Care Home: Sharston House Nursing Home

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What the care home does well The registered manager for the home works with a management team consisting of an administrator and a deputy manager. The manager is a registered nurse and is experienced at running care services for older people. She has worked at the home for over 20 years and knows the people who live there and the staff very well. The home does not act as appointee for any of the people living there and people`s relatives or representatives manage their finances with or for them. This is an example of good practice and helps people to have individual choices as to how they manage their own personal money. People living at the home all have single bedrooms which they are able to personalise with their own belongings to help their rooms feel more homely. People living at Sharston house told us they liked their rooms and the facilities on offer. There was a large amount of specialised equipment at Sharston House such as electric beds, pressure relieving mattresses and a number of hoists. Staff felt that they are always supplied with the best equipment to help them to care for people in the right way and to give the best care possible. The list of clinical updates and training attended by the trained staff has covered a wide selection of topic such as, eg, record keeping and nursing accountability, nasogastric tubes, syringe driver plus palliative care drugs, mental capacity, venepuncture, verification of death, continuing health assessment, end of life, vaccination, moving and handling trainer, dementia and end of life champion. Training records also showed lot of regular mandatory training which were mainly provided by the homes in house staff trainer, covering diverse topics including, eg, health and safety, fire safety training, accidents and risks, first aid, infection control, hydration, food hygiene, moving and handling and protection of vulnerable adults. This training helps to ensure staff are aware of how to safely support people especially with their individual needs. Staff training and development is progressing and over 50% of care staff held a national vocational qualification in care at level 2. These are nationally recognised qualifications for people working in social care and show they have been assessed as competent to provide good quality care and support for people. This means that a high percentage of the staff at Sharston House have the skills and knowledge to support the people who live there. The staff records we saw were well maintained and showed us that thorough employment checks are carried out before staff start working in the home. This helps to make sure that the staff are suitable to work with the people who live at Sharston House. The building is well maintained and there are detailed records kept to show that regular checks are carried out to make sure that the building and equipment are safe. These checks include water temperatures and fire protection system checks. These regular checks help to make sure that Sharston House provides a safe environment for people to live and work in. We received 10 completed surveys from people who live at Sharston House, overall they were positive in their comments stating, eg: "Clean and carers are attentive." "Very pleased comfortable here." "The care is excellent, all staff are very concerned for my relatives welfare." "In my opinion Sharston House does everything well. The staff are always pleasant, helpful and caring. They always seem to take time for everyone." "All staff are friendly, I feel very well looked after." We received 8 comment cards from staff at the home who overall were very positive about working at Sharston house. Staff told us they liked working at the home and alot of staff had worked there for many years. This gave alot of stability to the workforce. What has improved since the last inspection? People that we met told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. People told us on the day of our visit and in the comment cards submitted to us that they knew how to complain and knew who to go to if they had any concerns. Care plans were detailed and regularly reviewed. This is good practice and necessary to show how people are being cared for and supported with their wishes. The care plans covered a diverse range of needs such as, eg communication, care of specialist feeding tubes called pegs, diabetes, continence, care of catheters, personal care, mobility needs, arthritis, wounds, falls, safety, blood pressure and diverticulitis. Most staff had been on safeguarding adults training so they would know how to recognise the signs of abuse and what they would have to do to protect the people living at the home. Staff told us they would report any concerns they had and were confident and knowledgeable about their safeguarding policy. There are various checks in reviewing of health and safety within the home which included eg, reports on incidents and accidents, care plans and regular medication audits. These audits were examples of good practice to show what management checks were in place to ensure good standards were maintained to ensure people were kept safe and healthy at Sharston House. What the care home could do better: We found some areas that would benefit from further review and input, including a review of staffing levels to show how staffing levels are calculated and to ensure there are enough staff to provide care and support for the people who live at the home. Further reference to the areas we felt needed review is made in the body of this report. We consider that Sharston House provides excellent outcomes for the people who live there so rather than detail what they could improve we would expect that the home continues to review its practice in order to ensure that the standard of care provided to the residents at the time of this inspection is maintained and where possible improved upon. Key inspection report Care homes for older people Name: Address: Sharston House Nursing Home Manor Park South Knutsford Cheshire WA16 8AQ     The quality rating for this care home is:   three star excellent service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Diane Sharrock     Date: 2 2 0 3 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: Sharston House Nursing Home Manor Park South Knutsford Cheshire WA16 8AQ 01565633022 01565650656 