Care Home: Shila House

What the care home does well One resident told us her key worker was “alright”, another said “It’s nice here”. We noted in a service user’s file his psychiatrist had said that the service user was “fond of” the manager at the home. The manager has many years relevant experience. He and the deputy manager have been at the home for several years. This helps them to run it smoothly. The home supports service users who have complex and intense needs, sensitively and effectively. Assessment and care planning are well done.Shila HouseDS0000010620.V377329.R01.S.docVersion 5.2There is among the staff a good understanding of mental health needs and the links with physical wellbeing. There are systems and structures in place which ensure the smooth running of the home. The ethos and practices of the home are empowering, and people work within their abilities. What has improved since the last inspection? The home has met a number of the requirements which were made at the previous inspection. Health appointments had been recorded. Fridges and freezers were clean and in good order, an annual development plan had been devised and Person in Control (PIC) Regulation 26 visits have been instituted. The home applied to the Commission for Social Care Inspection (CSCI) to ensure their registration was in order. What the care home could do better: The inspection resulted in seven statutory requirements and seven good practice recommendations. Some additional risk assessing needs to be done. The environment of the home urgently needs to be brought up to the reasonable standards of safety and decor which one would expect in registered premises. Staff training which has fallen behind, must be brought up to date quickly. Medication practice needs some improvement and the safeguarding policy and procedure need some amendment.Shila HouseDS0000010620.V377329.R01.S.docVersion 5.2 Key inspection report CARE HOME ADULTS 18-65 Shila House 49-53 Main Avenue & 1 Poynter Road Enfield Middlesex EN1 1DS Lead Inspector Anne Chamberlain Key Unannounced Inspection 21st August 2009 - 4 September 2009 10:20 th Shila House DS0000010620.V377329.R01.S.doc Version 5.2 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 home adults 18-65 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. Shila House DS0000010620.V377329.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 Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shila House Address 49-53 Main Avenue & 1 Poynter Road Enfield Middlesex EN1 1DS 020 8367 8774 020 8350 5361 shilahouse@hotmail.co.uk 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) Simiks Care Limited Delroy George Watson Care Home 14 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (14) of places Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 11 people with mental health needs of either gender at 49-53 Main Avenue and 3 people at 1 Poynter Road. 13th October 2008 Date of last inspection Brief Description of the Service: Shila House is a home registered to provide care to fourteen people with a mental disorder, excluding learning disability or dementia. The home is located at Main Avenue in Enfield and the annexe is across the road at Poynter Road. There are eleven places at Main Avenue and three at Poynter Road. The home is managed by Simiks Care Limited. Most of the residents have enduring mental health issues. The home was first registered in 1994. The main house was built partly above and behind a parade of shops. Poynter Road is a small end of terrace house. Next to the home are a range of local shops and public transport. There are other leisure amenities in the local area. The annexe at Poynter Road is a semi-independent service where residents do their own cooking and other domestic chores. All have their own bedrooms and at Shila House there are en suite facilities. Shila House has two communal lounges and dining room areas. There are also two kitchens, one of which is for the residents to cook their own food if they wish. The home does not have a garden but does have a yard at the back of the home where people can sit. The home has staff available 24 hours a day. Most of the residents spend their time doing domestic activities in the home or going out in the local area. Shila House DS0000010620.V377329.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 two stars. This means that the people who use this service experience good quality outcomes. This report is written on behalf of the Care Quality Commission (CQC) and the terms ‘we’ and ‘us’ will be used throughout. Simiks Care Limited which used to own the home has now been bought by Zen Healthcare and are part of their group. At the time of the inspection there were ten service users at the home. Eight men and two women. Two of the men were living at 1 Poynter Road. This was an unannounced key inspection and took place over one and a half days with a short third visit following to check on fire safety work which had been done. We viewed key documentation, policies and procedures as well as the case files of three service users and their keyworkers. We viewed the arrangements for the administration of medication and we toured the homes and gardens including the store in the garden of 1 Poynter Road. We would like to take this opportunity to thank the service users, proprietor, manager and staff of the home for their assistance and co-operation with the inspection. What the service does well: One resident told us her key worker was “alright”, another said “It’s nice here”. We noted in a service user’s file his psychiatrist had said that the service user was “fond of” the manager at the home. The manager has many years relevant experience. He and the deputy manager have been at the home for several years. This helps them to run it smoothly. The home supports service users who have complex and intense needs, sensitively and effectively. Assessment and care planning are well done. