Care Home: Shalom

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What the care home does well What has improved since the last inspection? The manager has commenced checking and recording the fridge temperature in the kitchen, after this was highlighted by the Environmental Health Officer in the kitchen inspection report in 2007. What the care home could do better: Care plans contain all necessary information, but would be easier to follow if they were put into a more structured format. Medication management continues to be carried out using secondary dispensing into cassettes. This is normally regarded as an unsatisfactory procedure. However, the owner and her husband have been carrying out medication via this method, without any incidents, for the past 20 years. They are familiar with the concerns around this practice, and take care when filling the cassettes. There is a recommendation to review this situation again. CARE HOME ADULTS 18-65 Shalom 95 Northdown Park Road Margate Kent CT9 2TU Lead Inspector Mrs Susan Hall Unannounced Inspection 31st January 2008 09:50 Shalom DS0000023144.V357733.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 Shalom DS0000023144.V357733.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. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shalom Address 95 Northdown Park Road Margate Kent CT9 2TU 01843 299216 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) mackeyshalomres@aol.com Mr Clifford John Mackey Mrs Susan Margaret Mackey Mr Clifford John Mackey Mrs Susan Margaret Mackey Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2007 Brief Description of the Service: Shalom is registered to provide accommodation for up to three adults with a learning disability. The three male service users currently have low to medium dependency needs. The owners Mr & Mrs Mackey provide all the care and support, helped occasionally by other family members. The home is a spacious semi detached family property in a residential area of Cliftonville. All bedrooms are for single use and are situated on the first floor. Two of these are fitted with a wash hand basin. The home is not suitable for residents with mobility problems, as the first floor can only be accessed via the stairs. Residents have the use of all communal facilities, which include a bathroom and separate toilet, a kitchen, utility room, dining room, lounge and conservatory. There is also a well maintained enclosed garden at the rear of the property. The home has a parking space at the front, and there is also on street parking available. It is situated close to local shops, pubs and cafés, rail and bus services, the local church, and the seafront. Fees are currently met by Kent County Council, and range from £312 to £320 per week. Fees are all arranged on an individual basis, according to the needs of each resident. A copy of the latest inspection report is available on request at the home. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included checking all aspects of the service since the previous inspection; and was completed with a visit to the home which lasted two and a half hours. The home is owned by Mr. and Mrs. Mackey, and they work together to meet all the care needs for residents. No other staff are employed. Mrs. Mackey is the registered manager, and carries out day to day management and oversight of the home. Mr. Mackey manages all the maintenance needs, and assists with providing care for the residents. Mrs. Mackey was available throughout the inspection visit, and Mr. Mackey was present briefly during the morning. All three residents were in the home during the visit, and showed their contentment in living in the home through their relaxed attitudes, smiles and brief comments. Communication was difficult, due to speech and hearing problems for different residents, but one said that being in this home was “very good”. There have been no complaints since the last inspection, and no referrals to the Social Services Safeguarding Adults department. The service is run as a family home, and residents are enabled to make their own decisions about their day to day lives and routines. The owners have extensive experience, and ensure that they keep their own training needs updated. Residents living in the home are currently over the age of 65 years, and the inspector checked the registration category after the visit with the South East Registration Team. As the primary need for care is Learning Disability (and not old age) this set of National Minimum Standards for Younger Adults still applies. What the service does well: The home has an open and informal atmosphere, and residents are able to share their views, and expect to be listened to. Residents are enabled to make progress with maintaining existing living skills and developing new ones. They share in the daily life of the home, for example – choosing menus, and assisting with food preparation and washing up. The owners support residents with maintaining good links with families and friends, and help them to take part in a variety of activities and outings – according to their individual preferences. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 6 The owners ensure that there are good ongoing links with health professionals, so that the residents’ health needs are well met. What has improved since the last inspection? 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. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 7 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 Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 8 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): 1,2,4 Quality in this outcome area is good. The home has suitable procedures in place for arranging new admissions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose contains all the required information. It includes the aims and objectives of the home, and details of the manager and her husband, who are the only staff. It also includes the schedule of accommodation, and details of the services and facilities offered by the home. All contracts are arranged via Kent County Council. The service users’ guide is set out in a simple format with pictorial symbols at the side of each point, making it an easy to read version. It is produced in large print. The guide contains details of the terms and conditions (“residents’ agreement”) for living in the home, and contract arrangements. There is a very well written complaints procedure (“How to complain”), and clear information about care plan reviews; and respecting residents’ privacy and confidentiality. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 9 The home has not admitted any new residents for over 11 years, and some have lived at the home for over 20 years. However, it was good to see that this documentation has been kept in readiness for any time when a new admission may be considered. Any prospective resident would have a full care management assessment and care plan implemented prior to considering their suitability for this home. The manager stated that the pre-admission process would be implemented slowly, ensuring that any new person fitted in with existing residents. There is a trial period of 12 weeks for any new admissions. Shalom DS0000023144.V357733.