Care Home: Shipbourne House Hotel

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What the care home does well The home is extremely well run and the management are committed to providing a suitable environment to meet the needs of people with dementia. The management are always keen to respond to observations and recommendations made by the Commission. Good assessments are made prior to admission, these then used to formulate informative care plans that address the needs of the residents. What has improved since the last inspection? The assessment process of prospective residents` needs has been much improved. The home has improved its system for reducing the risk of infection by introducing of liquid soap and paper towels in all communal washrooms. What the care home could do better: Ensure that all medicines that are prescribed for residents are readily available. Make sure that Criminal Record Bureau checks have not been transported from another service. Extend the scope for activities within the home and in the community. Keep a record of all concerns however small so that the service can demonstrate the action taken. CARE HOMES FOR OLDER PEOPLE Shipbourne House Hotel 6 Vicarage Road Cromer Norfolk NR27 9DQ Lead Inspector Mrs Marilyn Fellingham Key Unannounced Inspection 17th September 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shipbourne House Hotel Address 6 Vicarage Road Cromer Norfolk NR27 9DQ 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) 01263 514370 NO FAX # steve@shipbournehouse.co.uk The Provider Miss Carole McCrory Manager post vacant Care Home 20 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (20) of places Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Shipbourne House Hotel is a three storey late Victorian building that has retained many of its original features and is registered as a residential care home offering care and accommodation for up to twenty older people with dementia. The home has been adapted to accommodate people with dementia needs. It benefits from the use of a shaft lift to all floors and service users have the choice of seventeen single or three shared bedrooms that all contain a washbasin, one has an en-suite toilet and all are sited near to adapted bathrooms containing assisted bath, sink and toilet. There is a newly fitted shower room on the ground floor and service users have the communal use of two lounges and a dining room. The home stands in its own grounds in a quiet residential area in the seaside town of Cromer and benefits from having the town centre and the sea front just a few minutes away. There is a small amount of parking to the side and rear of the building and small gardens to the front and rear of the building that are maintained in good order and offer wheelchair access and seating for those service users who wish to sit outside. A hairdressing facility is available and an independent chiropodist also visits. Shipbourne House Hotel DS0000027375.V371988.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 3 star. This means that people who use this service experience excellent outcomes. This was an unannounced inspection that took place over seven hours. The key inspection for this service has been carried out using information from previous inspections, information from some residents, relatives, visitors to the home and people who work in the home. The main method of inspection used was ‘case tracking’. This involved selecting individual care plans and information available about people who live in the home and tracking their experience and speaking to them and their relatives about the outcomes they experience as a result of the support provided. During our visit a tour of the premises was undertaken and resident’s records and staff files were looked at. The fees for this home are £440 per week. What the service does well: What has improved since the last inspection? Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 6 The assessment process of prospective residents’ needs has been much improved. The home has improved its system for reducing the risk of infection by introducing of liquid soap and paper towels in all communal washrooms. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People’s needs are thoroughly assessed before admission to the home so that individuals can be sure that the placement is appropriate and that their needs will be met. EVIDENCE: We looked at the assessment records for prior to admission for three residents; all three assessments were very detailed and addressed all areas of need including those related to their physical, social, emotional and dementia well being. A standardised format is used for this assessment that is then used to formulate the plans of care. All prospective admissions to the home are given the opportunity to visit with their families or representatives to ensure the right decisions are being made not only for the residents but to ensure that they will integrate well with the Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 9 other residents. A letter is sent to all the residents or their representatives to confirm that their needs can be met. One resident told us “I came for a one months trial to see if I liked it”; a relative told us that they all had had sufficient information to make a decision about the home. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The care planning system and the monitoring of changing needs means that the residents can be sure that their health, personal, social and dementia health needs can be met. Although the administration of medication could be improved it has not altered the overall judgement made. EVIDENCE: We looked at three care plans; the assessment used prior to admission was used in the first instance to formulate the plans, then after admission the residents are assessed again to ensure their needs have not changed since admission. We noted that all the assessed needs were also amended according to events and changing needs. There were very good daily notes that were very informative about the residents, these notes were then used, if applicable, to update the care plans. The care plans showed evidence of the resident’s relative’s involvement in the care planning and also of the residents Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 11 if they were able. We noted skin integrity assessments had been carried out along with nutritional assessments and monthly monitoring of weights. All three residents had had an assessment carried out to determine their mental capacity and dates were present in the records for their reviews. Risk assessments were in place for falls, medication, mobility and food and drink. We also noted that these residents were risk assessed in relation to their environment. A number of relatives have made positive comments about the care their relatives receive, one stated “good all round