Care Home: Shiels Court

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What the care home does well Prospective residents have their needs assessed prior to admission and the information is used as part of the care planning process, which helps to ensure people`s needs are met. The foundations for good care planning are in place. Medication is stored appropriately. Residents are supported to maintain contact with family, and friends, according to their wishes. A good level of activities and entertainment are provided for the people living at Shiels Court. Residents, their families and friends know their complaints will be listened to, taken seriously and acted upon. Shiels Court provides a clean, safe and well maintained environment for residents, with continuing improvements being undertaken. Shiels Court has safe recruitment practices and appropriate staffing levels. The management and staff team are kind and caring. What has improved since the last inspection? New care plans are being compiled using a new and better format. All care plans are in the process of being fully reviewed but are being maintained and updated on a regular basis. Residents` wishes are being respected and sufficient opportunities and support are being provided to enable residents to bathe in accordance with their wishes. Full medical information is being maintained and available for all residents and missing pages in the medication folder have been completed or replaced. Good quality crockery has been purchased and is being used for people eating in the small lounge/dining room and additional crockery for the large dining room has been ordered. Care plans now contain details of how residents` health and welfare needs are to be met, in respect of weight and nutrition. The times people are given their morning medication has been reviewed and altered, particularly in respect of the period between breakfast and lunch. Staff appear to be more observant and sensitive in respect of maintaining good and professional relationships with residents. The large lounge, dining room and kitchenette have been altered, giving thought to ensure the size and layout of these rooms are suitable for residents` needs. Residents are being supported to have more access to social activities and pursue their interests and hobbies and care plans are in the process of being updated. A menu is being followed, that is nutritionally balanced and is being developed following consultation with the people living at Shiels Court. Sufficient bathing facilities are available for residents. The entrance to the basement has been made safe and the gates are kept closed at all times that staff are not present. Courses have been booked for staff to undertake training in areas such as food hygiene, first aid, moving and handling and adult protection. Contact has been made with the local college to enroll staff on NVQ training. What the care home could do better: All care plans must continue to be reviewed and updated on a regular basis. All care staff must have up to date training in first aid, moving and handling, food hygiene and adult protection. A minimum of 50% of care staff must be trained to at least NVQ 2 or equivalent. Staff must receive formal one-to-one supervision on a regular basis. A formal Quality Assurance process must be carried out on a regular basis. Key inspection report Care homes for older people Name: Address: Shiels Court Braydeston Avenue Brundall Norwich Norfolk NR13 5JX     The quality rating for this care home is:   one star adequate 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: Debby Ames     Date: 1 1 1 2 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 30 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 30 Information about the care home Name of care home: Address: Shiels Court Braydeston Avenue Brundall Norwich Norfolk NR13 5JX 01603712029 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): shiels@broadgate-healthcare.co.uk shiels@broadgate-healthcare.co.uk Mr M Afsar Name of registered manager (if applicable) Type of registration: Number of places registered: care home 41 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is 41 The registered person may provide the following categories of service: 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: Dementia - Code DE Old age, not falling within any other category - Code OP Date of last inspection Brief description of the care home Shiels Court is a large Victorian house situated in the village of Brundall. The original house has been altered and extended over the years and now provides care and accommodation for up to 41 older people with dementia. The bedroom accommodation for residents is on three floors and consists of 26 single and 7 shared bedrooms (all Care Homes for Older People Page 4 of 30 Over 65 0 41 41 0 Brief description of the care home with en suite WC). The communal space consists of one very large lounge with a partition across separating the dining room, a separate smaller lounge and at the rear of the building a further small lounge, which is often used by staff for training purposes, and by visitors as an area to meet residents in private. The home also has extensive gardens continually being altered or added to in order to meet the needs of the residents. The current fees average £475 per week and residents are expected to pay extra for hairdressing, chiropody newspapers, magazines, manicures and hand massage. Care Homes for Older People Page 5 of 30 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: one star adequate 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: Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out, by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. The