Care Home: Shenstone

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What the care home does well The registered manager responded to the previous inspection report with comprehensive improvements. All requirements and the majority of good practice recommendations required at the last inspection visit were actioned. The information about the home was up to date and easy to understand, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had a contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, "feel it is a well run home". Each person, and as appropriate, their relatives were involved in the plan of how their care is to be provided. Care plans were well written and up to date, giving staff instructions how to care for and support each person. The medication systems were well managed and people received their medication at the time prescribed by their doctor. There were very good relationships with the local health care services, providing support for people living at the home. A district nurse told us that staff were knowledgeable about the people`s healthcare needs and always sought advice for any concerns. She felt they managed the care of people with diabetes well. Comments from surveys included, "seems well run with efficient, good staff". This demonstrated the very good level of trust and professional respect between the home and primary care services. People were encouraged to treat the home as their own home and to be as independent as possible. People were encouraged to personalise their bedrooms with their possessions, furniture and bedding if they wished. We received positive comments from people living at the home which included, "treat us as people, my room is always kept immaculate", and "the staff are very good and I always get good service" People could make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. The residents meetings were well established and well attended, with notes of topics discussed and actions decided. There was good involvement in the running of the home and people had contributed their views about the activities, planned outings and food. People told us they enjoyed their meals, which looked appetising. The home had maintained their 4 Stars and Silver Awards for food safety and healthy eating. There were good links with local churches with arrangements in place for people to practice their faith. People knew how to raise concerns and make complaints and were confident these would be dealt with. Up to date policies and procedures for protecting people from harm were available and staff had completed safeguarding training. The home had a relaxed, homely ambience and it was warm, generally clean and comfortable. Comments from people and their relatives included, "I like living here", and "what I see visiting my mother, I could not ask for more professional care and help in a clean environment" The staff were caring, committed, flexible, and well trained. Staff were thoroughly checked to make sure they were suitable to work with vulnerable people. Comments from staff surveys included, "I think that Shenstone is a very well run home and tries very hard to achieve a high standard of care for all people. The manager`s door is always open and she is very accommodating and will help if she possibly can. Staff are supported very well in all aspects of their job role", and "The home has a lovely homely atmosphere and I feel proud to work here." There were effective management systems with regular quality audits to make sure people were cared for in a safe environment. What has improved since the last inspection? Medication systems had been improved, with new storage arrangements and all senior staff had completed refresher medication training. As identified as part of "what the home does well" improvements had been put in place to make the home`s medication system, as safe as possible, so that each person received their medicines as prescribed at the right time. There was an on going programme of redecoration and refurbishment. There was a training programme to make sure all staff were up to date with all essential and good practice training, which meant they were knowledgeable and skilled to meet the needs of people living at the home. What the care home could do better: There were a few areas requiring improvement at this inspection. The organisation must provide appropriate arrangements to store peoples` medication at the correct temperature during very hot weather so that it remains effective for people`s health and well being. The redecoration and maintenance programme needs to be continued so that the standards of the premises are pleasant and safe for people using the service. Comments included, "some areas of the home are in need of care, and decoration, for example dementia training says that different colours, bright, help them find their way to the rooms or toilets", and "Some parts of the home are in need of redecoration, money is always a problem as there is never enough, I do feel dementia unit would benefit from having money spent on it, new signs, brighter paintwork, coordinated for the people." Key inspection report Care homes for older people Name: Address: Shenstone Kent Road Halesowen West Midlands B62 8PQ     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: Jean Edwards     Date: 1 4 0 7 2 0 0 9 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 36 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) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 36 Information about the care home Name of care home: Address: Shenstone Kent Road Halesowen West Midlands B62 8PQ 01384813470 01384813471 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: N/K Dudley Metropolitan Borough Council care home 44 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum numbers of service users who can be accommodated is: 44. The registered person may provide the following categories of service only: Care Home only PC - Code PC The 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 catergory - OP 44. Dementia - DE 17 Date of last inspection Brief description of the care home Shenstone is a purpose built building of three storey construction originally built in the 1960s. It was refurbished in 1998 and is owned and managed by Dudley