CARE HOMES FOR OLDER PEOPLE
The Sharmway 113 Handsworth Wood Road Handsworth Birmingham B20 2PH Lead Inspector
Monica Heaselgrave Unannounced 25 July 2005 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 Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Sharmway Address 113 Handsworth Wood Road Handsworth Birmingham B20 2PH 0121 554 6061 0121 554 6061 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) Mrs Winnie Purcell Mrs Winnie Purcell Care Home 11 Category(ies) of Older People [11] registration, with number of places The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The Home is registered to a maximum of 11 people for reasons of old age. Date of last inspection 4 Feburary 2005 Brief Description of the Service: The Sharmway is a three storey detached property located along Handsworth Wood Road. It accomodates up to 11 older adults, and is within access of public transport links to Birmingham City Centre. The home is close to local facilities including shops and places of worship. The property comprises of a double bedroom on the ground floor, with screens and wash hand basni. There is a WC with wash hand basin by the front entrance. A shower facility, laundry and kitchen are located along the hall. Adjacent to these aretwo lounge areas to the front and rear of the property are utilised as a dining room and seats eleven service users. The first floor is accessed via a stair lift, and has four single bedrooms and one double, a shower facility and bathroom with bath hoist chair. Two further WC are sited on this floor. The second floor is accessed via stairs, and has two single and one double bedroom, with bathroom and WC facilities. All bedrooms are lockable and have a hand wash basin, covered radiators, window restrictors and an emergency call system. Sited around the home is ramped access to the side of the property, and parallel handrails either side of the front passageway. There is a large well maintained garden to the rear, and front car parking.
The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 10:20am and 3:30pm on a weekday. The inspector met with the proprietor who is also the Registered Manager, the Assistant Manager, and two senior care staff. 11 service users were in the home at the time of inspection, two of these received respite care. The inspector met all eleven service users, six of whom were able to contribute to the inspection process. A number of records were inspected to include care plans, risk assessments, staff rotas, maintenance records, medication and staff training records. A tour of the property was also undertaken. The inspector has the pleasure of sharing in the afternoon refreshments. What the service does well:
The Sharmway has a consistently good record of maintaining a personalised service to its service users. At previous inspections, relatives and social workers (who place within the home), have commented upon good communication, consistency of care, and wholesome portions of food. At this inspection, whilst no relatives were in attendance, service users again commented upon these favourable features of the home. The proprietor has established good routines, which allow service users a good degree of choice. In this way, many service users chose when to get up, go to bed, or even when to eat their meals. There are no set meal times, those who require assistance due to Dementia are encouraged to eat at regular times, but a great deal of consideration is given to what works best for them, and so the care is individualised and very flexible and supportive. The management of health care needs is very good. There are good systems for monitoring, and acting upon and concerns noted. All of the service users who contributed to the inspection spoke highly of the manager and staff team. They described them as “caring and responsive.” One gentleman stated, “They know my needs and ask me what I want to do. My personal care routines are my choice with their help.” The Sharmway offers a small group living atmosphere experience, within which, the routines are relaxed, staff were observed to be tactile and gentle in their interactions with service users. The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 6 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 Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.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 Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.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) 1, 3 Prospective Service Users have good information as to the type of care to expect from the home. This provides them with the opportunity to exercise choices about whether to live in the home or not. The needs of service users are known, and care plans follow appropriate assessment procedures, this ensures that care needs can be met in the manner the service user requires or expects. EVIDENCE: The manager has provided the Commission with the Statement of Purpose, and Service User Guide, both having good detail to enable service users to make an informed choice about whether or not the home can meet their individual needs. Whilst some service users were not able to articulate their experiences of the home, two did advise the inspector that the home more than lived up to their expectations. One gentleman provided significant information as to how his care needs, health needs and cultural needs are currently met. There were well recorded in his care plan, which was seen to be reviewed and updated regularly, ensuring changing needs are monitored and acted upon accordingly. The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.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 There are good systems in place to ensure service users health and care needs are responded to. Care planning is linked to assessment information, incidents or changing care needs, in this way the well being of service users is promoted. EVIDENCE: Care plans are current, and have good written detail which ensured all aspects of health and social care needs are identified and planned for. Weight loss, risk of falling and risk of pressure areas were seen to be identified and acted upon. Equipment for the promotion of tissue viability is provided. Both the manager and deputy demonstrated a good understanding of health care and social needs, and gave direction to staff as to how these needs are to be met. The promotion of continence is pro-active, with clear guidelines for staff to encourage regular visits to the toilet. Observation of the care practice indicated that service users are treated with respect and their dignity upheld. This was evident in how staff managed their personal care needs discretely and sensitively. It was positive to note that staff were readily available to offer support to individuals who had difficulty managing their drinks and snacks. The shared bedrooms are equipped with screens to ensure privacy is not compromised.