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 6 There is among the staff a good understanding of mental health needs and the links with physical wellbeing. There are systems and structures in place which ensure the smooth running of the home. The ethos and practices of the home are empowering, and people work within their abilities. What has improved since the last inspection? What they could do better: The inspection resulted in seven statutory requirements and seven good practice recommendations. Some additional risk assessing needs to be done. The environment of the home urgently needs to be brought up to the reasonable standards of safety and decor which one would expect in registered premises. Staff training which has fallen behind, must be brought up to date quickly. Medication practice needs some improvement and the safeguarding policy and procedure need some amendment. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 7 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. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2. 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. Prospective service users would be properly assessed before being offered a placement at the home. EVIDENCE: We viewed the assessment information in the files and formed the view that the manager has the skills to make comprehensive, insightful assessments of people who experience mental health problems. There have not been any recent admissions to the home but the manager said that on receiving a referral he would ask for the person’s assessments, current care plan and risk assessments. He would study these before undertaking his own assessment by speaking with the person and those working with them. We were of the view that the home would not accept a referral unless they were fully satisfied that they could meet the person’s needs. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 10 Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 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): 6,7 and 9. 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. Service users have individual plans which address their changing needs. They have opportunities to make decisions for themselves and risks are carefully assessed. EVIDENCE: We viewed the files of three service users. They all contained good quality service user plans which linked to action plans and mental health risk assessments. The plans for support and intervention were arranged under subject headings (one care plan had 21) and gave carers detailed information about how to support service users. Guidelines for specific issues like Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 12 challenging behaviour or timetables for activities, supported the above mentioned documentation. Most of the residents are on Care Programme Approach (CPA) regimes. CPA meetings are held every three, six or twelve months according to how well the person is managing. Service users who are not on CPA regimes would have a placement review by social services and we saw evidence of one taking place on 29/6/09 and another on 15.8.09. The home does not have a review form as such but there were review dates made and evidence of review of care plans. We could see that care plans, action plans and risk assessments had been updated and changed on a regular basis and that this had been done in consultation with other care professionals involved. There was evidence of individuals making progress, for example in one person’s review it was stated “incidents of calling the police and fire brigade are now rare”. In another it said that the service user was “making good progress”. There were many examples noted throughout the inspection of service users making decisions in their lives. A major element of the work of the home is in helping service users to understand what they need to do to remain well and how they can avoid relapse. Service users are encouraged to become increasingly independent and take responsibilities in their lives. Mental health risk assessments were of a good standard. They encompassed every day risks as the reason people are vulnerable is because of their mental health. The risks were measured and strategies identified to reduce them. All the paperwork had been thoughtfully completed and the system held together well and addressed service user’s needs. The level of dating and signing of all key documentation was high and service users had obviously been consulted and involved. Two service users live in 1 Poynter Road which is an independence training unit where the aim is rehabilitate them. They shop and cook for themselves. The manager stated that one service user has risk assessments regarding food hygiene but the other does not. He needs these and the manager stated that they will be developed. A requirement has been made. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12,13,15,16 and 17. 