Inspection on 04/07/06 for The Shires

This inspection was carried out on 4th July 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Shires 19/05/09

The Shires 29/11/08

The Shires 23/06/08

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

CARE HOMES FOR OLDER PEOPLE The Shires 12 - 13 Gorringe Road Eastbourne East Sussex BN22 8XL Lead Inspector Angela Gunning Key Unannounced Inspection 4th July 2006 10:00 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 The Shires DS0000067518.V291556.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. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Shires Address 12 - 13 Gorringe Road Eastbourne East Sussex BN22 8XL 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) 01323 721032 01323 646771 Eaglecrest Care Management Ltd Vacant Care Home 27 Category(ies) of Dementia - over 65 years of age (27) registration, with number of places The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is twenty-seven (27). Service users must be older people aged sixty-five (65) years or over on admission. Service users with a dementia type illness only to be accommodated. Date of last inspection 5th December 2005 Brief Description of the Service: The Shires is a care home registered to provide accommodation and care for twenty seven (27) older people with a dementia type illness. The home is situated in a residential area of Eastbourne, nearly two miles from the town centre. The Shires provides twenty four (24) single rooms, fourteen (14) with en-suite toilet and hand basin facilities and three (3) double rooms. There are two assisted baths and two assisted shower facilities. The home provides several communal areas, including a conservatory and a large accessible rear garden. There is a stair lift to access the first floor accommodation. Prospective residents are given a copy of the home’s brochure and they can find out information about the services and facilities at The Shires via the internet on Carefinders. The range of fees charged as from 1 April 2006 is from £450 to £669 and in-house activities are included in the fees. Additional charges are made for hairdressing, toiletries, chiropody, newspapers and dry cleaning. Intermediate care is not provided. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which included a visit to the home for 6 hours, seeking information and the views of residents and relatives by survey and telephone contact. Surveys from seven relatives on behalf of residents were received. Two relatives were contacted by telephone and a care manager and a doctors’ surgery were also contacted as part of this inspection. Information was gathered from the pre-inspection information provided by the manager and from previous inspection reports. Several people were spoken to during the visit, including six residents, four members of care staff, the activities coordinator, the cook, the manager, the deputy manager and the provider. Most of the environment was inspected, including the bedrooms and the communal areas. Three care plans and two staff recruitment files were examined. What the service does well: What has improved since the last inspection? The home has carried out risk assessments and consulted with relatives/representatives regarding providing residents with lockable bedroom doors and storage facilities. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 6 A new manager has been employed with sole responsibility of managing the home, although has yet to register with the CSCI. 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 Shires DS0000067518.V291556.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Shires DS0000067518.V291556.R01.S.doc Version 5.2 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 the following standard(s): 1, 3, 6 (not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Preadmission procedures identify prospective residents’ needs and enables a decision to made as to whether or not the home can meet their assessed care needs. EVIDENCE: Pre-inspection information provided by the manager indicated that two people had been admitted to the home since the previous inspection. Preadmission information was available for these residents which indicated that the acting manager had carried out a preadmission assessment to record these peoples’ health and welfare needs, such as personal care and assistance, communication, medication, occupation and religion. It was noted that prospective residents and their relatives are given a copy of the homes brochure and informed about the services, facilities, philosophy and financial arrangements of the home. All 7 surveys returned from residents/relatives as part of this inspection, confirmed that ‘they received enough information about the home before they moved in so they could decide if it was the right place for them’. The home operates a keyworker system and a specific member of staff had assisted The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 9 residents’ move into the home go smoothly. One resident has been placed at the home under Adult Protection following a strategy decision developed by a series of multidisciplinary meetings prior to admission. The care manager for this resident said that “the manager facilitated this move very well” and praised the home for its’ role in this process. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents’ healthcare needs are fully met by competent staff who respect their privacy and dignity. EVIDENCE: Each resident has a care plan, which records various aspects of health and welfare for each person. Three care plans were examined and these were noted to be detailed and regularly reviewed. The home uses a computer system to assist staff in recording and monitoring residents’ care needs, which the deputy manager demonstrated how it is used, although this was not fully operational at the time of the site visit and the manager said “we are in the process of looking at implementing a different computer care system, that will be easier for staff to use.” It was noted that health and social care professionals, such as General Practitioners, District Nurses, Community Psychiatric Nurses and Social Workers are consulted when and as necessary and a record is maintained of these contacts and any agreed action necessary. Surveys returned indicated that residents ‘receive the medical support they need’. One relative commented that in their experience ‘the home will not hesitate in calling out The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 11 the Dr if thought necessary and they me know of any problems’. One doctor consulted with as part of this inspection confirmed that ‘the home communicates clearly and works in partnership’ with the doctors. Also he considers that ‘staff demonstrate a clear understanding of the care needs of the residents at the home.’ One relative spoken with over the telephone, whose relatives’ healthcare needs had increased and on advice from the doctor was moved to a nursing home, said that “staff gave a great deal of care and attention and did as much as they could”. Another relative commented that ‘the home has cared beautifully’ for their mother. It was noted that the procedures for the ordering, administration and recording of medication are well managed. Care plans contain residents’ medication requirements and staff were seen to carry out the correct procedures for the storage, recording and administration. A doctor confirmed that ‘residents’ medication is appropriately managed’. Staff have an understanding of the needs of people with dementia and were noted to be patient, kind and respected the individuality and privacy of each person. One relative commented that their mother always says ‘they are all very nice, it’s lovely here’. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The arrangements for leisure and social activities inside and outside the home provide good opportunity for mental and physical stimulation and promote independence and choice. Meals are varied and nutritious to ensure residents dietary needs are met. EVIDENCE: Pre-inspection information indicates a variety of activities are carried out such as a monthly church service, a weekly musical afternoon and parties. Some residents are taken to church and outings are arranged. The home employ an activities coordinator, who carries out various activities, such as flower arranging, ball games and reminiscence activities with residents four afternoons a week. During the site visit it was noted that residents were enjoying looking through old photos from the 1920’s. Surveys returned indicated ‘that there are activities arranged that residents these can take part in’. The activities coordinator was spoken with briefly and confirmed that provision for activities is now very good’. It was noted that residents’ independence and choice is promoted. Staff confirmed, “residents’ can go to bed and get up when they want, as it’s their home”. During the site visit a calm and peaceful atmosphere was experienced The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 13 and the various communal areas allow residents to choose where to be and what activities to be involved in. Residents’ religious needs are recorded in their care plan and staff said that “three residents are supported to go to church and a priest comes in to see one resident”. Relatives and friends can visit relatives at any time and relatives spoken with said “they are always made welcome”. It was noted that visitors on the day of the site visit were obviously comfortable in the home and were happy approaching staff and the acting manager. Residents dietary needs and likes and dislikes are recorded in their care plan and although the cook is aware of residents’ dietary needs and caters appropriately for these, she was not aware or their likes and dislikes. It was noted that fresh homemade meals are provided and homemade cakes and biscuits are made for residents and relatives. A cake had been made for two residents’ birthdays. There is a four weekly rotating menu and the cook confirmed that “residents have fresh vegetables every day” and she is “trying different meals and introducing more variety and more fish dishes during the week”. Staff confirmed that “the quality of the food is good” and residents have fresh fruit and that “a lovely fresh fruit salad had been made the day before”. Residents spoken with during the site visit said they “like the food” and surveys indicated that residents ‘like the meals at the home’. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 14 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 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. There is a complaints procedure in place to ensure residents and relatives feel that any concerns or complaints will be dealt with appropriately. There are satisfactory arrangements in place to prevent and protect residents from the risk of abuse. EVIDENCE: The homes’ complaints procedure is contained within the Statement Of Purpose and Service User Guide and is also displayed in home. Pre-inspection information indicates that neither the home or CSCI have received any complaints. Surveys returned indicated that residents/relatives know how to make a complaint. Pre-inspection information indicates that the homes’ adult protection and prevention of abuse policy was reviewed in January 2006. At present there is a resident placed at the home under Adult Protection and the manager is aware of the East Sussex, Brighton and Hove Policy and Procedures for the Protection of Vulnerable Adults and has been proactively involved in agreed procedures. Staff spoken with during the site visit were aware of procedures to be followed. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home is clean and well maintained to ensure residents live in a comfortable and homely environment. EVIDENCE: Surveys received from residents/relatives confirmed that they consider the home is kept ‘fresh and clean’ and during the site visit the home was seen to be kept clean and tidy. There is an annual maintenance and decoration programme and it was noted that new furniture and furnishings are budgeted for and provided on an ongoing basis. A maintenance person has been employed on a regular and permanent basis to carry out maintenance and decoration as and when needed. Residents’ bedrooms were well maintained and nicely decorated and it was evident that residents are able to bring in their own possessions in order to personalise their bedrooms. On the day of the site visit the home was clean and there are good systems in place to control the risk of infection. The The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 16 arrangements for carrying out laundry are satisfactory, with a separate laundry room that meets standards and washing machines that wash soiled laundry at high temperatures. Staff were observed to be working in ways that minimised the risk of infection, by wearing gloves and aprons when required. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Although there has been a high turnover of staff recently, there is a new developing staff team, with sufficient numbers of employed to meet the needs of residents. A staff training plan needs to be developed to ensure staff are competent in caring for older people with a dementia type illness. EVIDENCE: Pre-inspection information indicates that staffing levels are well above the calculated numbers needed based on the Department of Health formula. The staff rota showed that there are 5 carers on duty in the morning and 3 carers plus an afternoon assistant on duty in the afternoon. There are 2 carers working a waking night duty. Pre-inspection information and discussion with staff indicates that there has been a high turnover of staff and an unusual use of agency staff since the last inspection. The manager said that “there has been lots of staffing change and it has been a rough period but we are coming through it and have taken on more staff ”. The manager and other staff confirmed “there are enough staff now”. Surveys returned from relatives suggest that they consider ‘there are staff available when needed’. One member of staff spoken with said “The Shires is a nice home to work in as there are lots of staff to support people.” Another member of staff commented that she is “not used to so many staff and it is nice to have the extra time” to provide good person centred care. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 18 It was noted that there is a new developing staff team and the manager confirmed that “they all have had experience in caring for older people.” Preinspection information indicates that staff have received some training over the last 12 months and over 50 have a National Vocational Qualification (NVQ) in Care. However, the manager is aware that she needs to carry out a training audit and develop a training plan for each member of staff. Although staff spoken with said they had an in depth induction to the home it was noted that there was no record maintained of what was covered or if the training meets skills for care specification or that staff had gone through foundation training if they are not doing a National Vocational Qualification Recruitment records for two new members of staff indicated that there is a satisfactory recruitment procedure in place and Protection Of Vulnerable Adults first check are carried out prior to any carer working at the home whilst awaiting their Criminal Records Bureau (CRB) check. The manager confirmed that staff employed prior to the return of a satisfactory CRB check are supervised at all times to ensure that residents are placed at risk. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is clear leadership and management of the home so that the health and safety of residents’ and staff is promoted and protected. EVIDENCE: The manager has been in post for six months and has a clear job description to enable her to fulfil her duties. The registered manager, who took on further responsibilities within the organisation, has now resigned and the acting manger will apply to become the registered manager, to ensure that the home meets the required National Minimum Standards. There are various systems in place to form the homes quality assurance procedures. There is an annual maintenance and redecoration plan, which the provider monitors monthly and a handyman has recently been employed on a regular and permanent basis to carry out any maintenance and decoration as The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 20 needed. The provider carries out monthly monitoring visits to assess the standard of care and service being provided. The home has achieved Investors in People Status and this is reviewed regularly. The provider said that “the registered manager sent out surveys to relatives recently and he will follow up the results”. Residents’ relatives or representatives receive itemised bills for services such as hairdressing, chiropody, newspapers and toiletries. The home maintains a record of all extra amounts payable for these additional services and this is documented in the Service Users Guide and their terms and conditions of residency. The manager has implemented a programme of supervision, but due to the change in staffing not all staff have had a supervision session, to ensure that they are supported and monitored effectively. Pre-inspection information provided by the manager indicates that all health and safety checks are made and recorded. An independent Health and Safety consultant carries out an annual inspection visit to the home to ensure residents’ health and welfare is protected. The Shires DS0000067518.V291556.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 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes 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. 2. Standard OP30 OP36 Regulation 18(1)(c) 18(2) Requirement That a record of induction training that meets Skills for Care standards is maintained. That all staff receive regular one to one supervision sessions. This was a previous requirement). That the manager carries out a training audit and develop a training plan for each member of staff. Timescale for action 30/11/06 31/07/06 3. OP30 18(c)(i) 30/09/06 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 OP15 Good Practice Recommendations That the cook is aware of all residents’ food likes and dislikes. The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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. Extracts may not be used or reproduced without the express permission of CSCI The Shires DS0000067518.V291556.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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