fieldwork of this inspection was carried out over a period of six hours and included a tour of the premises, inspection of staff and residents records and the homes records relating to health and safety. Discussions also took place with the provider, manager, deputy and one resident. One questionnaire was completed and returned to the Commission by one resident and contained mostly very positive responses. Care Homes for Older People Page 6 of 30 Five requirements have been repeated following this inspection but each one has been acknowledged as work in progress and all of them are anticipated to be fully met by the next inspection. Care Homes for Older People Page 7 of 30 What the care home does well: What has improved since the last inspection? New care plans are being compiled using a new and better format. All care plans are in the process of being fully reviewed but are being maintained and updated on a regular basis. Residents wishes are being respected and sufficient opportunities and support are being provided to enable residents to bathe in accordance with their wishes. Full medical information is being maintained and available for all residents and missing pages in the medication folder have been completed or replaced. Good quality crockery has been purchased and is being used for people eating in the small lounge/dining room and additional crockery for the large dining room has been ordered. Care plans now contain details of how residents health and welfare needs are to be met, in respect of weight and nutrition. The times people are given their morning medication has been reviewed and altered, particularly in respect of the period between breakfast and lunch. Staff appear to be more observant and sensitive in respect of maintaining good and professional relationships with residents. Care Homes for Older People Page 8 of 30 The large lounge, dining room and kitchenette have been altered, giving thought to ensure the size and layout of these rooms are suitable for residents needs. Residents are being supported to have more access to social activities and pursue their interests and hobbies and care plans are in the process of being updated. A menu is being followed, that is nutritionally balanced and is being developed following consultation with the people living at Shiels Court. Sufficient bathing facilities are available for residents. The entrance to the basement has been made safe and the gates are kept closed at all times that staff are not present. Courses have been booked for staff to undertake training in areas such as food hygiene, first aid, moving and handling and adult protection. Contact has been made with the local college to enroll staff on NVQ training. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. 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 30 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 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents have their needs assessed prior to admission and the information is used as part of the care planning process, which helps to ensure peoples needs are met. Evidence: Since the last inspection in August 2009, a new format for care plans has been implemented which has made it much clearer to see how the pre-admission assessment information is used to ensure peoples needs are met. The new manager and deputy were noted to be working very closely together, to ensure consistency and continuity of care planning and it was stated in the AQAA that Shiels Court has maintained a good reputation with the relevant placing authorities. Residents, relatives, social workers, general practitioners, district nurses and community psychiatric nurses are all actively involved in the admissions process and gathering of appropriate information. Care Homes for Older People Page 11 of 30 Evidence: The family or significant others are also required to complete a history and record sheet and it was stated that handovers from the social workers and one of the local mental health hospitals are generally very good and include detailed medical and social information, from which good care planning can be based. It was confirmed that Shiels Court continues to have a welcoming policy for people to visit without appointment, while still remaining sensitive to the privacy and dignity of the people living in the Home. Care Homes for Older People Page 12 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The foundations for good care planning remain in place and reviews of care plans are being carried out on a more regular basis. Information recorded in the care plans is much more detailed and regularly completed/updated. Evidence: Considerable improvements were noted in respect of the care plans since the last inspection, which was carried out in August 2009. The care plans that were looked at for people who had recently been admitted showed a good level of detail in respect of individuals life histories, together with medical information, likes, dislikes, choices and preferences. These were also seen to be up to date. In respect of existing care plans, those that were looked at had been reviewed and showed evidence that baths were taking place regularly again. Peoples weights were also noted to have been recorded on a weekly basis, with a follow up process in place in respect of monitoring and taking appropriate action in the event of any significant Care Homes for Older People Page 13 of 30 Evidence: or noticeable changes. Additional records that were seen to be completed and maintained on a daily basis were nutritional monitoring sheets, which included information on what and when people had eaten, how much and how well. Bowel and seizure charts and records