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. Service users have the opportunity to take part in a range of appropriate activities inside the home and in the community. Their relationships are supported and their rights upheld. Service users are offered a good diet and enjoy their meals. EVIDENCE: The service users at the home mainly suffer from severe and enduring mental health illness. They are encouraged to get involved in everyday ordinary activities, like domestic tasks or going to the local shops. Some attend day centres and most are able to use public transport and to go about Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 14 independently in the community. One service user likes long bus rides and takes these on his own. Some service users have a history of going out and disappearing for days or more. An aim of the placement is to reduce and eliminate this behaviour. We noted one individual who has a history of taking off for days or weeks, now presents herself to the manager before she leaves the building, just to show him she is going out. This represents a more responsible attitude on her part and that she has understood that people need to know where she is and when to expect her to return. This service user has been at the home for less than a year but her behaviour according to the manager is much more stable. Relationships with families and friends are encouraged and the manager was able to report on strengthening of the relationships some service users have with their families. Families and friends are welcome at the home and are invited to parties sometimes. One mother comes regularly and one service user has started to visit his father. One service user has experienced two bereavements over the short time she has been at the home and has been supported to cope with these. She was supported to send flowers and attend the funeral of a very dear friend. Service users are also protected against negative relationships which have been a feature of their lives before coming to live at the home. The manager said that he had had made it clear to certain visitors that they are welcome at the home only if they have the best interests of their friend at heart. We visited the home over two days so were able to observe some of the daily routines. These were also evidenced in the daily logs of the service users. Each individual has their own pattern and the manager was able to talk knowledgeably about them. One service user has a distorted diurnal rhythm and needs a lot of encouragement to get up before lunchtime and not be awake at night. A focus of the work at the home is about giving people structure in their lives with regular meals, sleeping etc. The home has a yard area with an iron staircase up to the second floor. This yard has a table and chairs and a few pots of flowers. It provides an ideal neutral area for people to sit together in fine weather, talking or not as they choose. Most of the residents smoke and indulge this habit in this outdoor area. We noted that residents have quite frequent meetings. These are used to inform them of upcoming events and to reinforce messages about arrangements. We asked the manager if he would like the meetings to be more interactive and he stated that would and he has plans to involve residents more in their meeting. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 15 A rights workshop had been held at the home on 1/6/09 and was attended by several service users. We felt this was a good way of underpinning service users confidence and self esteem. We viewed the menu which was varied and nutritious. The manager stated that the food is ordered on line and delivered once a week on a Monday. When we toured the environment a care worker was cooking omelettes for lunch which looked very good. Service users are encouraged to undertake tasks in the general kitchen with the supervision of staff, or on their own in the independence kitchen. Breakfast and lunch are variable according to personal taste, but the manager stated that five service users sit down regularly together for dinner in the evening. Some prefer to eat alone and this is facilitated too. Service users have a pub lunch once a week and a fortnightly takeaway. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 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): 18,19 and 20. 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. EVIDENCE: All service users have key workers. One service user was able to name his for us. Care plans guide the staff in how to support service users in every aspect of care. Staff prompt, supervise and support people to attend to their personal hygiene, to take their medication regularly, to work with mental health professionals, to manage money, to access the community, to maintain relationships with others, etc. An important part of caring for service users is giving them emotional support and reassurance. Staff interact with service users constantly and they note down in files the dates when they talk and what they talk about. We saw these lists and the topics are very varied but they demonstrate that much one Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 17 to one work is taking place albeit on a very informal basis. In addition to these interactions there was some evidence of the manager having sit down chats with individuals. On the first day of the inspection there was an incident between two service users in the upstairs lounge. The manager intervened immediately and diffused the situation. Over the next day or two he uncovered the reason for the outburst and we noted that the work was written up in the service users file. Staff support service users to interact with a range of health professionals and there was evidence of this in the service users files. The service users access, psychiatric and psychology services, G.P’s dentists, clinical tests like blood tests, chiropodists, occupational therapists etc. The manager has an electronic back up system to ensure that follow up appointments are not overlooked. There