sharstonhouse@tiscali.co.uk www.sharstonhouse.co.ukEmailsharstonhouse@tiscali.co.uk Drew Care Ltd Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Lindsay Noden Type of registration: Number of places registered: care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home with nursing - Code N. To service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP. The maximum number of service users who can be accommodated is: 48. Date of last inspection Brief description of the care home Sharston House is a Victorian detached two storey, converted property situated in its own grounds one mile from the centre of Knutsford. A large extension has been added to the existing premises to bring the total number of bedrooms to 48. The bedroom accommodation consists of 36 single bedrooms with en-suite toilet facilities and 7 without en suites. There are 3 double bedrooms and one has en suite facilities. These rooms are usually used as single rooms but could also be used as doubles, for instance Care Homes for Older People Page 4 of 31 Over 65 48 0 2 6 0 9 2 0 0 8 Brief description of the care home for married couples. Bedroom accommodation is provided on both floors. There are two passenger lifts and two staircases providing access to all levels. Some ground floor rooms have patio doors providing access to the rear garden. A call system is provided throughout the home. Wheelchair access is possible via the side entrance and to all parts of the home. Shared living space includes three lounges and a dining room. There are sitting areas in the grounds of the home. There is a car park at the front of the home. Fees range from 542 pounds to 780 pounds per week. The homes statement of purpose, service user guide and the last inspection report can be supplied by the manager. These documents give information about Sharston House. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This visit was unannounced and was just one part of our visit. We also looked at other information we had received about the home. This included information we had been sent from the home in an annual questionnaire. This gives information about how the manager and owners see the services strengths and weakness and future plans, developments at the home. A selection of questionnaires were also sent out for people living at the home, families staff and health and social care professionals to find out their views about Sharston house. In total we have received 18 completed surveys from a variety of people and their comments are included in the report. Care Homes for Older People Page 6 of 31 During our visit to Sharston House, we looked at various records and walked round the home. We spoke with people living in the home and some of the staff. We watched how staff interact with the people who live there and how they provide care and support for people. We also looked at various records to see what care and support was being provided for the people who live at Sharston house. Care Homes for Older People Page 7 of 31 What the care home does well: The registered manager for the home works with a management team consisting of an administrator and a deputy manager. The manager is a registered nurse and is experienced at running care services for older people. She has worked at the home for over 20 years and knows the people who live there and the staff very well. The home does not act as appointee for any of the people living there and peoples relatives or representatives manage their finances with or for them. This is an example of good practice and helps people to have individual choices as to how they manage their own personal money. People living at the home all have single bedrooms which they are able to personalise with their own belongings to help their rooms feel more homely. People living at Sharston house told us they liked their rooms and the facilities on offer. There was a large amount of specialised equipment at Sharston House such as electric beds, pressure relieving mattresses and a number of hoists. Staff felt that they are always supplied with the best equipment to help them to care for people in the right way and to give the best care possible. The list of clinical updates and training attended by the trained staff has covered a wide selection of topic such as, eg, record keeping and nursing accountability, nasogastric tubes, syringe driver plus palliative care drugs, mental capacity, venepuncture, verification of death, continuing health assessment, end of life, vaccination, moving and handling trainer, dementia and end of life champion. Training records also showed lot of regular mandatory training which were mainly provided by the homes in house staff trainer, covering diverse topics including, eg, health and safety, fire safety training, accidents and risks, first aid, infection control, hydration, food hygiene, moving and handling and protection of vulnerable adults. This training helps to ensure staff are aware of how to safely support people especially with their individual needs. Staff training and development is progressing and over 50 of care staff held a national vocational qualification in care at level 2. These are nationally recognised qualifications for people working in social care and show they have been assessed as competent to provide good quality care and support for people. This means that a high percentage of the staff at Sharston House have the skills and knowledge to support the people who live there. The staff records we saw were well maintained and showed us that thorough employment checks are carried out before staff start working in the home. This helps to make sure that the staff are suitable to work with the people who live at Sharston House. The building is well maintained and there are detailed records kept to show that regular checks are carried out to make sure that the building and equipment are safe. These checks include water temperatures and fire protection system checks. These regular checks help to make sure that Sharston House provides a safe environment for people to live and work in. Care Homes for Older People Page 8 of 31 We received 10 completed surveys from people who live at Sharston House, overall they were positive in their comments stating, eg: Clean and carers are attentive. Very pleased comfortable here. The care is excellent, all staff are very concerned for my relatives welfare. In my opinion Sharston House does everything