Care Home: Shieling, The

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What the care home does well We found that people`s rights are central to the way the service is arranged, from the time they are introduced to the home and while they are living there. People who live in the home are involved in decision making and their opinions are valued in quality monitoring audits. We received positive comments during the visit and in surveys from people who live in the home and their relatives. "The Sheiling in my opinion, provides a warm and homely atmosphere. This without doubt benefits the people who live there. Nothing is overlooked." "The manager and staff go out of their way to ensure that people are exceptionally well cared for. Nothing is too much trouble. They review and respond to people`s needs." "I find the home is well run and have no complaints." "I have never made a complaint about The Sheiling. I have been given a copy of the complaints procedure. Staff are very approachable. I am sure they would be keen to put things right." "Food is well cooked and looks nice on the plate. You can have whatever you ask for." "I am comfortable, I have my own bathroom." What has improved since the last inspection? There are no requirements outstanding from the last inspection. Staff training achievements are ongoing and there is a high level of NVQ qualified staff working in The Sheiling. Procedures used in the home are being regularly reviewed to update them and ensure that staff understand and follow them. Improvements have been made across the service by the manager and providers as a result of ongoing consultation with the people who live in the Sheiling. The manager takes a proactive approach to service development and current best practice guidance and to protect people`s rights and in line with current best practice guidelines, staff have received training in deprivation of liberty safeguarding since our last visit. In the event of a `flu pandemic The Sheiling has a plan as to how the home will be run in the best interests of people who live and work there. This is to ensure that people will be properly supported and not placed at risk. What the care home could do better: The findings are that the home has retained a rating of excellent and no requirements or recommendations are given. However the manager will continue to monitor the service and take any remedial action identified in quality monitoring audits, residents` meetings, comment cards and provider visits. Key inspection report Care homes for older people Name: Address: Shieling, The 286 Southport Road Lydiate Liverpool Merseyside L31 4EQ     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: Patricia Thomas     Date: 2 7 1 1 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 26 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 26 Information about the care home Name of care home: Address: Shieling, The 286 Southport Road Lydiate Liverpool Merseyside L31 4EQ 01515319791 F/P01515319791 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Minearch Limited care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 28 Date of last inspection Brief description of the care home The Shieling is a purpose-built Residential Home located in a semi-rural environment. It has extensive grounds and farmland to the back. Some of the grounds are given over to car parking. The Home stands on the old Southport to Liverpool road, and has good links with public transport. The Shieling offers permanent residential care for a maximum of 28 residents. All have their own rooms and have access to 2 lounges and a dining room. Staff offer full care and support, promoting independence appropriate to service users capacities, and encourage the involvement of relatives wherever possible. Care Homes for Older People Page 4 of 26 Over 65 28 0 Brief description of the care home Links with the community enable visits and entertainments to be provided within the Home, and service users are helped to use all local facilities. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: three star excellent service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three stars. This means that people who use this service experience excellent quality outcomes. We made this unannounced visit to the home on 27th November 2009. It took five hours and was done by one inspector. During our visit we walked round the home and we checked various records to see what care people living there receive. We spoke with people who live at the home and they told us what they thought about it. We also spoke with staff and with the manager who gave us their views about The Sheiling. We have included their views throughout the report. Care records for two people were looked at. We use a system called case tracking. We track peoples care to see whether the service meets their individual needs. Care Homes for Older People Page 6 of 26 The visit was just one part of the inspection. Before the visit took place, we (the commission) asked the manager to complete a questionnaire that we call an Annual Quality Assurance Assessment (AQAA). It gives us information about how the home is meeting the needs of the people who use the service and includes plans for further development. We sent comment cards to people who use the service, to their relatives and staff. The comments they sent back to us are included in this report. The charges for this service range from £389.00 to £420.00 per week. There are extra charges for chiropody and hairdressing. Care Homes for Older People Page 7 of 26 What the care home does well: 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 Care Homes for Older People Page 8 of 26 following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 9 of 26 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 10 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have had their needs assessed and have all the information they need about The Sheiling before they move in. This is to help them make a decision about whether this will make a suitable home. Evidence: We found that there is a good system to introduce people to The Sheiling. The records show us that a lot of time and effort goes in to planning to make each admission to the home personal and well managed. People told us they were treated as individuals and staff had respect for their wishes and feelings during that time. In the service user guide, they are given clear information about the service to inform their decision about whether this will make a suitable home. This was confirmed in the surveys we received from service users and their families. Before moving in, each person has their needs assessed by staff to make sure that the home will be able to meet their needs. The home has good links with local councils Care Homes for Older People Page 11 of 26 Evidence: and assessments carried out by social services are also taken into account when making a decision about whether the home can meet the persons needs. People are invited to visit the home to before moving in, and there is a twenty eight day trail period for everyone who moves in, to make sure the person is happy in the home and that their needs are being met. The procedures