Care Home: Shire Oak House

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What the care home does well There is a commitment to continuous development, which cascades down from the manager to her staff team. Support to staff appears to be good, giving residents the benefit of motivated carers. Residents also benefit from a well maintained living environment. What has improved since the last inspection? The home is to be commended for its response to the requirements made at the last key inspection. They have been addressed to a satisfactory level. The development of a sensory room provides an additional resource for the resident group. The home has recently introduced the Skills for Care common induction standards, which will provide new staff with a good level of competence on which to develop their skills and knowledge. What the care home could do better: The home should install a controlled drugs cabinet that is consistent with regulations. To ensure all residents can continue to be weighed regularly the home should acquire sit on scales. There needs to be a photograph of the resident on the front sheet of their MAR. The company may wish to consider whether the registered manager needs to see the original CRB check herself. Supervisions need to meet the National Minimum Standard of 6 sessions per year. All staff need to complete infection control and safe handling of food training. CARE HOMES FOR OLDER PEOPLE Shire Oak House 33 Lichfield Road Shire Oak Walsall West Midlands WS9 9DH Lead Inspector Martin George Unannounced Inspection 20th February 2008 09:45 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 Shire Oak House DS0000020828.V340455.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. Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Shire Oak House Address 33 Lichfield Road Shire Oak Walsall West Midlands WS9 9DH 01543 372331 01543 372331 petedavies38@hotmail.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Quality Homes (UK) Limited Mrs Michelle Louise Ward Care Home 26 Category(ies) of Dementia (26), Old age, not falling within any registration, with number other category (26) of places Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Adherence to the Action Plan submitted by the registered provider dated 16 March 2006. The registered person may provide personal care (excluding nursing) and accommodation for service users of both sexes whose primary care needs on admission to the home are within the following categories:old age not falling within any other category, OP, 26; dementia, DE, 26. The maximum number of service users to be accommodated is 26. 3. Date of last inspection 6th July 2006 Brief Description of the Service: Shire Oak House is a large detached residence in the Shire Oak area of Walsall. It is surrounded by open countryside. The home has been extended and provides accommodation for up to 26 people. All bedrooms are single and the majority have an en suite toilet and wash hand basin. There is a passenger lift to the first floor. The home has parking facilities to the front and extensive gardens to the rear. It is owned by Quality Homes (UK) Limited who have other homes in the Walsall and Wolverhampton area. Fees charged at the home range from £337 to £354. Shire Oak House DS0000020828.V340455.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 2 star. This means the people who use this service experience good quality outcomes This unannounced key inspection was carried out by a single inspector between 09:45 and 16:00. As part of the inspection all National Minimum Standards defined by the Commission for Social Care Inspection (CSCI) as ‘key’ were inspected. Information about the performance of the home was sought and collated in a number of ways. Prior to inspection we were provided with written information and data about the home through their annual quality assurance assessment (AQAA). Information, including the last key and subsequent random inspection reports were analysed prior to inspection and helped to formulate a plan for the visit and helped in determining a judgement about the quality of care the home provides. On the day of the inspection we spoke to the registered manager and staff and held brief conversations with service users. We also undertook a tour of the premises and observed practice and this provided evidence in support of the records that were also checked on the day. What the service does well: What has improved since the last inspection? The home is to be commended for its response to the requirements made at the last key inspection. They have been addressed to a satisfactory level. The development of a sensory room provides an additional resource for the resident group. The home has recently introduced the Skills for Care common induction standards, which will provide new staff with a good level of competence on which to develop their skills and knowledge. Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 6 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. Shire Oak House DS0000020828.V340455.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 Shire Oak House DS0000020828.V340455.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): 2 and 3 Quality in this outcome area is good. The home ensures that good quality pre-placement assessments are in place that provide staff with the necessary knowledge to help them meet the needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of five residents were checked and on all we found evidence of good quality assessments, consistent with National Minimum Standard 3.3 and the assessments inform the plans of care for daily living, which are written in a way that usefully informs staff about the needs of each resident. The records all contained conditions of agreement but not all of the ones we checked were signed. Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 9 The AQAA states that there is a 28 day settling in period to ensure that residents and their family members are happy that the home is able to meet their needs. The manager stated that the level of dementia of the current group of residents means that there is very little involvement in devising and reviewing of their care plans. This is not entirely consistent with the AQAA, which states that residents have input into their care plans. We saw conditions of agreement on file and these detail what residents can expect from the home, but not all of the ones we checked were signed. They should be signed by either the resident or an advocate. Shire Oak House DS0000020828.V340455.