Inspection on 17/01/07 for The Shrubbery Nursing Home

This inspection was carried out on 17th January 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

The Shrubbery Nursing Home 21/06/07

The Shrubbery Nursing Home 25/07/06

The Shrubbery Nursing Home 22/12/05

The Shrubbery Nursing Home 05/09/05

The Shrubbery Nursing Home 08/02/05

The Shrubbery Nursing Home 18/07/04

The Shrubbery Nursing Home 03/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Shrubbery Nursing Home, The Birmingham Road Kidderminster Worcestershire DY10 2JZ Lead Inspector Lorraine Briggs Unannounced Inspection 17th January 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shrubbery Nursing Home, The DS0000004143.V326453.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. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shrubbery Nursing Home, The Address Birmingham Road Kidderminster Worcestershire DY10 2JZ 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) 01562 822787 01562 68122 Minster Care Homes Limited Nicholas Michael Peake Care Home 33 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (33), of places Physical disability (33) Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27/6/06 Brief Description of the Service: The Shrubbery Nursing Home is a Grade II listed building set in large gardens and approximately half a mile from Kidderminster town centre. Care is provided for the physically and mentally disabled who require both nursing and personal care. Single and double rooms are available on the ground and first floor. The first floor is accessed via a passenger lift. The home has a secure rear garden, which residents can access, via a conservatory. The fees for this service range between £343.00 - £618.00, depending on the size of the rooms and the assessed needs of the resident. Chiropody, hairdressing and newspapers are additional to the fee. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, staff records kept in the home, medication records, discussion with people who use the service, discussions with the staff team, discussion with the manager, tour of the premises, previous inspection reports, quality assurance process, Fire Authority reports, Environmental Health Office reports, observation of care experienced by people using the service. What the service does well: What has improved since the last inspection? 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. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 6 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 Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 7 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 and 3 Quality in this outcome area is adequate. Prospective residents and their representatives have the information needed to choose a home which will meet their needs. They have their needs assessed but are unsure about the fees they will pay for care provided. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At previous inspections, the admission process was more process driven and not particularly personalised with little extra consideration of individual requirements. The manager consults the improved assessment information to see if the home can meet the prospective service user’ needs before they make the decision to accept the application for admission and offer a placement. Records seen at Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 8 this inspection showed that the admission of new service users takes into account the individual needs, concerns and anxieties of the prospective service user and their families. The manager has received copies of the summary, and care plans, from those assessments carried out through care management arrangement for most of the service users. Staff training to ensure that they have the necessary skills and ability to care for residents who are admitted is improving. The provider has developed a statement of purpose, which sets out the aims and objectives of the home, and includes a service user guide, which provides basic information about the service. These documents are reported by the manager to be made available to prospective service users. They were also on display within each bedroom entered. Service users are provided with a statement of terms and conditions before admission to the home. It gives information on what service user can expect to receive for the fee they or a third party pays and sets out terms and conditions of occupancy. It is not set out in a way that would include the fee when a third party is paying in whole or part, although it refers the fact that another party may be involved in the payment arrangements. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 9 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. The health and personal care, which a resident receives is based on their individual needs. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Four care plans were examined. The plan in most cases includes the basic information necessary to plan the individuals care and includes a risk assessment element. There was recorded evidence of updating information and changing actions in the care plans. Monthly audits of the care plan process are carried out. This aspect has improved with the input of staff training. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 10 Service users have access to health care services that meet their assessed needs both within the home and in the local community. Service users have access to dentists, opticians and other community services. A member of staff has been made a wound care link nurse. The service users’ health is monitored and appropriate action taken. The home seeks professional advice on health care issues, acts upon it and generally is able to provide the aids and equipment recommended. A variety of hoists were seen to be used by staff when manually handling service users. There is written evidence in the care plan of health care treatment and intervention, and a record of general health care information including weight monitoring, and nutritional information. Plans were in place regarding the care of wounds, those seen were well recorded and up to date. The home has a medication policy which is accessible to staff, medication received, administered and disposed of are recorded. Occasional gaps were noted on the MAR charts and hand transcribed prescriptions had not been signed by two staff members for accuracy. The manager has been working towards improvement in this area and has accessed training which staff are working through. The manager’s audits demonstrate that staff who persistently do not comply with procedures are dealt with through the home’s disciplinary procedures. The management have been providing two qualified staff on duty each day to explore whether the medication administration to service users could be improved. Staff were seen to be aware of the need to treat residents with respect and to consider dignity when delivering personal care. Service users can enjoy the privacy of their own rooms. Service users spoken to stated they were happy with the way that most staff deliver their care and respect their dignity. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 11 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 adequate. Residents are able to choose their life style, social activity and can keep in contact with family and friends. Social, cultural and recreational activities meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users are given the opportunity to take part in a variety of activities both within the home and in the community, these are arranged by staff after consulting with service users. The service attempts to consider the preferences of the majority of its service users but may not always please everyone. The home now has an activity coordinator for 5 days a week. The home has open visiting arrangements and service users spoken with knew that they can entertain their family and friends in their own room. If they Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 12 prefer they can use communal areas of the home to talk to visitors and some private areas can be used. Service users and a visitor spoken with stated that the food in the home is of good quality, well presented and meets the dietary needs of residents. The cook has basic food hygiene training, consults with residents and tries to meet the preferences and suggested dishes when preparing the menu. Service users are able to choose to eat in their own room if they wish. Regular drinks and snacks are available. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is adequate. Residents have access to a complaints procedure and are assured that their complaint would be appropriately dealt with. Service users are protected from abuse and have their legal rights protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure which is explained in the service user guide. Complaints received are logged within in the diary or complaint log according to the status they are given. Concerns/complaints are investigated but the outcome is not always recorded when they are resolved. A visitor commented that she would definitely speak to the manager is she had concerns and felt that he would listen. All staff have attended adult protection training. Links with external agencies are satisfactory and include the CSCI, police and adult protection teams. Service users and others associated with the home state that they are satisfied with the service provision, and feel safe and supported. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 14 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 adequate. The physical design and layout of the home enables residents to live in a safe, better-maintained environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Minster Care Homes Ltd have provided resources to upgrade the home. It now has a rolling programme over 10yrs to improve the decoration, fixtures and fittings. A lounge carpet has been replaced. Service users can personalise their rooms. There is a choice of lounge areas and a large dining room. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 15 Service users stated they are comfortable, the home is clean, usually warm, well lit and there is sufficient hot water. The home is clean and tidy, and there have been no outbreaks of infection. The laundry room is well organised with an improved washing system installed. Each service user has individually named laundry in baskets. Some of the bed linen and towels are looking thin and frayed. Printed notices giving instruction to staff were seen around the home in public areas and a bedroom. The manager agreed to remove these as they detract from the homely environment they aim to achieve. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 16 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 adequate. Staff in the home are starting to be trained, skilled and in sufficient numbers to fill the aims of the home and meet the changing needs of residents. Incomplete staff recruitment does not assure service users that the service employs suitable people to work with vulnerable adults This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users who were able to comment stated that they are satisfied with that the care they receive and that staff meet their needs. They feel that staff are receiving more training and able to deliver their care needs. Induction programmes are in place and starting to be used with new staff, examples of which were seen. Plans for supervision and appraisals to monitor the performance of staff are in place and in progress. The manager stated that the practice of having two nurses on duty during the day has improved medication outcomes for service users. It is intended that this will continue. The service is now recognising the importance of training, and is planning to deliver a programme that meets statutory requirements. The manager has Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 17 identified priorities for training which has previously been lacking e.g. dementia, medicines, end of life care. The training staff participate in is documented. Staff are more clear regarding their role and what is expected of them. Observation of their practice showed good interaction between them and service users. The service’s recruitment procedure has not improved and does not meet the regulations and the national minimum standards. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 18 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 and 38 Quality in this outcome area is adequate. The management and administration of the home is based on openness and respect, and has effective quality assurance systems developed by the provider. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is starting to be aware of and work to the basic processes set out in the National Minimum Standards. The manager has an awareness of the need to sustain the programme to train and develop staff so that they are competent and maintain their competence to care for older people. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 19 The home has developed an improved approach to manage the health and safety requirements of legislation. The service has adopted an internal quality assurance process which identifies shortfalls to meet the National Minimum Standards. action plans are in place to address any failings. Records seen showed that accidents and incidents are recorded and monitored. The service provider takes responsibility for the home’s accounts and business development. Service users have the opportunity to manage their own money if they wish, and facilities are provided to help keep it safe. Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 20 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 2 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 21 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 OP2 Regulation 5 (a) Requirement Service users must be provided with a statement of terms and conditions before admission to the home. It must be amended in accordance to the changes in Regulation 5A. The registered manager must ensure that Medication Administration Record (MAR) sheets are completed adequately and at the time of administration. Remains outstanding from last inspection – 26/7/06 The registered manager must ensure that any handwritten amendments to the medication administration record (MAR) sheets are checked dated and counter signed by a second member of staff. Remains outstanding from last inspection – 26/7/06 The home must maintain a record of all complaints received and details of the investigation and any action taken. Timescale for action 31/03/07 2 OP9 13 (2) 31/03/07 3 OP9 13 (2) 31/03/07 4 OP16 16 (3) 31/03/07 Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 22 Remains outstanding from last inspection – 26/7/06 5 OP29 18 1 a The home must ensure that they adhere to their recruitment policy. Including obtaining two written references, a full employment history is provided and any gaps explained. Evidence of previous qualifications are provided. Remains outstanding from last inspection – 26/7/06 Staff records must contain an up to date photograph of the person employed Remains outstanding from last inspection – 26/7/06 The manager must complete the Registered Manager’s Award by September 2007. Remains outstanding from last inspection – 26/7/06 31/03/07 6 OP29 7,9,19 31/03/07 7 OP31 9 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shrubbery Nursing Home, The DS0000004143.V326453.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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. 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