and documents around admissions are subject to ongoing review and update, to ensure they help to make the process as helpful and efficient as possible for people who are hoping to move in to the home. Care Homes for Older People Page 12 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are individual to each person and give evidence that the service values and works towards improving outcomes for them. Evidence: During pre admission assessments and ongoing reviews, staff had obtained a lot of information about each persons health, personal care, social and cultural needs. Case tracking gave evidence that care plans are person centred and peoples rights to choice, privacy, dignity and equality are evident in the way their care is planned, recorded and given. In discussion, staff showed clear knowledge of best practice in care giving. Records showed us there are good systems in place to review peoples needs and carry out risk assessments to ensure they will be supported properly,safely and in the way they prefer. Staff showed awareness of the need to monitor and take action regarding any changes in the behaviour and general wellbing of each individual. There were clear records of contacts with health professionals and the outcomes, and care plans had been updated to show any change in their support needs. People who returned surveys Care Homes for Older People Page 13 of 26 Evidence: were satisfied with the care provided in this home, one person wrote, My mother has entered into a new and happier phase in her life. Your team are simply outstanding. Another comment was, The Sheiling has provided a high level of professional care to my elderly mother. Every member of staff in my opinion is compassionate and devoted. People we met during our visit told us, I find the home is well run and have no complaints. The home and my room are clean. Not really worried about anything. There is a good system for managing peoples medication and staff have received the relevant training and have written guidance about how to do this properly and safely. There are secure facilities for storing medication and the records which were checked were up to date. There is a system for returning unwanted medication to the pharmacy at month end to ensure that all medication accepted into the home will be accounted for. Care Homes for Older People Page 14 of 26 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. Peoples rights are promoted and protected in the home and they have a say in the way their home will be run. Evidence: We found that people are consulted regularly and have a say in the way their home is run. Central to The Sheilings aims and objectives is promotion of each individuals right to choose how and where to spend their time, their meal choices, and the activities and outings they prefer. One person said they had been to a residents meeting that day and that people are regularly given the opportunity to have their say about the service they receive. People told us that as well as being invited to meetings, they are given comment cards for written feedback on the service to management. They said that the manager and staff are very approachable and always listen to what they say. A visitor told us, There is an open style of management here and all the staff are the same, helpful, polite and dedicated. Relatives of people who live in the home told us that staff tell them about any change in their relatives condition and involve them in decision making. People lving in the home who have no relatives have access to advocacy services to ensure they have independant representation to protect their rights. Comments we received and records Care Homes for Older People Page 15 of 26 Evidence: gave information about how peoples culture and religion are supported in their home and people told us that ministers from local churches visit regularly. We went to the kitchen, looked at catering records and spoke with the chef. We found that meals are very well balanced and that people have nutritional assessments and support plans and their weight is regularly taken to track any significant changes. For those people assessed at risk of becoming under nourished or dehydrated, there are systems for monitoring fluids and making referrals through their G.P. to the dietician to ensure they will receive all the specialist support they need. There was good evidence that people are offered choices and alternatives and are regularly served drinks. The menu is displayed and people are asked daily about what they want for their meals. There is a pleasant dining room and tables had been laid carefully. The meal was served in a very relaxed atmosphere with music playing and people were not kept waiting for their food. People take their meals where they prefer and at their own pace and we saw they are given the one to one support they need with their food to ensure they will have enough to eat and enjoy their meal. People told us the food is, Lovely. Well cooked and looks nice on the plate. Another comment was, You can have whatever you ask for, nothing is too much trouble. Care Homes for Older People Page 16 of 26 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. The Sheiling has an open culture where people feel safe and supported to share any concerns in relation to their protection and safety. Evidence: We found that the ethos in the home is one which welcomes comments and suggestions from service users, and is open to learning from these and using them positively. To ensure that people know how to make a complaint, the homes procedure is regularly discussed with them and reviewed to make it user friendly. This is to make sure that people know about their right to complain and will be aware that their concerns are valued and will be acted upon. For staff guidance, there is a safeguarding procedure in the home and to ensure peoples rights are recognized and protected, deprivation of liberty training for staff is included in the mandatory training schedule. Protection of vulnerable adults training is regularly updated as was in evidence in training records. Five members of staff who were asked about protecting people who live in the home were aware of the indicators of abuse and how to report suspected abuse for investigation. A visitor told us, I have never made a complaint about The Sheiling but have been given a written complaints procedure. They are very approachable here and I know they would be keen to put things right. Care Homes for Older People Page 17 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment in The Sheiling meets the lifestyle and needs of the people who live there, it reflects their individuality and is homely, clean and well maintained. Evidence: The home is a converted school house set in beautiful gardens with off street parking and surrounding views of the countryside. This is a two storey building with aids and adaptations for people who are frail and need help getting around. These include grab rails, hoists, assisted bathing facilities and a passenger lift. Bedrooms are singles and situated on both floors with pleasant views and en suite facilities. The lounges and dining room are pleasant and comfortable