MBC. It is situated on the main Kent Road close to nearby Blackheath and Halesowen Town centres and there are good public transport link. There is limited care parking at the front of the building and attractive, secure gardens at the rear of the home. The home can accommodate up to 41 older people, providing 24 hour residential care. The home does not provide nursing care. There are five separate but interlinked units within the Care Homes for Older People Page 4 of 36 Over 65 0 44 17 0 Brief description of the care home building, including one unit with five short stay beds providing respite services for people with dementia, the other four units can each accommodate nine people. Each unit has its own kitchenette, dining room and lounge. The environment is light and airy, there are assisted bathing and toilet facilities and a range of aids and adaptations throughout the home. Care Homes for Older People Page 5 of 36 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 last Key Inspection was on 24/07/07 and the CSCI undertook an Annual Service Review in 2008. We, the Care Quality Commission (CQC), undertook an unannounced key inspection visit. This meant that the home had not been given prior notice of the inspection visit. We monitored the compliance with all Key National Minimum Standards at this visit. The range of inspection methods to obtain evidence and make judgements included discussions with the registered manager and staff on duty during the visit. We also talked to people living at the home, and made observations of people without verbal communication skills. Other information was gathered before this inspection visit including notification of incidents, accidents and events submitted to the Commission. We looked at a number of records and documents. The acting manager submitted the homes Annual Quality Assurance Assessment (AQAA) as requested prior to the inspection visit. We looked around the premises, including communal areas of the home, the Care Homes for Older People Page 6 of 36 bathrooms, toilets, laundry, kitchen areas, and peoples bedrooms, with their permission, where possible. Responses to CQC surveys have been included throughout the report. The home had published the range of fees in the service user guide, which ranged from £370.00 to £521.00 (Out of Borough placements) each week pounds. There were no Third Party Top Up Fees charged. People are advised to contact the home for up to date information about fees. Care Homes for Older People Page 7 of 36 What the care home does well: The registered manager responded to the previous inspection report with comprehensive improvements. All requirements and the majority of good practice recommendations required at the last inspection visit were actioned. The information about the home was up to date and easy to understand, with alternative versions for people who may not be able to read or understand written information. Everyone living at the home had a contracts and terms and conditions, which were clear and easy to understand. Comments were positive and included, feel it is a well run home. Each person, and as appropriate, their relatives were involved in the plan of how their care is to be provided. Care plans were well written and up to date, giving staff instructions how to care for and support each person. The medication systems were well managed and people received their medication at the time prescribed by their doctor. There were very good relationships with the local health care services, providing support for people living at the home. A district nurse told us that staff were knowledgeable about the peoples healthcare needs and always sought advice for any concerns. She felt they managed the care of people with diabetes well. Comments from surveys included, seems well run with efficient, good staff. This demonstrated the very good level of trust and professional respect between the home and primary care services. People were encouraged to treat the home as their own home and to be as independent as possible. People were encouraged to personalise their bedrooms with their possessions, furniture and bedding if they wished. We received positive comments from people living at the home which included, treat us as people, my room is always kept immaculate, and the staff are very good and I always get good service People could make choices about their daily routines, activities and meals. They were encouraged and supported to take an active part in meetings and surveys at the home. The residents meetings were well established and well attended, with notes of topics discussed and actions decided. There was good involvement in the running of the home and people had contributed their views about the activities, planned outings and food. People told us they enjoyed their meals, which looked appetising. The home had maintained their 4 Stars and Silver Awards for food safety and healthy eating. There were good links with local churches with arrangements in place for people to practice their faith. People knew how to raise concerns and make complaints and were confident these would be dealt with. Up to date policies and procedures for protecting people from Care Homes for Older People Page 8 of 36 harm were available and staff had completed safeguarding training. The home had a relaxed, homely ambience and it was warm, generally clean and comfortable. Comments from people and their relatives included, I like living here, and what I see visiting my mother, I could not ask for more professional care and help in a clean environment The staff were caring, committed, flexible, and well trained. Staff were thoroughly checked to make sure they were suitable to work with vulnerable people. Comments from staff surveys included, I think that Shenstone is a very well run home and tries very hard to achieve a high standard of care for all people. The managers door is always open and she is very accommodating and will help if she possibly can. Staff are supported very well in all aspects of their job role, and The home has a lovely homely atmosphere and I feel proud to work here. There were effective management systems with regular quality audits to make sure people were cared for in a safe environment. What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 