were forms in place for recording halth appointments with brief details of the consultation. On the days of the inspection one service user was in hospital, having tests for unexplained physical symptoms. The home were keeping in close touch with the hospital and staff were spending time with the individual. We confirmed that the person is able to make his needs known to hospital staff and once settled will just need visiting by staff from the home. We were satisfied that the outcome for service users is that their health, particularly their mental health, is well supported. However we asked the manager to develop health action plans for residents. This would provide one place where all health information can be recorded and would also encourage a pro-active approach to health care. We viewed the arrangements for the administration of medication. We were told that the deputy manager oversees this area and she assisted us. The medication is kept in a locked cabinet in a small locked room. It was hot on the day of the inspection and the temperature in the cabinet was 27 degrees celcius. This is too high. A blind has been hung at the window but it had not been lowered. The room has a fan but it had not been turned on. A requirement has been made that the home ensures the temperature at which the medication is stored is appropriate, i.e. around 25 degrees celcius. All the eight service users in the home take medication and none of them are self-medicating. Of the two service users who live at 1 Poynter Road one is self-medicating and one is not. We discussed with the manager the strategies which are in place to supervise the self medication and these seemed reasonable and effective. The service user is aware that spot checks will be Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 18 carried out, that his moods and behaviour are monitored and that the home ensures that he has his prescriptions renewed and dispensed regularly. The home has a medication folder which is divided up for individual service users. The photograph for one service user was not attached to his section, although the others were in place. On the third visit to the home we were told by the deputy manager that this omission had been rectified. The folder contained the Medication Administration Record (MAR) charts which were neatly completed with no unexplained gaps. Most medications are dispensed in dosette boxes, but some are loose in individual boxes. However if any tablets are left over at the end of the cycle they are returned to the pharmacist. The deputy manager stated that often the back of the dosette boxes are inaccurate with details which do not match the contents of the boxes. The home keeps a list of medications prescribed, so they know what should actually be in the dosette boxes. We were concerned about this pharmacy practice and would like the manager to raise it with the pharmacy to see if the list can either be updated and accurate or else not written up at all. We checked a number of the stocks of medications for the three service users we were case tracking and found no errors or discrepancies. The home keeps a record of all medications received into the home and disposed of. We suggested that the home draft a list of specimen signatures to improve the security of the medication arrangements Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 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): 22 and 23. 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. Staff listen to service users and understand their vulnerabilities. They protect them from abuse and support their rights. EVIDENCE: We viewed the complaints information which was adequate and displayed on a notice board. Complaints forms are also available. The home had received very few complaints, the last one being last year about an overdue repair. Service users seemed quite free about their views and a couple of things were raised with us which we passed on to the manager. We were satisfied with his explanations regarding both these points. The home has a safeguarding policy. This was appropriate but must be amended to state that in the first instance social services must be informed of any safeguarding alert and also that the home’s policy is followed in conjunction with the local authority policy. The home does not have a copy of the local authority policy and they are required to obtain one. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 20 The home has a missing persons procedure and forms, and photographs of service users. We were satisfied that they would act appropriately if a service user went missing. We viewed the arrangements for the safekeeping of service users’ monies. All the service users have post office accounts and free access to them. They also have tins for safekeeping of cash. Account books are kept and we sampled some balancing them against the cash in the tins. We found no discrepancies. The residents at the home are generally vulnerable to abuse and exploitation in the community. One service user has a history of giving away money. The manager was very aware of individual vulnerabilities and the service users’ documentation identified them. We felt that arrangements have been put in place to safeguard people as much as possible, without trespassing on their rights. We felt that people in the home are protected from abuse, neglect and self harm. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 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): 24 and 30. 