Care Home: Shalimar

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What the care home does well Shalimar is a five bed bungalow offering accommodation for up to five people with a learning disability within a village setting, continuously supported by well trained staff. New residents are offered clear written and pictorial guidelines stating what the service offers and after an initial assessment of their needs they are invited to visit the home to meet other people living there through an individual transition admission process, which could take sometime. Residents are consulted each week to discuss planning the weeks shopping, menu and activities. Recently the residents assisted with putting their ideas forward for the redecoration and refurbishment of the communal rooms. Residents meet up regularly with their key worker to discuss changes with their written care plan, this includes arranging appointments, planning individual activities and discussing ongoing day care to ensure that these meet their current needs. Staff support the residents to attend local community functions, shopping, trips to the seaside and on occasion a holiday. The home offers a safe and homely environment for people who wish to live there, supported by a friendly well trained staff team, who respect the need for residents to live a fulfilling life. What has improved since the last inspection? There has been two changes of acting manager in recent months and the residents can now look forward to improvements and stability. The last key inspection resulted with three requirements which have all been implemented. Activities are now recorded within the residents care plans. All complaints are recorded within the complaints log with the results of the investigation and action taken, which helps staff to focus whether there are trends forming. The carpets in bedrooms have been replaced and the communal lounge and dining room has recently been redecorated and refurbished. The organisation has introduced a more person centred care plan and has reduced the repetition of care by including this into one folder making it more reader friendly. What the care home could do better: The organisation offers transport however the current minibus does not display a professional service and needs to be overhauled and the seating needs to be fixed. The rear boundary needs to be made more safe for residents as currently there is a mound of sand covering one of the gaps in the fence causing a trip hazard. The conservatory is currently used as an office reducing communal space for residents. The quality assurance system needs to be recommenced taking the views of residents in a more formal manner to measure how the aims and objectives are being met.The acting manager needs to start the registration process, undertake the recommended management training and update her new role within the adult protection procedure. Key inspection report Care homes for adults (18-65 years) Name: Address: Shalimar Beech Avenue Taverham Norwich Norfolk NR8 6HP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Hilda Stephenson     Date: 0 7 0 7 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 29 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 Adults (18-65 years) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Shalimar Beech Avenue Taverham Norwich Norfolk NR8 6HP 01603869713 01603869713 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: New Boundaries Community Services Ltd care home 5 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home Shalimar is a five bed roomed bungalow in Taverham providing accommodation, care and support to five people with a learning disability. The home is currently run by Tracy Christianson who is the acting manager. The home is situated in an established residential area approximately five miles outside the city of Norwich. The service was opened in September 2002 and is provided by New Boundaries Community Services Ltd The property has been modified and extended and stands in substantial grounds within a residential housing area. Each of the bedrooms are single and ensuite. There are shared facilities including; kitchen, laundry, dining and lounge areas. There are large garden areas at the front and rear and car parking is available for visitors and staff. Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 5 Brief description of the care home The home also has its own transport. There is access to local facilities including shops and pubs. Residents living in the home access a combination of day services operated by the proprietor in North Walsham and other services available locally. The weekly charges range from £1500. Copies of CQC reports are made available to residents and their relatives upon request. Care Homes for Adults (18-65 years) Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The focus of the inspection undertaken by the Care Quality Commission (CQC) is upon outcomes for people who use the service and their views on the service provided. The process considers the providers capacity to meet regulatory requirements, minimum standards of practice, and focuses on aspects of service provision that needs further development. One inspector from CQC conducted the unannounced visit and was accompanied by a Lay Inspector known as an Expert by Experience with a support worker to assist with this inspection. The main method of inspection used is called case tracking which involves selecting people who use the service and looking at the quality of care they receive by speaking to them, observation, reading their records and asking staff about their needs. Care Homes for Adults (18-65 years) Page 6 of 29 The acting manager and one member of staff were spoken with as part of the visit, records relating to medication management was also inspected to form an opinion about the quality of care provided. A partial tour of the building was undertaken which included peoples bedrooms and communal areas they frequent to make sure that the environment is homely and safe. A review of all the information we have received about the home since the last key inspection was considered in planning this visit, which included the written information in the Annual Quality Assurance Assessment (AQAA) which was provided by the acting manager and operations manager. Care Homes for Adults (18-65 years) Page 7 of 29 What the care home does well: What has improved since the last inspection? What they could do better: The organisation offers transport however the current minibus does not display a professional service and needs to be overhauled and the seating needs to be fixed. The rear boundary needs to be made more safe for residents as currently there is a mound of sand covering one of the gaps in the fence causing a trip hazard. The conservatory is currently used as an office reducing communal space for residents. The quality assurance system needs to be recommenced taking the views of residents in a more formal manner to measure how the aims and objectives are being met. Care Homes for Adults (18-65 years) Page 8 of 29 The acting manager needs to start the registration process, undertake the recommended management training and update her new role within the adult protection procedure. 