9 of 36 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 36 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 36 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. There is a comprehensive and easy to read statement of purpose and service user guide and people living at the home have contracts terms and conditions of occupancy. This means that that people and their advocates have good information regarding their rights and entitlements, and how care will be provided. The home uses comprehensive assessment tools so that each persons needs are thoroughly assessed to ensure that their needs and preferences will be met. The home actively encourages introductory visits and people have the opportunity and time to make decisions, which are right for them. Evidence: The information contained in the homes AQAA (Annual Quality Assurance Assessment) about what it did well stated, Copies of Service User guides and Statement of Purpose are made available during domiciliary visits. These are also on display in reception and available in welcome packs. When necessary these are Care Homes for Older People Page 12 of 36 Evidence: provided in large print and have also been translated into Punjabi. We were able to verify the information in the AQAA and we saw that the home had an up to date statement of purpose and service user guide on display and in comprehensive welcome packs in each bedroom. We saw that these documents could also be provided in alternative formats on request. The aims and objectives, admission criteria were clearly set out and information about the home was easy to read and understand. The service user guide also had information about the range of fees and payment arrangements. Overall the information was useful for people to help them make decisions about their choice of home. We looked at a sample of case files of people recently admitted to the home, which showed that each person was provided with a contract and statement of terms and conditions. This document had also been updated and was easy to read and understand and set out in detail what was included in the fee, the role and responsibility of the provider, and the rights and obligations of the person living at the home. The home also provided terms and conditions of residency for people using the short stay respite service, which demonstrated good practice. From the information provided at the home we noted that the majority of people were funded through the Local Authorities whilst a small number of people were funding the costs of their own care. Responses from surveys returned to us confirmed people felt they had the right information to make a choice about the home and had received a copy of their contract or terms and conditions for their stay at the home. There was evidence from examination of a sample of care records at the home and from discussions, which confirmed the good practices claimed in the homes AQAA. Such as pre admission assessments, which were conducted professionally and sensitively and had usually involved the family or representative of the person. The pre-admission assessment documentation was well completed and individual preferences were recorded such as rising, retiring, preferred activities, likes and dislikes. This meant that staff had good and accurate information about each persons needs and preferences about how they wished their care to be provided. There was a short stay unit, Terrace View, on the ground floor providing respite care for people with dementia. This unit had facilities and staffing arrangements, which were separate from people living at the home on a permanent basis. The management had introduced terms and conditions for people using the respite service, which was a positive initiative. People we were able to speak with told us they enjoyed their time Care Homes for Older People Page 13 of 36 Evidence: at the home and were happy to have regular short stays. Care Homes for Older People Page 14 of 36 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. The comprehensive care planning, risk management and monitoring, provides staff with the information and guidance to meet peoples needs and preferences. Good multi disciplinary working takes place on a regular basis, giving people assurances that their health needs care needs are identified and well met. The medicine policy reflects good practice and people living at the home can feel confident they will receive their medicines as prescribed by their doctor. People living at this home can be assured that they will be respected at all times. Evidence: We looked at a sample of care records for new people admitted to the home and people who had lived at the home for longer periods of time. Each person had a comprehensive care plan to meet their needs for care and support. There was good practice of involving the person and their relatives or representatives in the development and review of their planned care. Care Homes for Older People Page 15 of 36 Evidence: Care plans were based on very comprehensive assessment information and included all essential information about each persons needs and identification of any associated risks. The personal preferences such as gender of carer, recording each persons preferred daily routines for staff guidance, and the introduction of my life history, made sure that care was delivered with a person centred approach. This was an excellent initiative, which was implemented well. From records and discussions we saw that each persons health was carefully monitored with appropriate action taken. There was evidence of well documented health care assessments, and screening tools, such as falls assessments, tissue viability and the Malnutrition Universal Screening Tool (MUST), which were used to assess skin condition and weight. There were examples where significant changes had been referred to doctors and health care professionals such as dieticians, speech and language therapists and the falls team for advice and support and appropriate reviews and monitoring. A visiting district nurse told us that she felt staff were helpful and knowledgeable about peoples needs and she was satisfied with the care and monitoring arrangements for people with diabetes