CARE HOMES FOR OLDER PEOPLE
The Shrubbery 66 College Street Higham Ferrers Northants NN10 8DZ
Lead Inspector Moira Mosley Unannounced 5th May 2005 10.00 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 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 Version 1.10 Page 3 SERVICE INFORMATION
Name of service The Shrubbery Address 66 College Street Higham Ferrers Northants NN10 8DZ 01933 317380 01933 317380 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Rochmills Limited Vacant Care Home 45 Category(ies) of OP Old Age (31) registration, with number DE Dementia (8) of places PD(E) Physical Disability - Over 65 (6) The Shrubbery Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 19th November 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 Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This statutory unannounced inspection took place over four hours. The care of two residents was reviewed and this included looking at their care plans and records including medication. Discussions were held with them and a further six residents in the home to find out how they felt about living in this home. In addition, four members of staff and a volunteer worker gave comments about working in the home. Communal areas of the home were seen including dining facilities and the kitchen and two resident bedrooms were viewed. The registered manager post is vacant with an acting manager in place from February 2005 who has applied for registration. What the service does well: What has improved since the last inspection?
A manager has been appointed, who has applied to the Commission for Social Care Inspection for registration. The management is proactive with clear leadership and direction being given to staff to ensure resident needs are being met.
The Shrubbery Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Shrubbery Version 1.10 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 Standards Statutory Requirements Identified During the Inspection The Shrubbery Version 1.10 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 standard(s) None of these standards were assessed on this inspection. EVIDENCE: The Shrubbery Version 1.10 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 standard(s) 7, 8, 9, 10 and 11. The residents are at risk of not having their needs met because care plans, healthcare assessments and medication records are insufficient to demonstrate action needed or to be taken by staff. EVIDENCE: The care plans did not contain sufficient information to direct staff in the care required. One resident was assessed as having dementia, was incontinent, needed staff for all personal care and was being nursed in bed. There were no care plans to instruct staff about any of these needs. Another resident had some care plans in place but the content was superficial for example in the communication plan it stated only that the resident needed to be encouraged to join in activities. Care plans were not regularly reviewed to reflect changes in resident needs. Healthcare assessments including nutritional and continence assessments were in place, however they were not reviewed regularly and where there was a cause for concern there was no evidence of action taken. One resident had a
The Shrubbery Version 1.10 Page 10 nutritional assessment identifying weight loss; however there was no clear record of weighing and no care plan for managing nutritional intake or referral to the GP or dietician for advice. There were no pressure ulcer risk assessments evident although one of the residents was clearly at risk, there was no care plan however a pressure relieving mattress was in use. There was no clear audit trail for the medication once it entered the home. One resident’s tablets showed a discrepancy of 9 tablets, the acting manager believes they may have been dispensed and then destroyed but there are no records to show this process. When medication is returned to the pharmacy there is no checking system to confirm what has been returned. The residents spoken to were very happy with the care they received and said the staff always respected their privacy and dignity when assisting them. Positive interactions were seen between staff and residents and some of the comments from residents included “they [staff] are very good” and “..so helpful and caring but very busy”. The care of one resident who was requiring terminal care was reviewed and it was clear that there was good liaison with healthcare professionals, including Macmillan nurses to ensure needs can be met and that families are fully involved and supported. However, as identified above the care plans did not fully support or direct the care that was being given. The Shrubbery Version 1.10 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 standard(s) 12, 13, 14 and 15. Daily activities and social interactions are well managed to provide residents with individual choices. A proactive strategy is in place to provide adequate nutrition for the residents. EVIDENCE: The residents said there were a range of activities including exercises and sing a longs that they enjoyed and there was a ‘Victory in Europe’ party arranged for that afternoon in the home. Three of the residents spoke about regular visitors in the home and that their families and friends were welcomed. Staff confirmed that it was a very busy home with lots of regular visitors, which the residents really enjoyed. One resident spoke about the choices she made in daily routines, for example when she got up in the morning, how she spent the day and what she wanted to eat. The lunchtime meal was served and most residents ate in the two dining rooms, with some choosing to have food in their bedrooms. All the residents spoke highly about the food and the kitchen staff confirmed that menus are
The Shrubbery Version 1.10 Page 12 available and they provide homemade meals with fresh vegetables and other local produce. It was identified that the kitchen staff had no training on producing specialised diets, especially in relation to nutritional content and food for people with dementia, the acting manager had identified a training course, and the staff were keen to take this up. The Shrubbery Version 1.10 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 standard(s) 16 and 17 There is an effective system for the home to respond appropriately to complaints and residents’ legal rights are protected. EVIDENCE: The complaints procedure was evident on notice boards and residents’ spoken to felt they could raise any concerns with the staff or the acting manager. All complaints are logged and detailed records maintained to show how these are dealt with and the outcome agreed with the complainant. On the day of the inspection, several residents were being supported to attend the local polling station to vote in the general election. The Shrubbery Version 1.10 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 standard(s) 19, 20 and 24 Residents are provided with safe and comfortable surroundings suitable for their needs however the lack of regular fire drills places the residents and staff at risk in the event of a fire. EVIDENCE: The communal lounges and dining rooms were clean and tidy with no hazards evident. The residents spoken to said they were happy with the facilities and furnishings in the home. The acting manager spoke about planned refurbishment and redecoration throughout the home in the coming months to update and improve the facilities for the residents. Resident bedrooms were personalised and equipment needed for their care was available. There is a maintenance person on site to ensure daily routine maintenance is kept up to date.