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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, 15 The ethos offers a ‘home from home’ experience for service users. Social needs of service users are well catered for with a range of spontaneous and planned activities on offer. Dietary needs are well met; food is nutritious, well balanced and varied. EVIDENCE: The Sharmway offers a small group living experience for the eleven service users who reside there. A number of service users are physically frail, and some have Dementia. The daily routines in the home reflected a nice relaxed and caring environment, within which the needs of those service users who are frail are particularly well responded to. Staff members were observed to be responsive and caring in their interactions. Support and assistance around mealtimes and personal care routines was very positive. Care plans provide good direction to staff members as to how to assist individuals, and detail their preferences and routes. A number of service users commented upon the kindness of the staff members, and their patience and understanding. They said the routines in the home are very flexible; they chose when to go to bed or get up. One gentleman stated he could bath or shower when he liked to, and had assistance from staff to do so.
The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 11 There was an Activities List, and residents meetings records, which reflected that service user’s social and recreational interests are explored, and opportunities planned for them. This included shopping trips, holidays, cards, bingo, walks, and a variety of music and board games. On the day of inspection, two gentlemen were singing along to their favourite Irish music, this is a particular feature of the home presently. The needs of service users with Dementia are also given consideration, their particular preferences, capabilities, and the level of support they need is specified in their care plan. Several service users commented upon the good quality of the meals, and that they have no rigid mealtime, but can have their breakfast and main meals to suit. One lady said, “The food is very good, the most important thing here for me.” A gentleman said they can have drinks and home made cake or biscuits whenever they want, and that the food is, “Very tasty and nicely presented.” The manager ensures that the dietary needs of service users are recorded, and food intake is monitored where there are specific dietary concerns. Menus showed that a choice or alternative is always available. Whilst the main meal was not observed, it was noted that drinks, snacks and fruit were freely available to service users, and that staff were on hand to support those service users who required it. The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 12 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) EVIDENCE: These standards were not inspected on this visit, however were met at the Announced Inspection dated July 04. The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 13 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) 19, 21, 22, 25, 26 Service users’ needs are met individually and collectively, in a safe, comfortable and homely way. The proprietor has addressed previous environmental requirements, which ensure that service users can continue to live in a well maintained home. EVIDENCE: Since the last unannounced inspection in February 2005, the proprietor has continued to improve the physical environment for the benefit and well being of the service users. Some of the lounge furniture has been replaced, and the front and rear pathway has been re-pointed to ensure level access through the garden. The home has a variety of aids and adaptations suited to the needs of the service users. There is a stair lift for access to the first floor. Service users who live on the second floor are currently able to negotiate the stairs without difficulty. Handrails are sited in corridors and toilet/bathroom areas to assist those service users with mobility difficulties. There are handrails to the front and rear exits, and a ramped exit to the rear of the property.
