Care Home: Sharnbrook Lodge

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What the care home does well Residents expressed a high level of satisfaction with respect to the quality of care and support they receive, a view echoed by two visiting relatives. Comments from residents, visitors and staff have been reflected throughout the report. An assessment is obtained before people go to live at the home to make sure staff are able to care for them. Staff are polite and respectful to people living at the home. An explanation is offered before staff assist the residents and they take time and do not hurry them. The meals provided at the home are of a good quality and residents like them. An alternative is offered if something is not liked. Menu planning takes place regularly, in order to include the taste and preference of residents. Good care and staff management systems are in place and these are being implemented to good effect. What has improved since the last inspection? The requirements made in the last inspection report dated 31 January 2008 have been addressed; this has resulted in an overall improved quality of service for residents.All the required checks, documents and information are being obtained before any new staff members start working at the home. This ensures they are safe to work with vulnerable people. An annual survey seeking the views and experience of residents regarding the quality of service offered to them at the home has been completed. The manager said that arrangements were in hand for the outcomes together with remedial actions if any, to be shared at a meeting with residents. The manager was aware that a copy of the report must be sent to the Commission. A report is now being produced for the monthly visits made by the owner under Regulation 26 of The Care Homes Regulations; a copy of the report is available to the manager so that action can be taken to improve the quality of the service provided. All staff have received training in moving and handling, so that techniques used protect the safety and wellbeing of both staff and residents. What the care home could do better: There are 3 requirements and 1 recommendation arising from this report, which must be addressed. A greater variety of recreational activities must be facilitated, in order to provide an appropriate level of stimulation for residents. Maintenance and repair work identified under standards 19-26 of this report must be addressed. All staff members must receive the required mandatory training; this would ensure a greater level of safety for residents and staff as well. Minutes of monthly reviews should be in greater details, to appropriately reflect the residents` changing needs and objectives for health and personal care. CARE HOMES FOR OLDER PEOPLE Sharnbrook Lodge 17a Park Road North Houghton Regis Bedfordshire LU5 5LD Lead Inspector Mr Neil Fernando Unannounced Inspection 4th June 2008 10:00 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 Lodge DS0000014966.V365987.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 Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sharnbrook Lodge Address 17a Park Road North Houghton Regis Bedfordshire LU5 5LD 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) 01582 866708 miriam.philips@bt.com Mr John Philips Mrs Miriam Philips Mrs Jean Flanagan Care Home 24 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (12), of places Physical disability over 65 years of age (12) Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2007 Brief Description of the Service: Sharnbrook Lodge is a privately owned residential care home. The service provides accommodation for twenty-four older people who may also have dementia and/or physical disabilities. The building is a detached property, situated on a main thoroughfare that gives direct access from Luton, Dunstable and Houghton Regis. The home is close proximity to local shops and other amenities. There is parking facilities for several cars at the front of the premises; there is a large garden at the back of the building that is accessible to people who live in the home. Communal facilities consist of two large lounge/dining areas and additional seating in alcoves on both floors of the home. Bedrooms are located on both floors of the home and can be accessed by stairs or by a passenger lift. A copy of the service user’s guide and inspection report is available for residents and visitors to read. The fees for this service vary between £457.06 and £525 per week; the exact fees are reflected in individual contracts for the residents. Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We, the Commission for Social Care Inspection, undertook this unannounced key inspection on 4 June 2008. We spoke with 5 residents, 2 visiting relatives, the registered manager and 3 staff. A brief tour of the premises was undertaken and a range of documents was viewed; we also observed staff care practices. At the time of the visit, there were 24 residents accommodated with no vacancies. We received a completed “AQAA” (Annual Quality Assurance Assessment) – a document, which gives the manager the opportunity to tell us how the agency is meeting the standards and regulations. To date, we have received surveys from 3 residents and 1 staff. Their views have been included in the report. The manager was present throughout the inspection. What the service does well: What has improved since the last inspection? The requirements made in the last inspection report dated 31 January 2008 have been addressed; this has resulted in an overall improved quality of service for residents. Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 6 All the required checks, documents and information are being obtained before any new staff members start working at the home. This ensures they are safe to work with vulnerable people. An annual survey seeking the views and experience of residents regarding the quality of service offered to them at the home has been completed. The manager said that arrangements were in hand for the outcomes together with remedial actions if any, to be shared at a meeting with residents. The manager was aware that a copy of the report must be sent to the Commission. A report is now being produced for the monthly visits made by the owner under Regulation 26 of The Care Homes Regulations; a copy of the report is available to the manager so that action can be taken to improve the quality of the service provided. All staff have received training in moving and handling, so that techniques used protect the safety and wellbeing of both staff and residents. 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 Lodge DS0000014966.V365987.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 Lodge DS0000014966.V365987.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): Standards 1, 3 and 5. Standard 6 is not applicable. Quality in this outcome area is good. The home obtains relevant information about the prospective residents before admission; this enables the home to ensure that their identified needs could be appropriately met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA indicates, A copy of the Service User Guide is available to prospective clients before they make a decision whether they wish to move to the home. Clients and relatives are always welcomed to visit the home before they make a firm decision”. Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 9 A copy of the statement of purpose and service user’s guide is given to the prospective resident and their representative. Few of the residents spoken with confirmed that they had visited the home as part of the admission process. In most instances, people moving into the home had been reliant on their relatives to visit and assess the home on their behalf. Two visiting relatives of a person living in the home stated that they had visited the home before deciding on Sharnbrook Lodge. The care records for three residents were assessed at this inspection. Each showed that detailed pre-admission assessments of needs had been carried out before they had been admitted to the home. Pre-admission assessments include information from placing authorities, and health care providers where people had been admitted from hospital. The home has an established admissions procedure that includes its own written assessment of needs, carried out by the manager and identified senior care staff. Sharnbrook Lodge DS0000014966.V365987.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): Standards 7, 8, 9 and 10. Quality in this outcome area is good. People living in the home are assured that their care including health needs will be addressed according to their wishes and that they will be protected through effective risk assessments. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA indicates, We provide a high standard of personal care to the individual, taking into account their privacy, dignity and choice. We provide all care as specified in their individual care plans. The care plans for three residents including the latest admission were viewed. These are based on detailed assessment of needs. They cover the personal, physical, health, social and recreational, emotional and religious needs of each Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 11 resident. Information is also available, which reflects people’s preferences for their daily lifestyle. Observation of care practices and conversation with staff members indicates that they are familiar with the identified needs of residents and how these are being met. Risk assessments are being carried out and reviewed at regular interval for each individual. The placing authority undertakes annual reviews for each individual. The manager, seniors and some care staff carry the monthly review care plans, with contribution from the resident and their representative. Minutes of monthly reviews should be in greater details to appropriately reflect the residents’ changing needs and objectives for health and personal care. Residents are registered with a GP; other professionals they have access to include optician, district nurse, dentist and chiropodist. Some residents spoken with confirmed that they had visits from various health personnel. “I am pleased to share with you that my health needs are well catered for”, said one resident. During the visit staff were observed using a variety of equipment to assist residents to transfer from and to chairs. All such assistance was provided in a professional and safe manner. Information from staff and training records seen evidence that staff have received training in moving and handling. The home has policies and procedures on medication, which have been reviewed in September 2007. Only the manager and senior staff members administer medication; they have all completed a 16 weeks course on medication, provided by a college. Medication records for eight residents were viewed and these were in order. Residents spoken with, who were able to express an opinion all said that staff treated them with dignity and respect and that their privacy was respected. Sharnbrook Lodge DS0000014966.V365987.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): Standards 12, 13, 14 and 15 Quality in this outcome area is good. Residents can be assured that they will be offered a varied diet that meets their requirements. Recreational activities for some residents are inadequate to maintain an appropriate level of stimulation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA indicates, We are very keen to improve on the activities provided to our clients to stimulate them and to provide more meaningful individual activities. To meet this, we would like to employ an activity co-ordinator to plan activities to cater for individual/group needs of the client group but it is proving rather difficult to find such person. The routines of daily living are made as flexible as possible to suit the needs and choice of individuals. Representatives of different faiths visit the home regularly so that residents can attend services and speak with the Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 13 representative of their choosing about their spiritual needs. There is a number of experienced staff from different cultural backgrounds and they bring a wealth of knowledge, and promote the equality and cultural diversity of the people who use the service. Most of the staff have received training on Mental Capacity Act in May 2008. Activities, which have occurred, include board games, art and crafts, reminiscence, reading books and newspapers, manicuring, music and watching television. The care staff also stated that they regularly sit down with residents and have a “one to one chat”. Most of the residents spoken with felt that an improved variety of recreational activities is necessary, in order to maintain an appropriate level of stimulation for them – a view shared by two staff members. The manager was aware of this shortcoming and she has been exploring ways in which people can have more opportunity to participate in meaningful interest in their daily lives. Visitors are welcomed into the home. Residents spoken with said that their visitors could come into the home at anytime. Two visiting relatives remarked on the welcome they receive and confirmed that there are no restrictions on visiting. Individual dietary needs are being assessed and recorded in care plans, and subsequent directions for any special diets are passed on to the cook. The menus seen showed a nutritious choice throughout the day. There is an alternative meal available if the main meal is not liked. One person said that his family often bring in various ethnic meals, which he loves very much. Residents described the food served to them as “Good” or “Very good”. “At meal times the staff are around to help those who need a hand”, said one resident. Several people said that at teatime they could have a choice of sandwiches or something on toast, e.g. egg or cheese. Sharnbrook Lodge DS0000014966.V365987.