well. The staff are always pleasant, helpful and caring. They always seem to take time for everyone. All staff are friendly, I feel very well looked after. We received 8 comment cards from staff at the home who overall were very positive about working at Sharston house. Staff told us they liked working at the home and alot of staff had worked there for many years. This gave alot of stability to the workforce. What has improved since the last inspection? What they could do better: We found some areas that would benefit from further review and input, including a review of staffing levels to show how staffing levels are calculated and to ensure there are enough staff to provide care and support for the people who live at the home. Further reference to the areas we felt needed review is made in the body of this report. We consider that Sharston House provides excellent outcomes for the people who live there so rather than detail what they could improve we would expect that the home continues to review its practice in order to ensure that the standard of care provided to the residents at the time of this inspection is maintained and where possible improved upon. Care Homes for Older People Page 9 of 31 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given enough information to help them make decisions and choices about the home. Evidence: The homes aqaa told us that, After the initial contact and the resident and relative have chosen Sharston we send an additional brochure and welcome letter. In addition we offer a trial or visit, a contract which includes the fee structure, statement of purpose, complaints procedure and philosophy of care and general information....We have a website with information including pictures of the Home and location..... They also told us that they felt they had developed over the last 12 months with doing, We have updated our website to include virtual tours and an improved preadmission assessment. New TVs in all Lounges. We looked at a sample of 4 care plans of people living at Sharston House, including Care Homes for Older People Page 12 of 31 Evidence: the records of two people who had recently moved to the home. Staff had completed checks about this persons needs before they moved in, using the homes paperwork to record all the persons health needs and wishes. They also get a copy of any other assessments that have been completed such as social work assessments. This helps them to assess whether the persons needs can be met at Sharston House, before they move in. Staff explained that they then provide a basic plan of care for the person so that when they move in, staff have information on how to initially provide care for that person. It also ensures that the staff can arrange for the right type of equipment to be in place for each person so they have everything they need. The staff told us that they provide people with a copy of information about how the home works and who it is for. These documents are called the service users guide and statement of purpose and they provide details about the home, including the facilities and services provided for people living there. This document would benefit from being reviewed further to include enough information to let people know how many staff they can expect to see throughout the day. This would help to show the companies commitment to the minimum amount of staffing levels that they commit to, to meet peoples needs. Care Homes for Older People Page 13 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Sharston House have a plan of care so that their care needs are identified and staff know what to do to make sure these needs are met in the way the person prefers. Evidence: The homes aqaa told us that they had made various developments over the last 12 months such as, Introduced a new drug administration system. Regular medication audits. Introduced a more in depth pre-admission assessment format. Purchased new camera to improve resident identification in care plans. Strive to improve our care plans by liaising with other homes and health care professionals...... We looked at a sample of 4 care plans of people who live at Sharston House to see what care was provided to them to meet their needs. Each one had been reviewed by staff. This ensures the plans provided enough information and guidance for staff on how to support the person safely and contained details on how the person wanted to be supported. This is good practice and necessary to include people in how they want to be cared for. The care plans covered a diverse range of needs such as, eg Care Homes for Older People Page 14 of 31 Evidence: communication, care of specialist feeding tubes called pegs, diabetes, continence, care of catheters, personal care, mobility needs, arthritis, wounds, falls, safety, blood pressure and diverticulitis. We saw that there was a large amount of specialised equipment such as electric beds and pressure relieving mattresses and a number of hoists in the home. This is very good practice and shows a good commitment from the company to invest in the best of equipment and facilities for the people they support. Staff felt that they are always supplied with the best equipment to help them to care for people in the right way and to give the best care possible. This comment was also made by 1 person living at the home who felt that the best of equipment was supplied which they felt enhanced the care given to them and helped them be comfortable living there. Throughout our visit, we saw staff talking to people respectfully and treating them with dignity. Staff were seen knocking on doors before entering peoples rooms. We noted that some bedroom doors were left open and some people could be seen lying in bed. Some of the staff said they left the doors open so they, ... could keep a check on people. However, with visitors and staff walking past throughout the day, peoples privacy could be compromised and we have recommended that this practice be reviewed with each person whose bedroom door was being left open to check that this was acceptable to them. The manager felt that some people had requested for their door to be kept open although we noted that not everyone would be able to make their choices and requests known. We chatted generally to people living at the home and they told us they were happy with the staff and felt that they could always talk to the staff if they needed anything. People