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): 6-10 Quality in this outcome area is good. Care plans are agreed with each individual, and cover all aspects of residents’ lives. The plans would be easier to follow if a clearer format was implemented, but this does not affect the outcomes for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three care plans were viewed. Care planning has been generated from the care management assessments, and care plans are reviewed every 6 months by the manager and care managers, with full involvement and discussion from the residents. The manager writes her own summary each year, showing changes which have taken place over the previous year, new skills learnt, details of contact with family and friends, and details of outings and holidays. The summaries give a very clear resume of the previous year. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 11 The care plans contain the necessary information to be able to evidence that all aspects of each resident’s life is taken into account (e.g. personal care needs, physical and mental health needs, activities, medication, spiritual needs, financial management). However, they are not in a clear format, and it is difficult to find the information required for any authorised person who is unfamiliar with the care plans. It is recommended that the plans are put into a more structured format, and that a front page is included with personal details such as next of kin, GP, religion etc. This would be of value to anyone needing to access information in a hurry – especially if the manager/owners were absent at the time. Residents are enabled to make their own decisions about how they run their lives each day, and about bigger decisions such as where to go on holiday. An example of this is that two residents decided to go on holiday together last year to Hastings, while the other resident chose to go to Great Yarmouth. Being supported in making their own decisions was also evidenced on the day of the inspection visit, when one resident was deciding whether or not to go for a walk. He was allowed to make this decision for himself, and chose not to go when he realised there were strong gale force winds, and it was raining. Residents are also supported in managing their finances. The manager is the appointee for two residents, for their personal pocket monies. These are paid on a weekly basis, and the residents sign to show they have received their money. The other resident is able to manage his own bank account independently. Care plans and daily records showed that residents participate fully in the life of the home, and are involved in discussions on a daily basis such as what to eat; where to go; and what activities they prefer to carry out that day. Risks for each resident are assessed and documented. These are updated on a yearly basis, or as necessary. One had risk assessments for items such as risks of tripping and falling, traffic road safety, bathing unsupervised, making drinks, going out inappropriately dressed, and having a hearing impairment. Another resident was assessed as being unsafe to use public transport independently, but is able to go out walking unsupervised, and has good road safety awareness. Documentation is kept in a locked cupboard, and residents are aware that their privacy and confidentiality is respected. This is clearly written in the service users’ guide. Shalom DS0000023144.V357733.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): 11-17 Quality in this outcome area is good. Residents are enabled to access facilities and activities according to choice, and to develop individual living skills This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a strong emphasis on enabling residents to maintain existing skills, and develop new ones. This includes day to day skills such as making the bed, putting their own washing away, making drinks/sandwiches, putting the rubbish out, and emptying the dishwasher. Skills developed over the last few months include using public transport independently, buying own theatre tickets, and using the telephone. Residents are enabled to carry out activities according to their own life preferences. These might include going to the bowls club or ten-pin bowling, going shopping, going out to the pub, visiting family or friends, theatre visits Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 13 and other outings. In-house activities include listening to their own choice of music or television. Residents have their own TV/DVD players if they wish. Residents are also enabled to attend church and associated activities, and some like to do this, attending events during each week. However, if residents do not wish to attend church this is also respected. Residents are supported in keeping in contact with family and friends. One said that he was looking forward to going to visit his brother that day. Holidays are discussed together, and residents said they had enjoyed their holidays last year. Two had stayed in a caravan in Hastings, and one in a hotel in Great Yarmouth – with appropriate support from the manager and her husband. Residents have their own daily routines, being able to get up/go to bed as they prefer, or rest on their beds during the day. Mail is given to them unopened, but support is given in understanding the contents if required. All areas of the home are available for residents to use, apart from the owners/manager’s own bedroom. Shalom DS0000023144.V357733.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): 18-21 Quality in this outcome area is good. Personal and health care needs are well managed in the home; but medication procedures would benefit from a review. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Assistance with personal hygiene is given as necessary, and is carried out with due regard to privacy and dignity. This may include continence care, and bathing or showering. Health care needs are very well maintained. There were clear records in care plans to show that residents have regular check-ups and medication reviews with their GP; and regular dental check-ups, eye tests, and chiropody visits. The Community Learning Disability Team have input into the home, and help to oversee individual situations. Residents have been supported in the last year in attending hospital and outpatient appointments. Psychiatry visits are arranged as required. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 15 One resident has diabetes, and this is monitored on a twice weekly basis. The manager ensures that his diabetic diet and medication are maintained. Medication is provided by a local pharmacist, and then re-dispensed by the manager and her husband into weekly cassettes. This is not an ideal practice, as secondary dispensing is not usually acceptable. However, the owners have been using this system for 20 years, and are confident with the management of medication in this way. The manager has recently updated her medication training. Medication is stored in a locked place, and is kept secure. Medication Administration Records (MAR charts) are maintained in a way that matches the cassette system in use, and were seen to be meticulously signed. There is a recommendation to review the medication procedures. There is a record in each resident’s care plan about their wishes in the event of death and dying. The residents have signed these, and there is evidence that these plans are discussed every so often and reviewed for any changes in decision. Shalom DS0000023144.V357733.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. Residents are able to voice any concerns and know that they will be listened to; and that appropriate action will be taken. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure in place, which has been produced in an easy read format. There have been no complaints in the home for a long time. Residents are encouraged to voice any concerns as they arise, and these are dealt with immediately. There are sometimes disagreements or behavioural difficulties, and the manager and her husband know how to dissipate these situations and handle them appropriately. The manager and her husband have kept their training updated in the management of challenging behaviour, and have a sound knowledge of safeguarding adults from different types of abuse. The manager’s training certificates were viewed for training in challenging behaviour, and adult protection. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 17 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): 24,25,26,28,30 Quality in this outcome area is good. The property is well maintained, and is suitable for it’ purpose and it provides a warm and friendly environment for the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was viewed in all areas, and was seen to be well maintained, clean, comfortable, and homely. Residents have chosen the décor and furniture for their own rooms. One of the bedrooms in use is under the recommended size, but the resident has chosen this room himself in preference to a larger bedroom. This room is not fitted with a wash hand basin, but the resident uses the adjoining bathroom. All communal areas of the home can be used by residents, and these include a large lounge, a dining room, kitchen, utility room, and conservatory. This leads into a pleasant garden at the rear of the property. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 18 Laundry is carried out in domestic washing facilities in the utility room. The manager was aware of the need to keep risk assessments of hot radiators in bedrooms under review, and to take action to cover these for safety if needed. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 19 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): 31,32,34,35 Quality in this outcome area is good. Staffing is appropriate for the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is staffed by Mr.& Mrs. Mackey, with Mrs. Mackey as the Registered Manager. As owners and providers for the home, both have undergone interview processes with CSCI. They do not employ any staff, but have two close relatives who help out occasionally – e.g. to enable Mr. And Mrs. Mackey to go on holiday. Both family members concerned have NVQ qualifications, and work in registered residential homes, and have had necessary checks carried out on them. CRB checks are kept on file, and three out of the four were viewed. Mrs. Mackey oversees all the day to day management and documentation, and Mr. Mackey oversees the maintenance. Both take an active role in carrying out personal and health care needs, and in day to day care in regards to activities, outings and holidays. Residents are accepted as part of the family home. It was evident through observation that they both have a good relationship with Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 20 the residents, and are fully aware of all their differing needs. They carry out their care with a high degree of commitment and affection for these residents. Mrs. Mackey frequently attends training updates to ensure she is up to date with training requirements. Evidence was seen of training in the last 2-3 years for health and safety, mental health awareness, basic food hygiene, moving and handling, medication management and adult protection. She is booked for training in the coming year for management of challenging behaviour, nutrition, and managing the elderly and their needs. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 21 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): 37,38,39,42 Quality in this outcome area is good. The home is well run, and the manager carries out training to keep up to date with changes in legislation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has an NVQ qualification, and has over 30 years of experience of working with people with learning difficulties. She works alongside other health professionals and care management to ensure that the needs of these residents continue to be met. She maintains an open and positive atmosphere in the home, so that residents know that they can voice any concerns or ideas at any time. One of the care Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 22 managers noted that a resident was “very happy and contented”; and a GP expressed he was pleased with the fitness of one of the residents. There is no formal quality assurance process in place, but residents are able to express themselves freely, and are encouraged to do so. Care manager reviews show evidence of their satisfaction with the placements, and relatives have previously reported their confidence in the management and ownership of this home. The manager ensures that safe working practices are maintained, with an awareness of health and safety needs, and fire awareness. Statements in residents’ files confirm that residents understand the fire procedures, and know what to do in the event of a fire. Documentation is retained for servicing contracts. The gas certificate, food inspection certificate, and electrical certificates were viewed and were satisfactory. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 X 4 3 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 2 26 3 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 3 3 X X 3 X Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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. 1 2 Refer to Standard YA6 YA20 Good Practice Recommendations To re-organise care plans into a more structured format. To review again the medication management procedures, in regards to secondary dispensing of medication. Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU 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 Shalom DS0000023144.V357733.R01.S.doc Version 5.2 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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