CARE HOMES FOR OLDER PEOPLE
Sheridan Care Home (The) 14 Durlston Road Parkstone Poole Dorset BH14 8PQ Lead Inspector
Trevor Julian Key Unannounced Inspection 9th October 2007 11:00 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 Sheridan Care Home (The) DS0000065206.V352532.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. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sheridan Care Home (The) Address 14 Durlston Road Parkstone Poole Dorset BH14 8PQ 01202 735674 F/P01202 735674 reshadkoussa@hotmail.com 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) RYSA Ltd Mr Reshad Koussa Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (23) Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th November 2006 Brief Description of the Service: The Sheridan cares for up to 23 people, who may have dementia or mental health problems, in an attractive converted house. It is set in a residential part of Poole in Lower Parkstone. The home has a large paved car parking area and a garden to the rear. Public transport is available nearby. The accommodation for residents in the home is over the ground and 1st floors with a passenger lift between. There are a variety of aids and adaptations around the building to allow residents to move about more independently. There are 19 single rooms and two doubles, fourteen of which have en suite facilities. There are additional communal toilets and bathrooms around the home. In October 2007, the weekly fees were £473 - £510 dependent on the level of care needs and the accommodation offered. Additional charges were made for hairdressing, chiropody, etc. See the following website for further guidance on fees and contracts: http:/www.csci.org.uk/about_csci/press_releases/better_advice_for_people_ choos.aspx Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Tuesday 9th October 2007 between11:00 and 16:00. Before the visit, the owners had returned an Annual Quality Assurance Assessment (AQAA) giving general management information about the home. Residents and visitors were invited to give their views through comment cards and 14 were returned in advance of the visit. During the inspection, further evidence was obtained through a review of records, a tour of the premises, discussion with residents, staff and the owners. Recently there had been an adult protection issue regarding manual handling staff from the local authority carried out an investigation and their findings are included in this report. What the service does well:
The home had continued to assess prospective residents to ensure that they can meet the needs of the individual. The care plans showed that social and personal histories and spiritual needs were also considered. The care plans showed what people could do for themselves helping the promotion of independence and well being. The care plans showed that health needs were met through referrals made to the healthcare teams. Comments on the care planning included: “… care plan is in place and the home has obtained relevant equipment e.g. hoists.” “The care home has assisted mum with her faith. There are services in the home.” Medication was safely stored and the records were up to date. The home had developed the activity programme following attendance at training events. During the visit people were playing cards and dominoes and enjoying a sing-along session. Photos in the hallway record some of the parties held in the home. One comment received appreciated the parties held in the home. “It is a friendly atmosphere and welcoming all the time, activities organised by the home such as Easter, Mothers day, Birthdays Christmas are very good for the residents & relatives to join in.” Throughout the visit, staff were seen with the residents and a good rapport was noted. Staff were seen knocking bedroom doors then waiting before entering.
Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 6 The standard of food provided was good and there was plenty of fresh fruit on the dessert trolley. The home had posted a copy of the complaints procedure in each of the bedrooms informing residents and visitors how to raise concerns and how to contact the Commission and the local authority. Staff were trained by the local authority in how to respond to allegations or signs of abuse. The staff on duty were aware of their responsibilities. The infection control procedures were good there were paper towels, soap and lidded bins in each room. Staff were using disposable gloves and aprons and there were alcohol hand cleaners for visitors and staff. Staff turnover had reduced considerably and that had improved continuity of care. Agency staff are rarely used to cover shifts. Work was still ongoing to ensure that 50 of staff have NVQ level 2 (or equivalent) in care with 2 staff working on the award. The home does not hold cash or manage finances for any resident, Mr Koussa invoices the person responsible for the persons finances any extra expenditure e.g. hairdressing and chiropody. The home uses a variety of methods to seek the views of the residents and visitors to the home including coffee mornings, social events and annual surveys. Health and safety routines were in place and those checked were up to date. What has improved since the last inspection? What they could do better:
Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 7 The care plans were generally well organised and easy to follow however in the case of one resident there was a significant change in care needs and this had not been recorded however staff were fully aware of the change and were taking appropriate action. The home had manual handling risk assessments for several residents but in some cases these had not been referred for Occupational Therapist review. Two people had bed rails, the home had completed a consent form but this was not in line with the latest guidance. The records showed that several people had ordered fish for lunch, however, they were served with meat. The error was rectified once we had pointed it out; fortunately, there were no vegetarians in the home at the time. The board also showed that apple pie and custard was offered as a dessert but jam tarts in custard was served. The registered person should ensure that where references for new staff are not forthcoming that records are maintained showing the action taken and that alternative sources are considered. At mealtimes several people were assisted with their meals the meals were unrushed, some people took a long time to finish, there was no pressure to clear the tables. On one occasion a staff member was seen assisting one person, the carer was standing beside the seated resident. Mrs Koussa quietly reminded the member of staff that sitting down would help to relax the resident who went on to clear her plate. 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. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 8 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 Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 9 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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s admission process helps to ensure that the home is able to meet the assessed needs of the individual. EVIDENCE: The files of three people were checked all had a pre-admission assessment completed before placement. Each contained information about the recommended topics. The assessment considered what the individuals could do for themselves helping to promote independence. None of the people seen during the visit could recall the admission process. The home’s AQAA stated that pre-admission checks take place before accommodation was offered and that the home was looking to develop the
Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 10 process further to ensure they had sufficient information about the individuals needs. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 11 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): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans were clear and well laid out to give staff clear information about how assessed needs were to be met, although it was clear that the care plan was not fully updated in the case of one person. The home generally ensured that healthcare needs were met with support from community health staff. EVIDENCE: The care plans were clear and appeared up to date. There was evidence that reviews were carried out, however, in the case of one person there had been significant change in care needs. Although the staff appeared to be very clear about how the need was to be addressed there was no information on the care plan. The records showed that the home contacted community health teams to manage healthcare matters. There was clear information and monitoring of nutritional intake and examples where referral had been made to the GP for
Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 12 dietician input. In one case, the home had introduced weekly weight checks as there was concern over weight loss. The care plans could be improved by the addition of the residents’ normal routines and times for getting up and going to bed. Specialist equipment had been provided for some residents these included hoists and pressure relieving equipment. There were manual handling assessments from Occupation Therapists for some residents with poor mobility. The recent adult protection investigation had recommended that the home’s management should seek earlier referral to Occupation Therapists for people with mobility problems rather than relying on their own assessments. Bed rails were in use for one person, the assessment had not considered the topics as recommended by the Department of Health guidance. Comment cards from the community health teams showed they had a good working relationship with the home and comments included: “Carers seem to be particularly cautious and diligent in referring for District Nurse support.” “The service is open and responsive”. The home uses a monitored dosage system supplied by a chemist chain. During the inspection, the person managing medication was seen taking the item to the individual and updating the record sheet. Some items were held separately a sample check showed the items were boxed and “in” date. All medication seen was safely and securely stored. Throughout the visit staff were seen interacting well with the residents. On several occasions, it was noted that as different residents recognised members of staff they smiled broadly and were clearly pleased to see them. During a tour of the premises, the staff were seen to knock on bedroom doors and waited before entering. No issues were identified from the comment cards received. A recent adult protection investigation carried out by the local authority had concluded that. “The care plans were clear, person centred and individual for each resident. They had been updated appropriately, and their evaluations of care given were clear and succinct. Files of documentation were easily found, organised and easy to read. Clear documentation of other professionals visiting could also be evidenced” Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 13 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 & 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Activities in the home promote stimulation and interaction between the residents. The home had improved choice available although there was confusion between the meals offered on the board and that given to residents. The food given was appetising and well presented helping to encourage a good nutritional intake. EVIDENCE: The care plans included information on the individual’s social history and preferred pastimes and activities. During the visit one resident spent time playing a version of patience while two other were enjoying a game of dominoes. Residents joined in a “sing-along” session and throughout the day there was background music being played. The home has monthly in house church services to help people to continue to follow their religious beliefs. One person goes to church on Sundays with her family. Religious needs and preferences were discussed during the admission process to ensure that the need could be appropriately met.
Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 14 The home had an orientation board in the dining room giving information on the date, weather, activities and the daily menu. The comment cards showed that the home welcomed visitors at any reasonable time. Residents were placed on the electoral register to allow them to vote in local or national elections. Food records appeared up to date however on the day of the visit it was noted that several people had ordered fish but were served meat this was rectified once we pointed the matter out, fortunately none of the residents were vegetarian. For dessert the notice board stated apple pie and custard was on offer instead jam tarts and custard was given. One person declined his main meal and was offered several alternatives also declined. He did then eat a good serving of bananas in custard. Staff commented that he normally had a healthy appetite and they would continue to monitor but there were no immediate concerns regarding his lack of appetite. The home uses a recognised nutritional assessment tool and individuals Body Mass Index is monitored monthly or weekly if there were concerns. One new resident clearly enjoyed his lunch and was offered seconds which he refused but said it was a very fine meal. The dessert trolley had a good supply of fresh fruit. Several residents were assisted to eat their meals, some took a long time to eat their serving but they were not rushed by the staff. On one occasion a staff member was seen assisting one person, the carer was standing beside the seated resident. Mrs Koussa quietly reminded the member of staff that sitting down would help to relax the resident who went on to clear her plate. Some people were helped to start eating their meals but then took over to feed themselves. The staff were chatting with the residents they were assisting and there was also reassurance from good eye contact. Comment cards showed no concerns regarding choice or food. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 15 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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s policies and systems enable people to raise concerns and help to protect the residents from the risk of abuse. EVIDENCE: Comment cards showed that the complaints procedure was posted in each of the residents rooms informing visitors how they could raise concerns, contact details of the Commission and Local Authority was included. There had been no complaints received in the home. There were cards and letters from appreciative relatives and friends for the care provided. Staff had been trained by the local authority in how to respond to allegations and signs of abuse. The home’s AQAA showed that they were committed to ensure staff received adequate training and that they were always looking to improve handling of the residents. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements to the home have made the premises safer and more comfortable for those living at The Sheridan. EVIDENCE: Since the last inspection the owners had made considerable improvements to the fabric of the building, all windows had been replaced and Mr Koussa said that the first floor windows were fitted with restricted openings. The entrance hallway and dining room had been redecorated and one empty room was being refurbished. A comment card showed that there were concerns about the uneven ground floor leading to the rear bedrooms, this was being addressed at the time of the visit. Another person said they would like the residents to have freer access to the garden. This had already been mentioned to Mr Koussa at a recent coffee morning. Mr Koussa said now that the workmen were nearly
Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 17 finished inside the property the next job was to make the garden secure allowing the residents more freedom to roam at their leisure. Extra radiators had been installed to improve overall comfort around the home. Radiators were either covered or had guaranteed low surface temperatures. Hot water temperatures were regulated throughout the home. As stated previously staff were seen following good infection control measures and there was easy access to soap and hand towels in the room visited. In discussion the staff said they had been trained in infection control. The laundry had easy clean surfaces and was sited away from food preparation and storage areas. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing in the home was appropriate to the needs of the residents. The staff were receiving good levels of training and had the skills and qualities to meet the needs of the residents. EVIDENCE: There continued to be a lower turnover of staff which helped with continuity of care for the residents. At the time of the visit, Mr Koussa was on site with his deputy manager supported by three carers and one cleaner. Staffing levels appeared appropriate to the care needs. The staff recruitment records showed continued improvement with the required checks, permits and clearances in place before starting work. One file showed that only one reference had been obtained and there was no evidence that there had been any follow up. Two of the staff on duty had received training in recognising and responding to abuse, manual handling, health and safety and infection control. One was hoping to shortly enrol for NVQ level 2 in care. Both said that they were able
Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 19 to raise concerns with the owners and they thought they listened to their views and ideas. The records showed that staff supervision was being carried out. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by an experienced and qualified person. The home has improved over recent years and now provides a safe haven for the residents. EVIDENCE: Mr Koussa had completed his registered managers award at NVQ level 4. He has operated the home for several years. It was clear from the comment cards and the improvements being made that Mr Koussa was addressing the issues identified to him. The next questionnaire was ready to be given to the residents and visitors this had been delayed as Mr Koussa had only recently sent out the Commission’s comment card. People
Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 21 are invited to give their views on the home at any time and there had been a recent coffee morning where relatives were asked for their opinions. Mr Koussa plans to encourage families and friend to increase their participation in the home. The AQAA states and Mr Koussa confirmed that he did not assist residents with their money. Additional expenses are invoiced to the person responsible for the individuals’ monies. The home’s public liability insurance certificate was displayed in the office. Bath hoists and portable hoists had their last inspection dates on each device and all had been completed in July 07. Fire safety policy was updated in June 2007. Staff were very clear about how they would proceed should the fire alarm sound. Fire records were not checked during this visit but the extinguishers had been serviced in July 2007. The gas and electrical installation had been check in July 07 and June 06 respectively. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME 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 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 23 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 OP8 Regulation 12(7) Requirement The registered person must ensure that a complete assessment of risk is completed before items which could be used as a restraint e.g. bedrails are used. Timescale for action 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations The care plan should be updated once a review has identified changes to care needs. The food records should include the food provided and taken by the residents. The registered person should ensure that where references for new staff are not forthcoming that records are maintained showing the action taken and that alternative
DS0000065206.V352532.R01.S.doc Version 5.2 Page 24 2. OP15 4. OP29 Sheridan Care Home (The) sources are considered. Sheridan Care Home (The) DS0000065206.V352532.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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
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