were also seen to have been maintained and one persons records showed that they had had a urine infection identified, following hospital tests, after a member of staff had recorded and reported that the resident was not themselves. Meanwhile, the new manager and deputy confirmed that they recognised the fact that a number of care plans were out of date in respect of some peoples individual support needs and that this was being addressed by way of a full review and update of everybodys plan. This area was therefore acknowledged as work in progress and the improvements noted, although a requirement has been made to ensure this work continues so that everybody living at Shiels Court has an up to date care plan and is assured of consistency in their care provision. Significant improvements were noted in respect of medication administration and it was confirmed by discussions and the records looked at that two additional medication rounds have been implemented, with the morning medication round starting one hour earlier. Additionally, prescribed sleeping tablets are being administered more in line with individuals personal needs and choices rather than at, the previously loosely specified, times such as tea-time or bed-time. As with the previous inspection report, the information in the medication folders was seen to be good with a medication profile compiled for each person, covering areas such as: Name, photograph, room number, allergies, doctors details, medication and route (i.e. oral, via P.E.G. etc). Signed consent forms were also seen for covert medication administration. Additionally, it was also noted that the medication folders had been tidied up considerably and the previously missing information was seen to have been put in place accordingly. As before, fridge temperatures were seen to have been consistently recorded, medication due to be returned was stored and recorded appropriately and controlled drugs also stored and recorded appropriately. Care Homes for Older People Page 14 of 30 Evidence: Overall, observations and discussions confirmed a much more settled and organised environment and two visitors were overheard discussing the high quality of care provided to the residents and stating how well everybody looked. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to maintain contact with family, and friends, according to their wishes. Activities and entertainment are provided for people living at Shiels Court, one-to-one time with staff has increased since the last inspection and meal choices have improved. Evidence: Observations during this inspection showed staff to be far more interactive with residents, both on a one-to-one basis and on a passing/routine basis. Various entertainment and activities were noted to continue to be provided such as games, sing-along/music, reminiscence, quiz-man, occasional bus trips to Great Yarmouth and visits by the local vicar and a volunteer. It was also confirmed that the staff are trying very hard, with the help of friends and relatives, to establish and reaffirm individuals hobbies and interests. The manager stated that she is currently making enquiries into a regular pat-a-dog visit and is arranging for staff to attend a training session on how to talk to people with dementia. A number of residents were observed having visitors during this inspection and the manager confirmed that a very welcoming approach is maintained by all the staff at Care Homes for Older People Page 16 of 30 Evidence: Shiels Court in respect of visitors. Meanwhile, vast improvements have been made to the physical layout of the large lounge and dining area, which appears to have had a very positive impact on the whole atmosphere and the air of confusion had reduced immensely. More specific information can be found in the Environment section of this report. The survey that was completed by one of the residents contained positive responses such as always to the question: Does the Home arrange activities you can take part in if you want? And usually to the question: Do you like the meals at the Home? In respect of mealtimes, it was noted that the cook now has up to date information regarding peoples likes and dislikes as well as information in respect of medical conditions, special dietary requirements and allergies. It was specifically stated that where people require pureed or softened food, this is presented in an appealing and respectful manner, with each food item placed separately on the plate. New planned menus are currently being worked on and adapted from another home, to suit the needs and choices of the people at Shiels Court. On the day of inspection the main meal choices were noted to be toad-in-the-hole, shepherds pie or chicken fricassee, with rice pudding as the dessert option. It was also confirmed that mealtimes and snack-stops regularly take place five times per day. Evidence of this was also noted in the care plans that were looked at, which confirmed breakfast, lunch, high tea, supper and evening food and drinks. Meanwhile, some residents were observed eating in the Royal Lounge with nice quality crockery and utensils and the atmosphere appeared altogether much more sociable and dignified. Further crockery was confirmed to be on order for the larger dining room and ideas are being sought and risk assessments being undertaken in respect of residents safety with regard to breakable crockery. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents, their families and friends know their complaints will be listened to, taken seriously and acted upon. Procedures are in place that help protect residents from abuse. Evidence: The survey completed by one of the residents confirmed that they knew how to make a complaint and who to talk to if they had any concerns. Shiels Court continues to keep the Commission informed of any notifiable incidents and one recent complaint was investigated by the provider very quickly, appropriately and within the mandatory timescale. All staff were confirmed as being informed and aware of the whistle-blowing policy and have been given copy of the policy. As with the previous inspection, the manager confirmed that no money is managed by the home on behalf of any of the residents, although small amounts of money are occasionally kept for some residents, but the usual practice is for the Home to pay for items/services and be reimbursed by peoples relatives. It was noted that written records and receipts are kept in this respect. It was stated in the AQAA that, following a complaint by a relative, the Adult Protection Team were called in but, after investigation, Shiels Court were not found to be at fault. It was further commented that the Adult Protection officer complemented Care Homes for Older People Page 18 of 30 Evidence: the manager and staff on the format and quality of their record keeping and risk assessments. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe and well maintained environment for residents, with further and ongoing improvements having been made to some of the tired areas. Sufficient and suitable toilet and bathing facilities are available for residents. Evidence: A tour of the premises showed the Home to be clean and hygienic, with no unpleasant odours noted during this visit. Further refurbishment and improvements to the home have continued since the last inspection and remain ongoing but do not appear to be causing any discomfort or inconvenience for the people living at Shiels Court. Since the last inspection, the hoist in the bathroom on the middle floor has been repaired and bathing records indicate that the Home now has sufficient toilet and bathing facilities. During the last inspection it was observed that the main lounge was very busy and could cause confusion for people with dementia or sensory impairment, due to mixture of noise from the large dining room, the large split lounge and the kitchenette. However, it was observed during this inspection that the large dining room had been Care Homes for Older People Page 20 of 30 Evidence: sectioned off from the lounge by using the sliding partition doors, which created a much more comfortable environment for people in both the dining area and the large part of the main lounge. Additionally, the kitchenette has been converted into the managers office, which means that there is a lot less erratic activity in this area and the manager is based in what appears to be the hub of the Home. The layout and positioning of the medication cupboard is also being altered to improve the security and accessibility for storage and administration of medication. Meanwhile, the large dining area has had new flooring and new tables and new curtains are on order, giving the whole room a far more comfortable and homely feel to it. Some of the chairs in the lounge have been replaced and there is now a large tropical fish tank situated in the reception area, which some of the residents were noted to be quite interested in. The basement entrance, which was noted to be a high risk area at the last inspection, has been made safe with wooden braces across the gates as a temporary measure and the manager has confirmed that she is in the process of having new gates purpose built, for added safety and security. Meanwhile, the gates were observed to be closed and did not pose a risk to residents during this inspection. Care Homes for Older People Page 21 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Shiels Court has safe recruitment practices and appropriate staffing levels. Some staff are currently lacking in training for certain areas, although the manager has made arrangements for this to be addressed. Evidence: As with the previous inspection, the personnel files contained copies of documentation or confirmation details for things such as application forms, references, identification and clear, enhanced Criminal Records Bureau (CRB) disclosures, therefore confirming that robust recruitment procedures are followed, which helps to protect the residents living at Shiels Court. In respect of training, an in-depth discussion was held with the manager and deputy, during which the shortfalls were acknowledged and the manager provided evidence of various courses, such as first aid, moving & handling, adult protection and food hygiene, that had been booked for staff to undertake in the early part of 2010. Additionally, contact has been made with the local college in order for the shortfall of staff to commence their NVQs. Although the requirements have been repeated in this respect, it is acknowledged that bringing the staff training up to date is work in progress and it is anticipated that Care Homes for Older People Page 22 of 30 Evidence: these requirements will have been fully met by the next inspection. From the staff records looked at, there continues to be evidence of a good induction process and early days supervision plus a buddy system with experienced carers. The rota was examined for the four weeks prior to the inspection, which showed appropriate staffing levels and there appeared to be sufficient numbers of staff on duty during this inspection. Meanwhile, from the survey received, the person responded always to the questions: Do you receive the care and support you need, are the staff available when you need them and do the staff listen to you and act on what you say? Care Homes for Older People Page 23 of 30 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The