Care Home: Sherwell

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What the care home does well People who use the service and their relatives were positive about the care and support provided by the staff and said the staff was flexible and responsive to their needs. Some comments include ‘staff are helpful’, ‘staff are excellent’,SherwellDS0000009163.V378594.R01.S.docVersion 5.2‘staff look after mums needs excellently’. People who use the service also stated they were always treated with dignity and respect. Good arrangements are in place to meet individual’s health needs and people who use the service were confident that medical services are promptly accessed when required. Flexible visiting arrangements are in place. People who use the service are positive about the varied and nutritional menu that reflects their preferences and choices. Some saying the food is ‘good’, ‘excellent’ and ‘there’s too much of it!’ The kitchen is suitably equipped and good standards of cleanliness are maintained. Relatives of and people who use the service said in the main they felt there was enough to do in the home and that it was their choice if they joined in the activities or not. One person felt more ‘mental stimulation’ was needed and another relative felt the level of meaningful activities could be increased. No one felt improvements to any other area of care could be identified. People who use the service and their relatives said that if they had any concerns they felt able to discuss them with their family, or with any member of staff and in particular the registered provider. They felt confident that the registered provider would listen to them and act upon any issues raised. The environment is homely, clean and comfortable and the people who use the service said they were satisfied with the accommodation provided. People who use the service and their relatives said they were satisfied with the care provided and that staff are ‘marvellous’, ‘nothing is too much trouble for them’, ‘staff are kind, supportive and helpful’. It is clear that positive and trusting relationships have been established between the staff and people who use the service. The home is maintained to a good standard ensuring that all health and safety and fire checks are carried out as per legislation. What has improved since the last inspection? The registered provider has complied with all the previous requirements identified at the last inspection. A new format for care plans has been developed. This care plan covers an individual’s personal care, physical care, social and leisure care needs. This is a vast improvement on previous care plans but further development is needed. Staff have attended formal medication training so that people who use the service can be confident that their medication is handled appropriately.SherwellDS0000009163.V378594.R01.S.docVersion 5.2To promote privacy and dignity locks have been fitted to bathroom doors, and bedroom doors if the person wishes. The registered provider was advised to ensure that these locks do have an override facility on them in case of needing to gain access in an emergency. Additional improvements to facilities have been made for example a new roof, new heating and boiler system installed. The adult safeguarding procedure and policy has been reviewed and now ensures staff are aware of the process needed to be followed. Sufficient staffing levels are on duty for the number of residents currently at the home. We discussed the staffing levels with people who use the service, relatives and staff and they felt the staffing levels were appropriate. Staff also knew how to gain extra support if needed and felt that their request would be listened too and acted upon. Staff have attended training for medication, first aid, manual handling, infection control and some have attended safeguarding training. Records needed for the inspection process were made available to the inspectors. What the care home could do better: It has been noted that there have been marked improvements to the service that Sherwell provides. However there are still some areas for improvement. Care plans must be developed further to reflect the individuals care needs and to ensure that they inform, direct and guide staff as to what caring interventions are needed so that care can be met in a consistent manner. The leak in the rear corridor must be repaired so that the health and safety of all who live, work or visit the home is maintained. A registered manager must be appointed as required by regulations. The recommendations include: it should be evidenced more clearly that pre admission assessments state who was present during this process so that all views of those involved in the admission are aware of what the home can offer the prospective resident. In addition a similar process should occur in the care plan reviews so that the views of those involved and the decisions made are recorded. The home should get an up dated version of the British National Formulary for staff use to reference medication queries. The registered provider should arrange staff training in the administration of eye drops to ensure this task is undertake correctly by competent and trained staff.SherwellDS0000009163.V378594.R01.S.docVersion 5.2Activity records should be written separately so that individuals’ confidentiality is maintained. The registered provider should ensure that as he is on the rota, that he has appropriate training to meet the needs of the people who use the service e.g. 1st aid and moving and handling to update his knowledge. The registered provider should complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. A policy and procedure in the management of people who use the service monies should be implemented to ensure protection form abuse. Recording a minimum of six formal supervision sessions of staff should occur so that there is a record of staff accountability and that issues such as care practice or training needs are identified and addressed accordingly. Interview notes should be recorded and kept on file as part of the recruitment process. The findings of the quality assurance process should be forwarded to the Commission It is recommended that the registered provider complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. The inspector would like to thank people who use the service, relatives, staff and the registered provider for their kind assistance and cooperation during this inspection process. Key inspection report CARE HOMES FOR OLDER PEOPLE Sherwell St Ives Road Carbis Bay St Ives Cornwall TR26 2SF Lead Inspector Lynda Kirtland with Melanie Hutton Key Unannounced Inspection 26th November 2009 09:30 DS0000009163.V378594.R01.S.do c Version 5.3 Page 1 This report is a review of the 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. 