told us that they were happy living at the home. Staff described how they support people to see health professionals such as their GP, chiropodist and opticians when needed. The records and care plans also showed how the staff plan for regular contact with these medical professionals to help keep people healthy and safe. We looked at how the medicines are managed in the home. We checked a sample of the medication records and the storage and management of the medications. The manager explained that they now had good contact and support from their local pharmacy. We looked at a sample of the managers audits and checks on the medications carried out by senior staff. These checks help to make sure that the medicines in the home are improved and continue to be well managed so that the people living there receive their medicines safely. Care Homes for Older People Page 15 of 31 Evidence: Care Homes for Older People Page 16 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to stay active and socially included in what they want to do. Evidence: The homes aqaa told us that they felt they had improved over the last 12 months to include, eg, Installation of large TV Area. Created a Dining Area in the Music Lounge. Extended Tuesdays Whist Days to two tables a week. Now have 2 hairdressing days to meet demands and reduce risk of residents and staff feeling rushed. We have found additional wheelchair accessible transport. We met various people living at the home who told us they were very happy at the home and felt they had various things to do. Some people said they just like their own company in their own room and some people choose to either go and watch what activities were on offer and some liked to get involved. Some people liked to go on trips out but due to the weather the last organised trip was last October. The activities organiser kept good records of all previous events that she had organised including who had been involved with each event. We noted that within each persons care records staff had developed, social profiles These records helped to give some basic information about, eg, each persons past social history, what they use to like doing and what contacts they had with people close to them. These records would benefit Care Homes for Older People Page 17 of 31 Evidence: from further development to provide care plans to show how staff could support people with their social needs and requests now and how this could then be used to help plan the ongoing activity programme on offer. There were various notice boards in the home which helped to keep people up to date with various things such as menus and activities. On the day of our visit the activities organiser explained that the hairdresser had visited that morning and that she mainly organises events for the afternoons between 2 to 4pm. She updated her activity programme each week so that everybody knew what was planned and on offer throughout the week. She planned on organising games for the afternoon which was also advertised within her activity programme. We looked at the minutes of the last meeting that people living at the home had attended. The manager organised them every 3 months. These meetings provide an opportunity for the people who live at the home to be included in developments about Sharston House and they are able to make suggestions for activities they would like to do. We looked at menus being used at the home. There are choices available and staff help people to choose their meals each day. Menus are displayed on the main notice board so that people know what choices are available each day. We discussed with staff the benefits of developing the menus further and making them even more accessible on dining tables so that everyone could easily view them each day. The basement store room was well stocked and organised however we noted there was alot of stock of frozen stock and limited stock of fresh vegetables and fresh fruit. This was discussed with the manager who agreed to review the menus and to take advice and guidance from the community dietitian, the staff and people living at the home. One relative survey and one person at the home told us they felt they didnt like alot of frozen food and they sometimes didnt like the menu on offer. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported to be safe with well trained staff to safeguard them. Evidence: The homes aqaa told us that they, We give out complaints procedures on admission. We record all complaints and record outcomes and how they were resolved. All complaints dealt with within 21 days. They also identified that they needed to, Reiterate complaints procedure generally despite been given an admission, a few people answered no to would you know how to make a formal complaint on questionnaire. The information given to people about how the home works includes information about the complaints procedure. This tells people how to make a complaint and how these would be dealt with in the home. We spoke to some of the staff on duty on the day of our visit and they all had a good understanding about safeguarding adults and complaints procedures. The training records showed that most staff had been on safeguarding adults training so they would know how to recognise the signs of abuse and what they would have to do to protect the people living at the home. Staff told us they would report any concerns they had and were confident and knowledgeable about their safeguarding policy. On the day of our visit, people told us they were confident that the staff would deal Care Homes for Older People Page 19 of 31 Evidence: with any concerns they may have. In total we received comment cards and everyone indicated they knew what to do if they needed to raise any concerns or complaints. Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sharston House was well maintained, with a continuing refurbishment programme, so that people living there do so in a comfortable and safe surroundings that are equipped to meet their needs. Evidence: The homes aqaa told us, We endeavour to exceed residents and relatives expectations and maintain and improve the environment and provide a caring homely and friendly environment where our residents feel safe and happy which is reflected in the feedback we receive from relatives and residents. The aqaa told us they had developed various areas over the last 12 months such as, Completed the new conservatory. Commenced re-slabbing the court yard area and constructing new raised flower beds. Extended the wood floor around the music room and conservatory area. Replaced windows. Renovated the Victorian sash windows. Replaced wardrobes etc in four bedrooms with fitted wardrobes and furniture. Replaced the carpets redecorated two lounges, the dining room and hall. Created door on corridor and constructed a ramp for easier access to the patio lounge area. Renewed carpets in several bedrooms where necessary. Installed new dishwasher. Re-painted external windows and woodwork. Replaced new hoist slings and purchased 2 new hoists. Installed large plasma TV in the main lounge and new TVs for lounges. Drug Administration System - new drug trolleys and fridge for medication. We have purchased more pressure mattresses. We have improved the efficiency of radiators. Care Homes for Older People Page 21 of 31 Evidence: The home has a maintenance person who works 4 days a week and he kept detailed records of how they manage the building and equipment, making sure that it is safe with any necessary actions taken to reduce any risks. Their records showed regular checks and risk assessments for eg, radiators, water temperatures and in house fire protection system checks. These records and practices showed good management of the environment. We walked round the home during our visit and looked at a number of areas including the communal spaces such as the bathrooms and dining room. We found a homely atmosphere in the home and the building was well maintained. People living there told us they liked their home, that they were very comfortable and had everything they needed. Everyone living at the home had their own bedroom which they could personalise as they chose to help to make it more homely. We looked at some of the bedrooms and saw they were all kept clean and tidy. Various rooms had evidence of lots of personal belongings such as pictures, televisions, radios, personal phones, computers, electric beds and mattresses and electric wheelchairs, ornaments and some personal furniture that people had brought with them when they moved into Sharston House. This helped people to settle into their room and feel more comfortable with their personal belongings around them. The home has a laundry with staff that are employed for laundry duties daily. It was equipped with industrial style machines and was found to be very organised, clean and tidy. However for the size of the home it was noted to be small and compact with no way to have separate areas for clean and dirty linen. Linen had to also be pressed in this room and we noted one machine had been located in the sluice room. Ideally a separate area for the storage and pressing of linen would be advantageous and would reduce risks to potential cross infection. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are supported by well trained staff who know the needs of the people they support. Evidence: The aqaa told us that they had, Low turnover of staff, we have an excellent record of staff retention. The new manager was recruited from within the home. Promote an open and friendly atmosphere amongst all staff which in turn promotes an honest and trustworthy workforce. The aqaa also told us about their plans for the next 12 months including, eg, Continue to access appropriate training and maintain mandatory training for all staff. Continue to liaise with staff re, their training needs in order to meet them...... We looked at a sample of 4 staff files which showed us that before anyone starts work in the home a series of checks were carried out. These include obtaining a completed application form, two references and a criminal records bureau disclosure. These checks help to ensure that staff are suitable and safe to work with the people living at Sharston House. The homes training records showed evidence of a lot of regular mandatory training which were mainly provided by the homes in house staff trainer, covering diverse topics including, eg, health and safety, fire safety training, accidents and risks, first Care Homes for Older People Page 23 of 31 Evidence: aid, infection control, hydration, food hygiene, moving and handling and protection of vulnerable adults. This training helps to ensure staff are aware of how to safely support people especially with their individual needs. We saw some gaps to necessary mandatory training for some subjects such as abuse awareness. The manager should ensure that all staff have updated training planned for them on a regular basis so their training needs are always met and kept up to date. We found limited evidence of what type of training each person had received as very few records of training or certificates were kept. The manager currently keeps a list of training with dates and names of staff who attended. We discussed the benefits of having a review of the management of the different types of training offered and to review how this is evidenced for each member of staff. Following our visit the manager has provided us with further details of the trained staffs recent training which was not accessible during our visit. The list of clinical updates and training attended by the trained staff has covered a wide selection of topic such as, eg, record keeping and nursing accountability, nasogastric tubes, syringe driver plus palliative care drugs, mental capacity, venepuncture, verification of death, continuing health assessment, end of life, vaccination, moving and handling trainer, dementia and end of life. The manager was also in the process of organising further updates and more training in regular refresher training. We met a lot of the staff on duty on the day of our visit and they told us that most of them had been working at the home for some time. Staff said they were very happy working at the home. They all felt well supported and fully trained and were regularly offered training to help them do their job. They were very enthusiastic to do their best. The manager arranges staff meetings every 3 months at the home. We looked at a sample of these minutes to see what topics had been discussed. Staff told us that they could raise any issues and could talk openly within their staff meetings. In the January (2010) minutes, staff had raised opinions and comments about struggling at lunch times to help people with their meals. They also discussed the effects of starting at 7 am and working