Care Home: Shakespeare House

What the care home does well People have a comfortable well maintained home to live in and have private accommodation, which they have made their own. We were told that routines are very flexible and " Mrs Howes discusses things with us and we have meetings." The manager wants to make sure that people who come to live at the home receive the care that they require and so ensures that people`s needs are assessed prior to them moving into the home.There are plenty of opportunities for people to feel part of the local community and live a meaningful lifestyle. What has improved since the last inspection? Care plans are now in a new format and have been expanded to show clear strategies to demonstrate how support is provided to meet people`s needs and show the changing needs of people. Risk assessments have been carried out for individuals so that they are safe at home and in the community. Since our last visit to Shakespeare House the bathroom in use by service users had been refurbished into a walk in shower room. Bedrooms have been redecorated and new furniture purchased for some rooms. The laundry room has been redecorated and a new washing machine purchased. The homes kitchen has been refurbished and touch free antibacterial foam soap dispenser has been installed for use by staff. A new system for carrying out checks and recording fire alarm system testing is now in place and staff have had fire emergency training. Staff training has improved and further training is planned. CARE HOME ADULTS 18-65 Shakespeare House 34 Pier Road Littlehampton West Sussex BN17 5LW Lead Inspector Diane Peel Unannounced Inspection 2nd June 2008 10:00 Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shakespeare House Address 34 Pier Road Littlehampton West Sussex BN17 5LW 01903 723164 F/P01903 723164 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) Mrs Susan Elizabeth Howes Mrs Susan Elizabeth Howes Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (2), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (1) Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Only service users in the MD (mental disorder, past or present) category under 65 years may be admitted to the home. 28th June 2007 Date of last inspection Brief Description of the Service: Shakespeare House is a care home registered to accommodate up to 3 residents in the category of younger adults, with an additional condition that 1 of the residents could be in the category of older persons. It is a three storey terraced property located in Littlehampton, near to the river and the sea. The service is owned and managed by Mrs. Susan Howes. The current week fee to live in this home is £303.00 to £425.00 per week. Shakespeare House DS0000014712.V365549.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 2 stars. This means the people who use this service experience good quality outcomes. This unannounced visit to Shakespeare House was carried out by Mrs Diane Peel on the 2nd June 2008. During this visit the intended outcomes for 34 standards were assessed; these included the key standards for care homes providing a service to younger adults The Annual Quality Assurance Assessment (AQAA) was returned to The Commission for Social Care Inspection (CSCI) prior to this visit to the home and this was used to address areas of improvements with the manager. On the day of our visit two people were recorded as living at the home but on the day of our visit one person was in hospital. During the course of the visit we met with the one person present at the home to discuss their experiences of living at Shakespeare House and had a further telephone conversation with this person after the visit. A case tracking exercise for this person was undertaken to look at how the assessed needs of this person were being met. We looked at other records in the home at random to make sure that the homes record keeping and working practices promote and protect people living at the home. What the service does well: People have a comfortable well maintained home to live in and have private accommodation, which they have made their own. We were told that routines are very flexible and “ Mrs Howes discusses things with us and we have meetings.” The manager wants to make sure that people who come to live at the home receive the care that they require and so ensures that people’s needs are assessed prior to them moving into the home. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 6 There are plenty of opportunities for people to feel part of the local community and live a meaningful lifestyle. What has improved since the last inspection? What they could do better: To ensure that people living at the home are fully protected all people employed to work at the home must have a CRB and POVA Disclosure carried out by their current employer. Mrs Howes is aware that she should ensure that arrangements for storing controlled medication meet the Misuse of Drugs Regulations, which were amended in 2007. Please contact the provider for advice of actions taken in response to this Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who come to live at the home only move in after a needs assessment has been carried out and people are encouraged to visit the home to try out the service before they make a decision about if it can meet their needs. EVIDENCE: During our visit we met with a person who had moved into the home last year. They told us about how they had visited Shakespeare House and other homes in the area before moving in to Shakespeare House. They had chosen it because they liked their independence and the information, which they had about the home seemed to promote independence. We spoke to the manager about the process of moving into Shakespeare House and she told us about a person who was due to come to live at the home. She showed us the assessment, which she has carried out during this persons visit to Shakespeare House to have a look around. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Shakespeare House have a care plan, which reflects their needs and choices so that they can retain their independence and have opportunities to develop new skills. EVIDENCE: At the time of the visit there were two people living at the home, one was in hospital. Both people living at Shakespeare House had a care plan and we looked at one to see how the plan had been developed to meet this persons needs and then spoke with this person about the level of support, which they needed. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 11 The plans are now in a new format and have been expanded to show clear strategies to demonstrate how support is provided to meet people’s needs and show the changing needs of people. The person living at Shakespeare House who we spoke with during our visit told us that they felt very well supported and lived as part of a family. This person told us that they have a file in their room containing information about the service. They told us that they had a weekly timetable “which I don’t have to stick to”. We saw this on the wall in this person’s bedroom when they invited us in to look around and it was observed to include structured activities as well as flexible time. The manager showed us a book, which she keeps recording all meeting with people who live at the home to demonstrate that they are involved in making decisions about their lives. Examples of this were discussing trips out, arranging to go for meals in restaurants and discussion about what people wanted for their meals and the continuation of having a chair lift in the home when it hadn’t been used recently. At the last visit to the home in June 2007 we asked the manager to undertake risk assessments to keep people safe in areas such as fire safety, vulnerability in the community and medication. Since our last visit this has been carried out and people now have risk assessments included in their care records. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15,16,17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People are supported to take part in appropriate activities, be part of the community and develop social and independent living skills so that they can live a fulfilling lifestyle. EVIDENCE: The care plan, which we saw for the one person living at the home, present on the day of our visit described what regular organised activities this person, took part in. This included attendance at a day centre two to three times a week. This person told us that they took part in cooking and crafts at the centre and showed us a certificate, which they had recently got for cooking skills. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 13 During our visit this person went out shopping to the local shops and on their return showed us clothing which they purchased as a gift for a friend. This person told us that Mrs Howes helps them with their budgeting and we saw this as a assessed need in this persons care plan. They told us about the mobile telephone, which they had recently got, the bus pass which they used to go shopping in other towns and about being able to go out for meals with the family to local restaurants. The manager also told us that she was looking into poetry reading, which the person living at Shakespeare House confirmed they were very interested in because they liked reading. Records of meeting with people who live at the home showed that they are involved in deciding how they spend their leisure time and record small group outing. On the day of our visit the kitchen was not in use to cook a main meal of the day due to a flood of the lower part of the building. We were told by the manager that snacks and breakfast were being prepared but take away meals, meals at a local restaurant and meals from outside caterers were being provided until the area had dried out and was safe. When we spoke to the person living at Shakespeare House they had accepted this arrangement and looked forward to eating out and having take a way meals. We were told that the environmental health officer had been to the home and agreed the arrangements for use of the kitchen. At lunchtime we heard this person asked what they would like for lunch and they chose a sandwich and they had previously told us that if they went out for the day they could ask for a packed lunch to take with them. The staff keep a record of what meals are provided and a list of each persons likes and dislikes which we saw on the day of our visit. A lounge/dining room is available on the first floor but we were told that both people currently living at the home choose to eat their meals in their own private accommodation. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18.19.20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for people’s healthcare needs are in place so that people know that their health is being monitored and their medication is being managed appropriately. EVIDENCE: The care plan, which we saw, recorded the arrangements for how people’s heath care needs were to be met. Care records also recorded visits to the GP and opticians and dentist and peoples weight. The person living at the home who spoke to us told us that “Mrs Howes makes appointments at the Doctors for me and I go on my own”. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 15 At the time of our visit one person was in hospital and the other person living at the home and staff had visited them. A monitored dosage system is being used at Shakespeare House and medication is stored in a secure metal cabinet. We looked at medication records during our visit, which were clear and completed up to the date of our visit. We also saw that the home has a controlled drugs book but as the person prescribed the medication was in hospital it hadn’t any entries for a few days. A medication returns book was also observed to be in use, which also recorded, returned controlled Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The welfare of people using the service are promoted and protected so that they can feel safe. EVIDENCE: Shakespeare House has a complaints procedure and we were told by the manager in the AQAA returned to us in May 2008 that no complaints had been received since our last visit to the home. The manager confirmed this information during our visit to the home. Both people living at the home who had returned the homes own quality assurance surveys reported that they knew who to speak to if they were not happy and that they knew how to make a complaint. The person we spoke with during our visit told us later in a telephone conversation that they had information about how to make a complaint if they had a complaint. We also saw a survey from a relative, which had been returned to the manager, which confirmed that they also knew how to make a complaint, but had not had to do so. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 17 During our visit to the home we observed that the home has a copy of the revised West Sussex Multi Agency Safe Guarding Adults procedures besides its own policies and procedures on safeguarding adults. Staff training records showed that both staff had attended safeguarding adults training. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service have a well maintained, comfortable home and so that they feel that their rooms are their own they are encouraged to individually personalise them. EVIDENCE: The people who use this service have private and communal on the ground floor and the upper floor of the property. The lower ground floor provides accommodation for the owner/manager and her family along with the kitchen, which is used to cook meals for the people using the service. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 19 During our visit we looked at the three bedrooms allocated for people who use the service. Those currently being used were observed to be well maintained and had been made homely by the people using them. Locks are fitted to the doors of private accommodation and people using the service have a key to both their own bedroom door and the external door to the property. The one vacant room had recently been redecorated and new furniture purchased in preparation for someone coming to live at the home. The communal lounge is homely and looks out over the river at Littlehampton. The person living at the home who was present during our visit told us how they likes to look see the river from both their own room and the lounge. Since our last visit to Shakespeare House the bathroom in use by service users had been refurbished into a walk in shower room. The manager told us that she had discussed the options for refurbishment with the people using the service before going ahead. The homes kitchen which is on the lower ground floor had also been refurbished since our last visit but there had been a flood the previous week which had put the kitchen out of use until it was dried out except for preparation of breakfasts and snacks. We were also told by the manager in the AQAA returned to us that the laundry room had been re-decorated and a new washing machine had been purchased. There is a stair lift to the upper floor, which we were told is being serviced on the 9th June 2008. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements to recruitment practices and training already being undertaken will ensure the protection of people living at the home. EVIDENCE: We were told by the manager prior to the visit to the service and during the visit that they only employ one member of staff to cover the times that they are away from the home. On the day of our visit we looked at the recruitment documentation for this person who had started work at the home at the end of January 2008. Although we were told that this person already had a Criminal record Bureau (CRB) and Protection of Vulnerable Adults (POVA) disclosure from previous employment and satisfactory references, which we saw during our visit, disclosures from the present employer were not available. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 21 We did see photocopies of the completed application forms for CRB and POVA disclosure, which had already been sent for processing in March 2008. Since our last visit to the home the manager has consulted with Skills for Care who sent a representative to the home to give advice about a training analysis. Both staff completed an analysis and devised an action plan for their learning and development. We saw these documents during our visit to the home and certificates of training attended since we last visited when a statutory requirement was made to improve staff training to meet the needs of people living at the home. Training undertaken included: safeguarding adults, moving and handling, health and safety and first aid. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management approach of the home ensures that people feel that they are involved in decisions made about everyday life in the home so that they experience a safe inclusive atmosphere. EVIDENCE: The manager, Mrs Howes also owns the service. Mrs Howes is currently undertaking her NVQ level 4 after the company who were assessing her Registered Manager award went into liquidation. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 23 She told us that another organisation have told her that she is unable to complete the Registered Managers award because she would not be able to demonstrate that she can manage more than one person. Records show that regular meetings take place to share information and the manager works directly with the people who live in the home everyday days. During our visit we saw the homes own satisfaction surveys, which showed that people were satisfied with the service. Since our last visit to the home Mrs Howes has engaged a consultant to carry out the fire risk assessment for the home, and fire training has taken taking place also with an outside trainer. Certificates of attendance were seen during our visit. The most recently employed person attended fire training on the 20th March 2008. The manager has told us that a new system for carrying out checks and recording of fire alarm system is now in place and fire-fighting equipment is now owned by the home and a contract of servicing agreed. Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 3 4 4 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 4 26 3 27 4 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 3 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 3 X X X 3 Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 25 No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Shakespeare House DS0000014712.V365549.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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