living at the home. We saw that all persons living at the home had good access to health care services to meet their assessed needs. Some people were able to choose their own GP within the limits of geographical borders and there was documentary evidence to demonstrate that all persons had good access to dentists, opticians, and other community services such as chiropody. The home had a key worker system, operating as a very good initiative to enhance the quality of individual, person centred care for people living at home, whether on a permanent or temporary basis. Staff spoken to demonstrated that they knew about each persons needs and preferences. We looked at the homes systems to manage the medication. The home used a Monitored Dosage System (MDS) for people living at the home on a permanent basis and medication for people at the home on a temporary basis had a variety of medication administration arrangements such as mediboxes, cassettes and original containers. We saw that the supplying pharmacy supported the home with advice related to medication issues at regular audit visits. Since the last key inspection in July 2007 the home had met all previous requirements and the majority of good practice recommendations. We were told that all senior care officers had recently received refresher ASET accredited medication training, and we saw the certificates on file. Care Homes for Older People Page 16 of 36 Evidence: There were improvements to the storage of medication with the provision of drug trolleys for each unit. Each drugs trolley had a thermometer and daily temperatures were recorded to make sure medication was appropriately stored in accordance with manufacturers guidance. The records told us that temperatures were below 25 degrees C for the majority of time. However there were records of excessive temperatures, between 27 degrees c and 33 degrees C over a nine day period, during the recent heat wave. The manager told us that they had tried moving the medication trolleys to various locations in the home to find a cooler storage area without success. The organisation must make appropriate arrangements, such as use of an air conditioning unit, to ensure medication is stored in accordance with manufacturers guidance so that it does not lose its effectiveness for peoples health and well being. There were lockable medication refrigerators, which were checked daily, with the minimum and maximum temperatures documented and recorded. This meant that peoples medication requiring refrigeration was stored at the correct temperatures to maintain its integrity and effectiveness. There was appropriate storage and records of Controlled Drugs and the random audits we carried out were accurate. We looked at a sample of MAR (Medication Administration Records) charts, which document each persons current medicine requirements and regime. The majority were well maintained, which meant that there was an accurate record to show medicine prescribed by their doctor was recorded, checked, monitored and administered in accordance with instructions. There were good procedures and checks in place to make sure that people received their correct medicine at the right time. Protocols and care plans had been put in place for the administration of when and as required (PRN) medication. The receipt, administration and disposal of medicine were also well recorded. The date of opening of medicine in original containers was documented, which meant it was easy to carry out audits. We carried out audits on a random sample of medication to ensure that medicine had been given to each person as prescribed by the GP. The random audits undertaken of prescribed medication were found to be accurate. There were a small number of areas were practices needed to be improved. Examples were: the majority of variable dosages were recorded, but some pain relieving and laxatives did not show whether one or two tablets, 5mls or 10mls had been given. There were some handwritten entries on MAR charts, which had not been signed and Care Homes for Older People Page 17 of 36 Evidence: witnessed by two staff to make sure the information was correct, and on two occasions the amount of medication received by the home had not been entered onto the MAR chart, which posed risks of errors. From our observations and in discussions it was evident that all staff were aware of how to treat each person with respect and to consider their dignity when delivering personal care. Care Homes for Older People Page 18 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are planned and spontaneous activities available on a regular basis offering people ample opportunities to take part in socially stimulating events. People are enabled and encouraged to maintain good contact with family and friends. The dietary needs of each person are well catered for with a balanced and varied selection of foods that meets their preferences and nutritional needs. Evidence: The homes AQAA cited the following evidence of what was done well, Continue to involve, liaise and consult regularly with clients, family and friends through daily contact, residents meetings, reviews and promotion of key worker system, to identify their preferred daily living routines and social activities allowing them a lifestyle that is as far as possible free from any restrictions. and to promote and maintain links with outside agencies in relation to attendance of local day centres, local churches to include in-house services, hairdresser, chiropodist, dentist, optician etc. Continue to progress to develop and change activities around the individual needs of people making sure that they have regular and appropriate access to the variety of different levels of activities available both in and outside of the home. We maintain and promote an open visiting times as well as open door policy for access to senior Care Homes for Older People Page 19 of 36 Evidence: team/management. We continue to use our flash cards and communication aids developed previously to ensure communication remains adequate for people with any degree of sensory deprivations. We saw ample evidence for the accuracy of the claims made in the homes AQAA. We saw that staff listened to people living at the home and made considerable efforts