rooms and communal facilities contained incontinence pads, which were in view of people walking by. One room with the door open had a full catheter bag at the side of the bed again in full view of those walking by another had a package marked ‘nappies’ on the bedside table. See requirements. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The quality rating for these standards is poor, as the home cannot yet demonstrate that it is meeting people’s social needs. In addition, while some minor improvements were seen at lunchtime, peoples nutritional needs were not being met in accordance with care plans. It cannot be said that the home demonstrably offers people choice in every day living. EVIDENCE: There was very little activity in the home on the day of inspection and records seen showed little evidence of peoples needs being met in this respect. As found at the previous inspection, care plans relating to social care needs still do not contain sufficient information. The home has made efforts to gather information from relatives and this is good practice, particularly where people have dementia and are not able to say what their social needs are. However, in one case information had been provided by a daughter of one resident, but not used to make improvements in the care that is provided. See requirements A new activities coordinator has been appointed and is to begin work on building up person-centred programmes of activities and gathering information about individuals. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 15 During the inspection visitors were seen to come and go without restriction and there were no concerns in this respect. Due to the lack of information in care plans about peoples preferences and observations made during the inspection show that people do not necessarily have choice and control over their lives. The following examples in relation to dining will provide some examples to support this judgement. Tabards were still placed around people’s necks with no consultation or choice. People were not offered choices at lunch. Some people were fed when clearly able to manage this themselves if food was prepared properly with time and prompting. There were some minor improvements to the lunch meal. At the start of the meal it appeared much calmer and there was no loud music playing as before. People were seated for lunch approximately 15 minutes before staff started to serve the food, which is an improvement made since the last inspection. Observations of mealtime showed that many improvements are yet to be made and many of the concerns highlighted at the previous inspection remain. Residents are not provided with a meaningful choice of food or drink. Staff spoken with said they decide what they think residents will like to eat. There was no apparent link to information contained in care plans about people’s nutritional needs and preferences. It was not clear how much choice people were given about where they were seated and certainly some residents were seated in a way which conflicted with information written in care plans. For instance, one resident’s care plans stated that she preferred to eat by herself, yet she was seated on a large table with several other people. Two other residents needed assistance with their meals and were seated on the large table with those that did not. In addition, those requiring assistance did not have their meals until most of the others at their table had already eaten their meal. There were two care assistants in the dining room to supervise 15 residents and they were assisting with meals. Other staff were assisting people to have meals in the lounge and their rooms. There appeared to be a lack of staff to cope with the routine established and as a result lunchtime became chaotic. Some residents who needed assisted meals were left waiting for up to one hour before being given their meal. Once again there was a change of carer midway through giving assistance with a meal. In the lounge there was one care assistant with six residents who all needed some support with eating. Two meals were brought into the lounge and one sat on the table for approximately 20 minutes before a care assistant came along and started to feed the resident, by this time the food would have been cold. Another resident who was assigned one-to-one support was given no support during the lunchtime period. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 16 Food was not necessarily prepared in a way that promoted independence. One resident was observed to be fed, yet following the meal was picking food off the table and eating it independently. If his nutritional needs had been properly assessed, the need for finger foods would have been identified and he may have been able to manage to eat independently. Similarly, another person was told by a care assistant to stop eating with her fingers and use a spoon. Finger foods would have been more manageable for this person; she was not offered any support with the use of a spoon. It was evident that some people were not able to manage their food independently due to the way in which it was prepared and presented. The cook was interviewed. She prepares the menus on a fortnightly basis, there is normally a choice of two main meal options (good practice) and food is blended for half of all residents. Blended food is prepared and served in separate portions (again good practice) and placed in either plastic bowls or on plates for about eight people. When questioned about the use of plastic bowls, the cook stated she felt it was for the benefit of staff so that food could be stacked and served more easily. Eight residents had objected to the plastic bowls and ate less from them so these people are now offered plates (good practice). However, those who had not expressed an opinion are still offered bowls. The manager informs the cook of peoples likes and dislikes on admission and also of any special dietary requirements. She relies on feedback from the staff as to what people think of the food but she was not aware of any formal quality monitoring process in this respect. Information about what people eat is recorded in a notebook and a record of nutritional intake is maintained. Staff also make an entry in the nutritional records. The cook was able to produce records that demonstrate compliance with environmental health requirements. Fresh meat and vegetables are bought locally, bulk shopping comes from a local supermarket and the local wholesalers. The cook feels well supported by manager, does not have any restrictions on shopping and is able to order what she thinks. Requirements are made in respect of choice and control, privacy and dignity, nutritional needs, assisted meals and the meals provided to others. See requirements Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 16, 18 The quality rating for these standards is adequate, as the