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): 7, 8, 9 and 10 Quality in this outcome area is good. The health needs of residents are well managed. Medication recording and practice meets minimum standards but would benefit from some minor improvements to further safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents’ plans that we looked at include information covering a wide range of needs and are written in easily understandable and non-judgemental language, providing useful information that staff can use to help them provide effective care to residents. We saw evidence in the plans of monitoring of pressure sores and were able to confirm through the records that the home seeks and acts upon professional advice about the promotion of continence. Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 11 The records provide evidence that weight is monitored on a regular basis but as the home has still not acquired a set of sit on scales there remains a problem with weighing residents who are unable to weight bear, which currently applies to one resident. The home needs to acquire sit on scales to ensure this aspect of care can be consistently met as residents ability to weight bear diminishes. Staff who are responsible for administering medication have all completed an accredited handling of medication course. We checked medication records and are satisfied that these are completed properly and kept up to date. To fully safeguard residents the home should make efforts to ensure that all directions on Medication Administration Records (MAR) are printed, rather than handwritten. We would also like to see a photograph of the resident on the front sheet of their MAR. Some MAR’s have a photograph but others don’t. The manager stated that none of the current resident group are capable of self administration but the home has a policy to cover this aspect of practice. We were shown a controlled drugs (CD) box (a metal cash tin) that has been secured to the base of a lockable, metal cabinet. Although this is relatively secure we recommend that the home fully comply with the Misuse of Drugs (Safe Custody) Regulations 1973, which requires a metal cupboard of specified gauge and with a specified locking mechanism. This should be fixed to a solid wall with either rawl or rag bolts. Our observations throughout the day evidenced a respectful and sensitive approach from staff toward residents, which is unrushed and involves an appropriate degree of humour. Shire Oak House DS0000020828.V340455.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): 12, 13, 14 and 15 Quality in this outcome area is good. The resident group benefit from an attentive staff team, a varied programme of activities and good quality, nutritious meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We had limited discussion with residents on the day of the inspection and the few comments we were offered were positive about the staff and the home in general. Our observation at varying times throughout the day suggest that residents are satisfied with what is happening and what is provided for them. The range of activities appears to be suitable for the current resident group and involves both in house and community options. During the afternoon of the inspection there was a keyboard player/singer entertaining the residents. Purely from observation it was difficult to assess how much the residents were enjoying this but the manager informed us that residents did consistently say they enjoyed this type of activity. Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 13 The home places no restrictions on visitors to residents, apart from when a resident informs staff that they do not wish to see someone. The AQAA states that because of the level of dementia within the resident group the home relies on informal chats rather than residents’ meetings to acquire their views and wishes. Although this is an acceptable way of gaining their views we would recommend these informal chats are recorded (as would be the case for a residents’ meeting) to provide evidence that the necessary importance is given to listening and responding to the views and wishes of residents. We examined menus and found these to be varied and interesting and we were informed that the preferences of residents are incorporated in menu planning. Meals are well presented and nutritious and are served in a pleasing environment, conducive to a relaxing mealtime experience for residents. Shire Oak House DS0000020828.V340455.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): 16 and 18 Quality in this outcome area is good. Residents are protected by a well trained staff team who have a good understanding of safeguarding practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a service user guide in each bedroom and this contains information about how the home deals with complaints. Information about complaints is also posted on the notice board in the main entrance area, but it would be beneficial to put this at an easier height to read and perhaps in larger print. The last complaint was two years ago and the manager informed us that she is satisfied there have been no incidents necessitating a complaint in that time. One male resident we had a brief conversation with stated he had no reason to complain about how he was cared for. The AQAA confirms that all complaints will be dealt with within 28 days. Training in the safeguarding of vulnerable adults has been completed and our observations on the day evidenced a good level of awareness in relation to safeguarding issues. Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 15 Procedures provide information about the actions that staff need to take in the event of suspected or actual abuse and we are confident that knowledge of how to use the procedures is sufficient to safeguard residents. We are satisfied that the process used to keep residents money and valuables safe is consistent with good practice. The AQAA states that for personal allowances two signatures are required for all in and out payments. Shire Oak House DS0000020828.V340455.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): 19, 24 and 26 Quality in this outcome area is good. There is an ongoing commitment to provide a safe and pleasing environment for the resident community. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the maintenance man was painting several of the ground floor areas as part of the ongoing refurbishment programme to keep the home a pleasant environment for residents. The availability of the maintenance man is shared with other homes in the company. Walsall environmental health recently carried out an infection control audit and gave the home an overall score of 88.6 , indicating that residents are well protected in this area of practice. Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 17 The laundry is very compact and it is not surprising that there are occasions when residents’ clothes get mixed up. There is a good quality washing machine, which incorporates a sluicing facility. The drier is of suitable size for the number of residents. There is an intention to create a larger laundry when a proposed extension goes ahead. The kitchen is well maintained and hygienic, with records providing evidence of when hygiene and safety checks are carried out. The home is being kept in good order throughout and residents’ rooms show evidence of being personalised. The garden is very spacious and safe for residents with limited mobility. It would be nice for the home to consider creating a sensory area in the garden, based around different scents and textures. The sensory idea has already been acted on in the house with a small sensory room having been created. Once the curtains are replaced with some kind of window covering that is capable of blocking out most of the light this will be a very useful additional and calming resource for the residents. Shire Oak House DS0000020828.V340455.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): 27, 28, 29 and 30 Quality in this outcome area is good. Residents are cared for by a team of staff committed to ongoing development of their skills and knowledge. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of the rotas provided evidence of cover throughout the 24 hour period that is sufficient to meet the complex needs of the residents. There is a trained first aider on shift at all times, including during waking night. To ensure that care staff are able to remain focussed on their key role at busy times there is an additional teatime cook. The AQAA identifies that the home is committed to qualifying staff to the appropriate level of NVQ, helping to establish a team with proven competence in the care of vulnerable older people. The staff files we examined contain evidence of all necessary checks for recruitment purposes. The manager does not get to see the original Criminal Records Bureau (CRB) check, but is instead sent a written confirmation from Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 19 head office that the check has been received and given the CRB reference number. Although guidance on this is not specific the company may wish to consider whether the registered manager should see the original CRB check herself. Staff files we checked show evidence of the training that is being provided to staff to improve their skills and knowledge in areas of practice pertinent to the resident group. As well as this the home has recently introduced the Skills for Care common induction standards and this will establish a good level of competence for new staff, enabling them to work confidently alongside more established colleagues in meeting the complex needs of residents. Shire Oak House DS0000020828.V340455.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): 31, 33, 35, 36 and 38 Quality in this outcome area is good. The manager is committed to ongoing development of self, her staff and the environment, all of which benefits the resident group. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is close to completing her Registered Manager Award (RMA) and is committed to the ongoing development of the service. Observations throughout the day satisfied us that lines of accountability are known about and used appropriately. Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 21 The AQAA states that the policies and procedures were last reviewed in April 2007 and a random check confirmed that they are up to date. We found evidence that the home seeks the views of residents and other people who come into contact with the home and responds positively to comments made. According to the manager none of the current residents are capable of dealing with their own finances. The manager should ensure that evidence that this is the case is included in care plans showing how this has been determined. Our examination of staff files provided evidence that supervision occurs regularly but the manager confirmed that she has not yet quite met the National Minimum Standard of 6 sessions per year. The AQAA confirms that heating, electrical, fire detection and fire fighting, gas and emergency call equipment checks have all been carried out. We also noted in the AQAA that only 7 staff have completed infection control training and this needs to be given priority to ensure residents continue to be protected from potential cross contamination. We also note that there is a shortfall in the numbers of staff who have completed the safe handling of food training and this too needs to be given the necessary priority. Fridge and freezer temperatures are checked and recorded regularly. There are no outstanding requirements from the most recent fire officer report. Shire Oak House DS0000020828.V340455.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 x 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x x x 3 x 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 3 x 3 Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP9 Regulation 13(2) Requirement The manager should ensure a properly fitted CD cabinet is installed, which meets the requirements of the Misuse of Drugs (Safe Custody) Regulations 1973 Timescale for action 31/05/08 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 OP8 Good Practice Recommendations The home should acquire seated scales to ensure that current and future residents are able to be weighed on a regular basis once their ability to weight bear has diminished The manager should ensure that every MAR front sheet has a photograph of the resident to help reduce the potential risk of incorrect administration The manager should ensure that risk assessments are completed for all residents who do not have a key to their own room, explaining how this has been assessed All staff who have not already done so need to complete the safe handling of food and infection control training DS0000020828.V340455.R01.S.doc Version 5.2 Page 24 2 3 4 OP9 OP24 OP30 Shire Oak House 5 OP36 courses without undue delay The manager should ensure that supervision meets the requirement of 6 times per year Shire Oak House DS0000020828.V340455.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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. 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