to provide flexible daily living routines, which enabled people to enjoy a good quality of life according to their personal preferences. We noted earlier in the report that the home has a key worker system, which enabled closer relationships between the people accommodated and staff, where likes, dislikes and needs were known in more detail and were met in a person centred way. We were told that the home does not employ an activities organiser and staff at the home took responsibility for collating the information gained from residents and staff meetings and used their knowledge of peoples preferences to plan activities, which each person could enjoy. The staff team provided a range of activities and access to community. There was an activities room, where people did craftwork and played darts and snooker on a new snooker table. We saw pictures of a trip to Weston Super Mare. We were told that ideas from residents and staff meetings were discussed and planned so that people were involved as much as possible. Further trips were planned for this year. We saw information displayed attractive formats in the reception bringing peoples attention to community events and activities. One person told us he regularly goes to the local pub for a pint of Guinness, sometimes on his own and sometimes with support from staff. This person had an appropriate risk assessment in place. One person writes poems and loves to recite them for people at the home and for special occasions. We were told the manager types them at the persons request and they are sent all over the world. It was positive that it was understood and respected that some people preferred to spend their time in their own bedrooms, and they were supported with individual interests. We saw evidence that the staff knew and understood about peoples faith and where this was an important part of their life, they were supported attend services as and when they wished. We also noted that staff were completing life histories for each person, which often gave staff valuable insight into each persons past life and improved the person centred aspect to their care. We spoke with staff who told us about one person who had been a model and had lived in France. Their knowledge Care Homes for Older People Page 20 of 36 Evidence: about this persons previous lifestyle gave them an appreciation of some of the reasons for behaviours associated with their condition. We looked at a sample of peoples individual activities records, which were well completed, with refusals recorded. We received some comments from people who felt there could be even more time dedicated to activities and social stimulation, which we discussed with the registered manager during the inspection. We saw that one person who wanted to work was given some appropriate administrative jobs to do, which was an excellent initiative. Comments from surveys returned to us included, manager found me jobs when I asked and lots of things to do, songs, darts, pool table. We saw evidence that family and friends were welcomed and people we spoke to told us they knew they could visit the home at any time. We were told that the management and staff team always made time to talk to visitors, offer refreshments and share information where this was appropriate. We saw that people were encouraged to bring in their personal possessions to personalise their room. We saw inventories of personal possessions on the sample of files examined, which were generally up to date, signed and dated by the person or their representative and witnessed by the member of staff. We discussed nutrition with the staff and the manager. They were knowledgeable about each persons nutritional needs and we saw that a choice was always offered. There was regular use of the MUST (Malnutrition Universal Screening Tool) and BMI (Body Mass Index) screening. This made sure that any concerns about each persons weight were quickly identified with action taken to involve doctors and dieticians as needed. We saw that the monitoring arrangements also reflected the good hydration and nutrition at the home. We saw plenty of cool drinks available around the home and heard staff offering frequent warm drinks. Special diets such as diabetic and soft diets were provided. There was also added calorific value at mealtimes for people with poor appetite or at risk of weight loss, using cream, butter and cheese. The home had retained the achievement of the Silver Award from Dudley Environmental Health for healthly eating and a 4 star rating for Scores on Doorsaward for food safety. We discretely observed mealtimes, though we were asked to leave one unit during breakfast. One person pointed out it was their mealtime. This was very positive and demonstrated people felt able to have their say about what they wanted to happen in their home. Staff were aware to the needs of people who found it difficult to eat and we noted that they offered sensitive assistance with feeding. They were aware of the importance of offering food at the persons pace, so that they were not hurried. A Care Homes for Older People Page 21 of 36 Evidence: small number of residents chose to have their meals at a different time, or in their bedrooms, to allow them time and space to eat at their own pace. Efforts had been made with the dining rooms to make it look inviting with attractive tablecloths, crockery and condiments. The meals appeared appetising, and meal times were protected to provide a sociable, enjoyable experience. We asked a sample of people about the food at meal times, and received generally very favourable comments, the food here is very good and we have plenty, and we have lots of choices. There were sample menus in the welcome packs in each bedroom. There were pictures of meals and snacks, these were colourful displaying meals, which looked appetising and appealing. There were also large print menus to show daily meal choices. These are excellent initiatives to assist people make real choices for their meals. Care Homes for Older People Page 22 of 36 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be sure that any concerns and complaints are listened to and action is taken to look into them, with systems in place to record investigations and outcomes. There are