Inspection on 11/09/08 for The Shrubbery

This inspection was carried out on 11th September 2008.

CSCI found this care home to be providing an Adequate service.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Shrubbery 10/10/07

The Shrubbery 03/05/07

The Shrubbery 12/05/06

The Shrubbery 11/10/05

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 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Shrubbery 66 College Street Higham Ferrers Northants NN10 8DZ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Judith Roan     Date: 1 1 0 9 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: The Shrubbery 66 College Street Higham Ferrers Northants NN10 8DZ 01933317380 01933317380 claire@rochmills.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Natalia Emilia Mychajlyszyn Type of registration: Number of places registered: Rochmills Limited care home 45 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Service users accommodated within the MD(E) category should only be admitted to the Churchill Wing of The Shrubbery. The Shrubbery care home is registered to provide personal care for male and female service users whose primary needs fall within the following categories: Old age, not falling within any other category (OP) 18 Dementia - over the age of 65 years DE(E) 8 Physical disability - over the age of 65 years PD(E) 6 Mental disorder - excluding learning disability and dementia - over the age of 65 years MD(E) 13 The maximum number of persons to be accommodated at The Shrubbery is 45. Date of last inspection Brief description of the care home The Shrubbery situated in Higham Ferrers is near to local facilities and amenities including shops. There are public transport links to the neighbouring towns of Rushden Care Homes for Older People Page 4 of 27 8 0 0 Over 65 0 31 6 Brief description of the care home 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 or a history of mental health and 6 with a physical disability. Accommodation 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. There are 33 single rooms of which 29 have ensuite facilities and 6 double rooms with 3 of these being ensuite. Information about the home can be found in their Statement of Purpose and Service User Guide. Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience aqequate quality outcomes. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. This process considers the services capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was case tracking which involved selecting three people who use the service and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. Care Homes for Older People Page 6 of 27 The Inspector also received questionnaires completed by four relatives and one staff member. The questionnaires provided good feedback on the quality of care service. The homes registered manager also completed an Annual Quality Assurance Assessment (AQAA) a questionnaire required to be completed by CSCI. The inspection was unannounced and was undertaken during the morning and afternoon lasted 7 Hours. Fee levels are from 341.55 to 464.00 What the care home does well: What has improved since the last inspection? What they could do better: A controlled medication cabinet should be installed in a locked storage area to comply with new legal requirements. The Registered Manager must submit a management plan of how the refurbishment within the home is completed, that shows how people using the service are to be supported during the period of the work and what steps are being taken to minimise the disruption for them. The Registered Manager must also provide evidence that they have sought advice and approval from the Fire Safety and Environmental Officers those temporary arrangements for access to the home and the facilities are safe. Staff must be updated with changes to emergency exit procedures and routes during the refurbishment. The Registered manager must submit to the CSCI how staffing levels have been determined in relation to the dependency levels of people who use the service. One Care Homes for Older People Page 8 of 27 relative commented that My perception is that staffing levels are low and that Staff are always busy. All care staff must receive training in Mental Health & dementia care to be competent in meeting the needs of residents cared for at the home. Sufficient numbers of assisted bathing areas should be provided to meet the identified needs of people resident at the home. The refurbishment plans need to reflect the bathing preferences of people presently using the service and in the future. Staff must receive formal supervision at least six times a year. Activities need to be based on individual personal preferences, social histories and be person centred. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admissions process ensures that assessed needs can be met within the home. Evidence: The statement of purpose and service users guide has been reviewed and updated to ensure that information remains current. These documents tell the reader clearly about the service available. The terms and conditions of residing at the home are contained in the contract that is issued to all residents and their families. People who replied in the surveys confirmed that they receive a service users guide. The AQAA states that Copies of our service user guide are available on request, we do have one on display at reception. Presently the refurbishment at the homes makes this difficult to achieve as the home is without a designated reception area. Care Homes for Older People Page 11 of 27 Evidence: People who are looking to use the service and relatives are given a choice of rooms available when they are viewing. Individuals are aware they are able to visit at any reasonable time to view. Assessments are completed prior to admission and care staff confirmed that they now receive more information that is accurate. In reviewing files it was clear that assessments had been completed and that all people using the service had a contract. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are person centred and demonstrate how the needs of people using the service are met. Evidence: Care plans record all the information necessary to meet the needs of people who use the service. The plans have improved significantly since the last inspection. The appointment of a new team leader to oversee this task will maintain quality in this outcome area. The AQAA states that developments in this area have improved the care plans but further improvements are required and will be met by further training for team leaders and senior staff in respect of report writing and the use of more appropriate terminology. The manager has clearly identified the challenges for the future and how improvements can be maintined by training for the staff team to recognise that report writing, documentation and the completion of the care plans is as important as the actual care the clients receive in respect of fulfilling standards. To meet targets for Care Homes for Older People Page 13 of 27 Evidence: new people being admitted to the home care plans are completed within 14 days and all staff are responsible not just the individual who undertakes the admission. Risk assessments are now in place and support the care plan in meeting individuals assessed needs. It was evident that manual handling assessments had been completed and in use for those people case tracked. However in observation of care staff supporting one individual they were not taking notice of their wishes not to be transferred. In discussion with the manager it was agreed that a review of how the persons wishes could be acheived and still take into account their healthcare needs in relation to pressure area care needs would be undertaken. Nutritional and fall assessments are now in place and ensure that protections are in place to minimise risks. During the inspection the inspector observed carers to be responsive to the needs of people living in the home. Carers communicate well with people using the service and maintain communication links about the well being with relatives. Administration of medication within the home is safe. On the files viewed profiles were evident and indicated the reasons for the medication. The homes manager needs to ensure that they comply with the new medication regulations in relation to the storage of controlled drugs that came into force in 2007. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Not everyone who uses the service has their needs met within the planned activities at the home. Evidence: There is a range of activities at the home but it is recognised by the manager that more could be achieved. We need to provide more activities for our clients with profound dementia and those with mental disorders. This requires more time for dedicated activities and training of staff to understand the needs of clients with dementia and mental health issues. Families are made to feel welcome at the home and are always kept up to date with changes in needs of their family member. There are no restrictions on times that families/friends can visit. Some people using the service said that they were assisted to make choices during their day and felt that their preferences were respected others were not so happy. The main meal served on the day of the inspections was well presented and Care Homes for Older People Page 15 of 27 Evidence: appetising. Individuals are consulted each day as to their choice from the menu. People who had difficulty with eating were supported individually. At teatime there is a choice of sandwiches or a hot option. On the day of the inspection the builders who are carrying out the refurbishment at the home accidentally ruptured the gas main. Carers acted positively to ensure that the teatime needs were met. Drinks are freely available throughout the day. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People using the service are protected by the policies and practices at the home. Evidence: People who use the service and their relatives are fully aware of how to have their concerns/complaints addressed. Relatives completing the surveys confirmed that they would be confident that concerns would be addressed. Carers have undertaken safeguarding/ abuse training and knew the whistle blowing procedures if a person using the service was at risk or being harmed. The robust recruitment practices protect people using the service There have been ten formal complaints received since the last inspection. All of these have been resolved to the satisfaction of the complaint. Care Homes for Older People Page 17 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The refurbishment programme at the home needs to ensure that safety is maintained to an acceptable standard. Evidence: On the day of the inspection the home was operating under difficult conditions with managing the refurbishment programme. The Registered manager is therefore required to submit a plan of how the remainder of the work is to be completed ensuring that the safety of people using the service is maintained. Access points needs to be kept clear and meet safety regulations. The Registered manager needs to seek the views of the Fire and environmental officers to ensure that future work does not compromise safety for people living at the home. General maintenance has improved and mandatory safety checks are being carried out. The provider has not addressed the requirement made at the last inspection in that there is only one operational bathroom offering lifting equipment to support people with bathing. In discussion with the manager concerns were shared that the refurbishment will remove assisted bathing facilities and replace these with wet rooms. The provider must undertake a review of the preferences of people using the service Care Homes for Older People Page 18 of 27 Evidence: as to their choice of bathing so that facilities are available according to their preferences. Care Homes for Older People Page 19 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures ensure that residents are protected, but additional training needs to underpin care practices. Evidence: The self-assessment undertaken by the registered manager during the monthly residential forum review indicates that staffing levels are still not at the levels needed to meet the identified needs of people using the service. The AQAA states that the service could do better if the provider reviewed staff levels. The