The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 14 Service users have a choice of bathing or shower facilities, the bathroom allows for assisted bathing and has a hoist chair. Toilet areas are in close proximity to communal areas, which ensures service users can maintain a degree of independence in this area. There are emergency call systems situated throughout the home. Radiators which can pose a risk of burning to service users who may be physically frail have, since the last inspection, been covered. Whilst no service user currently has pressure sores, the manager monitors this closely on service user’s care plans, and a pressure relieving mattress is available. All bedrooms, toilets, and bathroom areas have suitable locks fitted, allowing service users their privacy and dignity. There is a rolling programme of maintenance and decoration. Requirements from the Fire Officers inspection have been met in full. The proprietor continues to ensure that care staff have the equipment and training necessary to maintain hygiene and food safety within the home. Lidded waste bins, and a kitchen fly screen have recently been purchased. All staff have undertaken Food Safety training. Throughout, the home was found to be clean, odour free, very comfortable and homely. Service users stated they are happy and comfortable. The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 15 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, 29, 30 The number of staff available on each shift is appropriate to the needs of the service users. Staff are suitably deployed to ensure that both the care needs of service users and standards relating to food and hygiene are maintained. EVIDENCE: At the time of the visit, there were two senior care staff and the manager on duty. Rotas sampled indicated that each shift is normally covered by a minimum of two care and one senior member of staff during the day, and two waking night staff. Rotas have been improved since the last inspection and now specify the role and responsibilities of each staff member. The rotas identify a domestic and a gardener. Rotas matched the staff on duty, and specify the actual hours worked by each member. Care staff undertake the cooking of meals, and Food Safety training has been undertaken. Service users commented that there are always staff to assist them both at peak periods in the day and otherwise. Service users described a very flexible routine in the home in relation to choices around the time of meals, and getting up and going to bed, which would further indicate that there are sufficient staff numbers to enable them to exercise these choices in their daily living arrangements. Staff records showed that staff have undertaken mandatory training to enable them to undertake their role. This has included First Aid, manual handling,
The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 16 Health and Safety, fire training, COSHH training, Medicine Awareness, food and hygiene. The proprietor maintains a training matrix, and a Falls Awareness Course is planned for September 2005. Since the last inspection in February 2005, the proprietor has purchased the TOPSS Induction package to ensure that all training is in line with TOPSS requirements. This will further ensure that staff have the skills and knowledge to meet the assessed needs of the service users accommodated. The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 17 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 38 The home is being managed properly, with clear leadership and guidance to staff, which ensures service users receive consistent good quality care. Arrangements for health and safety matters are consistently good, ensuring service users are not put at risk. EVIDENCE: The proprietor is the Registered Manager. She has commenced her NVQ Level 4 in Care and Management. The Assistant Manager is a qualified RGN and has worked in the community as a District Nurse with older adults. Both have a wide range of experience, skill and expertise in meeting the needs of older persons. Service users and staff speak positively about the ethos of the home. There are good examples of written communication to ensure consistency of care. The proprietor has developed and completed a Quality Audit, based upon seeking the views of service users and families. The results of these were
The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 18 made available to service users – however, the last Quality Audit was dated 2002. The proprietor is planning to compliment this again in September 2005. The proprietor has ensured all the equipment, and heating systems are maintained property, certificates for this were seen. The Heath and Safety of service users is promoted via the use of individual Risk Assessments, and a risk assessment for the premises. Where requirements have been made with regard to the home’s physical environment, these have met. Staff have received a variety of training pertinent to their role as Care Assistants, this has included First Aid, Fire Prevention, Medication Awareness, Manual Handling, Health and Safety, COSHH and Food and Hygiene. A ‘Falls Awareness’ training is planned for September 2005. The management of incidents and accidents in the home meets with requirements. The management of safe working practices within the home is consistently good, there are platforms for the monitoring and review of all practice areas, and this ensures that the well being of both service users and staff working within the home is promoted. The proprietor has purchased the TOPSS Induction package. When implemented, this will further ensure that staff receive training to meet TOPSS specifications, on all safe working practices. The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 19 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 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 3
COMPLAINTS AND PROTECTION 3 x 3 3 x x 3 3 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x 3 3 2 x x x x 3 The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 20 No 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 30 Regulation 18 (a) (c) 24 (1) (2) (3) Requirement Staff Induction and training needs to be developed further to bring it in line with TOPSS requirements. A Quality Assurance system should be implemented within the home. A copy of this report should be made available to service users, their representatives and the Commission. The system shall provide for consultation with service users and their representatives. Timescale for action 1 September 2005 1 November 2005 2. 33 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations The Sharmway E54 S17027 The Sharmway V241800 250705 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Birmingham & Solihull Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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