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Inspection on 05/09/05 for The Shrubbery Nursing Home

Also see our care home review for The Shrubbery Nursing Home for more information

This inspection was carried out on 5th September 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 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

The home offers a high standard of nursing care to residents with complex needs. The grounds and gardens are well kept and the home is well maintained. A recent survey carried out by the deputy manager confirmed that residents are happy living in the home. Training is a priority for the home and this is reflected in the high number of staff who have attained an NVQ award in direct care. The recruitment procedures are robust.

What has improved since the last inspection?

The home continues to meet the demands of a changing resident group. There is a stable workforce and the recruitment of a dedicated training manager ensures staff receive mandatory training and training specific to the care needs of the residents.

What the care home could do better:

Care plan documentation was of a poor quality and there was evidence monthly reviews in some care plans had lapsed.

CARE HOMES FOR OLDER PEOPLE The Shrubbery Nursing Home Birmingham Road Kidderminster Worcestershire DY10 2JZ Lead Inspector Chrissy Presley Unannounced 5 September 2005 09:00 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. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Shrubbery Nursing Home Address Birmingham Road Kidderminster Worcestershire DY10 2JZ 01562 822787 01562 68122 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) Minster Care Homes Ltd Mrs Joy Tompkinson Care Home with Nursing 32 Category(ies) of DE(E) Dementia (over 65) - 3 registration, with number OP Old Age - 32 of places PD Physical Disability - 32 The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8 February 2005 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 Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place during the morning and early afternoon, this inspection concentrated on care records, recruitment procedures, mandatory training and health and safety records. Time was spent with the registered manager who is a first level nurse and her deputy. What the service does well: What has improved since the last inspection? The home continues to meet the demands of a changing resident group. There is a stable workforce and the recruitment of a dedicated training manager ensures staff receive mandatory training and training specific to the care needs of the residents. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 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 The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 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) 3 & 4 Residents are assessed prior to admission and information gathered at this assessment ensures care needs can be met by the home. EVIDENCE: All residents are assessed prior to admission by a first level nurse using documentation, which ensures adequate information is gathered at assessment to formulate a care plan. A further assessment of need is carried out on admission to the home. Both documents were seen in the care plan sampled. Training of staff was a high priority and staff had access to mandatory and training specific to the needs of the residents. This ensures resident’s needs are being met. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 & 10 Care plans and risk assessments are of a poor quality and do not reflect current care needs the health and safety of residents is therefore compromised. EVIDENCE: Three care plans were inspected in detail, from records seen the care plans did not reflect current care needs and risk assessments were either out of date or had not been amended. Instructions in the documents to staff were not clear. There were records of weights of residents; those residents at risk did not have a specific care plan, and one resident was noted to have lost a significant amount of weight in a short time span, the risk assessment tool used had not been added up correctly; this resident’s health and safety was therefore compromised. Wound plans were of a poor quality and documentation was out of date, no recent photographs had been taken of wounds. Care plans had not been reviewed monthly and those that had did not have a specific date. There was evidence of resident’s involvement in care plans. Staff were heard and seen speaking kindly to residents. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 10 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) 12,14 & 35 Residents are offered a stimulating programme of activities relevant to their abilities. EVIDENCE: The home employs an activities co-ordinator who works four sessions a week. Records of activities offered are displayed, the activities reflect the ability of the residents and are therefore suitable. A Summer Fayre was arranged and a monthly newsletter is produced by the activities co-ordinator for residents, family, friends and visitors to the home. Residents are offered a key to their bedrooms providing a risk assessment is carried out. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 11 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 & 18 Management continue to ensure all staff have the required knowledge and understanding of adult protection issues ensuring a safe environment for residents. EVIDENCE: The complaints procedure is readily available to residents and families, the policy sets out clear time scales and complaints in the past have been dealt with using this policy and procedure. There have been no complaints to the Commission for Social Care Inspection since the last inspection. The policies and procedures in respect of the vulnerable adult, which include ‘Whistle-blowing’, are robust and staff have received training in this field, this training is updated yearly. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 12 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) None of the standards in this section of the report were inspected at this visit. EVIDENCE: The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 13 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) 27,28 & 29 Staff receive appropriate training which ensures the complex needs of the residents are met. Residents are safeguarded by the homes thorough recruitment selection procedures. EVIDENCE: The home employs a training manager who is a first level nurse and works three days a week, she is the NVQ assessor and a high proportion of care staff have attained an NVQ level 2 in direct care and some have an NVQ 3. Training is relevant to the current care needs of the residents and mandatory training records seen evidenced staff received these updates regularly. Recruitment procedures were robust and all staff employed were subject to a POVA first check and a criminal record check at enhanced level. Some staff files did not contain a current photograph, which is a requirement of the Care Homes Regulations 2001. Staff are employed in enough number to meet residents needs and the home uses agency staff to cover sickness and holidays when necessary. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 14 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) 33, 35, 36 &38 Health and safety within the environment is a high priority and residents live in a safe home. EVIDENCE: A recent quality assurance audit, which was available in the Statement of Purpose, evidenced residents were happy living in the home, were happy with the food and felt safe. The training manager ensures all staff receive regular supervision and further training needs are identified during these sessions. The training manager has specific training in health and safety arranged in September and will become the nominated health and safety officer in the home. Mandatory training such as fire training, moving and handling, food hygiene, first aid and infection control were evidenced in a training matrix, there were some shortfalls noted. Records of service contracts were open to inspection. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 15 Fire records were seen and there was evidence of testing of fire equipment and a recent fire drill. The home offers a facility whereby they will hold small amounts of cash for residents. Records of these were seen and there was evidence they had been audited monthly. Other residents are invoiced for extras. The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 16 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 x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 4 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x 3 x 3 The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 17 yes 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. Standard OP7 Regulation 15 Requirement Residents care plans must cover all aspects of health care needs and identified risks must be assessed and acted upon. Care plans must be reviewed monthy Those residents identified as losing weight must have a care plan which reflects this current need, clearly stating actions to be taken to prevent further weight loss Dates in care plan records must be specific Nursing tool documentation used to identify risk must be added up correctly Wound and pressure sore documentation must be up to date and reflect the wound care needs of the resident Staff records must contain an up to date photograph of the person employed Staff must receive fire training every three months The nominated member of staff must have specific health and safety training The nominated first aider on E52 S4143 The Shrubbery NH V247135 050905.doc Timescale for action Immediate 2. 3. OP7 OP7 15 13 &15 Immediate Immediate 4. 5. 6. OP7 OP7 OP7 15 15 15 Immediate Immediate Immediate 7. 8. 9. 10. OP29 OP38 OP38 OP38 7,9,19 23 13 13 Immediate Immediate and ongoing Immediate Immediate Page 18 The Shrubbery Nursing Home Version 1.40 11. OP38 17 duty must be named and identified on the off duty. There must be documented evidence of furnishing belonging to residents and ongoing Immediate 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. Refer to Standard OP33 Good Practice Recommendations It is recommended the quality assurance audit includes other stakeholders such as professional visitors to the home; doctors, chiropodist, district nurse etc End of recommendations The Shrubbery Nursing Home E52 S4143 The Shrubbery NH V247135 050905.doc Version 1.40 Page 19 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW 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. 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