Care Home: Sharnbrook House

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What the care home does well The home is very much part of the village and people spoken to said they had always known that they would live at the home.Prior to admission the manager carried out a thorough pre-admission assessment of residents. The manager encouraged anyone to talk over concerns that they had so that they did not become big problems All of the residents spoken to said that they looked forward to mealtimes and were very happy with the environment in which they lived. What has improved since the last inspection? Since the last inspection it was apparent that care plans had been written in more detail. Residents safety had been ensured by replacing bedroom doors with ones that would close automatically in the event of a fire. What the care home could do better: There were very few areas that must be improved, but the manager was aware of the areas she wanted to improve to benefit the residents. CARE HOMES FOR OLDER PEOPLE Sharnbrook House High Street Sharnbrook Bedfordshire MK44 1PB Lead Inspector Sally Snelson Unannounced Inspection 7th November 2007 08:30 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 Sharnbrook House DS0000014967.V349621.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. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sharnbrook House Address High Street Sharnbrook Bedfordshire MK44 1PB 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) 01234 781294 01234 783127 sue@greensleeves.org.uk www.greensleeves.org.uk Greensleeves Homes Trust Mrs Susan Whitehouse Care Home 30 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (30), of places Physical disability over 65 years of age (30) Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2006 Brief Description of the Service: Sharnbrook house is a home owned by the Greensleeves Homes Trust (a not for profit organisation), within an old Victorian house located in a small village with the same name. Sharnbrook is close to Bedford, on a bus route, and the home is positioned in 2.5 acres of land with a lake and swans at the bottom of its well-maintained and large garden. Elderly residents are cared for, some with dementia. The house, which is a listed building, is well maintained and tastefully furnished following its original style. The home offers a real village atmosphere in a very homely environment. In the village all amenities are close and the home has developed community connections with local people and places. The accommodation includes 23 single and 7 single en-suite rooms. There are passenger and stair lifts. There is a small car park to the front of the house. Information about this service can be obtained from the home’s website, or by phoning or visiting the home. The following information about fees was obtained on 8th November 2006: Lowest fee £430.00 weekly; Highest fee £500.00 weekly; Items not included in the fees are hairdressing (starts at £3 for men, and £5 for women), newspapers, personal telephone bills, and private chiropody Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out in accordance with the Commission for Social Care Inspection’s (CSCI) policy and methodologies, which require review of the key standards for the provision of a care home for older people that takes account of service users’ views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. The inspection of Sharnbrook House was a key inspection, was unannounced and took place from 08.30 on 7th November 2007. The manager Mrs Susan Whitehouse was present during the whole inspection and feedback was given throughout. During the inspection the care of three people who used the service was case tracked. This involved reading their records and comparing what was documented to what was provided. In addition to sampling files, people who lived at the home, staff and visitors were spoken to and their opinions sought. Prior to the inspection five service users and /or their families had completed questionnaires. Any comments received from staff or service users about their views of the home plus all the information gathered on the day was used to form a judgement about the service. The inspector would like to thank all those involved in the inspection for their input and support. What the service does well: The home is very much part of the village and people spoken to said they had always known that they would live at the home. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 6 Prior to admission the manager carried out a thorough pre-admission assessment of residents. The manager encouraged anyone to talk over concerns that they had so that they did not become big problems All of the residents spoken to said that they looked forward to mealtimes and were very happy with the environment in which they lived. 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. Sharnbrook House DS0000014967.V349621.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 Sharnbrook House DS0000014967.V349621.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): 1,3,4,5,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to admission a perspective resident is thoroughly assessed and provided with sufficient information to ensure that Sharnbrook House can meet their needs and that they can make an informed choice about the home. EVIDENCE: The Statement of Purpose was well compiled and included all the information required. The manager told us that some of the head office details may not be up-to-date, but as the document was not dated and did not have a review date it was difficult to tell exactly when it had been written. In addition to the Statement of Purpose prospective residents were provided with information about fees and how they were to be paid. The company had decided that a personal letter about fees should accompany the Statement of Purpose. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 9 Two people spoken to told us that they had lived in the village a number of years and always knew that one day they would live at Sharnbrook House. Prior to admission the manager carried out a thorough pre-admission assessment of residents that enabled her to work out the dependency banding of the resident in a variety of areas such as personal care, mobility and night care. She could then be sure that she had the staff team that could meet the needs of the resident. On the day of the inspection a new person was admitted to the home. Staff planned that they would all do something different for this person, so that she could get to meet them all. For example one staff member completed the necessary documentation, and another helped with the unpacking. This person was aware that the first weeks of her stay were a trial and that if she did not get on she did not have to stay. Her family had taken the opportunity to look at the home in advance. At the time of the inspection Sharnbrook House did not offer intermediate care but could if, capacity allowed take respite admissions. Sharnbrook House DS0000014967.V349621.