good arrangements in place to safeguard people living at the home from risks of harm. Evidence: There were copies of the corporate complaints procedure displayed in the reception area, and on units throughout the home. There were also copies in the service user guide and in welcome packs in each bedroom. We saw that the information telling people how they could raise concerns or complain were supplied in pictorial and other formats. Information in the Homes AQAA told us that the home had received four complaints, over 12 months, which had been investigated and upheld by the provider within 28 days, with satisfactory resolutions implemented. There were complaint forms available, which provided detailed information. The responses during the inspection and from surveys returned to us indicated that people were aware of how to raise concerns or use the homes complaints procedure. This demonstrated positive practice and the homes proactive response to peoples experiences and perceptions of the service. We were told that the home had two situations of concern, which had been referred to Care Homes for Older People Page 23 of 36 Evidence: Dudley Directorate of Adult, Community and Housing Services (DACHS) under the Safeguard and Protect multi agency procedures. The registered manager cooperated fully, with investigations into the incidents, and remedial measures were introduced to safeguard all persons using the service. We were told that Shenstone had now been allocated extra staffing hours to meet the needs of dementia clients. The homes AQAA told us, any issues regarding people with mental health, or dementia are supported appropriate through the use of the appropriate Independent Mental Capacity Advocates. We also saw that the organisations Advocacy Procedure was readily available around the home. There was a copy of Dudley DACHS (Directorate of Adult Community and Housing Services) multi-agency procedures relating to safeguarding vulnerable persons living at the home. There were corporate policies and procedures such as Whistle blowing, which were in line with regulations and other external guidance. We were told that the registered manager and some senior staff had attended training regarding Mental Capacity Act and Deprivation of Liberty regulations and she told us about her plans to make this training available to the staff team, which demonstrated a very positive proactive approach. We were given documentary evidence that all staff have been made aware and have been given time to read and understand procedures for the protection of vulnerable adults. The majority of staff had attended training, which provided appropriate awareness of safeguarding vulnerable adults and staff we spoke to were aware of what they needed to do should an incident occur. The organisation followed rigours recruitment processes to make sure only staff suitable to work with vulnerable people were employed at the home. Care Homes for Older People Page 24 of 36 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a warm, homely and comfortable environment for people living there. There are sufficiently robust systems in place for maintaining infection control. Evidence: This was a large 3 storey, purpose built detached home opened in the 1960s and refurbished in 1998. It was divided within into five separate units making it feel less institutional, more homely and comfortable. Each unit had its own communal living and dining space. The size of the home meant that continual maintenance and repair work was needed to meet standards required. We had reported at the previous key inspection in 2007 that the corporate provider employed only one maintenance person to be shared between the local authority residential homes. The post holder was no longer employed and the registered manager did not have the information as to whether the post was going to be filled in the future. We saw that the registered manager had a maintenance and renewal plan and a reporting system for minor repairs, which required a reactive response. She told us that the organisation employed contractors to carry redecoration and we saw this taking place on one unit during the inspection visit. However there were parts of the home, which were looking tired and shabby, such as the paintwork in corridors and bedrooms on various units, especially the respite and dementia units. We noticed that the covering for the hot water pipes was worn in places leaving them exposed, which Care Homes for Older People Page 25 of 36 Evidence: posed a potential risk of burns for people living at the home. There were also bubbled areas on the sluice walls, which needed attention to maintain good infection controls. The registered manager explained her plans for improved orientation of the environment for people with dementia and she had submitted a bid for funding from an organisational central budget. The homes AQAA cited the following improvements to the environment, We have improved the garden area to ensure that this has been more attractive, colourful and pleasant environment for people to access. This has proved a very rewarding and attractive area for people to socialise in. We have had fencing erected around the garden area, this makes the area much more contained especially when caring for people with dementia. The interior of the home was a bright, cheerful and homely. There were attractive rear gardens, with garden furniture for people to use in the warm weather. We were told that there were plans to improve access to the gardens. We looked at a sample of bedrooms with peoples permission where possible. Some were adequately furnished and needed renovation and redecoration, acknowledged by the registered manager. Others had been attractively redecorated and personalised according to individual preferences, such as family photographs, ornaments and small items of personal furniture. One person particularly wanted to show us their bedroom. This person had lived at the home for 12 months and told us it was a big decision to leave their own home, but was very pleased to be living at Shenstone and really liked their bedroom. During discussions with people some told us they did not wish us to go into their rooms, which was a decision we respected. It was positive