Inspection on 11/10/05 for The Shrubbery

This inspection was carried out on 11th October 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Shrubbery 11/09/08

The Shrubbery 10/10/07

The Shrubbery 03/05/07

The Shrubbery 12/05/06

The Shrubbery 05/05/05

The Shrubbery 19/11/04

The Shrubbery 13/05/04

The Shrubbery 03/02/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Shrubbery 66 College Street Higham Ferrers Northants NN10 8DZ Lead Inspector Mrs Linda Preen Unannounced Inspection 11th October 2005 9.30 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 Shrubbery DS0000012910.V255259.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 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 Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Shrubbery Address 66 College Street Higham Ferrers Northants NN10 8DZ 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) 01933 317380 01933 317380 claire@rochmills.co.uk Rochmills Limited Natalia Emilia Mychajlyszyn Care Home 45 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (31), Physical disability over 65 of places years of age (6) The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th May 2005 Brief Description of the Service: The Shrubbery is a care home in Higham Ferrers. There are local facilities and amenities including shops and there are public transport links to the neighbouring towns of Rushden and Wellingborough. The home provides personal care for up to 45 people over the age of 65 years; within this they are registered to provide care for up to 8 residents who have dementia and 6 with a physical disability. Accomodation is provided over two floors with a passenger lift and staircase for access to the first floor bedrooms. On the ground floor there are several communal rooms including two dining rooms, three lounge areas and a conservatory. There are gardens and level access to the main entrance with ample car parking for visitors. Over the two floors there are 33 single rooms of which 29 have ensuite facilities and 6 double rooms with 3 of these being ensuite. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One hour was spent prior to the inspection reviewing previous requirements and recommendations. The inspection took place over a period of four hours as part of the statutory inspection programme. Three residents were chosen in order that their experience in the home could be monitored. This included looking at their records, talking to them and also to the staff concerning the care received. In addition to this staff rotas and staff training records were seen, as well as Health and Safety records. A limited tour of the environment was undertaken. What the service does well: What has improved since the last inspection? What they could do better: The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 6 Residents do not have their weight monitored in order to identify health needs in this area. Residents in shared rooms do not have privacy screens provided in order to preserve their dignity. Call bells in these shared rooms cannot be accessed by both occupants owing to the layout of the rooms. Some areas of the home are becoming very shabby and do not present as welcoming and homely. Access to the garden is limited and the garden is poorly maintained. Arrangements for laundry and the venting of tumble dryers are unsatisfactory and cause discomfort and inconvenience to residents and staff. The company has been required to address these issues. 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 Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 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 Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 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, 2, and 3 Residents have the information needed to make an informed choice about living in the home. EVIDENCE: Comprehensive pre-admission assessments were available for the residents who were case tracked. These included Social Services assessments as well as assessments completed by the Registered Manager. Signed copies of the residents Terms and Conditions of residence were in evidence, that clearly stated the service offered and extra charges to be paid, as well as the room to be occupied and arrangements for terminating their residence. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10 Staff have the necessary information to meet the needs of residents. Safe systems are in place for the control of medication in the home. Residents do not always have their privacy respected. EVIDENCE: Clear plans of care had been formulated following the initial assessment and there was evidence of review of these plans having taken place. There was however no evidence that the resident or their advocate had any input into these documents or their review. One resident who had a diagnosis of dementia had a very basic dementia care plan that did not give staff sufficient guidance as to how to meet her needs. A separate risk assessment for this lady did give more clear instruction and advice was given that the information in these two documents should be amalgamated. Risk assessments had been completed for pressure ulcers and appropriate referrals had been made to the District Nursing service where needed. Pressure relieving mattresses and cushions were in place for those residents who the district nurse agreed were at risk. Nutritional assessments had been completed and the general practitioner contacted where residents were found to be at risk. There were no records of The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 10 resident’s weight, and the Registered Manager stated that the scales were out of order and awaiting a new charger. A requirement was made in this respect. Residents spoken to appeared clean and well groomed and complimented staff on the care and attention provided. The Registered Manager has implemented a revised system of tracking the medication in the home and clear audit trails are now in place. Staff were observed to be treating residents in a respectful manner and were observed to knock before entering residents rooms. There were no privacy screens in double rooms to allow personal care to be provided in private. A requirement was made concerning this. The positioning of call bells in some rooms meant that they could not be accessed by the resident from their bed, so they would be unable to call for assistance. A requirement was made in this respect. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 11 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, and 15 Social activities and meals provide variation and interest for residents in the home. EVIDENCE: A record of individual preferences for food and activities is available in individual residents files. An activities co-ordinator organises such thing as BINGO, card games, board games and music and movement sessions. Residents enjoy a visiting entertainer and like to sing along with him. A group of residents are planning to go to the Pantomime and a summer fete proved popular. A resident who had moved in to the home on the day before the inspection said he was looking forward to joining in. Visitors were observed to be coming to the home freely and records were available of residents going out with family and friends. Relatives collected one lady during the inspection. Residents spoken to stated that the standard of food was good and that they were offered a choice on a daily basis. Lunch was observed at the time of the inspection and both looked and smelled appetising. It was served at attractively set tables in one of two dining rooms or in the resident’s room according to personal choice. Staff reported when residents did not eat their lunch and appropriate action was taken to monitor this and provide extra fluids. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 12 The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 13 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): 18 Residents are protected from abuse. EVIDENCE: A member of care staff spoken to was aware of her responsibilities in reporting any actual or suspicion of abuse. Staff training records demonstrate that some staff have received training in Protection of Vulnerable Adults procedures and an update for all staff is planned for the next few weeks. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 14 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, 20, 21, 23, 24, 25 and 26 Limited improvements to the décor have been made, but some areas of the home are very shabby and do not present a pleasant place in which to live. Access to the outside of the home is limited. The Registered Manager has identified outstanding maintenance issues but these have yet to be addressed by the company. EVIDENCE: A limited tour of the environment was undertaken. This demonstrated that the home was clean and tidy, but that paintwork and décor was becoming very shabby in places. The Registered Manager had identified a list of maintenance issues at the beginning of September but these had yet to be actioned. A selection of communal sitting areas is available along with two pleasant dining rooms. Although the home is set in its own grounds, residents are not able to access the garden areas as they are not secure and do not offer level access. The garden areas are not well cared for and along with the poorly maintained outside of the building do not provide a welcome to visitors. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 15 A ventilation flue for the tumble dryer has been installed close to the main entrance to the home. This large metal pipe finishes outside a residents window on the first floor, spoiling her view and discharging its fluff all over her window, into her room if the window is open and also all over the wall and adjacent roof. A large hole in the wall where this pipe enters the house has been left unfilled and is very unsightly. Requirements have been made concerning this pipe. Resident’s rooms seen were pleasantly furnished with evidence of personalisation in the form of pictures and ornaments on display. Some of the residents have their own television sets and one lady said she enjoyed watching her own choice of programmes. Four resident rooms have been refurbished since the last inspection and new carpets and furniture provided. A new carpet has been delivered for the first floor corridor and is waiting to be fitted. Bathrooms seen were very dreary and institutional in appearance and did not provide a pleasant environment in which to bathe. En-suite facilities in resident’s rooms are also becoming very shabby and are in need of updating and redecoration. One ensuite has been recently refitted but this is still very clinical in appearance. It is recommended that attempts should be made to provide a more homely environment in these areas. The laundry area is badly organised with clean laundry spilling out into corridor areas in the home, giving an untidy appearance. A requirement was made in this respect. Staff hand washing facilities were provided throughout the home. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 16 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 and 30 Staffing levels and recruiting practices protect residents in the home. The new Registered Manager has a commitment to training to ensure that residents receive the care and attention required. EVIDENCE: Staff rotas demonstrated that there are five staff on during the day and three staff at night. Dependency scores are available for all residents but these results are not taken into consideration when staffing the home. Residents spoken to were complimentary concerning the care received and appeared well cared for, so it appears that staffing numbers are sufficient to meet the needs of this current group. There are several vacancies for care staff at present and two staff are on maternity leave. The remaining staff are working extra shifts to cover. Care must be taken that they do not work excessive hours which would be detrimental to both the staff and residents well being. The Registered Manager has developed a staff training matrix and training sessions have been planned to ensure that statutory training is up to date. New staff complete the TOPPS induction programme. A staff member spoken to confirmed that she had been supernumerary when she started in the home so that she could work with a more experienced staff member. Nine care staff currently hold a National Vocational Qualification in care and three more are working towards this at present. A selection of staff files was seen and these demonstrated that Criminal Records Bureau checks had been completed for these staff members. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 17 Information on employment history and health status as well as equal opportunity information was available in these files. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 18 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, 32, 35 and 38 The Registered Manager tries to ensure that the home is run in the best interests of the residents, where issues are within her control. EVIDENCE: The Registered Manager is a First Level Registered Nurse with many years experience of caring and management. Staff and residents confirmed that she is available and willing to listen to them at all times. Resident pocket money accounts were seen. Advice was given that two signatures should be recorded for each transaction and that receipts should be available for expenditure, in order to protect both residents and staff. A requirement was made concerning this. Records of the testing of fire alarms and emergency lighting were seen and found to be satisfactory. Maintenance records for these facilities were also available. The fire officer had visited recently and was satisfied with fire arrangements in the home. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 19 Staff were receiving updates on Moving and Handling on the day of the inspection and evidence was available of staff induction using the TOPPS programme. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 20 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 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 2 2 3 x 3 3 2 2 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 3 x x 2 x x 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 21 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 Requirement All residents must have their weight monitored in order to identify any health issues relating to nutrition. Privacy screens must be provided in shared rooms in order to maintain residents dignity. All residents must be able to call for assistance when they are in bed. A plan of maintenance and redecoration must be submitted to the Commission for Social Care Inspection to address the shabby paintwork and décor in the home. Safe access must be provided to the outdoor space at the home, and attention must be paid to the maintenance of the garden. An alternative method of venting the tumble dryer must be found to remove the risk to the resident in the room affected by the vent, and to restore the view from her room. Repairs to the brickwork around this vent must be made. DS0000012910.V255259.R01.S.doc Timescale for action 01/11/05 2 OP10 12(4)a 01/11/05 3 4 OP10 OP19 13(1)b 23(2)b &d 01/11/05 14/11/05 5 OP19 23(2)o 01/12/05 6 OP19 16(2)j 14/11/05 The Shrubbery Version 5.0 Page 22 7 OP26 16(2)j 8 OP35 16(2)k The laundry area must be reorganised to remove the necessity of clean laundry being stored in the corridor. Records of resident pocket money accounts must be reviewed and systems put in place to include the provision of receipts for all transactions. 01/01/06 01/11/05 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 Refer to Standard OP21 OP7 Good Practice Recommendations It is recommended that bathrooms are made more homely in order to make them a more pleasant place in which to bathe. Evidence of resident or their advocate being involved in planning and reviewing care, should be available. The Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Shrubbery DS0000012910.V255259.R01.S.doc Version 5.0 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!