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 environment of the home on both sites has a variety of shortfalls and needs significant improvement. The home is generally clean but not in all areas. EVIDENCE: The environment at the home is generally below a reasonable standard for a residential care home. The building of Shila House is not particularly suitable, consisting of a terrace of shops with the corner property converted to a home and most of the service users bedrooms located above the rest of the shops. The premises we saw were not of a substantial construction and had not been well cared for. The standard of décor was quite poor in some places. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 22 There is however a refurbished single storey building, in the garden of Shila House which although unfinished will be an asset to the home. The home uses it for events like workshops and on one of the inspection days a service user was enjoying a nap on a sofa there. The manager copied for us his list of works which need to be done at Shila House and 1 Poynter Road. This included fire security items which must be prioritised. A return visit was made to the home eleven days after the second visit and most of the works had been done. One outstanding issue was a fire closer on a kitchen door. The manager stated that a new closer was needed and this had been agreed and would be fitted urgently. The list covered works to the majority of rooms in the house, ranging from touching up paintwork to replacing flooring, to securing banisters, and the fire escape. In our view all the work on the list is urgent. In addition to the list of repairs and refurbishment needed, we noted the following: Shila House A small fan in bedroom No 3 is very dirty needs cleaning or replacing. A small fan in bedroom No 1 has no cover and very dirty. It needs cleaning and the cover replacing. One service user bedroom has a kitchen sink in it which must come out. 1 Poynter Road Slabs which had fallen off of the front exterior wall were stacked up in the front garden. They need to be replaced on the wall. In the bathroom the toilet seat was off and the light does not work. On our third visit we were told that these two repairs had both been done. An unpleasant smell coming from an en suite in an identified ground floor bedroom where the toilet won’t flush. On the day of the inspection five of the en suite showers in the bedrooms were out of commission because there had been flood damage to the shops below. This was unsurprising as the shower trays were very shallow. The home had agreed with the shopkeepers not to use the showers until they had been refurbished with deeper shower trays and suitably fitted waterproof flooring. Two service users live in the rehabilitation unit at 1 Poynter Road. On the day of the inspection there had been a water leak from the first floor bathroom into the kitchen of the home, which had caused the electrical fuse to blow. The manager had evacuated the home until it could be declared safe by a qualified electrician. The two service users had had to sleep at Shila House in makeshift arrangements. They were able to return to their home on the day after the first day of the inspection. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 23 We met the proprietor of the service and discussed with him the environmental issues at the home. He stated that he had a plan for the refurbishment and he had a budget for it. He said that he has previous experience as an architect and understands the scale of what needs to be done at the homes. We emphasised to the proprietor and the manager that the home needs more than a face lift. It needs a radical upgrade to achieve a clean and safe living and working environment. We further emphasised that the staff need to be free to do skilled work with the service users in a well maintained environment. A positive factor is that the home has a part time cleaner. The whole premises of both Shila House and 1 Poynter Road must be brought up to an acceptable standard of maintenance, décor and cleanliness. The home at Shila House has a yard where a metal fire escape staircase leads to the first floor accommodation. On the days of the inspection the weather was very warm and as previously mentioned service users were sitting out around the table in the yard. One resident was sitting on the fire escape staircase. At times staff were sitting with them. We felt that this yard was a real asset to the home from a service user point of view, as they clearly liked to socialise there. As previously stated the home has a cleaner and this is an advantage. The home could not be said to be wholly free of mal odours. This is partly due to the habits of the service users, and partly due to the poor condition and maintenance of the building. For example on the day of the inspection one of the toilets was not flushing but a service user had continued to use it causing an unpleasant smell. The manager stated that none of the service users suffers from any infectious disease currently. He has written a procedure for the possibility of swine flu and is also prepared that service users are potentially at risk from hospital acquired infections. The manager stated that the home does have personal protective equipment available and chemicals for dealing with spills. They are currently trying to obtain the proper face masks for dealing with swine flu. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 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): 32,34,35 and 36. 