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): Standards16 and 18. Quality in this outcome area is good. People using this service can be confident that they will be kept safe by the home’s procedures around safe working practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have established that the home has satisfactory written complaints and safeguarding procedures. The manager reported that there have been no complaints made to the home about any aspects of the service since the last inspection in January 2008. None have been made to the Commission. Residents living in the home and two visiting relatives confirmed that they felt able to raise a concern, if dissatisfied with the service. “I would speak to the manager if I was worried” and “I am able to speak to staff and I am confident they would resolve any concerns I may have” reported two residents. Records indicate that staff have received training on safeguarding issues. All three staff members spoken to showed an understanding of the safeguarding Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 15 procedure. There were no safeguarding matters pending at the time of the visit. Sharnbrook Lodge DS0000014966.V365987.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): Standards 19, 22 and 26 Quality in this outcome area is good. Residents living at Sharnbrook Lodge benefit from a comfortable, clean environment that is, in the main, well maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The premises are suitable for their purpose. The standard of furniture and fittings are satisfactory. Bedrooms are personalised offering a homely, lived in feel. Residents spoken with said that they were happy with their bedrooms and other facilities available to them. “It is a lovely home and I am quite content, said one resident. Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 17 The home is able to meet the individual needs of the residents with physical disabilities. The manager ensures the availability of suitable specialist equipment, which is maintained to good order. Bedrooms are situated on both floors of the home and can be accessed by stairs or a passenger lift. The standard of decoration is good except for a few bedroom doors where the paint is damaged; some redecoration is required. There is system in place for ensuring that windows are fitted with restrictor devices for the safety of residents. The handle of one bedroom window was damaged and requires a replacement. Sharnbrook Lodge DS0000014966.V365987.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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. The numbers and skills of the staff are adequate to meet the needs of the residents. The robustness of the recruitment process means that residents are appropriately protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff duty rotas for a period of four weeks indicate that the minimum number of care staff required for looking after the people accommodated in the home had indeed been rostered on duty. There are 4 care staff available at all times during the day shifts and 2 waking members, on each night. Members of staff on duty, care and ancillary, were seen to treat people living in the home with kindness and good skill. They showed empathy and commitment towards those people they looked after. The staff files for three members of staff were looked at and they all contained the necessary recruitment checks and information required by regulations. Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 19 Records show that all new members of staff are provided with induction. A recently recruited staff said, “My induction has been very satisfactory”. Other training courses completed by staff since the last inspection in January 2008 includes Adult Protection, Medication, Dementia, Care Planning, Mental Capacity Act and mandatory training. 6 of the 13 care staff members (46.1 ) have completed their NVQ level 2 training and 1 is currently doing the same course. A further 3 members would be starting their training in September 2008. “We all receive good training,” said a staff member. NVQ training is being given a high profile and this will have a positive impact on the quality of service offered to residents. Sharnbrook Lodge DS0000014966.V365987.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): Standards 31, 33, 35, 36, 37 and 38 Quality in this outcome area is good. Whilst the home is being well managed, staff must receive all mandatory training; this would ensure a greater level of safety for residents and staff as well. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for a number of years; she has been registered with the Commission as manager since May 2005. She holds a Higher National Diploma in care management and she completed the Registered Manager’s Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 21 Award in March 2008. She has also completed a 12-week course in Dementia; the manager intends to start her NVQ Level 4 (National Vocational Qualification) towards the end of 2008. Four senior staff members support the manager. The staff on duty stated that they find the manager “very approachable and that she always has time for the staff”. “It’s a nice place to work and the staff and manager are very supportive to residents”, said one staff. An annual survey seeking the views and experience of residents regarding the quality of service offered to them has been completed. The manager said that arrangements were in hand for the outcomes together with remedial actions, to be shared at a meeting with residents. The manager was aware that a copy of the report must be sent to the Commission. The owner has also undertaken monthly visits to the home; a sample of visits reports was viewed and is satisfactory. Staff are not involved or keep money on behalf of residents but the home provides lockable facilities in each room. Residents’ relatives or their representatives are invoiced directly for fees for hairdressing, chiropody and other services. A programme of formal supervision for staff to monitor their practice and support them is being implemented. “I can tell you that supervision is now taking place regularly”, said a member A number of records were viewed and these were in good order. Health and safety are being attended to; however two staff had not completed their mandatory training in first aid and health and safety. The manager was aware that action is required. Sharnbrook Lodge DS0000014966.V365987.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 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 X X X 4 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 3 X 3 X 3 3 3 2 Sharnbrook Lodge DS0000014966.V365987.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 OP12 Regulation 16 (2) (m) Requirement Provide a greater variety of recreational activities, in order to maintain an appropriate level of stimulation for residents. Timescale for action 20/08/08 2. OP19 23 (2) (b) & (d) 18 (1) (c) Maintenance and repair work 20/08/08 identified under standards 19-26 of this report must be addressed. All staff must receive the required mandatory training, in order to ensure a safe working practice. 01/09/08 3. OP38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations Minutes of monthly reviews should be in greater details to appropriately reflect the residents’ changing needs and objectives for health and personal care. DS0000014966.V365987.R01.S.doc Version 5.2 Page 24 Sharnbrook Lodge Sharnbrook Lodge DS0000014966.V365987.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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