Inspection on 15/09/09 for The Shrubbery

This inspection was carried out on 15th September 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC 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 22/09/08

The Shrubbery 25/07/07

The Shrubbery 25/04/06

The Shrubbery 23/06/05

The Shrubbery 06/04/05

The Shrubbery 06/01/05

The Shrubbery 21/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE The Shrubbery 33 Woodgreen Road Wednesbury West Midlands WS10 9QS Lead Inspector Mandy Beck Key Unannounced Inspection 15th September 2009 09:00 DS0000004831.V377636.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Shrubbery Address 33 Woodgreen Road Wednesbury West Midlands WS10 9QS 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) 0121 556 8899 F/P 0121 556 8899 www.winchestercaregroup.co.uk Mr Avtar Singh Sandhu Mrs Amarjit Kaur Sandhu Manager post vacant Care Home 15 Category(ies) of Dementia (15) registration, with number of places The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE) The maximum number of service users who can be accommodated is: 15 22nd September 2008 Date of last inspection Brief Description of the Service: The home is situated on a main route between Wednesbury and the M6 and is easy to access by public transport and car. The facilities offered by Wednesbury town centre are also in easy reach. The house itself is a mature detached residence set in its own grounds and well screened from the road with ample off road car parking. The house has three floors, all accessible by lift. There are many pleasing period features that have been retained that add character and ambience to the home. The ground floor consists of two lounges, a quiet room, a dining room, one bedroom, bathroom, toilets and service areas (kitchen, laundry). The other two floors contain bedrooms, toilets and bath/shower rooms. The home has a range of adaptations that include bath hoists, grab rails, raised toilet seats; call system, although the home is not seen as suitable for people who are permanent wheelchair users. The range of fees the home charges for residency are not included in the service use guide. People are asked to contact the home directly for this information. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that people who use this service experience adequate quality outcomes. We looked at all the information that we have received, or asked for, since the last key inspection. This included: • The annual quality assurance assessment (AQAA) that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the home. • Information we have about how the home has managed any complaints. • What the home has told us about things that have happened in the home; these are called “notifications” and are a legal requirement. • The previous key inspection and the results of any other visits that we have made to the service in the last 12 months. • Relevant information from other organisations • We also spent time talking to the people who use the service and to the staff who support them. • We looked at the care of three people who use this service in depth. This is part of our case tracking process and helps us make judgements about the home’s abilities to meet people’s needs. What the service does well: People choosing to live in this home are supported by a friendly staff group who try hard to meet people’s needs. People told us “I have no concerns about the care my relative gets in this home, I have peace of mind”. The home is a pleasant place for people to live and there is a good sized garden for people to enjoy. What has improved since the last inspection? The home has improved the care planning system it had in place. The new system is based upon a person centred approach. This means a more individual approach to planning people’s care. This type of planning gives people the opportunity to discuss what they would like and how they would like to receive their care. The home does however need to improve upon the delivery of the people’s person centred plans. Current staffing levels in the home do mean that some aspects of people’s care are being met. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.2 Page 6 Medication practices have also improved. The home has better systems in place for the ordering, administration and safe storage of people’s medication. What they could do better: 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. The Shrubbery DS0000004831.V377636.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 Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3 and 6 People using the 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 choosing to live in this home have the information they need in order to make a choice about living there. People can be confident a full assessment of their needs will be completed before they are admitted. EVIDENCE: The home has both a Statement of Purpose and Service User Guide that give people some of the information they will need to know about the service the home provides. It does not include the range of fees people are expected to pay and the additional extras that will not be included in the weekly fee. The information on the home’s website does not include any details of the home’s registration for dementia care. This should also be given consideration. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 9 Before people agree to move into the home the manager will spend time with them completing an assessment of their needs. This is done to make sure the home is able to meet people’s needs and that it will be the right place for them. We looked at the needs assessments of four people during this inspection and found that each one had been completed and provided a sound basis for staff to be able to plan care for people. People choosing to live here are given ample opportunity to sample the service before they agree to move in. We were told that people are encouraged to spend time in the home on trial visits. One person told us “I had been to several places but chose this one”. The home does not provide intermediate care facilities at this time. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in this home can expect their physical health needs to be met. Staff struggle to meet people’s needs in relation to dementia care because of lack of resources. Medication practices have improved and some people did not have their medication as the doctor has prescribed it. EVIDENCE: All of the people whose care we case tracked had a plan of care that included information about their health, personal and social care needs. There was evidence that care plans included people’s choices such as time of getting up and going to bed and which gender of care staff they preferred to care for them. Care plans were very detailed about people’s choices, wishes and preferences for care. They also included details of what makes them upset and unhappy and the signs that staff should look out for. People we spoke to told The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 11 us “there isn’t enough staff on duty so that this happens, I know one person who gets really agitated but calms down if we sit by her and hold her hand. We can’t do this all of the time and she gets worse”, another person said “I am very pleased with the care my wife gets at this home”. Each person is assessed for their risk of developing pressure sores, of falling, moving and handling, and malnutrition. Once a risk has been identified the home will then draw up a plan of care to show how they intend to reduce the risk to people. In addition to this the home is supported by the district nursing service that will visit people at the home and provide them with specialist equipment for pressure area relief for example. People have access to and are seen regularly by a range of health professionals opticians, chiropodists, dentists and when they are ill staff ensure that their Doctor is called to arrange for a visit. Relatives also confirmed that this is case by telling us “When my mother has needed a doctor or needed to go into hospital they have arranged it and kept us well informed”. They also said “Staff are always available and checking on them regularly” and “the care and support seems very satisfactory”. Medication practices have improved since our last inspection. We have seen the home has systems in place for ordering, administration and return of medication. We have found that further improvements are still needed. We have made requirements and recommendations in order for this to happen. For example staff need to make sure they record the actual amount of medication they give when a variable dose has been prescribed. This will give a clearer picture of the amount of medication people are taking. We also noted the supplying pharmacy had not supplied eye drops for one person as part of the monthly medication delivery. Staff had recognised this and has contacted the pharmacy however the eye drops had still not been delivered to the home after fourteen days. This means the person had not had their medication for this length of time. The home was asked to contact the pharmacist again and make sure the medication was delivered. We saw staff talking to people throughout this inspection in a polite and courteous manner. People we spoke to said, “they are kind to us”, “they help me but I would like to go out now and again”. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People using the 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 home does not support all of the people living here in leading an active life. There are few activities for people to take part in. Mealtimes are a relaxed occasion and people will be supported as needed. EVIDENCE: The home’s service user guide states “the Shrubbery believes that social contact is a crucial part of living a fulfilled and healthy life, the home is able to provide a variety of ways people engage in the enjoyment of social activities, hobbies, leisure interests such as bingo and entertainment... activities are designed for people with dementia staff will undertake comprehensive activity training that specialises in person centred care and reminiscence”. The home does make some provision for activity. There are regular trips out on Fridays to the local pub for lunch and once a week staff use their own time to take people to church. The home told us in the AQAA they have “increased the level of activity outside of the home including weekly outings for a pub The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 13 lunch and weekly afternoon outings to a local club”. We have received a variety of comments from people living in the home and from staff. These include “I wish there was more to do”, “it would be nice if we had more staff to spend time doing activity with people because then I think they wouldn’t get so bored”, “there needs to be more money into the home for outdoor seating and to make the home cosier for us”, “It would be nice if they could go out to the shops something different than sitting in the home day after day”. We also spoke to the responsible individual for the service who told us “we have considered this but if we put extra staff on duty it would be a cost the company couldn’t afford”. When we looked in people’s care records we could not find evidence that any activities were taking place in order to keep people occupied throughout the day or to involve them in daily routines to keep them active. People’s care plans clearly detail the need for social activity and occupation. We also spoke to staff and looked at training records both confirmed that no specialist training had taken place in relation to activities for people with dementia. The home must consider further improvements in relation to activity for people to take part in. The home does encourage people to have visitors when they want them. People can choose to see people in their own rooms if they want privacy. The home does not place restrictions on people visiting. We looked at some people’s bedrooms as part of our case tracking process and found they had been personalised with pictures and ornaments from home. Meal times in the home are a relaxed occasion. We saw people eating breakfast and dinner during this inspection. Each time the dining room tables were laid and people were assisted as needed. The home operates an eight weekly menu and offers a choice to people each meal. One person told us “the food is very nice there is a lot of choice”, another person told us “I would like to see more choice but I am happy with what I get”. We saw people were being given their meals on tea plates rather than a standard dinner plate. We asked why this happening, staff said “if we give them dinner on big plates they were leaving it but the small plates seem to help with this”. We noted that whilst this may be the case the portions of food given to people were also smaller so that food would fit onto the smaller plate. The home will need to monitor this situation to make sure that people’s weight is not going to be affected by reduced portion size. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People’s concerns will be listened to and acted upon. Staff need training in safeguarding vulnerable adults and the deprivation of liberty safeguards if people are to be protected from harm. EVIDENCE: The home has a complaints policy that is available to all people. A copy of the complaints policy is in the service user guide. The home has told us they have received no complaints since our last visit. We spoke to visitors during this inspection who told us they had no concerns and they knew who to speak to if they were unhappy about anything. All of the people who answered our surveys told us they know who to talk to if the were unhappy about any aspect of their care. The home has policies in place for dealing with allegations of abuse and keeping people safe from harm. We call this safeguarding vulnerable adults. We spoke to staff about this. All of the staff we spoke to were able to tell us what different types of abuse there were and how they would recognise the signs of abuse. Generally most of the staff knew who to refer to if an allegation was made to them or they had witnessed an act of abuse. Not all of The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 15 the staff has had training in safeguarding vulnerable adults and the home will need to make sure this happens. We also talked to staff about their knowledge of the Mental Capacity Act 2005 and the deprivation of liberty safeguards. We did this because we wanted to know if staff were aware of what the implications for practice this legislation has. Staff need to be able to understand what a deprivation of liberty is so that they can take action to prevent it from happening or to take steps to protect the people in their care. Staff told us they had not had any training in this and were not aware of what it meant. We looked at recruitment practices and found the home is taking steps to prevent unsuitable people from working with vulnerable adults. This includes required checks against the Protection of Vulnerable Adults list (PoVA) and a Criminal Records Bureau disclosure (CRB). The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a home that is adequately maintained and is clean. EVIDENCE: We looked at most of the home during this inspection. We found on the whole the home is clean and free from offensive odours. There are areas for improvement and the home will need to take action to make sure these are addressed. We saw on the first floor, three people’s bedrooms had windows screwed shut. We have asked the home to contact the fire officer to make sure that they are happy with this arrangement. People must be able to get out the building in the event of fire, screwing windows shut does not enable this and could be potentially dangerous. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 17 In another bedroom we saw the wallpaper on the ceiling is peeling off, the home will need to address this and also take steps to remove the stale odour in this room. The communal areas downstairs are welcoming and people said they liked living there. One person told us “I have been here that long now it does feel like home to me”. There are two lounges downstairs for people to use. The dining room is located at the rear of the home and was pleasant to look at and offered a relaxing place for people to eat their meals. The home will need to take action with the frayed carpet in the doorway of the dining as it could pose a trip hazard to people living in the home. There is a garden at the back of the home which can be accessed by all of the people living in the home. We noted that the fencing which provides some security to the garden was in need of repair. We were also told the gate to the side of the home was not secure. One person said “I wouldn’t want to be here at night I wouldn’t feel safe”. This information was shared with the provider who told us the problem with the gate and the fence was due to be sorted out in the very near future. Throughout the home their are suitable bathing and toilet facilities for people to use. All of the bathrooms we looked at were clean and pleasantly decorated. We saw liquid soap and paper towels available for staff to use. This will help reduce the risk of cross infection happening between people. The home has laundry facilities on site and they are sufficient in meeting the needs of the people living here. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staffing levels do not support people’s need for social interaction and specialised activity in relation to dementia. The home does take steps to recruit people safely and make sure that unsuitable workers are prevented from working with vulnerable adults. Staff training could be improved upon so that staff are kept up to date with current best practice. EVIDENCE: The home is staffed with three carers in a morning, two carers in the afternoon and night-time. There is an additional worker employed from 16:00hrs to 19:00hrs. This person will work in the kitchen preparing people’s tea and doing domestic chores where needed. The staff told us that there is no regular domestic cover for the home and at times they are expected to cover these duties as well. The home does employ a domestic staff member. Staff have commented “it would be nice if we had the staff to be able to take people out more often”; “once people come in here they rarely see the light of day again”. Others said “we feel undervalued and underpaid at times, what we say doesn’t count”. We were also told “when people need one to one care they The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 19 can’t have it because there is only two of us on duty, one can’t meet everybody else’s needs while we do one to one.” We saw evidence in people’s care files that showed us there is very little in the way of activities being undertaken in the home. The people who are more able tend to be the ones who go out more. One person told us “they are easier to manage that’s why, the others have to stay in and there not a lot going on”. We have expressed our concerns about the reduced staffing levels to the provider of the home and have asked them to review the situation. The service is not meeting people’s need for socialisation and recreation with their current levels and only basic care is being given by staff. We looked at staff training and recruitment. We found that all of the care staff had completed their National Vocational Qualification level 2 (NVQ). However other training such as safeguarding of vulnerable adults, infection control, health and safety, food hygiene and first aid were not as up to date as they should be. The provider has told us that this training is due to start this month for all staff and should be up to date by October 2009. We looked at recruitment practices in the home. We saw four staff files and found them to be satisfactory, with the home taking the required precautions and safety checks to prevent unsuitable workers from working with vulnerable adults. Each new worker is supported through an induction that meets the Skills for Care induction standards and give new workers a basic introduction to social care. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People using the 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 home is without a manager and current arrangements mean that people’s needs are not always being met. EVIDENCE: The home currently has no registered manager. The providers have told us they are in the process of recruiting a new manager and they hope to have someone in post within three months. We will require the home to put forward a manager for registration. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 21 The home does have a quality assurance system in place. They have recently surveyed people living in the home but as yet they have not produced an action plan to show how they are going to address the comments made. We made a note of the comments which included, “I would like more opportunities for my mum to undertake activities, she seems bored, if she has been out I would like to know so that I know these things are happening. Mum is very active and needs to occupied more”. “Also wasn’t the building supposed to be refurbished in April 09. It would be good if relatives have more access to a newsletter to put us in the picture”. “The residents are being taken out more now and the manager is trying to get more exercise and physical activities for the residents so we are happier more is being done”. “Concerned that the gate is not locked at the side of the building”. “I am pleased with the quality of care which our mother is receiving and also with the way we are welcome to visit as often as we like.” The quality assurance system will need to be improved upon so that shortfalls in practice can be addressed. The home did send us the AQAA when we requested it and it gave us a reasonable picture of the current situation within the service. The AQAA gives us limited information about the areas the home still needs to improve upon and this will need to be developed. The home will also need to develop staff understanding of the Mental Capacity Act 2005 and the deprivation of liberty safeguard. There are no clear policies and procedures in place for staff to follow. When we spoke to staff they did not know about the Mental Capacity Act and the deprivation of liberty safeguard. The home needs to look at the activity provision in place for people and how it supports people’s need for social interaction. We were told at this inspection supplying an extra member of staff so that people could have a more active life would mean the business may not be financially viable. The home will need to seriously consider these options in the best interests of the people living in the home. The home does have suitable arrangements in place to deal with people’s money. The home will keep only personal allowances for people and they obtain receipts and signatures for all transactions made. We looked at the health and safety arrangements in the home and found that routine maintenance and servicing of equipment is being kept up to date. We noted that staff training however is “hit and miss” and needs to be addressed by the home so that staff are kept up to date with current best practice. The The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 22 provider told us during this inspection that training was due to begin again later this month (September 2009) for all staff. The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 23 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 X X 2 The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 24 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 The home must make sure when risk assessments clearly show that weekly weights are recorded for people this is done. This will help the home manage the risk of unplanned weight loss/gain for people living in the home. The home must make sure that people’s medication is available in the home for them to take as it has been prescribed. The home must make sure that two staff sign handwritten entries on the MAR sheet. Timescale for action 30/12/09 2 OP9 13 30/12/09 3 OP9 13 30/12/09 4 OP9 13 This will reduce the risk of errors occurring in transcribing and reduce risk to people living in the home. The home must make sure that 30/12/09 when a variable dose of medication is prescribed for people, staff record the dose that has been administered. This will help the home keep The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 25 5 OP12 12 track of what medication people have been taking. The home must make sure that all people’s need for socialisation, activity and inclusion is addressed. The home must make sure that all staff understand their roles and responsibility in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. They must do this so people’s liberty is not restricted inappropriately. The home must make sure they have the written approval of the fire officer for sealing windows shut with screws. 30/12/09 6 OP18 13 30/12/09 7 OP19 16 30/09/09 8 OP31 8 They must do this so they can be sure people in the home are not being placed at risk. A manager must be appointed 30/11/09 for the home. 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 OP1 Good Practice Recommendations The statement of purpose and service user guide should include the range of fees that people are expected to pay for residency. This will help give people the information they need when making a decision about living in the home. A system should be introduced to ensure that accurate medicine audits can be done, these checking that people DS0000004831.V377636.R01.S.doc Version 5.3 Page 26 2 OP9 The Shrubbery who use the service have been administered medication according to the directions of a General Practitioner. This recommendation has not been addressed. 3 OP12 The home should make sure that all staff receive the training in specialised activities for people with dementia as outlined in their own statement of purpose. The registered provider should progress the development of activities that provides people with daily stimulation, and involves community contact, this in accordance with people’s expressed wishes. This recommendation has not been addressed and was made during our last inspection. The home should keep under review the use of small tea plates for people’s meals, this should also include a regular review of people’s weight to make sure there is no unplanned weight loss as a result of this practice. The registered provider needs to ensure that any disclaimers signed are fully completed prior to signing so there is no doubt as to exactly what limitations are placed on residents, with clear reasoning as to why in care plans or risk assessments. This is necessary to ensure that any limitations are appropriate, measured, fair and agreed with residents. 7 OP30 The home should ensure that the homes training plan is up to date and planned training is clearly evidenced on said plan, this so the home is better able to evidence that staff are trained in accordance with the needs of the people living there. The home needs to develop the quality assurance system so that shortfalls in practice can be identified and actioned. The home must make sure the heated food trolley is repaired so meals can be kept hot when transported to the dining room. This recommendation has not been addressed the heated food trolley was not working properly during our inspection. 4 OP12 5 OP15 6 OP17 8 9 OP33 OP38 The Shrubbery DS0000004831.V377636.R01.S.doc Version 5.3 Page 27 Care Quality Commission Care Quality Commission West Midlands Region Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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. 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