new manager has taken very positive steps to improve the standards of care within the Home and has worked hard to ensure compliance with the requirements from the last inspection. Evidence: As mentioned in the previous inspection report dated 4th September 2009, the previous manager was absent from Shiels Court for a number of months prior to the acting manager being appointed in August 2009. The new manager has been working at Shiels Court for thirteen years and has been the deputy for a considerable period of time. It was acknowledged that the new manager had a great deal of work to do in order to catch up and it was recognised during this inspection that the manager, deputy and staff team as a whole, have indeed worked extremely hard to improve the standards of care within the Home and ensure compliance with the requirements from the last inspection. Care Homes for Older People Page 24 of 30 Evidence: From observations, discussions and records seen it was evident that Shiels Court is generally being run in the best interests of the residents, although in respect of the most recent Quality Assurance Audit, full records and feedback were still only available from the one carried out in 2007. However, the manager confirmed that this requirement will be met by early 2010 and this was acknowledged as work in progress. As mentioned in a previous section, the manager confirmed that no money is managed by the home on behalf of any of the residents, although small amounts of money are occasionally kept for some residents. The usual practice is for the Home to pay for items/services and be reimbursed by peoples relatives. It was noted that written records and receipts are kept in this respect. As before, staff one-to-one supervisions have fallen behind due to the recent management changes but the new manager was seen to be in the process of catching up and confirmed that these will be fully up to date again within a few months. Meanwhile, it was also stated that the manager has a totally open-door policy and has regular contact and discussions with staff on a daily basis. Checks in respect of health and safety were seen to be carried out on a regular basis and remained up to date, such as fire safety tests etc. As before, the general practice during fire drills is for staff and visitors only to evacuate but full evacuations have been carried out on two occasions. Recent audits have been carried out at Shiels Court by the local Fire Department and Environmental Health Department. Although a few requirements and recommendations were made following these audits, the over all outcomes were seen to be good. All the health and safety policies were noted to remain up to date and in order. In respect of the concerns around the safety and welfare of staff and residents due to the lack of staff training, as mentioned previously, although the requirements have been repeated in this respect, it is acknowledged that bringing the staff training up to date is work in progress and it is anticipated that these requirements will have been fully met by the next inspection. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 7 15 Care plans must be reviewed 08/12/2009 and updated on a regular basis. To ensure residents needs continue to be met and that there is consistency in care provision. 2 30 18 A minimum of 50 of care staff must be trained to at least NVQ 2 or equivalent. To ensure staff have the necessary skills to carry out their duties and that residents are consistently supported by competent staff. 27/08/2010 3 30 18 All staff dealing with food at any time must receive training in food hygiene. To ensure residents health, safety and welfare is protected and maintained at all times. 31/12/2009 4 30 18 All care staff must have up to 31/12/2009 date training in first aid, moving and handling and adult protection. To ensure residents health, safety and welfare is protected and maintained at all times. Care Homes for Older People Page 26 of 30 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 5 33 24 A formal Quality Assurance process must be carried out on a regular basis. To ensure the service continues to meet residents needs. 31/12/2009 6 36 18 Staff must receive formal one-to-one supervision on a regular basis. To ensure staff are supported and any concerns or issues can be discussed and addressed. 31/12/2009 Care Homes for Older People Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 All care plans must continue to be reviewed and updated on a regular basis. To ensure residents needs continue to be met and that there is consistency in care provision. 01/06/2010 2 30 18 A minimum of 50 of care staff must be trained to at least NVQ 2 or equivalent. To ensure staff have the necessary skills to carry out their duties and that residents are consistently supported by competent staff. 01/09/2010 3 30 18 All care staff must have up to date training in first aid, moving and handling, food hygiene and adult protection. 01/06/2010 Care Homes for Older People Page 28 of 30 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 To ensure residents health, safety and welfare is protected and maintained at all times. 4 33 24 A formal Quality Assurance process must be carried out on a regular basis. To ensure the service continues to meet residents needs. 5 36 18 Staff must receive formal one-to-one supervision on a regular basis. To ensure staff are supported and any concerns or issues can be discussed and addressed. 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 01/06/2010 01/06/2010 Care Homes for Older People Page 29 of 30 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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