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): 7,8,9,10,11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans had been written in sufficient detail to ensure that the staff team were aware of the needs of the people living at Sharnbrook House. This ensured that correct, consistent care was provided. EVIDENCE: We looked at the care files of three residents and noted that the care files were neatly kept and divided into sections, which the staff were all familiar with. With the exception of not being able to find the date that a catheter was due to be changed all the information we expected to find for the people ‘case tracked’, was in the plans. (We were aware that the responsibility for changing a catheter was with the community nurses, but to ensure that no aspects of care were overlooked the catheter plan would have benefited from including the date the next change was due.) Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 11 All of the care plans were regularly reviewed and altered as needs changed and there was evidence that some resident’s were involved in the planning and reviewing of their care. The manager reported that the home had good links with the local GP’s and community nurses and that she made the home available for any training they wished to provide to Sharnbrook House and other local care homes. The GP visited every fortnight and would hold a “surgery” in the home but would also visit as and when required. The home had a low incidence of pressure sores, and when the skin of a resident did show signs of breaking down the staff worked closely with community nurses to heal them. The manager reported that the residents had good skin because the home had clear procedures for prevention such as daily creaming regimes and high risk pressure mattresses on most beds. Health care needs such as tissue viability and nutrition were regularly assessed and changes to care made as indicated. The Medication Administration Record (MAR) sheets of the people whose care was tracked were looked at in detail. It was clear that medications were being ordered, signed into the home, administered, stored and disposed of correctly. Throughout the inspection people were observed being treated with dignity and respect. Staff made conversation with people when providing care and when going about other tasks. There was a natural rapport between the people living and working in the home, which made it feel like an extended family situation. It was noted that some people were addressed using their first names and others with their title and surname. Residents and/or their relatives were asked to provide details of their wishes for the time of sudden ill-health or death. These details were recorded in the care plan and included who should be called and when. Sharnbrook House DS0000014967.V349621.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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mealtimes were a social occasion when residents were provided with the choice of balanced meal in pleasant surroundings, EVIDENCE: The people using the service confirmed that they could make decisions about their day and how they should spend it, although it was noted that they all choose to have their main meal at the same time. Care plans included details about the persons past life, which gave staff conversational topics. Earlier in the year an activity co-ordinator had been appointed but at the last minute had had to withdraw for personal reasons. The manager was aware that this was disappointing and continued to encourage staff to provide activities when they could. The post had been readvertised. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 13 The home befitted from a volunteer group who fund raised and provided activities. On the day of the inspection two people from this group came into play whist with those who wished. The day before a group had been on an outing to a local supermarket where they had enjoyed afternoon tea and a look around the shop. The group volunteer group had funded the specialist taxi used as the transport. The residents also enjoyed the large garden, which they could view, walk in or work in. The gardener involved the residents in planting in patio pots. The home was apply to supply itself with most of the fruit and vegetables it needed and any surplus was sold to the local community, again forging community links. The manager had reported as part of the Annual Quality Assurance Assessment (AQAA) that she was aware that the people living at Sharnbrook House were frailer now and the activities needed to be more tailored to suit them. The home had also invested in a number of activities designed for those people with dementia. Throughout the inspection it was noted that visitors were welcomed into the home and were provided with drinks by the staff, although there was an area where they could prepare a drink for themselves if they wished. The inspection spanned lunchtime, which was a very sociable occasion with all but two poorly residents sitting at tables in the dining room. The table were attractively set out and each person had a name place. It was noted that staff carefully introduced the new service user to her fellow diners. Few of the tables were full so there was some flexibility in where people sat if required. Each service user had chosen between chicken curry and sausage meat plait in advance and were served with their meal, which included rice, fresh vegetables and a homemade tomato sauce. The cook confirmed that there was a four week rolling programme but it was subject to alteration as the produce were sourced locally and availability could determine the meal. All of the residents spoken to said that they looked forward to mealtimes. Sharnbrook House DS0000014967.V349621.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems and the manager’s availability ensured that people living in the home, staff and visitors could be sure they were listened to and protected from harm. EVIDENCE: There had been no complaints made to, or about, the home since the last inspection. A robust quality assurance process had ensured that any problems were identified and given attention. It was clear from reading files that staff involved relatives in the care that was being provided to their loved ones. The manager believed this went along way to preventing the need for complaints. The Statement of Purpose also encouraged anyone involved to discuss any suggestions, comments and complaints with staff immediately they were identified. All of the residents who were asked about how they would make a complaint made it clear that there was not a need to complain, but that if there were they would talk to the manager. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 15 Training records indicated that staff had completed mandatory safeguarding training. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 16 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): 19.23,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The decoration within the home provided the people that lived there with a clean, homely but spacious environment in which to live. EVIDENCE: As already stated the large garden was well-kept and residents had access to it. Since the last inspection bedroom doors on the first and second floor had been replaced with automatic closing doors, which allowed those people who wanted their bedroom door open at night to have them open without compromising their safety. There was still some decorating that needed completing as a result of this work but all areas of the home were clean and tidy. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 17 Because the original building dated back to the Georgian period and the building had been appropriately extended at various times, each of the bedrooms were unique and all were well in excess of 12sq metres. The home provided bedroom furniture, but many of the people living at Sharnbrook House had bought with them items of their own. The ancillary team (cleaners and handyman) should be commended on the way they looked after the home. A visitor, when asked how she had chosen Sharnbrook House for her mother said, “with my nose, it always smells fresh”. One of the cleaners reported that she could shampoo the same carpet up to five times in day to ensure that it did not smell. She also indicated that her views were considered when alternative floorings were being looked at for rooms where the occupants had continence problems. It was apparent that the laundry staff took pride in ensuring that residents looked smart. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team had received a variety of training ensuring that they had the skills and experience to care for the people living at Sharnbrook House. EVIDENCE: On duty at the start of the inspection was the manager and her deputy, four care staff, four domestic staff including kitchen staff, a handyman and an administrator. The manager confirmed that staffing ratios were constantly kept under review and additional staff would be on the rota if the residents needs changed. There was currently a staff vacancy at the home, but the manager reported that staff were often happy, and wanted, to work extra hours and they also received good support from a recruitment agency in Northampton so the vacancy had not caused a problem. The manager and the deputy both held the Registered Managers Award (RMA) and usually worked opposite shifts, so there was always a senior member of staff on duty at weekends. At the time of completing the AQAA it was reported Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 19 that 78 of the care staff had NVQ level 2 or above which demonstrated that the home had a commitment to learning. A robust computerised training matrix had been established. This included all staff ,including the ancillary staff and confirmed that staff had a wide variety of mandatory and specialist training. We were pleased to see that the cook had attended dementia awareness training and that the manager kept pro-formas about the qualifications of any agency staff used. Recently all staff had had dementia and mental health awareness training from the Alzheimer’s Society, and as with all areas of training, a senior member of staff was responsible for taking the lead in a particular subject. The manager was aware that infection control training had been basic and needs to be upgraded and had enrolled two senior carers on a train the trainer course so that they could roll out more information to all staff. Staff personal files indicated that all staff received induction training and that recruitment procedures were correct and safe. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 20 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): 31,33,35,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The atmosphere of the home was one of efficiency and friendliness. This was due to the way the manager supported the staff to work as a team. EVIDENCE: The manager held a NVQ level5 in management and used her skills to ensure that the home ran efficiently. She kept herself up-to date and knew the staff and residents well. She had completed her AQAA well, and indicated that she was aware of how to make improvements and had plans for then future of the home Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 21 In addition to the annual quality review undertaken by the home the organisation had commissioned an independent company to survey residents families. The results for each of the homes had been published and the manager had addressed the main concern raised. This was about disseminating information by producing a quarterly newsletter. This was being sent to families, and the manager had had a positive response. Relatives had been asked if they would like to have relatives meetings but this had been declined. However the opinions of those people using the service (resident’s) was sought at meetings, which were usually chaired by a volunteer to ensure anonymity. The manager was aware of the need to ensure the voice of those people who were frailer was heard. The home held very little money on behalf of the service users and none of the residents whose care was case tracked had money held on their behalf. Therefore one account was randomly chosen and checked and found to be accurate. The manager was aware that not all of the staff had received the required six supervision sessions in the year since the last inspection. However she felt that having identified senior staff to support her this would be rectified by the next inspection. All of the staff had meet with the manager for an annual appraisal. All health and safety checks had been complied with. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 22 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 4 4 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 2 x 3 Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 23 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 OP36 Regulation 18(2) Requirement The manager must ensure that the staff have the opportunity for regular supervision. Timescale for action 01/01/08 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 OP1 Good Practice Recommendations The Statement of Purpose should include the date it was produced and reviewed or due to be reviewed. Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Sharnbrook House DS0000014967.V349621.R01.S.doc Version 5.2 Page 25 - 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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