to see that some people had their own door keys and preferred to keep their door locked, which meant that no one could enter their private room without their permission. People told us that the home was generally clean, warm, and comfortable. These views were also confirmed in responses in surveys returned to us. There were assisted bathing and toilet facilities close to bedrooms and communal areas throughout the home. These would also benefit from redecoration and some minor repairs, such as a replacement for the cracked bath panel on the Parker bath on the first floor. We saw that the signage for toilet and bathroom doors has also been produced in Punjabi to aid the understanding of one person using the homes respite service. Care Homes for Older People Page 26 of 36 Evidence: There large laundry was well equipped with commercial washers and tumble dryers and a rotary iron. The laundry service was generally well organised and the staff demonstrated good standards of infection control. There was a laundry procedure and supplies of disposable gloves and aprons readily available in the laundry at all times. However we saw that there was a large basket of unlabelled tights and stockings in the laundry, the registered manager arranged the disposal of the contents during the inspection visit. She gave us assurances that this matter would be raised as an area for discussion with the staff. We were told that tights and socks were usually washed in peoples bedrooms because it was difficult to identify them if they were sent to the laundry. A discussion was held about suitable alternatives to make sure people could have their small items of clothing laundered appropriately and returned to them safely. The kitchen was maintained in good order, and it was clean and tidy and well organised. The catering arrangements were provided from a Direct Service Organisation, Dudley Catering DSO, arms length from the Local Authority. We noted that appropriate food hygiene and safety measures were in place, with records, monitored by the catering manager, and Environmental Services. We noted that there two cracked pest proof containers in poor condition used to store dried foods, which needed to be replaced. The registered manager assured us that she would request the replacements. The home had achieved the Dudley MBCs Environmental Health Four Star Scores on the Doors and Silver Food Award for healthy eating and food hygiene. Care Homes for Older People Page 27 of 36 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. There is a stable staff team and good skill mix so that people receive consistent and good standards of care. The staff recruitment processes are robust, which means that there are effective safeguards for people living at the home. There is a strong commitment to staff training and development. Evidence: The homes AQAA cited the following as evidence of what they do well, We still regularly monitor and review peoples dependency levels in order to ensure we maintain adequate staffing levels. Ensure that all rotas clearly identify the appropriate level of staff who are on duty during each shift. Ensuring that there are always three wakeful night staff on duty at all times, these are supported by the senior on Call from Shenstone as well as a Local Manager on Call available for further advice and support if necessary. We continue to improve and update our training and development program recorded on our matrix to ensure that our staff group remain highly skilled. We are constantly implementing new initiatives at Shenstone. All staff have a current/up to date CRB and have been through the appropriate recruitment and selection process including departmental inductions and Skills for Care. A dedicated Manager and staff team have been employed for many years maintaining consistency for all service users. We were able to verify the good practices claimed from observations, discussions and examination of samples of records during this visit. We noted that there were 39 people accommodated, with a variety of dependency levels Care Homes for Older People Page 28 of 36 Evidence: and diverse needs. The registered manager told us that she reviewed staffing levels on a regular basis, taking account of the occupancy and dependency levels of the people accommodated, which demonstrated good practice. Assessment of staffing rotas and information from the AQAA and staff personnel records demonstrated that the home was maintaining satisfactory staffing levels. The Home had a stable staff team including 26 care staff, 9 ancillary staff, the Registered Manager and catering staff supplied from the Direct Service Organisation. One member of staff had left the homes employ since in the past 12 months, and there was ongoing recruitment for staff vacancies including an allocation of 210 new care hours at the time of this inspection. The majority of staff personnel files had been taken to the organisations Human Resources department as part of a negotiation process. At the last key inspection the personnel files were satisfactory. The registered manager was able to tell us about the recruitment procedures, which were robust. We saw information for two people part way through the recruitment process, which showed that procedures were being diligently followed. The organisation and registered manager continued to demonstrate a strong commitment to staff training and development and had continued to provide all staff with appropriate training to raise awareness and skills to respond to peoples changing needs. We saw evidence that 21 of 26 care staff had achieved an NVQ level 2 care award with new candidates registered for training. The majority of the senior team had achieved the NVQ level 3 management and A1 Assessors Awards with two additional senior care officers enrolled as candidates. The domestic staff had achieved NVQ awards, which was very positive. We spoke with a visiting district nurse who told us it was a pleasure to visit this home and the staff were welcoming, knowledgeable and helpful. The staff told us they felt supported and this was confirmed in surveys returned to us. The comments received from staff included, I feel that Shenstone tries to do most things very well. Staff, I feel are caring and