attention to cleanliness, my mother has been well cared for the whole time she has been in the home”. Another comments about their relative “since being in Shipbourne my relative has been looked after extremely well, the care received from the owners and all members of staff has been outstanding and all her needs have been met”: this relative goes on to say that that their relative has said “ this is the best place I could have ended up in, the staff are all nice and very friendly”. One daughter stated in our survey that “my mother is cared for in a very supportive way and I am very happy with this” she also commented, “the staff are very kind and caring”. We made a random check of medicines in stock and that being used as prescribed, all medication tallied with the medicine record charts; however we did note that those residents that are prescribed creams for various reasons had gaps on the medicine record charts for these so it was difficult to ascertain if they had been applied or not. We did note that the gaps appeared for the early morning application or the evening application. The manager stated that she had already spoken to the person responsible for this and would follow it through again. One resident had been prescribed prednisilone, we noted that they had missed a dose; this is unsatisfactory and can lead to complications if stopped suddenly. We asked the manager why this was and she stated that the staff and she had failed to check that the prescription had arrived from the surgery. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Although there is room for improvement the home offers a wide range of activities that are stimulating and motivating. Meals and mealtimes are not rushed and appear to be enjoyable. EVIDENCE: Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 13 Whilst we were visiting the home we observed a lot if interaction between the staff and residents and also amongst the residents themselves. We noted one resident helping another with their drink then ensuring that they had a blanket over their legs. We discussed with the manager and staff about the activities that were provided by the home and these appeared to be very varied stimulating. The service provides music for health once a fortnight, carpet darts, carpet bowls and other activities that are physically stimulating. A number of residents enjoy one to one activities and one resident was taken to Marks and Spencer shopping as this is what she enjoys. The staff knew this because every resident has a life history taken from themselves or their relatives. Another resident wanted to go back to where they were born, so this was arranged by the management; we saw photos that confirmed this visit: other residents have been on trips out. One relative felt that their relative could be taken out in their wheel chair more as she felt because she could not remember things she forgets to ask to go out. Another relative tells us “the residents are taken out for a walk, those who can manage on foot and those that cannot are in wheelchairs”. This relative went on to tell us that there is a pleasant garden for the residents to sit in” We spoke with the manager about activities and she told us that she thinks that they need to amend their activities and have a more structured approach to them and involve specialist Dementia services in this. One relative commented in our survey that there could be more encouragement of physical and intellectual stimulation. Another relative whom we spoke with during our visit said that they felt there was a lack of stimulation. A number of positive remarks were made by relatives, in our surveys, they included “when we visit the home we are always made welcome”. A record is kept of all residents’ involvement in activities and we saw these. We observed lunch being served, we noted that those residents who needed their food cut up for them had this done in privacy before it was taken into the dining room. All residents if able choose where they wish to have their meals although they are encouraged to eat in the dining room as a means of socialising. We noted this mealtime was totally unhurried and relaxed and those residents who needed help were given it in an empathetic way. A record is kept of what residents need help and to what extent this help is required. The home ensures that all the residents have sufficient fluid intake and we saw evidence of this, they are also offered a alcoholic drink if suitable in relation to the rest of their care, this can stimulate the gastric juices before lunch is served. Residents are provided with specialist equipment to help them maintain their independence whilst eating. One resident told us “ I enjoyed lunch and the food is always nice” another told us “food is very, very good, there is a good cook”. A relative told us “the residents get good homemade food. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives feel listened to and are confident that their concerns are acted upon. The process for documenting all areas of concern however small needs to be developed. EVIDENCE: The Commission has not received any formal complaints about the home since the last inspection; records in the home also confirm that they have not received any complaints. We asked the manager if they kept records for concerns that have been expressed by relatives or the residents, she said that they did not and mostly any concerns were dealt with on a day-to-day basis. One relative tells us in the survey that their relative has never expressed any concerns since living in the home; a resident tells us “I would ask a member of staff”, other comments made confirmed that everyone knew how to air their concerns. The complaints procedure is posted in the hall way and it is also included in the residents ‘statement of purpose’ and in the residents contract. We saw the policies and procedures relating to safeguarding adults, these were clear and all staff we spoke with were familiar with their content. All staff except the latest recruits have had training relating to safeguarding adults and records for this were seen. One member of staff we spoke with “I am not afraid to report abuse” another said “I understand about whistle Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 15 blowing”, another member of staff told us “I have done POVA training and I know how to report a matter of abuse”. Relatives tell us that the Manager/provider and her partner are very approachable and always listen to them and are most helpful. One resident whom we spoke with said, “I know how to make a complaint” and also told us “I feel safe here”. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The overall improvements and maintenance of the home means that the residents live in a safe and an acceptable environment and suitable to meet their needs. EVIDENCE: We undertook a tour of the home, it was found to be very clean and tidy and no unpleasant odours were detected. A relative tells us “there is good all round attention to cleanliness”. A number of improvements have been made to the environment internally and externally to make it suitable for it new stated purpose related to the Registration for Dementia Care. We found it to be safe, well maintained and easily accessible. The home has a programme for maintenance in place that is constantly being updated and they have an Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 17 improvement plan to incorporate a dedicated hairdressing room/room for chiropody. The banister on the top floor is being raised as a safety measure and an area being converted for wheelchair storage. Extra call bell are to be installed in the summerhouse and on the top floor. The area outside has been re designed to offer a safe and secure environment for those with dementia. It has some raised flowerbeds to allow those residents who wish to, to do some gardening. There is a delightful summerhouse that apparently according to the staff, the residents enjoy using. There is a gravel driveway in front of the home with some parking; it is the intention of the providers to put a small path down to accommodate wheelchairs. All but three bedrooms have been decorated with new carpets and the stairs and front hall have been re carpeted. Both the lounges have been re decorated and new curtains are in place. The bathrooms have been fully re furbished with new assisted baths. A new kitchen is in place that has been inspected successfully by the Environmental Health Department. The gas fires have been replaced to ensure the residents safety. All the communal wash areas now have paper towels and liquid soap to maintain the control of infection. On entering the home it felt very homely and the residents appeared comfortable, and one told us that they liked the new carpets. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are met by the numbers of staff at any given time. The home has a good training plan in place, which results in good outcomes for the people who use the service who are also mostly protected by the home’s recruitment practices. EVIDENCE: Comments made verbally and written suggested that people felt that they were getting the support they needed. The residents and relatives we spoke with had very high praise for the staff and management with comments such as “staff are great”, “I feel well cared for and I get on very well with all of them”. One relative’s comments we received tells us “the staff are mostly very kind and caring, usually finding time for a laugh and a joke with my mum, which she appreciates”. Another relative comments “kind caring staff”. The staff rosters showed us that the service is well staffed and the Manager/provider and her partner are in the home most days along with a reasonable amount of staff as well. We interviewed five members of staff, all were happy to be working in the home. One told us that they liked it there because “everything is done properly”, another said, “we are here for the residents not for us”; another told Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 19 us “I like working here”. The new recruits confirmed that they had had an induction and we saw records for this. All the staff we spoke with felt they had the skills to do their job; all of them have had basic training in dementia and are going to commence further training in this subject. All those staff who give medication have had training in this, some need to be reminded of their responsibilities when filling in the medicine record charts, as observed earlier in this report and in ensuring all prescribed medicines are available for administration. One member of staff we spoke with said “I have been taught everything since I have been here”. Training records confirmed that all but 20 of staff have an NVQ qualification and 2 members are going to do NVQ4. The management team have ensured that those staff who have been promoted have the skills and support to deal with their new roles, one promoted member told us “I am well supported in my new role”. We looked at all records for newly appointed staff, for most of these all the relevant checks had been made, however the manager needs to be reminded that CRB checks are not transportable, once this had been discussed with the management team they were more than happy to respond to our request to have them in place for the ones that they had thought were transportable. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. There is an excellent management structure in place, which ensures that the home is being run in the best interest of the people who use the service. The health safety of the residents has been promoted and protected because of the excellent management of the home. EVIDENCE: The home is extremely well managed by the manager/provider and her partner: we received very positive comments from staff, residents and relatives about how the home was managed. The comments from staff included “Steve and Carole have an open door”, another said “Steve and Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 21 Carole approachable and always accessible”; another went on to say “the general running of the home seems very good. Carole and Steve try their best to ensure everything is done by the book, if something is not working well then they will try to find an alternative route to make everything run smoothly fir the staff and residents”. Relative’s comments included “excellent management”; “it would be good if all care homes were run as well as Shipbourne House”. We looked at health and safety related information these showed that there are servicing arrangements in place for all equipment. There were records in place for fire testing. All staff receive formal supervision every six weeks, this was confirmed by staff and also the records we looked at. The service has a system in place for monitoring the quality of the service it provides, the management are aware it needs further development and are working to achieve this. Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 4 4 4 4 4 x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X x 4 4 4 Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP16 Good Practice Recommendations It is recommended that the service keep a record of all concerns however small, expressed by residents and relatives so that it can demonstrate how these are dealt with. The home must make sure that they are not employing anyone with a transportable CRB check, this will ensure the continuing safety of the residents. It is necessary for all staff to adhere to the policy and procedure for administrating medicines. 2. 3. OP29 OP9 Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Shipbourne House Hotel DS0000027375.V371988.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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