long shifts. Although the senior managers told us that they had reviewed this, there was no other information or evidence to show what actions had been taken about staff opinions and what reviews had taken place about the staffing levels and the dependencies of people living at the home. Reviews of staffing levels and dependancy levels should be regularly reviewed with consultation with people. This will help to ensure the staffing levels offered will meet the ongoing needs of the people living at the home. Discussion took place regarding how the company have calculated the current Care Homes for Older People Page 24 of 31 Evidence: numbers of staff needed to provide the right type of care for each shift throughout the day. At present the manager advised verbally that they usually have; 3 trained staff and 10 carers in the morning, then in the afternoon they have 3 trained staff and 7 carers and in the evening they have 2 trained staff and 4 carers. At night they explained they have 1 trained nurse and 3 carers. The ongoing staffing levels provided for each shift throughout the day and night should be openly displayed for peoples information. This would ensure they are aware of the companies commitment to the staffing levels provided to always meet their needs and so they know how staffing levels are calculated, reviewed and managed and people are aware of how many staff are on duty each day. We received 8 comment cards from staff who overall were very positive however they made various comments and suggestions such as, eg, 4 people felt the staff needed help with motivation and better job satisfaction. Two people felt they didnt have enough knowledge about healthcare needs and medications. These comments should be reviewed with staff to show how their comments are listened to. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sharston House was well managed to make sure that it is a safe place to live and work in and it was managed in the best interests of the people living there. Evidence: The aqaa told us that,, We maintain good admin and management procedures. Health and safety issues are addressed principally including servicing of equipment. The management are keen to instigate improvements to care, premises and procedures. A long standing and dedicated management and admin team who communicate with all grades to create a happy and friendly home. This information was well evidenced during our visit and shows appropriate and safe management of Sharston House. The registered manager for the home works with a management team consisting of an administrator and a deputy manager. The manager is a registered nurse and is experienced at running care services for older people. She has worked at the home for Care Homes for Older People Page 26 of 31 Evidence: over 20 years and knows the people who live there and the staff very well. The provider told us that the home does not act as appointee for any of the people living there and peoples relatives or representatives manage their finances with or for them. This is an example of good practice and helps people to have individual choices as to how they manage their own personal money. We looked at a sample of certificates and records which showed us that a series of health and safety checks are carried out on the building and equipment at Sharston House to ensure the home is safe. These include regular checks and risks assessments of eg, fire equipment and facilities, the lift and mobile hoists. In addition, regular health and safety audits are carried out by the homes staff to include eg, water temperatures and small electrical appliances. The manager ensures there are other checks such as regular reviewing of health and safety within the home, reports on incidents and accidents, care plans and regular medication audits. These audits were examples of good practice to show what management checks were in place to ensure good standards were maintained to ensure people were kept safe and healthy at Sharston House. We saw samples of quarterly minutes of meetings of both staff, relatives and people living at the home. Regular meetings help achieve good communication about the home, how it is running and helps include them with planned developments of their home. Comments made within the body of this report should be reviewed with people to offer them the opportunity of more meetings throughout the year to elicit their ongoing comments and suggestions. Care Homes for Older People Page 27 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 28 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 The practice of keeping bedroom doors open when people are in bed should be reviewed with each person whose door is usually kept open. This will help staff to take any necessary action to try to protect each persons privacy. To develop social care plans to show how staff could support people with their social needs and requests and how this could be used to help plan the ongoing activity programme on offer to meet their social needs. To review the menus and food stocks ordered and to take advice and guidance from the community dietitian, the staff and people living at the home regarding the ongoing use of frozen food stock. To gain updated opinions from people and to give them regular feedback regarding their suggestions and input. To revew the current laundry facilities. Ideally a separate area for the storage and pressing of linen would be advantageous and would reduce risks to potential cross infection. Information about staffing levels should be published and available for everyone. Everyone should be aware of the Page 29 of 31 2 12 3 15 4 26 5 27 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations minimum amount of staffing levels that the company commits to, to meet their standards of care. Regular consultation and review should take place around the reviews of staffing levels. 6 30 To review the management and record keeping of training at the home. This will ensure that each staff member has the necessary training that meets their needs and enables them to be able to do their job. Detailed record keeping will help to further evidence how each persons training needs are met and will show how refresher training and updated training is managed. All staff should have updated training on abuse awareness. Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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