The Shrubbery Version 1.10 Page 15 The fire records showed routine checks on equipment but there was no evidence of recent fire drills, in addition, the passenger lift was out of order at the time of this inspection and these are discussed further within National Minimum Standard 38. The Shrubbery Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30. There is a pro-active management strategy in place to ensure staff are in sufficient numbers and suitably trained to meet resident needs. EVIDENCE: The staff rotas showed there were adequate numbers of staff on duty to meet resident needs, although the acting manager identified a need to review staffing as increasingly dependent residents were admitted. The training matrix showed that staff were receiving regular training including statutory training needs. There are currently 10 staff with a National Vocational Qualification (NVQ) at level 2 or above and there are plans in place to continue the progress towards the 50 of staff with a NVQ. Staff spoken to confirmed they had received an induction when they started employment at the home and there is The National Training Organisation for Social Care (TOPSS) induction process in place. The Shrubbery Version 1.10 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33 and 38. The health and safety of the residents is not being effectively managed to ensure their protection. EVIDENCE: Since the last inspection, a manager has been appointed and has applied to the Commission for Social Care Inspection for registration. The residents and staff spoken to confirmed that they were happy with how the home was being managed and felt able to contribute to the running of the home and that their feelings and comments were taken seriously. Regular resident meetings are held and minutes are posted on the notice board. The passenger lift had been broken for nearly a week. It was evident that appropriate action had been taken for its repair; however there was no clear risk assessment to ensure resident needs could be met. One resident identified
The Shrubbery Version 1.10 Page 18 had an inconsistent approach from staff towards his need to smoke and no definite plan been agreed. This potentially put him and other residents at risk. There was no evidence of regular fire drills and the requirement made at the last inspection has been restated with an agreed short timescale for compliance. The Shrubbery Version 1.10 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3
COMPLAINTS AND PROTECTION 2 3 x x x 3 x x STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x x 3 3 x x x x 1 The Shrubbery Version 1.10 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 38 Regulation 13(4)(c ) 17(2) Schedule 4 (14) and 23(4) 12(1)(a)( b) and 15 12(1)(a)( b) and 13(4)(c) 13(2) 17(1)(a) and schedule 3 (3)(i) 13(4) Requirement Timescale for action 01/06/05 2. 7 3. 8 4. 9 The frequency of fire drills must be agreed with the fire officer and detailed records of all drills kept. (previous timescale not met) A care plan must be developed 01/07/05 for all areas of need, be regularly reviewed and identify detailed action to be taken by staff. Healthcare assessments 01/07/05 including nutrition, pressure ulcer and continence must be completed and any action required clearly identified. A clear audit trail of all 01/07/05 medication in the home including disposal must be maintained. There must be a risk assessed plan in place to ensure residents safety during the breakdown of the passenger lift or any event that may adversely affect their health and safety. 01/06/05 5. 38 The Shrubbery Version 1.10 Page 21 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 Good Practice Recommendations The Shrubbery Version 1.10 Page 22 Commission for Social Care Inspection 1st Floor, Newland House Cambell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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