rota clearly defines staff roles and the skill mix of the staff names on duty. Staff hours are also clearly stated and the AQAA confirms that More staff have been recruited, staff hours are within working time directives with staff receiving days off. Relatives stated that My perception is that staffing levels are low and that Staff are always busy. One person also said that There appears to be a shortage of qualified staff ,they also said that it would be helpful if information about the staff detailing their area of responsibility was displayed. The recruitment procedures at the home protect people using the service by taking full details within the application and undertaking required employment checks through references and criminal record bureau (CRB) disclosures. Protection of Vulnerable Care Homes for Older People Page 20 of 27 Evidence: adults confirmation is included within the CRB process. Mandatory staff training is maintained and staff files reviewed contained evidence that they had completed their in house training. Staff spoken with indicated that induction and basic training is completed. The AQAA confirms that further training is promoted and that of a care team of twenty seven twelve staff have completed NVQ 2, seven are undertaking NVQ 2 in care and five are undertaking NVQ 3 in care. In addition three non-care staff have completed NVQ 2 in food preparation and catering. The AQAA also states that more training is required for staff in the area of Dementia Care and mental health awareness to improve the service. In touring the building it was found that staff on duty were not fully aware of the emergency procedures in operating a fire door that is locked for security with an access key stored close by. The manager arranged for a notice to be placed to inform people of the procedure and agreed to inform all staff. Keeping staff up to date with all the emergency arrangements in a constantly changing environment is particularly important to ensure that people using the service are safe. Care Homes for Older People Page 21 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is not always managed in the best interests of people using the service. Evidence: The AQAA confirms that a quality assurance system is in place with surveys being undertaken annually. The results being reflected in a development plan for the service. Surveys received from relatives confirm that they are consulted. Information is also gained from service user meetings held regularly throughout the year. Any issues that are highlighted are addressed and put into place as soon as is practicable. People spoken to during the inspection were able to confirm this and were happy that their views were being listened too. Relatives mainly support the people who use the service with their finances. In a few situations the homes administrator keeps valuables. There is a good recording system to protect people who use the service. Care Homes for Older People Page 22 of 27 Evidence: The manager ensures that important records relating to the well being of people who use the service are maintained by monitoring consistency and accuracy of records. However the manager must fulfil their duty in ensuring that notifications are sent to the CSCI when the well being of people who use the service are affected. Health and safety checks are now maintained and full records are kept. The manager must ensure that throughout the refurbishment, that all changes in emergency procedures are relayed to staff. The refurbishment programme is not always managed in the best interests of people using the service and there needs to be more consideration of how people are moved within the building and the timescales in which this happens to minimise the disruption and affect on their well being. A system of staff supervision has been set up but not yet implemented. A requirement is made to ensure that staff have the opportunity to discuss their work and development. Care Homes for Older People Page 23 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action 1 21 23 Sufficient numbers of 31/12/2007 assisted bathing areas should be provided to meet the identified needs of people resident at the home The Registered manager 30/11/2007 must submit to the CSCI how staffing levels have been determined in relation to the dependency levels of people who use the service. Care staff must receive training in Mental Health & dementia care to be competent in meeting the needs of residents cared for at the home. Previous timescale of 01/09/07 not fully met. 31/12/2007 2 27 18 3 30 18 (1) Care Homes for Older People Page 24 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 10 13 The registered persons must 30/01/2009 have a controlled medication cabinet installed in a locked storage area. To comply with new legal requirements in relation to medication storage. 2 14 16 Individual care plans need to 31/12/2008 reflect the personal choices in relation to their chosen lifestyle. That people using the service choices of how they spend their day are respected. 3 19 23 The Registered manager is required to submit a plan of how the refurbishment works at the home is to be completed. To ensure that the safety of people using the service is maintained. 31/10/2008 Care Homes for Older People Page 25 of 27 4 30 12 Staff must have health and safety training updated to meet the changing needs of the environment at the home. Staff need to know about changes to emergency exit procedures and routes to ensure that people using the service are safe. 31/10/2008 5 36 18 Staff should receive the required level of supervision To ensure that they are supported and developed to improve the quality of the service. 31/12/2008 6 38 37 The manager must fulfil their duty in ensuring that notifications are sent to the CSCI when the well being of people who use the service are affected To ensure that health and safety procedures are implemented and protect people using the service. 31/10/2008 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 12 Activities need to be based on individual personal preferences, social histories and be person centred. Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - 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!