Inspection on 16/09/05 for The Shires

This inspection was carried out on 16th September 2005.

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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Shires 19/01/07

The Shires 28/02/06

The Shires 15/12/04

The Shires 13/07/04

The Shires 25/02/04

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

CARE HOME ADULTS 18-65 Shires The 116 Aylestone Hill Hereford Herefordshire HR1 1JJ Lead Inspector D Lewis Unannounced Inspection 16th September 2005 9:30 Shires The DS0000027691.V251084.R01.S.doc Version 5.0 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 Shires The DS0000027691.V251084.R01.S.doc Version 5.0 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. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Shires The Address 116 Aylestone Hill Hereford Herefordshire HR1 1JJ 01432 271785 01432 276806 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) Herefordshire Mind Association Mr Alan John Riley Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (13) Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2004 Brief Description of the Service: The Shires is a 3-storey Victorian house set in extensive grounds that are well maintained and easily accessible, with open views overlooking the Lugg Meadows. It is on the outskirts of Hereford, which offers shopping and recreational facilities. There is a small newsagents shop within very close walking distance. There are nine single bedrooms and two shared double bedrooms, none of which have en-suite facilities. The home is fitted with a passenger lift to all floors with the exception of the second floor. The two bedrooms on the second floor are used specifically for service users with a greater degree of independent living skills. The home provides accommodation, care and nursing for up to 13 adults (some over 65) with enduring mental health needs. The Primary Care Trust owns the property. The provision of security of tenure through a Service Level Agreement with the Primary Care Trust is unresolved. The registered provider of the service is Herefordshire MIND and their General Manager, Mr Andrew Strong, is the responsible individual. The registered manager of the home is Mr Allan Riley. Mr Riley also manages a counselling & psychotherapy service and a supported living service. In the past this has been an accepted arrangement, but may be reconsidered as demands of any of these services alter. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a Friday morning in September and was the inspector’s first visit to the home, other than an initial meeting with the registered manager earlier in the year. The aim was to follow up on previous requirements and to meet service users. The inspector was welcomed in the home and met several staff. The inspector spoke at length with 4 service users and briefly met some others. The inspector was told there had been several new service users in the past few months, but none were in the home during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 6 contacting your local CSCI office. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 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 Shires The DS0000027691.V251084.R01.S.doc Version 5.0 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 and 5 Documents enabling prospective service users to have access to information about the home were not easily available in the home. Service users did not have copies of their contracts. While some people may prefer staff to keep their copies, they should be in the home so service users have easy access to them. EVIDENCE: The statement of purpose provided during the inspection had not been adjusted, as required previously, to meet the standard. A service users’ guide was not seen and the registered manager was asked to provide a copy by post to the inspector. Updated copies of the statement of purpose and the service users’ guide, which met the standard, were provided after the inspection. 3 service users asked said they did not have copies of their contract, and their contracts were not found in the office – the RMN on duty said they were held at the head office. A contract was seen (in the office) for a more recently admitted service user, which included details of proportions of fees and who was to pay them. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 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 Service user plans seen were detailed and had been updated to meet changing needs. They included the service user’s viewpoint. EVIDENCE: Service user plans were sampled to see how a recent change to one service user’s circumstances had been managed. It was clear that plans had been updated promptly and included comments from the service user on how they wanted staff to respond. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 10 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): None of these standards were specifically assessed. All met the standards at the previous inspection. EVIDENCE: Most of the service users were out of the home during the inspection, involved with various activities. Some who remained did not appear to have much activity in their lives. This could be their personal preferences or a reflection of their current circumstances. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 11 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 Service users were being supported with personal care as they wished. EVIDENCE: Service user plans stated service user’s preferences. Service users spoke highly of the staff and described them as “very good”, “gentle” and “terribly kind” and some described how staff responded well when service users were distressed. Routines were flexible. Assistance with personal hygiene was given if needed. The home employed trained psychiatric nurses, who were key workers, and support workers. Healthcare given was not fully assessed, but it was noted that there was no record of chiropody treatment for one person with a foot problem. Medication was not assessed but it was noted that it was stored securely and MAR charts (medication administration records) had been completed. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 12 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 and 23 Staff were approachable and concerns were dealt with, but service users should be made more aware of the formal procedure. There was no concern about practices in the home, but staff should be trained in adult protection and the home needs a clear policy covering management of service users’ finances. EVIDENCE: The complaints procedure was previously found to be satisfactory. A record of complaints was kept in the office, including details of the investigations and responses. Service users felt able to talk to staff about concerns, but not all were aware of a complaints procedure. The home had an adult protection policy (discussed in previous inspections). The inspector advised that staff should receive relevant training in adult protection. Service user plans showed staff awareness of understanding causes/triggers for challenging behaviour. The home had previously been asked to produce a policy regarding management of service user’ money, but this was still available in draft form only. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 13 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, 30 The home was generally homely and comfortable. It was also clean & hygienic, though there was some concern about a new area for making snacks. EVIDENCE: The inspector saw most shared areas of the home and one bedroom. The home was generally clean, homely and well maintained. The lounge carpet needed to be cleaned or replaced. The inspector was told that there were 2 shared bedrooms. The occupants were unavailable to talk with the inspector. The single bedroom seen was very homely and included facilities for making hot drinks. The dining area had been recently altered to provide an area for service users to easily get their own drinks and snacks (previously food was only kept in the main kitchen). This was popular with service users, although one person raised concerns about hygiene. The inspector was told that food hygiene training was being planned for all service users, which should be beneficial. The inspector also suggested contacting the environmental health department for advice. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 14 There were still some unsealed edges in the downstairs bathroom (previously recommended to be sealed for hygiene reasons). Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 15 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): None were fully assessed. EVIDENCE: The inspector was told that staff levels remained unchanged. A rota was seen which showed adequate staff levels. It did not show the registered manager’s hours. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 16 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, 43 The registered manager is competent, popular and valued in the home, but his reduced day-to-day input perhaps limits his availability to keep on top of all managerial tasks e.g. revising policies and other documentation. The overall management arrangements rely heavily on a stable, professional and well functioning staff team, and there is no evidence that they have had an adverse effect on service users, but more structured management arrangements need to be considered for the home. EVIDENCE: The registered manager is a Registered Mental Nurse and has managed the home for the last 10 years. He has furthered his education by successfully obtaining teaching and assessing certificates, a Bachelor of Science degree with honours in Health Studies and a Post Graduate Diploma in Management. He is away from the home for most of his time, although available on the telephone (or service users can visit him at the Mind office in town). The inspector was told he is at the home approximately for 2 working shifts per month and for meetings or lunch approximately twice per month. Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 17 The registered provider visited the home on occasion but there was not evidence in the home (nor had reports been sent to CSCI) of monthly visits as are required by regulation 26. (Standard 42 – it was noted that one fire exit was reached via a lockable bedroom and the inspector has asked that the fire authority give advice on this arrangement.) Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 18 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 X X X 2 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 2 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Shires The Score 3 X X X Standard No 37 38 39 40 41 42 43 Score 3 X X X X X 2 DS0000027691.V251084.R01.S.doc Version 5.0 Page 19 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 Regulation Requirement The Provider must review the Home’s financial policy and procedure for the management of service users monies when acting as their appointee. (Timescales of 30/06/04 and 31/03/05 not met) 2 YA23 20 A copy of the financial policy and procedure for the management of service users monies must be submitted to the CSCI. (Timescale of 14/04/05 not met) 3 YA30 4 16 The home must make suitable arrangements to maintain hygiene in the new kitchenette. The registered provider must visit the Home unannounced on a monthly basis and supply a copy of the report to the Commission in accordance with this Regulation. (Timescale of immediate and ongoing not met) 5 YA42 23 The registered provider must obtain advice from the Fire Authority regarding access to one fire exit being via a lockable bedroom. 30/11/05 Timescale for action YA23 20 30/11/05 30/11/05 YA41 26 31/10/05 31/10/05 Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 20 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 3 4 5 6 7 YA37 Refer to Standard YA5 YA19 YA22 YA23 YA30 YA33 Good Practice Recommendations All service users should be provided with an up to date copy of their contract. All aspects of healthcare (e.g. chiropody arrangements) should be clearly recorded in service users’ plans. The registered manager should ensure that all service users are aware of the formal complaints procedure. Staff should receive training in adult protection. The edges of the washable floor in the ground floor bathroom should be sealed. (Brought forward, partially completed) The staff rota should include the times when the registered manager is in the home. The registered provider should give consideration to the future management arrangements for the home, and discuss these with the CSCI (Commission for Social Care Inspection). Shires The DS0000027691.V251084.R01.S.doc Version 5.0 Page 21 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW National Enquiry Line: 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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