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. Sherwell DS0000009163.V378594.R01.S.doc Version 5.2 Page 2 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 Sherwell DS0000009163.V378594.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sherwell Address St Ives Road Carbis Bay St Ives Cornwall TR26 2SF 01736 796142 01736 798621 carricklodge@btconnect.com 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) Mr Ronald James Cottam Manager post vacant Care Home 9 Category(ies) of Old age, not falling within any other category registration, with number (9) of places Sherwell DS0000009163.V378594.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who may be accommodated is 9. 13 January 2009 Key Inspection plus Random Inspections Date of last inspection Brief Description of the Service: Sherwell is a double fronted Victorian style property, situated on the main road between Carbis Bay and St Ives. The care home offers accommodation and personal care for up to nine elderly people. All people who use the service have their own bedrooms, and all bedrooms have an ensuite toilet and wash hand basin. There is a lounge / conservatory at the front of the care home, which looks out on to the road with the sea in the distance. There are car parking spaces and there is also a lawned area at the front of the property. A small garden has been developed at the rear of the home and a patio area to the side. Mr Cottam, the registered provider does not currently employ a registered manager. He manages the home on a day to day basis with support from the registered manager from his other care home, Carrick Lodge. This is a temporary arrangement until such time as a new manager is recruited. A copy of the inspection report is available from management on request. A copy of this or previous inspection reports can also be obtained from CSCI on 0845 015 0120 / 0191 233 3323 or via our website at www.csci.org.uk. The registered Provider told us that the maximum fee is £350 per week at the time of this inspection. There are additional charges e.g. for hairdressing, chiropody, and newspapers etc. Sherwell DS0000009163.V378594.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two inspectors undertook an unannounced key inspection at the home on 26 November 2009 that lasted for six and a half hours. Information about the home received by the Care Quality Commission since the previous inspection was taken into account when planning the inspection. The purpose of the inspection was to ensure that the care needs of people who use the service are appropriately met in the home, with particular regard for ensuring good outcomes for them. This involved interviews with people who use the service, observation of their daily life and care provided. Interviews with relatives/ representatives also occurred. There was an inspection of the home’s premises and of written documents concerning the care and protection of the residents and the ongoing management of the home. We talked to staff who were on duty and at times during the day were able to observe their care practices. We also spent time in discussion with the registered provider. The principle method used was case tracking. This involves examining the care notes and documents for a select number of people who use the service and following this through including talking to them and the staff working with them. This provides a useful, in-depth insight as to how their needs are being met in the home. At this inspection, the four people who use the service were case tracked. In talking with some of the people who use the service they said that they were ‘happy’ and ‘it’s good here’. In discussion with relatives for all of the people who use the service they were satisfied with the care that their relative received and the calibre of the staff team. The only improvement that was highlighted by two relatives was to increase the level of activities. The Care Quality Commission received the Annual Quality Assurance Assessment, which is a questionnaire that the registered provider completed. This was not completed satisfactorily. What the service does well: People who use the service and their relatives were positive about the care and support provided by the staff and said the staff was flexible and responsive to their needs. Some comments include ‘staff are helpful’, ‘staff are excellent’, Sherwell DS0000009163.V378594.R01.S.doc Version 5.2 Page 6 ‘staff look after mums needs excellently’. People who use the service also stated they were always treated with dignity and respect. Good arrangements are in place to meet individual’s health needs and people who use the service were confident that medical services are promptly accessed when required. Flexible visiting arrangements are in place. People who use the service are positive about the varied and nutritional menu that reflects their preferences and choices. Some saying the food is ‘good’, ‘excellent’ and ‘there’s too much of it!’ The kitchen is suitably equipped and good standards of cleanliness are maintained. Relatives of and people who use the service said in the main they felt there was enough to do in the home and that it was their choice if they joined in the activities or not. One person felt more ‘mental stimulation’ was needed and another relative felt the level of meaningful activities could be increased. No one felt improvements to any other area of care could be identified. People who use the service and their relatives said that if they had any concerns they felt able to discuss them with their family, or with any member of staff and in particular the registered provider. They felt confident that the registered provider would listen to them and act upon any issues raised. The environment is homely, clean and comfortable and the people who use the service said they were satisfied with the accommodation provided. People who use the service and their relatives said they were satisfied with the care provided and that staff are ‘marvellous’, ‘nothing is too much trouble for them’, ‘staff are kind, supportive and helpful’. It is clear that positive and trusting relationships have been established between the staff and people who use the service. The home is maintained to a good standard ensuring that all health and safety and fire checks are carried out as per legislation. What has improved since the last inspection? The registered provider has complied with all the previous requirements identified at the last inspection. A new format for care plans has been developed. This care plan covers an individual’s personal care, physical care, social and leisure care needs. This is a vast improvement on previous care plans but further development is needed. Staff have attended formal medication training so that people who use the service can be confident that their medication is handled appropriately. Sherwell DS0000009163.V378594.R01.S.doc Version 5.2 Page 7 To promote privacy and dignity locks have been fitted to bathroom doors, and bedroom doors if the person wishes. The registered provider was advised to ensure that these locks do have an override facility on them in case of needing to gain access in an emergency. Additional improvements to facilities have been made for example a new roof, new heating and boiler system installed. The adult safeguarding procedure and policy has been reviewed and now ensures staff are aware of the process needed to be followed. Sufficient staffing levels are on duty for the number of residents currently at the home. We discussed the staffing levels with people who use the service, relatives and staff and they felt the staffing levels were appropriate. Staff also knew how to gain extra support if needed and felt that their request would be listened too and acted upon. Staff have attended training for medication, first aid, manual handling, infection control and some have attended safeguarding training. Records needed for the inspection process were made available to the inspectors. What they could do better: It has been noted that there have been marked improvements to the service that Sherwell provides. However there are still some areas for improvement. Care plans must be developed further to reflect the individuals care needs and to ensure that they inform, direct and guide staff as to what caring interventions are needed so that care can be met in a consistent manner. The leak in the rear corridor must be repaired so that the health and safety of all who live, work or visit the home is maintained. A registered manager must be appointed as required by regulations. The recommendations include: it should be evidenced more clearly that pre admission assessments state who was present during this process so that all views of those involved in the admission are aware of what the home can offer the prospective resident. In addition a similar process should occur in the care plan reviews so that the views of those involved and the decisions made are recorded. The home should get an up dated version of the British National Formulary for staff use to reference medication queries. The registered provider should arrange staff training in the administration of eye drops to ensure this task is undertake correctly by competent and trained staff. Sherwell DS0000009163.V378594.R01.S.doc Version 5.2 Page 8 Activity records should be written separately so that individuals’ confidentiality is maintained. The registered provider should ensure that as he is on the rota, that he has appropriate training to meet the needs of the people who use the service e.g. 1st aid and moving and handling to update his knowledge. The registered provider should complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. A policy and procedure in the management of people who use the service monies should be implemented to ensure protection form abuse. Recording a minimum of six formal supervision sessions of staff should occur so that there is a record of staff accountability and that issues such as care practice or training needs are identified and addressed accordingly. Interview notes should be recorded and kept on file as part of the recruitment process. The findings of the quality assurance process should be forwarded to the Commission It is recommended that the registered provider complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. The inspector would like to thank people who use the service, relatives, staff and the registered provider for their kind assistance and cooperation during this inspection process. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 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 Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4,5 People using the 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 needs of prospective residents are assessed so that they can be assured that the home can provide adequate care EVIDENCE: There are four people living at Sherwell. From discussions with relatives of people who have recently come to live at Sherwell they said that they were welcomed to the home by staff and their relative was emotionally supported as they settled into their new surroundings. Visitors were observed during the inspection to be shown around the home as part of the introduction process as they are seeking a placement for their relative. The registered provider stated that they encourage the prospective resident and their family to visit the home so that they can make an informed choice as to if the home is suitable for them. Documentation evidenced an assessment had occurred taking into account prospective residents physical, emotional, Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 11 social and diverse needs. The homes assessment does not make clear who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. People who use the service however, feel that the home involved them in their care arrangements. Assessments from sponsoring authorities were present on the file and the care needs identified were included in the pre admission assessment process. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Written care plans do not consistently inform staff in detail of the individuals care needs. The healthcare needs of people are monitored and addressed so that their needs are met. People who use the service stated they are treated respectfully at all times so that they retain their dignity and enjoy a good quality of life in the home. EVIDENCE: The registered provider has introduced a new design of care plans. This new format covers a persons, personal care, health, social and leisure needs fully. From inspecting the care plans, two were completed in full in line with the new design, one was three quarters completed and one was in the beginning stages. From the two completed care plans this did inform staff of the individuals care and health needs and in the main informed staff of what intervention was needed to ensure that a care task was carried out consistently for the individual i.e. dressing ability, personal care tasks. However there does need to be further guidance on how to manage certain health tasks in particular i.e. in the area of continence, who has assessed this area, what Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 13 equipment should be used, and when does a person need support to use the toilet: i.e. how to manage people’s specific dietary needs must be expanded on. The registered provider agreed to make relevant referrals to the speech and language therapist to ensure that peoples care needs are met appropriately. The registered provider stated that they review the care plans every three months, unless a concern arises in the meantime and then this is reviewed immediately. Relatives stated that they were aware of the care that their relative received and that if care needs changed this would be discussed with the registered provider or staff and would be addressed. It is recommended that when a review occurs that a written record is kept of the review, in particular who was present and what decisions were made so that it evidences that all parties views are considered when a care plan is reviewed and any changes made. People who use the service, and their relatives who we spoke to, said they were happy with the care provided. They said care was delivered according to their wishes and needs. All people living in the home looked clean, well dressed and well cared for. People who use the service spoke positively regarding the attitude of staff. On the day of inspection two care staff were on duty until 10am with an activities coordinator present in the morning and the registered provider was present for the majority of the day. A cook was employed from 10-2pm. This level of staffing was satisfactory to meet the care needs, as outlined in the individuals care plans for the four people who are currently using the service. Health care support appears to be to a satisfactory standard. People who use the service said they could see a doctor or other medical practitioner when this is necessary. However as noted above, referrals to the speech and language therapist need to be made to identify what support a person needs in this area of care. The medication policy inspected is satisfactory and appears to contain appropriate information. The medication system was inspected. Records regarding the operation of the system are to a good standard. Since the previous inspection, staff have recently attended Boots medication training regarding the administration of medication and therefore have complied with the requirement previously identified. In addition guidance from the pharmacist regarding the storage of medication has been sought. The home does not currently store any Controlled Drugs and the cabinet available to store them in does not meet current specific requirements. However, the registered provider informed us that this will be rectified when controlled drugs are needed to be stored at the home. Likewise they have no specific fridge for the storage of medications. However the pharmacist has given advice on how Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 14 to store medication safely in the general fridge whilst they have ordered a fridge for the home. It is recommended that the home gets an up dated version of BNF as their copy is dated March 2004. They do have a copy of the Royal pharmaceutical guidelines available for staff at all times. It is also recommended that as staff administer eye drops that they receive training in how to administer this. This was discussed with the registered provider who agreed to arrange training in this area with the district nurses. The privacy and dignity of people who use the service is generally well maintained. We observed staff speaking with people who use the service in an appropriate manner throughout the inspection. People who use the service said that staff are ‘kind’, ‘lovely’ and ‘nothing is too much trouble for them’. Relatives also echoed similar sentiments one stating that the ‘calibre of staff is very high’. Privacy and dignity care needs are considered in the individuals care plan. Improvements have been made, since the last inspection, to improving privacy in bathrooms and toilets. Since the previous inspection, the requirement to place a lock between the connecting door in the downstairs bathroom and the laundry room has been done. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,1,4,15 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines are generally satisfactory to meet the needs of people who use the service. For the current people who live at the home there are sufficient opportunities to participate in activities. The food is to a good standard. EVIDENCE: We arrived at the home at 9:30 am. People living in the home had just had their breakfast, and/ or were in the process of getting up. Routines appeared relaxed and people seem to be able to spend their time as they wish. People can spend their time either in the lounge / conservatory at the front of the house or in their bedrooms. An activities organiser was present and was observed to socialise with the people who use the service in both a group and individual bases. Singing, ball games and making Christmas decorations were occurring. The activities coordinator told us she is a qualified masseur and undertakes nail and hand care. In talking with the activities coordinator she showed us her records of activities that occur on weekly bases. It is recommended that these records are written separately so that individuals’ confidentiality is kept too as Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 