home can demonstrate that complaints are taken seriously and investigated in line with the procedures. But the home cannot fully demonstrate that people are protected due to concerns relating to recruitment procedures. EVIDENCE: The home has a complaints policy and procedure that is publicised in the reception area of the home and in the service users guide. The manager maintains a log of all complaints, whether written or verbal and a complaints record is completed stating the response to the outcome of the investigation and measures taken to resolve matters if appropriate. The home has had three complaints since the last inspection, all of which were made verbally. Records showed that the complaints were dealt with in accordance with the procedures. The manager has a structured daily programme of visiting residents and any relatives to ensure that if people wish to raise concerns or complaint they can do so. The home has a policy and procedure in respect of adult protection that includes the whistle-blowing procedure and all staff are trained in adult protection. There are some concerns about recruitment practice that shows the home cannot say that they are fully protecting people. For evidence see standard 29 and requirements. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 19,22,23,24,25,26 The quality rating for these standards is poor. Improvements have been made to the environment, however further work is needed before it can be said that the standard and safety of environment is adequate enough to meet the needs of people that live there. EVIDENCE: All areas appeared fairly clean with no offensive odours. Some improvements have been made to the main lounge in Rose Unit to make it more homely. Curtains have been erected to separate the two areas and shelves have been put up with ornaments on them. Some pictures have been put up and some new furniture has been added to give it a less institutional appearance and the chairs have been rearranged. Some redecoration has been completed and carpets are due to be replaced in the next phase. There is an ongoing plan of maintenance and renewal, the home employs a maintenance person to attend to day-to-day issues in the home. Records Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 19 relating to maintenance were inspected and showed that necessary equipment checks and servicing was completed. There were still some issues with the use of communal toiletries and toiletries and other products that could expose people to risk in rooms. For example some rooms contained prescribed creams and razors, risk assessments had not been completed, as required at the last inspection. See requirements. Improvements still need to be made to assist people to orientate. Some new directional signage has been introduced which is good, however more directional signage is needed around the home. Some rooms did not have names on them and inside some rooms were very impersonal and sparse. See requirements. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The quality rating for these standards is poor. Even-though improvements have been made with training, only minor improvements can be seen in staff practice. The home still cannot fully demonstrate that they have sufficient numbers of skilled trained staff to meet people’s needs and recruitment practice needs some improvement before it can be said that it is robust enough to protect people from harm. EVIDENCE: Information taken from the pre-inspection questionnaire shows that the home currently accommodates 42 people with high dependency needs. The home has determined that the number of staff hours required is 273 and the number provided is 276. The staffing rotas show that the home has 10 staff on duty in the mornings, 8 staff on duty in the afternoons and 5 at night between 8pm and 8am. These numbers include at least 2 nurses during the day and 1 at night. The number of staff on duty at the time of the inspection appeared to be adequate, however, staffing levels reduce to 5 and on occasions 4 after 8pm and the Inspector was unable to assess adequacy of staff at this time of the day. It raises questions about how peoples needs are met adequately and how they are provided with choice when the staffing levels are so low at that time of the day. It is required that the home carries out a review of the staffing levels. See requirements. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 21 During the day, although numbers of staff appeared to be adequate there was evidence of peoples needs not being met. Examples are given in standards 711 and 12-15. See requirements. Training has improved with the recent appointment of the training coordinator. This person has supported each care worker through skills for care induction programme and completed a training needs analysis for each one. There was lots of evidence of training and further training planned. All staff have completed mandatory refresher training, in addition to specialist training in dementia and person-centred care. Foreign staff have also completed additional English classes to improve their English language. Training is significantly improved, however, observations of care practice show that staff need to be supported to transfer learning to practice and there is an obvious gap here. Mentoring is necessary and a programme of work practice supervision leading to individual performance plans is needed. See recommendations Recruitment practice was assessed and the home has policies and procedures in place. Staff files were inspected and it was found that application forms are completed, face-to-face interviews, CRB and POVA checks. Reference checks were of concern and in several cases there were issues with references either being inadequate or from inappropriate sources. Recruitment practice needs to be more thorough in order to fully protect people. See requirements Staff files were organised in accordance with the regulations. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 22 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The quality rating for these standards is poor. Due to the remaining concerns about this home, it cannot be said with any certainty that it is adequately managed. The home cannot fully demonstrate that the health safety and welfare of residents is promoted fully. The home cannot fully demonstrate that they actively seeking to make improvements to the service. EVIDENCE: Discussions were held with the manager about her personal development and any further training. No training has been undertaken since the last inspection and nothing is planned for the near future. The manager feels that she maintains up to date knowledge of best practice by reading journals and sourcing information off the internet. Throughout the inspection it was evident that there are still a significant number of concerns about the management of the home. 9 of the 15 requirements have not been met and this is of concern. Some of the Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 23 requirements are about protecting people from harm and should have been addressed promptly following the last inspection. The manager needs to improve her knowledge in dementia care to be able to recognise poor care practice and work towards effectively meeting the needs of all people who live in the home or the management of the dementia unit should be delegated to someone who has the necessary skills and expertise. Thus freeing time for the management of the nursing wing for people who do not have dementia type needs See requirements. Records relating to health and safety in the home were inspected, risk assessments have still not been completed for all risks posed. See requirements. Staff have been trained in fire safety, health and safety, moving and handling and COSHH. Service user finances were inspected. The home holds a small amount of money for all service users, which is used for paying the hairdresser, chiropodist and other items. Monies are held in individual wallets locked in the safe. Financial transaction records are maintained and show credits and debits to the fund. The home carries out regular audits to ensure that the records match the money held. The homes quality assurance processes were inspected. There is a policy and procedure in place for monitoring the quality of the service. The home has an audit schedule that looks at specific areas of quality each month, each area is scored and any deficits are identified. The deficits are used to inform the annual business plan so that improvements can be made in a planned way. Stakeholder surveys are sent out twice yearly and the results are analysed and any necessary action is taken in response to comments made. The manager does not have a system in place for informing stakeholders of the results of the quality assurance surveys and therefore people cannot see the value of their contribution. The home had a poor response to the last survey and this could be a contributory factor. It was suggested that the home finds a way to publish the results. In addition, the home does not yet produce an annual report on the quality of the service. Given the number of concerns and unmet requirements the effectiveness of the QA processes are questionable and this should be reviewed. See requirements Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 24 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 1 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 2 X 2 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 12(1-4) Requirement The registered person must ensure that they promote the health and welfare of residents. This relates to the need to ensure that people’s health and care needs are properly assessed, recorded and met. This is made for the third time The registered providers must ensure that adequate information relating to resident’s social care needs is contained within the service user plan. This is made for the third time. The registered provider must ensure that risk assessments are completed and are meaningful to the individual. This is made for the second time The registered provider must ensure that service user plans are kept under regular review. This includes the review of care plans and risk assessments. This is made for the third time The registered provider must ensure that proper provision for DS0000015681.V303230.R01.S.doc Timescale for action 31/08/06 2 OP7 16 (m)(n) 31/08/06 3 OP8 13 (4)(b) 31/08/06 4 OP7 15(2)(b) 31/08/06 5 OP8 12(1)(b) 31/08/06 Shouldham Hall Nursing Home Version 5.2 Page 26 6 OP9 13(2) 7 OP10 12(4)(a) 8 OP10 12(5)(b) 9 OP12 16(m)(n) 10 OP14 12(2)(3) 11 OP15 16(2)(i) care is made and treatment and supervision of service users. This relates to the need for nutritional screening and assistance with eating meals. This is made for the third time The registered provider must ensure the home has arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This is made for the fourth time. The registered provider must ensure that the home is conducted in a manner that promotes the privacy and dignity of the service users. This is made for the second time The registered person must encourage staff to maintain good personal and professional relationships with service users. This relates to engaging in conversation with residents, acknowledging their presence and effective communication. This is made for the second time. The registered person must consult with residents or their representatives in order to establish their interests, hobbies and preferred activities. This information must be recorded in the care plan. This is made for the third time. The registered person must ensure that choice is promoted and residents are encouraged to make their own decisions where possible. This is made for the third time. The registered provider must ensure that liquidised food is presented in a manner that is attractive and appealing and that DS0000015681.V303230.R01.S.doc 21/07/06 31/08/06 31/08/06 31/08/06 31/08/06 31/08/06 Shouldham Hall Nursing Home Version 5.2 Page 27 12 OP19 23(2)(a) 13 OP19 13(4)(abc ) 14 OP28 18(1)(c)(i ) 18(1) 15 OP27 16 17 OP29 OP33 19(c) 24(1)(2)( 3) staff assisting with eating do so in a consistent manner. This is made for the second time. The registered person must ensure that the physical design of the home meets the needs of its users. This relates to the improvements needed in the EMI unit. This is made for the third time. The registered person must ensure that risks to service users are identified and eliminated. This relates to the need for risk assessments relating to the environment. This is made for the second time. The registered person must ensure that 50 of care staff are trained to NVQ level 2. This is made for the third time. The registered person must ensure there are sufficient staff on duty at all times of the day. A review of staffing levels must be completed to ensure that people’s holistic needs are being met with the current levels. The registered person must ensure that recruitment is robust. The registered person must ensure that a quality assurance system is introduced and a report on the quality of the service is made available to stakeholders and the Commission. 31/08/06 31/08/06 30/09/06 31/08/06 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 28 No. 1 Refer to Standard OP30 Good Practice Recommendations It is recommended that the registered provider introduce a system of mentoring to support staff to transfer learning to practice effectively. Shouldham Hall Nursing Home DS0000015681.V303230.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Norfolk Area Office 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 DS0000015681.V303230.R01.S.doc Version 5.2 Page 30 - 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. 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