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. Care Homes for Adults (18-65 years) Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents are visited and assessed to make sure that Shalimar is the right place for them. Written information is available to explain the services offered. The transition process is individually based and can take several weeks. Evidence: The home has written information to offer new residents coming into the home to explain the facilities offered to them. The statement of purpose will need to be changed when the acting manager becomes registered to explain who manages the home. There had been no admissions in the past year so the pre-admission details of the resident that was present in the home during the inspection was read. The details included visits undertaken by the manager at the time collecting personal care needs, mental health and behavioural needs and social needs as well as usual routines. Residents are invited to visit the home before moving in to meet the other residents already living there, this can vary from person to person and can take several weeks known as the transition stage. Some of the visits can be for a meal, or overnight stay Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: depending on the individual. Each resident has a contract of care drawn up stating the price of fees and extra charges for personal items, service they will receive and notification of leaving. The current fees start at £ 1500.00 depending on level of care provided. Care Homes for Adults (18-65 years) Page 12 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents make their own choices throughout the day. Evidence: The organisation has implemented a new care planning process which is presented in a more person centred format, commencing with the residents personal profile. The residents key worker works alongside them to identify their individual skills and deficits to assist them when the care plan is compiled. To confirm the involvement of the residents the expert by experience lay inspector asked the resident if they made choices on a daily basis. One resident said I can get to choose when I want a bath or shower, I get to choose what I want to eat and what I want to do during the day. The AQAA states that the care plan is constructured identifying changes needed to enjoy a happy, fulfilling and safe life, a risk management system to manage risks thereby removing barriers to achieve full enjoyment. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: The care plan of the resident who was case tracked during this inspection had risk assessments in place to identify and reduce harm. The care plans had been developed since the last inspection reducing the repetition of details as previously seen. These care records were much easier and clearer to read. Care Homes for Adults (18-65 years) Page 14 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by staff to continue to live their individual lifestyle. Evidence: The main part of the evidence was gained by the expert speaking to the resident in the home during the day. Asking how they spent there day, did they have any hobbies and did they choose what they had to eat. The resident did not have any hobbies, preferred to spend her day at the home or garden and could choose what they wanted to eat. The care plans showed that residents are encouraged to use the community facilities such as the local shops, pub for meals out and visit family or Friends. Some of the current residents access the day centre at North Walsham undertaking social skills, cookery and horticulture. The home has its own transport, although this Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: was rather battered and the middle seat didnt move easily making it difficult for the resident sitting in the back of the vehicle to get out. The residents who returned from the day centre stated they enjoyed going to the day centre as there were lots to do. It was noted that residents participate in trips out to local towns, shops and resorts with the support from the staff. The acting manager stated that she holds a meeting with the residents on a Tuesday to plan the following weeks menu, so when they go shopping the following day they have a list of ingredients. Residents are encouraged to be involved with the preparation of meals if able and staff sit and eat with them making it a more sociable occasion. Some household tasks are undertaken by residents like there laundry, keeping there own rooms tidy and washing up after meal times. Care Homes for Adults (18-65 years) Page 16 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to access healthcare services. Evidence: The care plans were read of two residents and both contained healthcare and personal care needs and how the staff manage these needs, in a respectful manner. The expert discussed with a resident how they access the health care services such as the GP and dentist, the reply was the doctor comes here and I havent been to the dentist for a while. The manager confirmed that if any of the residents have appointments then they would be accompanied by a support worker. The medication record sheets of the residents who were being case tracked were checked and found to be in good order. The ordering and returning of medication was straightforward with records in place. Medication is administered by staff who have undergone relevant training, and the manager said that the staff were updating their skills by completing a distance learning medication course. There were no controlled drugs prescribed, although the home can accommodate this if required. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: Medicines were stored safely within the home. Care Homes for Adults (18-65 years) Page 18 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents complaints will be dealt with and they will be safe from harm. Evidence: When asked, the residents knew who to complain to if they had any problems with the service. The manager explained how a complaint would be dealt with and these were recorded, investigated with a result of the outcomethen discussed with the complainant, which is good practice. The complaints procedure is now in a picture format in the hall, and the resident understood this better than the written format. The expert asked the resident if they were aware of the complaints procedure, and they replied she knows how to make a complaint but has none to make. Staff were aware of the protection of vulnerable adults procedure and explained how they would put this into practice. The manager will need a more detailed adult protection training to understand fully her role in any referrals. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a homely environment. Evidence: Each of the residents gave their permission to see their individual bedrooms. All were nicely decorated and contained a variety of their personal possessions. They all have en suite facilities although one bedroom also contained a shower. There is a communal bathroom containing a shower. Both the inspector and the expert toured the building and garden. The majority of the interior has recently been redecorated, the lounge also contains new furniture, the expert pointed out that they could do with some more pictures and ornaments or plants so that the lounge area was more homely. Shalimar is a detached bungalow containing five bedrooms and a small room for storage. The kitchen is clutter free and contains adequate facilities, the laundry facilities is situated in its own room. There is a large combined lounge and dining room, and a conservatory where the manager is using as an office. This does reduce the communal facilities and the small room used as storage may be more suitable as an office. The expert also found that the edge of the garden was open in an area and recommended to the manager to fence that part. The garden was extensive the rear Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: garden was protected with a security gate. There was seating and tables if the residents wished to eat outside, and also a summer house and a variety of outdoor games. One resident had there own trampoline. The organisation provides transport for residents in the form of a minibus. Care Homes for Adults (18-65 years) Page 21 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported by a well trained competent staff team. Evidence: During the inspection the acting manager was supervising a new support worker who was currently supernumerary and undergoing induction training. There was one resident in the home during the day. The manager explained how the rota worked and how the staff were delegated there roles each day, depending whether residents went to day centres or elsewhere. There appeared to be adequate amount of support workers on duty to support residents with there daily routines. The staff who was undergoing the induction was spoken with and stated how she felt well supported by the staff to enable her to settle into her new role. Two staff files were looked at and these contained a number of certificates of past training events, including mandatory and extra training to enable the staff to be competent to support residents within the home. The operations manager was present for part of the inspection and explained the recruitment procedure when employing new staff. The required references and checks are undertaken before new staff commence work to ensure that residents are Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: protected. New staff are employed to work in specific homes although they are usually sent round to the organisations other homes to meet the residents thus reducing the use of agency staff. New staff are supernumerary for approximately six weeks when they are supervised and encouraged to complete the induction training. The staff at Shalimar are encouraged to undertake the recommended NVQ (national vocation qualification) training with five of the eight permanent staff having already achieved this. Care Homes for Adults (18-65 years) Page 23 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a safely managed home, however, have experienced an unsettling period of management changes. Evidence: The home has undergone two changes of manager since the registered manager has left. There is now an acting manager who is waiting to be registered and who will be required to undertake the managers training. The acting manager Tracy Christianson has worked for the organisation for several years. She manages four bungalows supporting fourteen residents. She is based at Shalimar and visits the other homes during the week. Tracy has been managing the home for a month supported by the operational manager, although she knows the residents very well as she was the team leader at Shalimar before becoming the acting manager. The operations manager confirmed that due to the temporary managers changing the quality assurance had not been undertaken this needs to be carried out to obtain a clear audit of the service. Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: The acting manager holds some personal spending money for some of the residents for safe keeping only. One of these records was checked and found to be accurate. The manager explained how she supervises the team leaders in all the bungalows she manages. This is cascaded by the team leaders who supervise the support workers. These records were seen within the staff files. One member of staff stated the manager is always available and is very helpful. The member of staff also explained that the manager has arranged staff meetings on a regular basis so that any arrangements or future planning within the home then residents and staff are consulted. A random check of the required health and safety records such as fire, accidents, COSHH, water temperatures and boiler maintenance as well as the security of the building were all found to be in good order. The insurance of the home was displayed alongside the registration certificate. The home has sound health and safety measures in place including risk assessments to support residents to live the lifestyle they wish. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 39 24 The quality assurance system needs to be recommenced based on the views of the residents to measure how the aims and objectives are being met. Views need to be obtained from those parties who have an interest in the service. 07/10/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 13 The homes own transport is rather battered and does not look very professional, the middle seat in the minibus is difficult to move making it difficult for residents in the back of the bus to get out, this needs to be attended to by the provider. The acting manager needs to update her knowledge on her role within adult protection referrals. The rear gardens boundary may need to be made secure, currently there is a mound of sand in one of the gaps in the fence. 2 3 23 24 Care Homes for Adults (18-65 years) Page 27 of 29 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 5 6 24 37 37 The conservatory used currently as an office reduces the communal space for residents. The acting manager needs to start the registration process to become the registered manager. The acting manager should complete the NVQ 4 training in management. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: 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. 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