Inspection on 30/05/06 for The Shieling

This inspection was carried out on 30th May 2006.

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 found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Shieling 14/11/07

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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

CARE HOME ADULTS 18-65 Sheilings The Sheilings St. Ebba`s Hook Road Epsom Surrey KT19 8QJ Lead Inspector Kenneth Dunn Unannounced Inspection 30th May 2006 10:00 Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 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 Sheilings DS0000066519.V298255.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 Adults 18-65. 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. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sheilings Address 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) The Sheilings St. Ebba`s Hook Road Epsom Surrey KT19 8QJ 01372 203014 Surrey Oaklands NHS Trust Christine Ann Ephraim Care Home 10 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Sheilings is a large detached property situated within the St Ebba’s Hospital Complex Epsom Surrey. It is currently registered to provide residential care for up to 10 adults with learning disabilities. The accommodation for Service Users is provided on one floor. The communal space is provided in two good size dining rooms and two comfortable lounges. Service users have access to a large enclosed garden, which was laid out in lawns and an area trees at the rear boundary. The home has limited parking space to the front with an additional space provided for the home’s minibus. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first inspection of a new service since it was registered in April 2006. The inspection was carried out by one inspector over a period of one day. This was an unannounced visit, which meant that staff and residents were not aware that it was due to happen. The inspector spent the first part of the visit in discussion with the duty manager, and staff, checking the shared parts of the home and looking at care plans and reports. The home is still in its developing and settling in stage and it is recognised that the service users and staff are all in the process of finding their feet and becoming familiar with their new accommodation. Care and health plans were found to provide a good level of information about each individual, based upon a sound assessment of their needs and aspirations. In general the Sheilings was found to be developing into a good supportive service, with a staff team who promote the best interests of the service users. The inspector wishes to thank the staff and service users for their hospitality and co-operation during the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The home was generally operating to a good standard. The care and support offered of the service users is good. The manager must however ensure that Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 6 all documentation required by legislation is current and accurate in respect to the Sheilings and not the previous NHS unit they transferred from. 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. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and/or their representatives were able to visit the service prior to its completion and their final admission into the Sheilings. The information supplied by the service together with the home’s procedure of carrying out detailed assessments and offering a well-structured series of visits prior to admission, enable service users and prospective service users to make an informed choice about admission to the home. Contracts were in place for all service users EVIDENCE: The care plans sampled during this inspection were seen to be based on comprehensive care manager needs assessments and the homes own in depth assessment. Where available, the views and experience of previous carers and relatives have been included. The service users and the staff group have worked together for some considerable time and they have all been very fortunate to transfer to the Sheilings as one cohesive unit. Contracts were in place for all service users and to have been signed on their behalf by a care manager or alternatively by their independent advocate/representatives. The contracts include the fees charged, room to be occupied, a copy of the service user plan, arrangements for review of needs and external care provided. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service users’ individual plans are clear and comprehensive including details of needs and goals. They also incorporate known or indicated preferences with in depth risk assessments. EVIDENCE: The service users have only been at the home for two months and the staff are still reviewing and identifying further needs and developing future plans for each individual. This group have been together for a long time and both the service users and the staff transferred to the home as one unit, allowing considerable stability to the service users during this change. This is especially so due to the complex nature of the disabilities and communication needs of the service users accommodated at the home. During this inspection the service users were seen to be making clear choices about their daily lives and to be supported by staff as necessary. Service users were seen to be choosing where they went and what they did in the home with confidence. If they wanted assistance with an activity, such as listening to music, they came to a staff member indicating that they wanted help and showing or taking the staff to what they needed. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 10 However it was noticeable that one or two of the service users had a very limited wardrobe of clothes to choose from. The inspector was informed that attempts have been made to arrange appropriate financial support for the service users in question but the situation has not been resolved. The manager must make representation to facilitate independent advocacy for all service users. There is in-depth risk assessment on file for all of the service users and activities they take part in, the inspector reviewed a set of detailed assessments for 3 service users who were about to go on a holiday to the countryside. The service is still in the process of change and it was noted that care plans and other documents are still NHS tools and require to be updated to ensure that they are current and accurate. The manager must ensure that all files active documents are transferred to Sheilings. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users have opportunities for personal development, to take part in appropriate activities within the home and in the local community although this is hindered by the location of the service. They are supported and enabled to maintain and develop appropriate personal and family relationships. Meals were well-balanced and varied. Systems are in place to ensure that service users’ rights are respected. EVIDENCE: The care plans sampled detail each service users known, previous preferences for leisure activities. The staff are gradually introducing new activities and experiences, both inside and outside the home and are monitoring and documenting the individual service users reactions and indicated preferences. accompanying staff. Each service user has a weekly plan of activities in place. They can indicate which they wish to attend or not. Most individuals have activities of a shorter duration, rather than a half or whole day. This is based on their needs, as most would not cope with longer sessions. Most service users have contact with their family and some go to their relative’s home on visits and are taken for trips out. The main meal of the day is in the evening and is cooked by staff. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 12 Service users are able to participate in a limited way. One individual has to follow a special diet and the staff support him to maintain healthy balance. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 & 21 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal care and healthcare support and assistance is planned and was seen to be provided, where needed, in a respectful and sensitive manner. Sound policies and procedures are in place for the administration and management of medications within the service, however a review of the procedures regarding medication and home visits is needed to ensure safe working practices. Improvement was also needed in respect of the home’s policy for ageing, illness, and dying. EVIDENCE: During this inspection all personal care and support was carried out in privacy with the doors closed. Service users were up on the whole well dressed and dressed appropriately for the time of year. All were observed to be relaxed and comfortable with the staff on duty. The care plans sampled provided evidence that service users’ healthcare needs are being met effectively. Service users are all registered with a local GP and referrals to other health care professionals are obtained, as necessary, from the GP surgery. The policies and procedures in operation are generally sound however the system used, which allows secondary dispensation of medication for service users going home, must be stopped. The manager must ensure that the medication policy fully complies with current safe working practises and the Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 14 National Minimum Standards. Furthermore the policy in operation offering guidance for aging, illness and dying must be revised to ensure all elements of standard 21 of the National Minimum Standards for Younger Adults is fully engaged. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has an up to date copy of the local authority (i.e. Surrey County Council) Multi Agency Safeguarding Adults Policy. The homes policy fully reflects the requirements of this document. However it is very doubtful because of the extremely complex needs of the service users that this policy could be translated into a format, which they could fully understand. Service users were consulted and listened to, with regular meetings taking place. EVIDENCE: Policies and procedures are in place to ensure that service users are safeguarded from harm or abuse. The inspector reviewed both policies and procedures and discussed them with the manager at the time of her registration. There is evidence of residents meetings being and minutes were seen. A log is kept of all complaints and compliments received into the home. A review of this log would indicate that there has been no formal complaints have been recorded since the service was registered. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 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. The location and layout of the home is suitable for it’s stated purpose. It is accessible, safe and designed with this specific service users group in mind. The home was found to meet service users’ individual and collective needs in a comfortable and homely way, and was observed to be clean. EVIDENCE: The home has only recently been opened after undergoing an extensive renovation project and is fortunate to have been designed with this particular service user group in mind. The home offers the service user fully flexible environment to live in and is designed to adapt to meet their changing needs. The fixtures, fittings, furniture and décor are all to a high standard with consideration being given to the service user group to be accommodated within the home at every stage of the planning and its final completion. The service users’ individual rooms have all been highly personalised with the service users’ own belongings and mementos. The provided furniture was seen to be suited to the needs of the service users and to be chosen with care and consideration towards reducing the risk of accidental injury. The garden is extensive and mostly laid to lawn with secure fences and an access gate being locked, offering privacy and security. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 17 During this inspection service users were seen to be entering communal rooms and their own rooms with confidence and at will. It was obvious that the service users have a sense of ownership over their home whilst at the same time respecting the other service users’ personal rooms. On the day of inspection the home was warm, bright and clean with a homely atmosphere. However the over reliance on chemical air fresheners in every area of the home should be given further consideration. This is in view of the strong perfume evident at the inspection, which was noted to be very overbearing. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The staff rota demonstrated that the staffing numbers and skill mix were appropriate to meet the assessed care needs of the service users in the home on the day of inspection. Staffing is kept under review and provided to meet the needs of the service users at all times. The Registered Manager ensures that care workers receive appropriate induction and training, including National Vocational Qualifications (‘NVQ’) training. EVIDENCE: Review of the month’s staffing rota demonstrated that adequate numbers of care workers with appropriate skill mix were roistered on duty, with special attention to increased staffing at peak periods and the one-to-one needs of specific service users. In house training, specific to each individual service user, is provided to all staff. This has been the focus of the training since the home opened in order to ensure that the transition from their previous home to this one is as smooth and stress free as possible for the service users and the staff group. The home is to be congratulated for their success in this area, which is demonstrated by all service users seen to be calm, settled and happy at all times during this inspection and so soon after the upheaval of the move to their new home. The staff displayed their skills, knowledge and understanding in all interactions observed. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures were in place to ensure the health and safety of the service users and staff. There was clear evidence that these were being followed at the time of the inspection. The homes Abuse policy is in line with the local authority Safeguarding Adults Multi agency policy. This is a new home and has only been in operation for two months it has therefore not been possible at this point to fully ascertain the effectiveness of the management structure of the service. EVIDENCE: Discussion with the staff indicated that everyone was encouraged to contribute their ideas to the effective running of the Home. The home was still in the process of settling into its new accommodation. The inspector was informed that every one working at the service had responsibility to share their ideas about the service provided. The Inspector was unable to review the effectiveness of the homes quality audit procedures as it has only been registered for two months. However the Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 20 minutes of the first full service meeting, which included the service users and their families and advocates indicated a high level of satisfaction with the home and the care the service users receive. All required written policies and procedures are in place at the home. The staff carries out all of the necessary health and safety checks out with documentary evidence inspected of routine fire practices and evacuations, fire, gas and electrical safety certificates. Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 2 3 X 3 X X 3 X Sheilings DS0000066519.V298255.R01.S.doc Version 5.2 Page 22 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 YA6 Standard Regulation 15 Schedule 3.1 12(2)(3) Schedule 3.3 Requirement All documents in use at the service must be transferred from the previous NHS format to the Sheilings. Timescale for action 30/07/06 2 YA7 3 YA20 13(2) Schedule 3.3 4 YA21 12(1-4) 37 Schedule 3.3 The registered person(s) must 30/07/06 ensure that all service users have adequate, sufficient, and appropriate clothing to meet their needs. Consideration should be given to independent advocacy for service users where required in respect of their needs and requirements being promoted. The registered person(s) must 30/07/06 ensure that the medication policy fully complies with current safe working practises and the National Minimum Standards. The current practice of secondary dispensing medication when service users visit their families and friends must be reviewed. The policy in operation offering 30/07/06 guidance for ageing, illness and dying must be revised to ensure all elements of standard 21 of the National Minimum Standards DS0000066519.V298255.R01.S.doc Version 5.2 Page 23 Sheilings for Younger Adults is fully included. 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 YA30 Good Practice Recommendations The over reliance on chemical air fresheners in every area of the home should be reviewed in view of the overbearing perfume evident at the time of the inspection. 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