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 staff are competent and qualified but their training needs to be updated. Recruitment is safe and robust and supervision is frequent and regular. EVIDENCE: We viewed three care worker personnel files. They were for keyworkers to the three service users whose files we had selected for viewing. The personnel files demonstrated a safe and robust recruitment process, with an application form, face to face interview, two professional references, Criminal Records Bureau (CRB) disclosure and proof of identity. We noted that one worker had ‘limited leave to remain’ in the UK in 2005 and asked the manager to check into his current immigration status. We also pointed out to the manager that he could improve practice by ensuring that he checks dates of employment with referees to ensure they match those given by the applicant. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 25 We viewed the training records for the three staff and we noted evidence of induction training for all three. We were concerned to see that all three workers had failed to keep up to date (every 1- 2 years refreshing) their core basic training. The following gaps were found: Worker 1 needed to update training in: Safeguarding adults Health and Safety Food Hygiene Medication Manual Handling She had a three year certificate in First Aid dated 2008 and had NVQ credits in January 2007. She has completed a Safer Foods Folder recently. Worker 2 needed to update training in: Medication Infection Control Manual Handling Food and Hygiene Health and Safety First Aid This worker has NVQ level 2 in February 2007 and has completed a Safer Foods Folder recently. Worker 3 needed to update training in: Food Hygiene Manual Handling Health and Safety Safeguarding Adults Medication Infection Control First Aid The manager must ensure that core basic training is brought up to date for all workers. First Aid being refreshed before the certificate runs out. The manager must ensure that there is always a qualified First Aider on duty at all times. We viewed the records for supervision. We noted that supervision is frequent and well recorded with both parties signing the dated documentation. We also Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 26 noted that staff had development plans. We have no concerns about the supervision of the staff. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 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): 37,39,40, 42 and 43. 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 home is well run and service users views are sought. Policies and procedures safeguard service users best interests and the management is competent and accountable. The health and safety of service users is promoted but poor maintenance undermines practice in this area. EVIDENCE: The registered manager is competent to run this demanding service. He is qualified and has substantial relevant experience. He is supported by an able deputy and both have been in their posts for some years. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 28 Our view is that these management staff would be very difficult to replace and we have made a recommendation related to notice periods. There was evidence that the home annually surveys the service users for their views, and we also saw evidence that a service user had been involved in producing the survey material in 2008. The format had changed in 2009 to a tick box form with space to enlarge on answers on the back. We also saw a business plan which covers three years and had been developed in 2008. There is an annual development plan for 2008-2009. We viewed the policies and procedures manual for the home. The home has a number of relevant policies including, accident procedure, bullying, infection control, complaints, code of conduct (for staff) confidentiality, medication, restraint, whistle blowing, restraint and violent behaviour and emergency admission. Some topics have more than one policy dealing with them. This is potentially confusing as a staff member may feel they have read a policy when in fact there is more information elsewhere. We suggested that where policies deal with a broadly similar topic, they either are either combined or are clearly marked with signposts to other similar policies. There is a policy for emergency admissions and we asked that this be amended to show that compatibility with other service users will be taken into account before a placement is offered. The home is in the process of introducing a new independently provided system for health and safety. This is a comprehensive system which provides policies and guidance for every aspect of health and safety in a care home. The manager stated that in the introductory period the home will have to run the old and new systems in parallel. We looked at the arrangements for fire safety. For Shila House The home has a fire risk assessment, which was seen. There are alarms in place at Shila House and a fire alarm test certificate was issued on 20/8/09. In January 2009 Chubb, an outside contractor inspected the fire equipment including extinguishers at Shila House and issued a certificate. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 29 There was evidence of an electrical installation check on 26/10/07 at Shilia House. There was a landlords gas safety certificate for Shila House for 2009. For 1 Poynter Road The home has a fire risk assessment which was seen. The manager stated that Chubb visited 1 Poynter road in January 2009 at the same time that they visited Shila House. However they had not documented this or issued a certificate. The manager produced a fire extinguisher from Poynter Road which bore the date January 2009. This indicated that the inspection had taken place at 1 Poynter Road at the same time as Shila House. On the third visit to the home we were shown a fire alarm test certificate by an outside contractor dated dated 28/8/09. We were told by the manager that 1 Poynter Road has a hardwired smoke alarm system, to ensure no reliance on batteries. There was evidence of an electrical installation check on 26/10/07 at 1 Poynter Road. PAT testing was undertaken at Shila House on 20/8/09, but there was no evidence of PAT testing at 1 Poynter Road. However this was undertaken before the third visit to the home and evidence was seen of PAT testing on 28/8/09. On the third visit to the home a British Gas checklist dated 2/9/09 was seen and we were told by the manager that a certificate is to follow. The manager stated that the home orders all its Control of Substances Hazardous to Health (COSHH) products from ASDA supermarkets and keeps them under lock and key in a store in the garden at 1 Poynter Road. We viewed these. Daily supplies are brought over by staff and not kept at Shila House. We believe that service users benefit from the competent and accountable running of the service. The home has systems and structures in place which underpin smooth running. Key documentation is clear and well written and record keeping is of a good standard. The proprietor undertakes Regulation 26 Person in Control (PIC) visits, and we viewed the reports submitted to the manager following visits. It seemed to us that the inspections had not been in depth and they did demonstrate any Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 30 auditing of systems. One recent report stated that the level of training was satisfactory, which we believe it is not. We recommend that the organisation review the way in which they undertake Regulation 26 visits. Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 2 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 3 3 2 3 Version 5.2 Page 32 Shila House DS0000010620.V377329.R01.S.doc no Are there any outstanding requirements from the last inspection? 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 YA20 Regulation 13 Requirement The registered manager must ensure that medication is stored at the right temperature at all times i.e. around 25 degrees celcius. To avoid deterioration of medications. 2. YA9 13(4) The registered persons must ensure risk assessments are undertaken for residents who are expected to shop and cook for themselves, to address the risks of food poisoning from consuming out of date foods. The risk assessment must include a management plan which determines what action staff will take in this area. To reduce risks to service users. 3. YA23 13(6) The registered manager must ensure that the safeguarding policy is amended to state that safeguarding alerts will be referred to the local authority DS0000010620.V377329.R01.S.doc Timescale for action 15/09/09 15/09/09 15/09/09 Shila House Version 5.2 Page 33 social services in the first instance. Also that the policy will be followed in conjunction with the local authority policy. The registered manager must ensure that the home has a copy of the local authority safeguarding adults policy. To properly safeguard service users. 4. YA24 23 The registered manager must ensure that the maintenance and décor of both houses is brought up to a reasonable standard. This includes fixing any broken facilities and removing a kitchen sink from an identified bedroom. To give service users and staff a safe and decent environment to live and work in. The registered manager must ensure that staff core basic training is brought up to date for all staff. This means that all workers must refresh their training in Medication, Health and Safety, Safeguarding Adults, Food Hygiene, Manual Handling and Infection Control within two years. First Aid must be refreshed before the certificate runs out. To ensure staff are properly trained to do their work. The registered manager must ensure that there is a qualified First Aider on duty at all times. To safeguard service users and staff in a medical emergency. The manager must ensure that DS0000010620.V377329.R01.S.doc 01/11/09 5. YA35 18 01/12/09 6. YA35 18 15/09/09 7. YA42 24(4) 01/09/09 Page 34 Shila House Version 5.2 all the fire doors and fire exits and dorguards are functioning in proper order. To protect service users and staff from fire. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA20 Good Practice Recommendations We recommend that the home develops health action plans where all information relating to an individual’s health is recorded. We recommend that the medication folder carry a list of specimen signatures for staff who administer medication. We recommend that the home raise with the pharmacy the practice of inaccurate listing of medication on the back of dosette boxes. We recommend that the registered manager and deputy manager have a contract which states they need to give three months notice before leaving their posts. We recommend the organisation reviews the way they undertake and report Regulation 26 Person in Control visits, to include auditing of systems. We recommend that where policies deal with one topic they are either combined, or signposts are put in them to reference the other policies. The emergency admission policy should take into account issues of compatibility with existing residents. 2. 3. 4. 5. YA20 YA20 YA37 YA39 6. 7. YA40 YA40 Shila House DS0000010620.V377329.R01.S.doc Version 5.2 Page 35 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. 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. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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