and residents of the home have a say in how they will be decorated. From inside, there is level access to the garden, which is well maintained and has mature plants with seating and shade for comfort and convenience. People told us the garden is well used and enjoyed in summer months. The building has been made interesting through displays of the art and craft work done by residents and staff jointly. There is a large television screen in one of the lounges and people said they enjoy film shows. We saw books, newspapers and a range of DVDs, tapes, board games and craft materials for peoples amusement. Some of the comments received from people who live in The Sheiling include, I am very comfortable and I have my bits and pieces around me in my bedroom. I am comfortable, I have my own bathroom. I could get the lift but I walked down the Care Homes for Older People Page 18 of 26 Evidence: stairs today. The building was clean and free of odours and well lit, in the areas which we saw. There are cleaning schedules and staff have procedural guidance and training in control of substances hazardous to health and infection control. Domestic staff are employed and the person on duty told us there is always plenty of cleaning materials and protective clothing in the home to keep it clean, hygienic and safe. We saw that there are good systems in practice in the laundry to avoid contamination and the laundry is well equipped. Clothing is marked with peoples names to help ensure that laundered items will be returned to the right person. The kitchen was clean, hygienic and well organized and there are safe systems for storing fresh, frozen and dry food stocks. Care Homes for Older People Page 19 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well vetted and have the skills in care giving and communication to support people properly,safely and in the way they prefer. Evidence: The rosters showed us that the home has plenty of staff available to support the care and leisure needs of people in an individualised and flexible way. The service is innovative and shows a high level of awareness of the staff levels and skills needed to support people properly and safely at times when they may require more assistance through illness or infirmity. There was evidence of good levels of training beyond basic mandatory training and national vocational training requirements. Staff competence is monitored and supported through the appraisal and supervision systems followed by the manager. Staff who were spoken with showed a high level of skill in best practice in care giving and supporting peoples needs, rights and equality in the home. The service has a highly developed recruitment procedure which has regularly been reviewed and improved. The manager explained that she sees the recruitment of good quality carers as integral to the delivery of an excellent service and it is therefore important to select the right person for the job rather than just fill the vacancy. We looked at a sample of staff files which gave evidence of the satisfactory references and Care Homes for Older People Page 20 of 26 Evidence: clearances obtained for each new staff member, such as criminal records bureau checks and employers references. Staff said they are well supported by a cosistent management team and their comments gave evidence that staff morale is high. One person said, The Sheiling is the best run home I have ever worked in. It is a family owned home and standards are high. We are the best. I think the home does well with everything. I think the home is fantastic. A new member of staff told us she was doing her induction training and was being supervised by experienced staff during this time. She said she had been given time to get to know the people who live in the home. She said that the home is friendly and well managed and people are being well looked after. Care Homes for Older People Page 21 of 26 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. There is a high level of consultatation with people who use the service and the home is managed in their best interests. Evidence: The manager of the Sheiling has the required qualifications and experience to run the home in accordance with its stated aims and objectivies. To provide continuity, there is a clear management structure in the home and this will ensure that there is a nominated person in charge in the managers absence. The was good evidence that the manager works closely with the providers and outside agencies (such as health authorities and social services) to provide a service which meets the needs of the people who live in The Sheiling. Visitors to the home, staff and people who live there said the manager is competent and approachable. In discussion the manager was able to communicate a clear sense of direction for the service and showed a sound understanding and knowledge of the application of best practice in operational systems, quality assurance, human rights legislation and equality and diversity. Care Homes for Older People Page 22 of 26 Evidence: The AQAA contains excellent information that is fully supported by appropriate evidence. It demonstrates a high level of understanding about the importance of equality and diversity and good information about how management have listened to residents of the home whose views are central to the way it is being managed. Policies, procedures and practice in the home are constantly reviewed and amended as needed so that standards and outcomes to people will be maintained and improved upon. There are robust quality assurance systems to obtain peoples views and take remedial action as needed. These include an annual independent audit, regular distribution of comment cards to obtain feedback, registered providers visits and resident and staff meetings to ensure transparency and freedom of speech. Internal audits and reviews of care plans are regularly carried out to ensure people are being supported properly and safely in their home. There is an open door management style which supports ongoing communication with people through daily contact and feedback. From peoples comments there is good evidence that they feel safe and protected in the home and there are systems for ensuring that any money held on their behalf will be properly accounted for. It was confirmed that the home does not become involved in the financial affairs of the people they support and those who are at risk have access to advocacy and court of protection as needed. We looked at the systems for keeping the building safe and suitable for people to live and work in and found that safety certificates were satisfactory and up to date. Records showed us that health and safety systems are regularly reviewed and updated and are developed on the basis of risk assessments and outcomes to the people using the service. All staff have been trained in health and safety matters and records show the training is regularly updated in accordance with legislation and best practice guidelines. Care Homes for Older People Page 23 of 26 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 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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