Care Home: Shawside Nursing Home

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What the care home does well The management team responds well to concerns of statutory agencies, cooperates fully with the inspection process and is keen to implement and develop the best practice in all aspects of social and health care. The service has a robust admissions process and effective assessment and care planning systems are in place. These will promote good health and positive wellbeing for people using the service. People living in the home continue to be complimentary about staff, saying that they are listened to. Comments included: `I think the care and support is very good.` People continue to appear well cared for with attention to details, such as hair and nail care, and clothing was co-ordinated. Residents said that staff listened and respected their wishes in relation to personal care and socialisation. Visitors were welcome into the home. The new manager states that, concerns that have come to light through meetings or discussions with residents are always dealt properly so that they do not become complaints. Employment recruitment practices were safe so staff who may have posed a risk to residents were not employed. The monitoring of the service is now completed monthly visits (Regulation 26) and a copy of this report sent to the Commission for Social Care Inspection. People receive appropriate health care, including effective pressure area care and referrals to specialist health professionals. What has improved since the last inspection? Since the previous inspection the documentation concerning referral to healthcare professionals for further advice has improved. Since the previous inspection a manager has been employed who is experienced and who has completed the Commission for Social Care Inspection registration process, this means that the staff have stable leadership that improves the outcomes for people living at the home.Since the last inspection the manager has asked people about the meals and some changes made. Since the last inspection activities offered are varied enough to meet the individual preferences of people at Shawside. What the care home could do better: The outcomes for people living at Shawside could be improved if the daily records completed by staff related to the instructions in care plan as this would make it easier to monitor it`s effectiveness and show the plan has been followed. The environment needs to be improved so that all the units fully meet the needs of the people living there and so that all the units are free from unpleasant smells. The training matrix needs to show that all staff receive specialist training, according to their role and that this training is provided from specialists in their field and has a positive impact on the way the way they work. The manager should take steps to make sure that 50% of staff achieve National Vocational Qualification (NVQ) level 2 in health and social care. CARE HOMES FOR OLDER PEOPLE Shawside Nursing Home 77 Oldham Road Shaw Oldham Lancashire OL2 8SP Lead Inspector Michelle Haller Unannounced Inspection 29th & 31st October 2008 09:30 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 Shawside Nursing Home DS0000025453.V372940.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. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shawside Nursing Home Address 77 Oldham Road Shaw Oldham Lancashire OL2 8SP 01706 882290 01706 290770 waltonjo@bupa.com www.bupa.com BUPA Care Homes (CFHCare) Ltd 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) Care Home 150 Category(ies) of Dementia - over 65 years of age (30), Old age, registration, with number not falling within any other category (57), of places Physical disability (120), Physical disability over 65 years of age (120) Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. 7. 8. The manager to be supernumerary at all times. No more than 90 places to be used for nursing care. No service users under 55 years of age to be accommodated into the home. One named service user above 39 years of age may be accommodated in the home. A minimum of 630 nursing staff hours must be provided each week. A minimum of 630 care hours must be provided on Beech House each week. One named service user under the age of 65 years to be admitted to Beech house in the category DE(E). The home is registered for a maximum of 150 service users to include: *up to 57 service users in the category of OP (Old age not falling within any other category); *up to 120 service users in the category of PD (Physical disability under 65 years of age); *up to 120 service users in the category of PD(E) (Physical disability over 65 years of age); *up to 30 service users in the category of DE(E) (Dementia over 65 years of age). 13th December 2007 Date of last inspection Brief Description of the Service: Shawside is a care home that provides 24-hour residential and nursing care for up to 150 service users. Care First Health Care Limited, a part of BUPA, owns the home. Shawside is situated on the outskirts of Shaw and is approximately three miles from Oldham town centre. Local shops, libraries, GP surgeries and pubs are available in Shaw centre, which is about a ten-minute walk away. Bus services are available close by. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 5 The home provides accommodation in five separate units or houses. Car parking facilities are provided close to each house and garden areas are accessible both at the front of the home and at the rear of each house. All bedrooms are single, none have en-suite facilities. Accessible toilets are situated close to bedrooms and communal areas. Some of the bedrooms have patio windows that open onto the garden areas, all bedrooms overlook the grounds. Each house has its own assisted bathing facilities and walk-in showers are also available. One unit at Shawside remains closed. A copy of the home’s last inspection report was available from the main reception of the home. Communal lounge and dining areas and a small servery are available in each house. Kitchen facilities and laundry facilities are located within the main reception buildings. The fees charged by Shawside range from £360 to £408.80 including additional health service payments. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was a key inspection that included an unannounced visit to the service. This means the manager did not know in advance that we were coming to do an inspection. During the visit we looked around the building, talked to residents, relatives and staff, including unit managers and the manager of the home. We observed the interactions between people living at Shawside and examined care plans, files and other records concerned with the care and support provided to people in the home. We also looked at all the information that we have received or asked for since the last inspection. This included: The annual quality assurance assessment (AQAA) that was sent to us by the service. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Information we have about how the manager has managed any complaints and any adult protection issues that may have arisen. What the manager has told us about things that have happened in the home through ‘notifications.’ We also received eight Commission for Social Care Inspection (CSCI) staff surveys that were returned to us. There have been three protection of vulnerable adult investigations; these were fully investigated by the BUPA management team. No complaints had investigated by the home since the previous inspection. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? Since the previous inspection the documentation concerning referral to healthcare professionals for further advice has improved. Since the previous inspection a manager has been employed who is experienced and who has completed the Commission for Social Care Inspection registration process, this means that the staff have stable leadership that improves the outcomes for people living at the home. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 8 Since the last inspection the manager has asked people about the meals and some changes made. Since the last inspection activities offered are varied enough to meet the individual preferences of people at Shawside. 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. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 9 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 Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 10 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): 3 (NMS 6 is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The manager ensures that new people are only admitted to the home following a full assessment of needs that has been carried out by people trained to do so. EVIDENCE: In total, eight residents’ files were looked at; two from each unit that was open, and all contained a detailed assessment of needs that had been completed prior to or very soon after admission to the home. The most recent admission had been fully assessed and information included a profile of the day and night routines and preferences, general health needs, including pressure area care, moving and handling needs, mood and emotional wellbeing, nutritional status, communication and family involvement. Signatures confirmed that qualified nurses carried out these assessments. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 11 The manager also stated that she also ensured that an assessment from the referring agency was also provided before people moved into the home. These were seen on file. In most cases, social interests and historical information had also been documented in detail. Notes also confirmed that the person and their relatives were able to be involved in the initial assessment process. The manager also provides people with a letter that confirms that an assessment has taken place and that the needs identified can be met at Shawside. All the staff who returned surveys said that they always had enough information about what people needed. In the information returned to us, the manager stated admission to the Shawside included ‘an extensive assessment, taking into account resident choice.’ And relative’s comments included: ‘My … was visited by staff while she was in hospital before she came to the home.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 12 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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Shawside benefit from health and personal care based on their individual needs, which is provided with respect, dignity and privacy. EVIDENCE: The care plans and other care records for eight people were looked at in detail. This included people who were at risk of developing pressure sores. On the day of inspection the manager stated that there were five people in total with pressure wounds and that nearly all had been admitted with these wounds. Files showed that risk assessments in relation to developing pressure sores had been carried out. Positional change charts were in place and in use. The home employs a tissue viability (skin care) nurse specialist who has close links with the Primary Care Trust (PCT) or health service community nurses. The pressure mattresses are checked daily and signed to confirm that it is on the correct setting for people’s weight. This could be improved if the actual weight and setting were recorded. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 13 The progress of the wound is monitored through recording these on a body chart and also through taking pictures at different stages of the healing process. Staff who were spoken to were keen to describe their role in helping to ensure that people’s skin condition remains good. Comments included, ‘We have to make sure they sit in different chairs, and that if they need cream that we put it on.’ The manager needs to make sure that staff always monitor people’s skin condition and report what they see. At the previous inspection it was found that there was always a detailed description of skin problems and pressure areas were checked each day. At this inspection this was not the case, as it was not possible to confirm through records that people at risk of pressure wounds were closely monitored. Care plans are detailed, as the assessment and care plan systems used by BUPA prompts staff into completing comprehensive needs led assessment and corresponding care plans. The process is called QUEST and uses a scoring system that, if used properly, will also ‘trigger’ the development of specialist risk assessments and involvement of other professionals in areas of concern. As well as tissue viability, this includes specialist and routine health needs, social care and maintaining independence and safety, such as moving and handling, diet, mental health, infection control, sensory needs, dental health, podiatry, medication issues and continence needs, communication and all other aspects of life including relationships. Staff said that they found the system of assessment and care plan ensured that they knew what to do in order to ensure people’s needs are met. Comments from staff included: ‘We have Quest care plans which give very detailed information about our residents. Updated every month and changed if there is any change in a resident’s condition.’ Each care plan that was looked at was detailed and descriptive, providing staff with clear instructions about the actions were to take. For example, ‘Talk casually, don’t ask too many questions as this causes anxiety and frustration.’ The care plans had been reviewed and signatures and comments confirmed that people and their relatives were involved in this activity. In the information returned to us, the manager stated that ‘Everyone has a care plan.’ Care staff also commented that: ‘We have care plans which give very detailed information about our residents. Updated every month and changed if there is any change in the resident’s condition.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 14 The system prompts staff to record professional visits and this record confirmed that people had regular access to general practitioners, dentists, podiatrist and relevant routine and specialist health care and check-ups, including hospital outpatient appointments. The quality of information provided in daily records needs to improve as, in general, on each unit the information written in them did not always relate to the care plans or provide a description of what people had experienced from day to day. All reports were written a respectful manner. A number of medication record sheet were examined and no omissions were noted and medication was stored correctly. Controlled medication was properly accounted for and two members of staff witnessed that it was administered. The manager needs to ensure that the controlled medication cupboard meets current pharmaceutical guidelines. The manager also needs to ensure that staff follow the company’s policy and guidance when the medication fridge is outside of the accepted temperature range, so that it is serviced and mended. This is important because medication needs to be kept between the recommend temperature ranges to prevent it’s effectiveness from changing. Infection control procedures were observed and staff were observed putting on aprons and washing their hands prior to dealing with food. No personal care was observed. The interaction between people and staff was observed throughout the day on the four units in use. It was observed that people are treated with respect and kindness. Staff routinely provided support in a dignified manner asking people what they wanted, and preparing them for things that were about to happen. For example, prior to moving and handling procedures or being supported to eat their meals. People made positive comments about the health and personal care provided at Shawside. They said: ‘Yes health care is given quickly’; ‘They seem to get medical help quickly’; ‘The health care is very efficient and the staff act quickly on what is said’; ‘She has come on so much since she came here. Even when she stays on her bed they make sure she is well dressed and make sure she looks nice and not left in her nighty’ and ‘They seem to have got to know her without speech.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 15 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): 11, 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Shawside benefit from a service that enables them to make choices about their lifestyle, supports them to develop their life skills and meets their individual, social, educational, cultural and recreational needs. EVIDENCE: There are three activities co-ordinators employed to work approximately 21 hours each week. The activities calendar displayed in the units indicated that activities planned for the week included a Halloween party, discussing what was written in the newspaper, baking, musical bingo, dominoes and cards, manicure and hand massages, one to one sessions, karaoke and sing-alongs and visits to the newly opened coffee ‘shop’. Other events and activities described by residents and staff includes a regular Church service, regular visits from the mobile library, visit from a dog petting organisation, reminiscence, bingo and arts and craft. Activities were organised that would given people to learn about new things. For example, one event at Shawside involved everyone going on virtual cruise. This included introducing people to music, food and other aspects of life from the different countries. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 16 During the morning a reminiscence session was observed and people enjoyed joining in. The session was very lively and stimulating. This session was especially successful because people who had initially refused to join in became interested and gradually participated in full. Activities that people had participated in during the day were not written in daily records, however, the activities co-ordinators kept an individual record and file. These records were detailed and showed whether people benefited and enjoyed the activity. These records also indicated that each person was able to benefit from some individual activity with a co-ordinator. This included playing a game, having a book read or looking at pictures or having a discussion. This is an improvement since the previous inspection. There were photographs on display of people currently living in the home, participating in the activities. Care staff said that they also arrange activities such as games, putting on music and singing along, or spent time talking to people, at in the evenings or at weekends when the activities co-ordinators were not available. The routines in the home are flexible and people were observed visiting their friends and relatives throughout the day. People who visited said that staff had taken time to get to know people as individuals, and said that they had taken ideas from staff about individualised gifts that people would enjoy. Two activities co-ordinators were spoken to and they felt that BUPA were keen to provide meaningful activities and recreation. In their experience, the organisation had funded different initiatives, including links with other organisations and the purchase of equipment and materials. The social history and life story information that has been collated for each person demonstrated the management’s commitment to providing individualised and person centred activities and the records did show that was happening. People are supported to maintain families and friends and family information about people had been the person and their relative; appropriate. good relationships and contact with their contact was documented and a lot of gathered through staff spending time with communication with relatives appears Comments included ‘We are so content and feel welcome because she is made a part of the home’; ‘Yes there’s enough going on to keep her awake and interested. There’s basketball, basket weaving, film evenings, people can visit when they want.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 17 ‘We do have activities, dominoes, bingo, karaoke. There’s trips we can go on and I have enjoyed them, we went to the Panto last year, the safari park and pub lunches. There’s a Halloween party this week and I go to the coffee shop that I really enjoy. Staff give me messages from my family.’ Mealtimes were observed on three of the units and, in the main, this appeared to be a pleasant experience. In the morning it was observed that people were able to have a relaxed breakfast. The choice of cereal or porridge and a full cooked breakfast was available to everyone. People came down at different times and some items, such as poached eggs and toast, were cooked to order. The lunchtime meal on the first day of inspection was homemade tomato and basil soup, sandwiches or pilchards on toast, followed by cheesecake or icecream. During lunch time people were heard to comment that they were enjoying the meal. The soup was sampled, this was hot and tasty. The main meal of the day is served in the late afternoon. On the first day of inspection the choice was fish in parsley sauce or sausages in gravy with potatoes, peas and sweetcorn. People were offered a choice of food at all the meal times that were observed. Hot and cold drinks and snacks were also provided. People were heard making appreciative comments about the meals such as ‘I enjoyed that’ and ‘That was beautiful.’ Weight charts and food records indicated that meals and snack were readily available and frail and undernourished people gained weight following admission to the home. No negative comments were made about the food, people said ‘The food is not bad at all, we have a choice- I like the cooked breakfast’ and ‘Food is very good- I like mash and we get it.’ At lunch it was observed that care staff provided support to those who needed assistance. The dining areas were clean and furniture was pleasant to use and free of stains. Staff were respectful, helpful and patient at all times. This comment summarises the general feeling of people living at Shawside ‘I’m better than when I came in- food is very good we are given a choice … there is enough going on to keep me entertained and awake … people can visit when they want and the staff are very nice.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People are confident about how to complain, are listened to and procedures are in place to protect people living in the home from abuse. EVIDENCE: People who commented stated that they were confident about making a complaint and would address any concerns initially to the unit managers. Comments included ‘If I had any complaints I would speak to the unit manager’ and ‘I’ve not had any complaints all the time that (relative) has been in but would talk to manager.’ Also: ‘I’ve never had a complaint but wouldn’t hesitate to speak to the unit manager- they speak to you so much anyway.’ Staff felt that they were aware of how to deal with complaints and felt that people’s concerns would be taken seriously. One person said- ‘We speak to them and refer them to our home manager who is very respectful and kind. If she is not around, the deputy manager will address concerns.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 19 The complaints record was examined and the information confirmed that complaints were dealt with fairly and transparently. Complaints are analysed by BUPA head office so that any patterns can be recognised and appropriate corporate interventions put in place. The manager said that since the previous inspection, in December 2007, there had been a reduction in complaints, and she had not dealt with any complaints since managing the home. She said that issues that people wanted to change were discussed at residents’ meetings and these were attended to immediately. The training matrix indicated that the majority of staff had completed the BUPA in-house training ‘Abuse in the care home.’ This training includes watching a film about preventing and the effects of abuse and completion of a workbook. Staff also have opportunity to attend adult protection training provided by Oldham Metropolitan Borough Council (OMBC) local authority learning partnership. Staff who were interviewed were clear about the actions they would take if they were to witness inappropriate behaviour and said that they felt more confident in how to tackle such issues. Newly appointed staff and those new to working in the social care sector were interviewed. Each had received POVA training as a part of their induction. One person said the training had ‘opened her eyes’ to what was abuse and her responsibility in protecting people from harm. She also said that she felt that people were safe. In the information returned to us the manager for Shawside stated that ‘BUPA Care Services has a clearly defined complaints policy with agreed timescales for managing complaints. The information that accompanies the policy is prominently displayed in the home. This manager has dealt with one investigation under the protection of vulnerable adults (POVA) procedure and records showed that this was dealt with openly and in keeping with the OMBC safeguarding guidelines. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 20 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Furniture, fixtures and fittings are homely and provides a comfortable place to live, although additional steps are still required to make all the units free of unpleasant odours. EVIDENCE: A tour of the four open units at Shawside was completed. The majority of the home was free of unpleasant odours, and this is an improvement since the previous inspection in December 2007, however, on one unit, there was still that a smell of stale urine. This was discussed with the manager who stated that there had been a decision to renew and refurbish all the carpets, fixtures and fittings throughout the home. She felt hat this would resolve the problem that continued on one unit. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 21 This is continuation of the programme discussed at the previous inspection in December 2007. It is important that manager approaches the registered providers for an agreed time scale and schedule for these refurbishments. The refurbishment of Beech House, the dementia care unit, was discussed. The manager stated she would ensure that the refurbishment would take into account best practice in relation to providing an environment that suits the needs of people affected by dementia. This process has already begun in that people had memory boxes and pictures of themselves outside their doors to help with orientation. The unit also had red toilet seats, which the manager said had increased people’s independence as they needed less assistance to use the toilet properly and safely. On checking the carpet, chairs, beds and other furniture, fixtures and fittings these items looked worn but free from stains. In the main, people were seen using the facilities safely and with confidence. There was enough space for people to do different activities, by going to another unit, using a quiet room or returning to their own rooms. All the bedrooms that were looked at were clean, free from stale unpleasant smells and had been personalised with people’s own items of furniture, artwork, ornaments or photographs. People were complimentary about the environment and said: ‘The home is clean, they always seem to be cleaning’ and staff said ‘Bedrooms are personalised.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. People living at Shawside benefit from staff who receive training and in sufficient numbers to support them and meet their needs. EVIDENCE: The manager stated that she is currently on a recruitment drive, however she did not have problems staffing the units. The staffing ratio on one unit was checked. There were 28 people living on the unit supported by two trained nurses and four care staff. The activities coordinator also spent time with people and two domestics were also on duty. Staff, relatives and people using the services felt that there were sufficient staff on duty. They said: ‘staff attitude is generally good- they do run around sometimes but the residents are always ok’; ‘Staff are excellent, we’re not got up too early and we don’t have to wait’ and ‘Yes there’s usually enough staff and we don’t have to wait. Staff files were examined and each contained job application, references, start date and up-to-date Criminal Record Bureau checks and POVA Firsts. There were no gaps or missing items in the records examined. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 23 BUPA have established specialist nurses who will become experts in pressure wound care and who will cascade their knowledge to staff at Shawside and also be able to provide prompt nursing intervention and guidance so that situations do not deteriorate, this role is ongoing and has proved successful to date, although the manager needs to ensure that it is possible to confirm which staff have received training, especially taking into account staff turnover. The training matrix confirmed that the majority of staff had received essential training including: BUPA skills for care induction standard, introduction to fire safety, abuse in the care home, understanding dementia care, basic infection control, introduction and people handling. The training matrix should also confirm that staff have received other training provided by the organisation, such as risk assessments, facilitators refresher, managing violence, nutrition, record keeping and care planning, assessment and administration of medicines, professional communications and key skills in communication. The manager stated that the future training plan would include a National Vocational Qualification for domestic staff and housekeepers. She is trying to arrange control of substances hazardous to Health (CoSHH) training. The activities co-ordinators are to receive training that is been rolled out by BUPA for all activities staff. In the information returned to us, the manager stated that approximately 45 of care staff had attained National Vocational Qualification (NVQ) level 2 in Health and Social Care, and that an additional ten members of staff were completing the course. The provider stated in the improvement plan completed in October 2007 that all unit managers had received updated training in pressure area care. This has improved the quality of life for people living in the home, as there is now less risk of them developing pressure sores and they are also more likely to receive prompt attention at the first sign of a problem. It is essential that the improvements in this area be sustained. Care staff continue to be developed in line with the BUPA initiative called ‘Personal Best’. Staff who were interviewed were pleased with their involvement on the scheme and said that it had helped them to improve their knowledge, practice and relationships with people using the service and each other. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 24 Staff who returned CSCI surveys confirmed that training was good and prepared them for the work they did and kept them up to date with new ways of working. Staff who were interviewed were confident about the importance of meeting people’s equality and diversity. This was achieved through discussion with the person, the staff team and the person’s family when appropriate. One person said ‘We also talk to families as everyone is different and it’s part of the job.’ Staff also said: ‘We are fully staffed and it is possible for staff to cover- we had a few problems at night but regular agency is now in place.’ Comments from staff also included: ‘Training is always given for mandatory purposes such as fire prevention and moving and handling. Other relevant courses are always available such as health and safety food hygiene, etc., I have attended many courses within my career.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 25 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. People at Shawside benefit from an ethos that aims to promote the safety and well-being and take account of the opinions of all who are involved in the home. EVIDENCE: The BUPA organisation has now employed a manager who has been put forward for CSCI registration and at the time of this inspection the interview date was set. This person has worked in other BUPA homes and has a track record of supporting staff to make permanent and positive improvements in the standard of care and support provided. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 26 The manager has re-established staff and residents’ meetings. The notes from these show that she listens to what people say and attempts to implement suggestions if this will improve the service. Topics discussed included additions to the meals, menus, activities and the proposed refurbishment. Each Unit Manager also organises their own meetings so that issues that relate to these residents are discussed in a smaller group. This information is then fed back to manager at Unit managers’ meetings. The manager said that she is especially interested in lifestyle and activities and plans to make sure that lifestyle is excellent. She is active in her management style and since her employment at Shawside, she has organised a tearoom on site that residents can go to three afternoons each week. This is a popular facility that was praised by residents, relatives and staff. The manager co-operated with the inspection process and was concerned that people receive the care they need from staff that are competent and aware of the conduct expected of them. The manager is aware that she needs to sustain and build on the improvements already achieved at Shawside, especially in relation to pressure area and wound prevention and care. It is essential that this person continues to work closely with other senior managers in BUPA and that the systems that have been introduced are made robust and imbedded, so that these improvement can be sustained. BUPA is in the process of completing the quality audit that includes a customer satisfaction questionnaire and questionnaire for visiting professionals. This was looked at and people who responded seemed content with the service at Shawside. The administrator demonstrated how residents’ finances were handled through a computerised accounting system that is audited by BUPA Head office. She confirmed that residents generally bought the items they wanted and this was invoiced to their portion of money held in a residents’ account. A statement was looked at and it showed the amounts owned by each person. Interest was also being paid to the residents. The home has a handyman who takes responsibility for maintenance of services and equipment- he is about to complete additional professional training so that he can test small electrical appliances. In the information returned to CSCI it was noted that all health and safety equipment checks, except the Gas Safety, were within the expected timescale, however the manager checked the maintenance record and confirmed that the Gas Safety had been completed just prior to the inspection and so was also up to date. Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 27 Overall, those who commented about the general running of the home were positive. This comment summarises what was said: ‘I think every area does well, one could not work without the other. Communication has improved greatly.’ Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 28 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x 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 x x x 2 STAFFING Standard No Score 27 2 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 x x 3 Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The manager should ensure that all information and records are consistently detailed and developed to a high standard this will ensure that people receive equal access to effective and personalised support. The manager should ensure that the refurbishment that is planned results in an environment that meets specialist needs and helps to promote clean air free from unpleasant odours. The manager needs to be able to show that staff have received all the training the needs to meet the different needs of the residents and roles within the home. The manager needs to ensure that the NVQ level 2 qualification is achieved by at least 50 of staff. 2 OP26 3 4 OP27 OP28 Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection NW Regional Area Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ 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 Shawside Nursing Home DS0000025453.V372940.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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