16 currently records are kept as a group. The activities coordinator stated that no one who currently lives at the home wishes to go out but this is something that she would like to pursue in the future if people show a wish to do this. In discussing with the relatives and some people who use the service, whilst they said in the main there is enough to do, they would also like to see more ‘mental stimulation’. The registered provider said people are also offered the opportunity to go over to Sherwell’s sister home to attend events there. Staff and the registered provider said staff do try to organise other activities but it is difficult to motivate people to participate in these. People who use the service have said they felt they could exercise choice over their lives; for example where to spend their time in the home, what they could wear etc. People can look after their own money. It was evident people who use the service could bring their own furniture and belongings into the home. For example bedrooms are individualised with people’s personal belongings such as photographs and ornaments. Relatives and friends can visit people who use the service when they wish. The main meal is served at lunchtime. People who use the service said they enjoyed the food provided. The only ‘complaint’ that the home has received is that they ‘have too much food’. Relatives spoke highly of the food available and the choices given to people who use the service. A cook is now employed during the week from 10am to 2 pm. The carers serve breakfast; the cook asks the people who use the service if they are happy with the lunch for the day and will provide an alternative if asked and asks for their preferences for tea i.e. either sandwiches or a hot alternative. The cook stated she knows individuals likes/ dislikes and can cater for dietary needs. The cook also prepares the tea and on a Friday prepares the main meal for the Saturday lunch. On the Sunday the main meal comes from the sister home to Sherwell. The cook has menu planning records and completes the Safer Food Better Business guidance. An environmental health inspection occurred in July 2008 and concluded ‘good standards maintained’, the registered provider stated that all recommendations from that report have been addressed. The cook initially comes on duty from 8 to 10 and undertakes caring duties. She then changes into her cooking uniform and prepares food from 10 -2pm. She stated she has the basic food and hygiene certificate. As she undertakes the majority of cooking tasks it is recommended that she undertakes the intermediate food hygiene course to gain more knowledge in this area. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 People using the 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 registered provider has a suitable complaints and adult safeguarding procedure to ensure that people who use the service are protected from poor and abusive practice. EVIDENCE: Information regarding what people can do if they have a concern or complaint is in the service user guide. There are also notices in the communal part of the home stating how people can make a complaint. The registered provider stated that they have received no complaints since the last inspection. People who use the service and their relatives said that if they had any concerns they would be able to raise these with the registered provider or staff. They stated that they believed that any concerns raised would be listened too and acted on. The registered provider has reviewed the Safeguarding policy and procedure in line with the requirement identified at the last inspection. This is now satisfactory. Staff were aware of how to raise concerns or safeguarding issues and stated they felt confident to raise any issues with the registered provider. Two staff have attended formal safeguarding training. The registered provider stated all staff have seen the safeguarding video. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 18 The registered provider said no allegations of abuse had been made. No exstaff had been referred to the Protection of Vulnerable Register (POVA) list (A list of people who are considered unsuitable to work with the vulnerable). All staff currently employed have received a POVA First check and / or a full CRB/ POVA check (Criminal Records Bureau / Protection of Vulnerable Adults check which help to check the person is deemed as suitable to work with vulnerable adults). Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sherwell offers a generally pleasant environment for the people who use the service, although some improvement are still required to bring facilities up to the National Minimum Standards EVIDENCE: The building was inspected. The building was warm, clean and hygienic on the day of the inspection. Decorations, fixtures and fittings are generally in good condition. As the home is currently only registered for nine people this helps to provide an intimate setting for people accommodated. Facilities consist of a lounge / conservatory at the front of the home. A kitchen and dining room are situated at the rear of the home. There is a downstairs bathroom and a separate downstairs toilet. There is a very small office for the storage of files etc. A stair lift connects the downstairs with the upstairs to Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 20 enable those with walking difficulties to get up and down the stairs. There is an upstairs bathroom which is equipped to a good standard and has been redecorated. The registered provider has developed a small garden area at the rear of the home. The registered provider said he plans to put a conservatory on the rear of the home. He has also developed a patio area to the side of the home. An extension at the rear of the home has been completed. There is a leak by the rear door, which the registered provider said he is in the process of fixing. The extension provides two further en suite bedrooms which are decorated and furnished to a good standard and the rooms are personalised. The registered provider stated he has asked the people who use the rooms if they are happy with the vinyl flooring, they have stated they are, this needs to be recorded. He stated that if a person wanted carpet fitted in the rooms then he would ensure this was done. All bedrooms are of a