Care Home: Shalder House Extra Care

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What the care home does well People can be confident that their needs will be fully assessed by healthcare professionals and the home prior to staying. People are supported in a manner that enables them to maximise their independence so supporting them in being able to return home. There is a high emphasis on promoting the privacy and dignity of people. Individual wishes are taken into account so that people can be confident that their support is tailored to meet any diverse needs. People staying in the home are confident in the support provided by the care staff and management and stated that they felt well supported. What has improved since the last inspection? The induction programme for staff has been developed and expanded and supports staff in their role. The quality assurance records and monitoring processes have improved. What the care home could do better: Care plans and reviews would benefit from being set out separately so that they are easier for staff to access. There are some key areas of staff training that need addressing. Areas of the home would benefit from some refurbishment in accordance with Medway councils modernisations strategy. CARE HOMES FOR OLDER PEOPLE Shalder House Extra Care Shalder House Medway Road Gillingham Kent ME7 1NY Lead Inspector Anne Butts Unannounced Inspection 20th March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shalder House Extra Care DS0000035709.V359443.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 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. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shalder House Extra Care Address Shalder House Medway Road Gillingham Kent ME7 1NY 01634 852917 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) julie.morris@medway.gov.uk Medway Council Julie May Morris Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1. The registered person may provide the following catergory/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) 2. The maximum number of service users to be accommodated is fifteen Date of last inspection Brief Description of the Service: Shalder House is one of a number of homes managed by Medway Council Social Services. This service offers 24-hour care to people for the purpose of rehabilitation only and is a short-term stay. It is based within a sheltered housing complex also managed by Medway Council. The service is registered for 15 flats, although will only currently offer services for people up to the occupancy of 8 flats. Each flat comprises of a bed-sitting area, small kitchenette and an en-suite facility of a toilet and washbasin. There are communal bathroom, laundry and lounge facilities. There is an emergency call system in place and all flats have telephone and television points. There is a shaft lift access between floors. Parking is available on road or at the rear of the property. Shalder House Extra Care DS0000035709.V359443.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 star. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection that took place over the course of one day. Prior to the visit the home was required to complete and return an Annual Assessment Quality Assurance (AQAA), they did this within the required timescales. There were no surveys sent out as this home only offers shortterm rehabilitation care. People who were currently using the service were able to spend time talking to us and we were also able to talk to members of staff and a healthcare professional who supports the service. We also spent time looking at care plans, assessments and staff files. Judgements have been made with regards to each outcome area in this report, based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable The Commission for Social Care Inspection (CSCI) to be able to make an informed decision about each outcome area. Some judgements about quality of life and choices were taken from direct conversation with service users What the service does well: What has improved since the last inspection? The induction programme for staff has been developed and expanded and supports staff in their role. The quality assurance records and monitoring processes have improved. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Shalder House Extra Care DS0000035709.V359443.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 Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a comprehensive assessment of their needs prior to moving into the home to ensure their assessed needs can be met. EVIDENCE: The Statement of Purpose has recently been updated to reflect changes in the staffing structure of the service and the number of current intermediate care places offered. The current level of placements offered is eight. The Statement of Purpose clearly states the nature of the service offered and the support people can expect to receive. The home only supports people on a short term basis – providing rehabilitation support so enabling people to be able to return to their own homes. They are an interim service and support those who have been in hospital or cannot support themselves at home for particular reasons – but do not need Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 9 residential care. An average stay is approximately six weeks, although it is dependent on the needs and circumstances of the individual person. People are referred to the service via Care Managers. An assessment is then carried out by the Occupational Therapist or a nurse form the Rapid response team to make sure that the home can meet their needs. This is then supplemented by an assessment carried out by the home, they have a set criteria and will only accept people whose needs they can meet. Records show that people continue to be supported by Occupational Therapists and together with the support staff care plans are put in place to aid recovery and support their return home if appropriate. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from care plans that identify their needs, how to maximise their independence and are reviewed regularly. Subject to appropriate risk assessments people are responsible for their own medication and are protected by a safe Medication Administration System. Personal and healthcare support is offered in a way that promotes and protects people’s dignity and privacy. EVIDENCE: A review of the care plans and discussions with people evidenced that their individual needs are being met. Care plans are set up when someone moves in and then reviewed on a weekly basis. Care plans included risk assessments, likes and dislikes, mobility issues, communication, psychological support needed and nutrition. They gave guidance on how to support an individual Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 11 person in maximising their independence and are updated as people continue to improve. Care plans are supported by a pen portrait for individual people which gives an overview of what people can manage. The updates of care plans are, however, contained within the daily notes and this means that the information is not always readily available. We recommend that the care plan and ongoing updates be set out separately so that information is easily accessible for all staff. People are regularly assessed on their capabilities and the level of support is dependent on what they can manage. The emphasis is to promote independence so enabling people to move back home. Health care needs are well monitored with ongoing support from the occupational therapist and the rapid response team. The occupational therapists visit on a regular basis and instruct the home on the support needed. If there any other needs such as nutritional then a referral is made to the appropriate healthcare professional. The home sets goals in agreement with people and if for any reason they are unable to meet a particular goal then these are reviewed, and additional support or advice is sought. People are supported with their medication in accordance with their individual needs. They are supported with a risk assessment when they first move in to assess how they manage their medication. As people’s independence increases then the support is tailored accordingly and people are promoted in self-management. There are Medication Administration Record (MAR) sheets maintained in the individual rooms. All rooms have individual lockable cupboards for medication. People confirmed that they are assisted with selfmedication. One lady told us that when she first moved in that they “sorted out my pills and now they only check to make sure I have taken them – I couldn’t have managed it without their support”. Everyone has their own flat with their own front door. We saw that staff always knocked on the door before entering and people confirmed that they respected their privacy. Comments included: “I have been thoroughly spoilt and I want to take the staff home with me. I didn’t realise such a nice place existed”. “They are absolutely wonderful – so kind and polite”. “They are always very cheerful and kind – they have respected me and treated me with dignity”. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a service that matches their expectations and preferences and they are encouraged to exercise control and choice over their lives. People benefit from having individually planned meals, which they have chosen and if appropriate have shopped for and cooked for themselves. EVIDENCE: We spoke to people who were currently staying in the home. They all confirmed that they were very happy with the service provided and that activities were organised that suited their needs. This included staff spending time on a one-to-one basis or organised activities. One person said “They arrange quizzes and games – they have brought me in jigsaws – I have been able to bring any of my own possessions”. People are supported in going out and about so that they can gradually building up their confidence and independence. One lady told us how they went to the local shops with her or escorted her to visit her G.P. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 13 Another lady told us “When I first moved in I couldn’t do a lot for myself – they helped me to start to cook and do my washing again – they have really built up my confidence. Now I can do all the things again for myself that I used to be to do”. Family and friends are encouraged to visit and made welcome at any time. People are supported with making their own choices and are able to bring in their own possessions. One lady told us “I am able to do what I want and I know that staff are just round the corner if I need them”. Much of the support provided is about boosting people’s confidence and assisting them to be able to manage at home. People confirmed that staff supported them in this. We were told by one lady “they have helped me to be able to go back home – I wouldn’t be able to do that without them”. People are supported to buy, choose and cook their own food at Shalder House. This is an integral part of the rehabilitation that is carried out. If people can’t physically go out and shop then staff will do this on their behalf. Each flat has its own kitchenette, which includes a cooker microwave and fridge freezer. People also told us that occasionally staff have arranged for a communal dinner such as Sunday lunch for example. One lady told us “we make a small contribution, which was very reasonable for such a lovely meal”. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear complaints procedure in place, but people are potentially put at risk due to not all staff being trained in safeguarding adults. EVIDENCE: There is a complaints procedure in place and when people move in they are told how to make any complaints or raise any concerns. The home is proactive in managing any concerns and checks with people on a daily basis. There have been no complaints since our last visit and people we spoke to at the time of our visit all confirmed that they had no complaints. There are Adult protection policies and procedures in place and staff are aware of the importance of safeguarding the people staying in the home. The home had raised one safeguarding adult alert in the last year and this had been investigated by the appropriate authorities. Staff are provided with information in their induction about safeguarding people, but not all staff had received full adult protection training. The home needs to make sure that this is addressed. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from living in a clean, safe environment that suits their needs. EVIDENCE: Shalder House is set out with independent flats, communal living spaces and a communal laundry. We took a partial tour of the building and this included visiting three independent flats. People are free to access the communal areas as they wish or spend time in their own rooms should they prefer. The flats consist of a bed sitting area, small kitchenette and en-suite facilities. People’s individual rooms reflected their needs and people are able to bring in their own possessions to make it more homely whilst they are staying in the Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 16 home. Everyone we spoke to at our visit confirmed that they liked their rooms and were comfortable staying in the home. It is an older building that is in need of refurbishment especially in the bathrooms. It is part of Medway Council’s modernisation strategy. The Annual Quality Assurance Assessment (AQAA) also recognises that modernisation is needed. All areas of the home are clean and well maintained. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are protected by the home’s robust recruitment procedures and through induction programme. Ongoing training for staff would further benefit the people staying in the home. EVIDENCE: We discussed the staffing levels with the manager and viewed rotas. This showed that there are sufficient staff on duty and this includes staff support to accompany people out and about in the community. They had recently carried out a risk assessment to make sure that the staffing levels are sufficient to meet the needs of the people. We spoke to people staying in the home and they all confirmed that there was always enough staff and that someone would come straight away if they rang their call bell. There is a thorough recruitment procedure that meets with the National Minimum Standards and Care Regulations. People complete an application form and are given a face to face interview. Appropriate checks are carried out including proof of identity and Protection of Vulnerable Adults (POVAfirst) and Criminal Records Bureau (CRB) check. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 18 Since our last visit the manager has introduced a new induction programme which is based on the Skills For Care standards. The induction training is given through a variety of sources including practice based, formal awareness training and e-learning. Staff complete a work book and then are assessed as competent for the role they are to perform. Staff are issued with a handbook and information sheets. We viewed the training records and there were some shortfalls where staff had not benefited from all the appropriate mandatory training. Training is arranged through Medway Council and there is a regular training programme. The home must make sure that staff complete their training. People staying in the home all confirmed that they felt well supported by staff. Comments included: “I have been thoroughly spoilt”. “All staff have been really helpful – they have supported me in being able to look after myself again”. “They are always there if I need them”. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People benefit from a service, which is run and managed in their best interests. The quality assurance processes and regular safety check promote and safeguard people’s health, safety and welfare. EVIDENCE: The registered manager has been in post since September 2006 and has spent time identifying areas that need development and implemented systems to address this. There are clear lines of accountability within the home. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 20 The ethos is to promote and maximise people’s independence so that they can return home. They are pro-active in supporting people with this and work with individual people and other healthcare professionals in an open and transparent manner that benefits the people staying in the home. Whilst people are staying in the home their views and comments are actively sought so that the home can identify and address any shortfalls. Regular meetings are held with people staying in the home. Staff and other healthcare professionals also meet on a regular basis to review the care and support being provided. There are comprehensive risk assessments in place both for the environment and for the individual. The manager maintains robust quality assurance monitoring records. The completed Annual Quality Assurance Assessment confirms this. People have their own lockable space in their individual rooms and are promoted and encouraged to manage their own money. They have polices and procedures in place for this and staff are made aware of the importance of following these procedures. The AQAA confirmed that there are regular health and safety checks carried out including the maintenance of equipment in the home. This includes regular electrical and gas safety checks. People can be confident that this service will meet their assessed needs. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X X X X 3 Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 22 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 OP30 Regulation 18 (1) (c) (i) Requirement The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (c) Ensure that the persons employed by the registered person to work at the care home receive — (i) training appropriate to the work they are to perform. In that staff receive the training to meet the needs of the people staying in the home this should include adult protection training. Timescale for action 30/06/08 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 OP7 Good Practice Recommendations That care plans are set out separately from daily notes so the information is more accessible. Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 23 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. Extracts may not be used or reproduced without the express permission of CSCI Shalder House Extra Care DS0000035709.V359443.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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