conscientious. We have a very good record of staff achieving NVQ level 2, this is ongoing so we always have staff working towards this qualification, and warm friendly home, approachable management team, quality care for service users with clear care plans, regular supervision, adequate training, recent increase in staffing hours due to care for our residents with dementia, we feel we are listened to, and The home has a lovely homely atmosphere and I feel proud to work here. Care Homes for Older People Page 29 of 36 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. The home has effective management team providing good leadership and direction, which ensures continuity and safeguards people. There are systems for consultation with people living at the home and peoples views are formally sought and acted upon. Evidence: The registered manager, Tricia Ghaley-Rose, with a number of years of managerial experience had been manager at Shenstone for five years. She had achieved the NVQ level 4 Award in Management and Care and the RMA (Registered Managers Award) and continued to demonstrate a commitment to her own professional development. She had a good awareness of the recently implemented Deprivation of Liberty Safeguarding Regulations and its implications for people living at the home. She planned to arrange for staff to receive appropriate training to raise their awareness and knowledge to benefit people using services provided at the home. During discussions there was evidence of an open, approachable ethos, which encouraged good communication with people living at the home, their relatives and Care Homes for Older People Page 30 of 36 Evidence: staff. We saw evidence that representatives of the registered proprietor visited the home regularly. We looked at the Regulation 26 Reports undertaken by the service manager, held at the home and noted that they were comprehensive and constructive. The quality assurance system was based on KLORA (Key Lines of Regulatory Assessment) and equality and diversity. We saw evidence of very positive quality audits during this inspection visit, which meant positive outcomes for people receiving the service. There were clear lines of accountability within the home, and through the management structure. We noted that the registered manager had devised and implemented the homes annual business and development plan for the current year. We saw very good evidence that the registered manager had used good self auditing systems, and these included monthly audits of areas such as peoples case files, food, the environment, staffing levels and accidents, incidents and falls, with remedial actions to minimise risks identified. The registered manager and staff team have continued very good efforts to involve people living at the home, their relatives, representatives and other community stakeholders in the running of the home. We noted that there were regular monthly residents meetings held on different units to encourage participation, with minutes available. The homes survey questionnaires had been distributed to people at the home, relatives and stakeholders, with completed forms returned, and results collated and published. We saw evidence that the results had been acted upon in any area where there were concerns or where performance needed improvement. For example the meals were regularly discussed and reviewed. We noted that staff meetings were taking place, with minutes available. The structured formal supervision system appeared to be working well with supervision sessions identifying training needs, personal development and support. This staff development had benefits for people living at the home. We noted that people were offered the opportunity to manage their own money if they wished, and the home provided facilities to help keep it safe. We looked at a random sample of balances and records of monies held in temporary safekeeping on behalf of people living at the home, which were accurate, with well documented records of all transactions. Care Homes for Older People Page 31 of 36 Evidence: We looked at a sample of heath and safety, fire safety and maintenance documentation, which was satisfactory and very well organised. There was evidence that all staff received mandatory training appropriate to their roles, such as fire training, drills twice each year, moving and handling, first aid, food hygiene, health and safety and infection control training. The registered manager had an effective system for auditing, analysing and evaluating accidents involving residents, with effective measures implemented. Care Homes for Older People Page 32 of 36 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 33 of 36 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 1 9 13 To provide alternative 01/09/2009 storage for medication during hot weather to ensure that all medication is stored in accordance with the manufacturers instructions, that is below 25 degrees C, so that medication does not lose its effectiveness. This is to safeguard the health and well-being of people living there in the home. 2 19 13 To ensure that any exposed 30/09/2009 water pipes in communal areas of the home risk assessed and appropriately covered so that people living at home are protected from risks of harm. This is to safeguard people from risks of harm. Care Homes for Older People Page 34 of 36 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 2 9 9 All medication received in to the home should be appropriately recorded on the persons MAR chart. Hand written medication records should be signed and witnessed by two appropriately trained two staff to confirm that the information written is correct. It was recommended that the organisation should give serious consideration to the employment of a handy person with sufficient allocated hours to maintain the environment to satisfactory and safe standards. It was recommended that additional pest proof containers should be provided for dried foods to ensure effective food safety. It was recommended that fridge temperatures in kitchens on units should be recorded consistently. 3 19 4 26 5 26 Care Homes for Older People Page 35 of 36 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. 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