satisfactory size; all are decorated and furnished to a good standard. Locks are fitted to bedroom doors but it is recommended that over ride locks are fitted in case of emergency and currently staff would struggle to gain access to the rooms. The registered provider stated he has made the following improvements since the last inspection: the front door bell works: a lock on the front door to aide security has been fitted: the roof has been replaced, a new heating system has been installed, as has a new boiler and fans are available in the conservatory to assist with ventilation. The registered provider is still considering converting two rooms into a lounge and office space but is awaiting the outcome of today’s inspection rating before he proceeds with this. He also has plans to put a conservatory on the rear of the home, to extend the rear of the home so that the laundry area is larger and has separate access to it rather then entering via the bathroom. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient qualified, competent staff are on duty at all times to meet people’s needs safely. Staff are qualified and competent to work with the people who use the service. They are recruited on the basis of fair, safe and effective recruitment and selection policies and practices. They have access to training to maintain their knowledge and skills. EVIDENCE: From discussion with people who use the service, relatives and staff it was noted that all felt that there were sufficient staff on duty at all times. People who use the service commented that staff respond quickly when they ask for assistance, and some acknowledged that at times there is a ‘little wait but that is because staff are dealing with someone else’. No one found this to be an issue. On the day of inspection there were two carers on duty from 8am to 10 am. One carer then changes role to become the cook from 10 to 2pm. An activities coordinator was present in the home for the morning. The registered provider had completed the sleep in and was present in the home most of the day due to the inspection. The rota showed that two staff members are on duty from 8am to 6pm. One carer is then on their own from 6pm to 8pm and then the sleeping in night staff member starts at 8pm till 8am following day. The registered provider told us, confirmed by staff that the sleeping in staff member usually stops shift around 10pm and starts in the morning at 6am. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 22 Staff were aware as to how to call for extra support if needed i.e. via the registered provider or via the sister care home, and said that this would be acted on immediately. As the home currently has four people resident the staffing levels do appear to meet theses peoples needs. However, if the home increases in number of residents or dependency levels increase then the registered provider agreed that a review of staffing needs to be undertaken and to consult with the Commission regarding this. The duty rota does need to show any changes to the rota i.e. sickness, leaving early etc and should also record the registered provider hours in the home to evidence the staffing levels in the home at all times. This was discussed with the registered provider who agreed to action this immediately. People who use the service and the relatives were very positive about the staff and it is clear that positive and trusting relationships have been established. People who use the service said they felt in control of the care and support provided which they viewed as sensitive, positive, reliable and flexible. Six staff files were inspected, of which two staff have achieved the NVQ level 2. Therefore to achieve the 50 target as recommended in the national Minimum Standards more staff need to achieve the NVQ level 2. This will enable staff to gain more knowledge in their role and ensure they are sufficiently qualified to undertake their work. Residents and relatives can then too be confident of the competency of the people looking after them. Of the files inspected, five staff have completed first aid and manual handling courses. The registered provider agreed that as he undertakes sleeping in duty that he must do this course and the manual handling course to update this knowledge. All staff have attended recent fire training and infection control courses. Three staff have completed food hygiene courses and one person had completed courses regarding diabetes awareness. It was encouraging to see that staff have recently attended training. It is recommended that the registered provider complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. From inspecting staff recruitment files it was evident that relevant recruitment checks are undertaken prior to a person commencing work and that no one starts work at the home until they have received their CRB clearance. Interview notes need to be kept as currently this does not occur. Staff records showed that four people had completed an induction and one had an induction record on their file but it was blank. These need to be completed to evidence that staff are aware of their role and what is expected of them. Staff at the home said they were well supported and were clear about their roles and responsibilities. It is clear the staff group are committed to helping Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 23 people maintain their independence as far as possible. Staff said they enjoyed working at the home. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the 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 registered provider is attempting to work with the Commission to ensure that the national Minimum Standards are met so that the home is well run for the benefit of the people who live, and work at the home. There is no registered manager to assist with this and consequently there is more to develop such as quality assurance processes to ensure that there is effective management and review of the service. EVIDENCE: The registered provider said that there is no current registered manager and that dependant on today’s quality rating he would then plan what action would be taken. As the overall rating from today’s inspection is adequate the registered provider said he would be employing a registered manager and would now be able to admit more residents into the home, thus making the Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 25 home financially viable. The registered provider will consult with the Commission as to the progress of recruiting a registered manager. In the meantime, the registered provider with support from the registered manager from the sister home is managing the home on a day to day basis, as an interim measure. Staff felt that this management arrangement was working well and felt able to approach either manager for advice or support. The registered provider as explained in the previous section needs to ensure that training in the areas of first aid and manual handling needs to be updated as he covers night shifts on his own. The registered provider said he has a policy regarding quality assurance policy. The registered provider stated that this is ‘in progress’. His findings must be forwarded to the Commission with an action plan as to how he will meet any recommendations made. The registered provider explained that the only money that he manages for people who use the service is when relatives give him money for things such as hairdressing or chiropody. He states this money is paid out as soon as received as appointments with the hairdresser/ chiropodist are planned. However there is no record of any monies received or paid out. To protect the registered provider or staff from possible allegations of receiving/ depositing/ spending monies on peoples behalf a robust record of all transactions must be kept. The registered provider agreed to address this. The registered provider stated that he or staff do not act as appointee for government financial benefits, for any of the people who use the service. The registered provider said records are kept of fees paid, although these were not inspected on this occasion. The registered provider said currently valuables are not looked after on behalf of people who use the service. The registered provider has a health and safety policy. An accident book is maintained. Records of accidents were kept in people’s individual files and cross referenced with daily logs. The registered provider acknowledged that he has not been recording formal supervision of staff. This must occur so that there is a record of staff accountability and those issues such as care practice or training needs are identified and addressed accordingly. Staff confirmed that they meet with the registered provider and that he is available to meet with them when they need to discuss issues as they arise. But they confirmed this is not officially recorded and hence a recommendation to this effect has been identified at this time. Likewise staff annual appraisals need to be recorded. Records reviewed at this inspection indicate that they are appropriately maintained and held, to ensure the welfare and safety of people who use the service. There are suitable storage facilities and records are in the main kept in ways that protect their confidentiality. In addition we observed that the daily Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 26 logs do not reflect the actual care that we saw on the day of inspection, staff were observed to spend time talking with residents, offering positive patient care and this is not recorded and therefore staff are not evidencing the positive care that they are providing to its residents. In respect of health and safety from records inspected it was evident that regular fire, gas, electric, Pat, equipment checks are carried out on a regular bases. It is recommended that with the new heating system/ boiler that a check on water temperatures is undertaken in the wash basins as the water was very hot on the day of inspection (unable to keep hands under water as too hot). It was noted that bath water temperatures are taken. Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 n/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 3 3 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 1 2 2 3 Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 28 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 (1) Requirement Care plans must be developed further to reflect the individuals care needs and to ensure that they inform, direct and guide staff as to what caring interventions are needed so that care can be met in a consistent manner. The leak in the rear corridor must be repaired so that the health and safety of all who live, work or visit the home is maintained. A registered manager must be appointed as per care Standards legislation. Timescale for action 30/03/10 2 OP19 23(2)(b) 30/01/10 3 OP31 9(1)(2) 28/02/10 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 29 1 OP3 The home’s assessment should record who was present at the assessment. This would provide evidence that the prospective resident and their family, or representatives, were involved in the assessment to ensure that their diverse needs were recorded. Care plan reviews should be recorded plus who was present at the review so that it evidences that all parties views are expressed and what actions have been agreed. The home should get an up dated version of BNF for staff use to reference medication queries. The registered provider should arrange staff training in the administration of eye drops to ensure this task is undertake correctly by competent and trained staff. Interview notes should be recorded and kept on file as part of the recruitment process The registered provider should ensure that as he is on the rota that he has the first aid and manual handling course to update this knowledge. The registered provider should complete a staff-training plan for the home, which sets out training staff have had and are expected to undertake, so that they maintain their knowledge and skills. A policy and procedure in the management of people who use the service monies should be implemented to ensure protection from abuse. Recording a minimum of six formal supervision of staff should occur so that there is a record of staff accountability and that issues such as care practice or training needs are identified and addressed accordingly. The findings of the quality assurance process should be forwarded to the Commission. 2 3 4 OP7 OP9 OP9 5 6 7 OP29 OP30 OP30 8 9 OP35 OP36 10 OP33 Sherwell DS0000009163.V378594.R01.S.doc Version 5.3 Page 30 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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