Care Home: Shirebrook Place

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Shirebrook Place Eaton Avenue Newark Nottinghamshire NG24 4JD two star good service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Nancy Bradley Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Shirebrook Place Eaton Avenue Newark Nottinghamshire NG24 4JD 01636646565 01636646564 shirebrookplace@shirebrookcaregroup.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Shirebrook Care Limited Name of registered manager (if applicable) Mrs Patricia Ann Atkin Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 10 10 0 0 care home 10 learning disability physical disability Additional conditions: The registered person may provide the following categories of service only: Care Home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Physical Disability - Code PD Learning Disability - Code LD The maximum number of service users who can be accommodated is 10 Date of last inspection A bit about the care home Shirebrook Place as a residential care home for people with a learning disability and who may also have a physical disability. The main funding for this service will be through health and social care funding and where feasible through persons who may wish to fund their own care privately. The maximum number of service users who can be accommodated is ten. The rooms are all single and en-suite. There is a small garden are to the rear and side of the house. The home is two-storey house located in a quite part of Newark in an established community. The home is local to shops, and health services. There is good road and rail network. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection and took place over a total of three hours. We spoke with the registered manager. The home currently has only one person living there and on the day we visited was attending the local day center. The inspection activity during this site visit was to assess the service against the key National Minimum Standards and these are identified through the report. We looked at all the information that we received or asked for, since the last key inspection. This included the annual quality assurance assessment that was sent to us by the home. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the home. The one person living at the home was case tracked. Case tracking is a method used to track the care of individuals from the assessments undertaken before they are admitted to a service through to the care and support they receive on a daily basis. This includes looking at support plans and other documents relating to that persons care, talking to staff regarding the care they provide and if possible talking to the individual. Additionally, time was spent in preparation for the visit, looking at the service history. Records were examined relating to the people living there and the general running of the home. The home has been open since July 2008. We gave out one Have Your Say questionnaires for the person living at the home who confirmed they were very happy at the home and were looked after by the staff and could not wish to live anywhere else. We received eight completed questionnaires from staff all were very positive about the home, were happy and enjoyed working there. What the care home does well The home provides good opportunities for the people living at the home with staff taking people on holiday. The home offers good choices about how they spend their day and provides individual support for the people living there. Good communication between the staff, which ensures they are kept informed about changes to the care of the people they are looking after. The home is comfortable in appearance, well maintained, set in pleasant and quite surroundings. Wh got fro las ins Thi sec not app as the ins for ser Wh car cou bet Alth ther maj of imp the nee add area high in t This will vali nex insp whe env the will prov care mor If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Nancy Bradley Cambridge Local Office PC1 Capital Business Park Fulbourn Cambridge CB21 5XE 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Arrangements are in place to ensure that peoples needs are fully assessed and met prior to admission. This ensures that peoples holistic needs are appropriately met. Evidence: During the site visit the care plan of the most recent person admitted to the home was examined. The home currently has a suspension on contracts in place due to concerns raised by the placing authorities on other homes in the group. People who are admitted to the home have their needs assessed through the care management system, which highlights any additional needs, and the need for additional staffing hours. The home also undertakes its own individual comprehensive needs assessment and which is in accordance with Shirebrook Care Ltd assessment process and the National Minimum Standard 2.3. The assessment then forms part of the care plan compiled by the home. There was evidence on file to show that the care needs assessment of the person had been reviewed by the referring agency following admission and will be reviewed again within the next twelve months. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There is a care planning system in place, which enhances the care people receive. Evidence: During the visit the care plan of one person who lives at the home was seen. The registered manager had compiled the care plan and evidence was seen of care plans being reviewed on a monthly regular basis. The person living at the home was case tracked and had a care plan, which was in accordance with their assessed need and formulated within a risk assessment. This persons care plan detailed their individual lifestyle preferences and choices and the interventions prescribed by outside healthcare professionals were appropriate. Daily records are also maintained. There was evidence to show the care plan is being reviewed on a regular basis. The manager currently reviews the care records on a monthly basis. The home has yet to establish a formal reviewing system with the referring agency. The home operates a key worker system. The care plan has been explained to the person living in the home and the relevant people have signed all the appropriate sections. Risk assessments were in place covering such issues as, peoples health and safety, physical health, nutrition, mobility, behaviour management and risks associated with social activities. Risk assessments were are also monitored and updated. As discussed with the registered manager risk assessments will need to be reviewed as and when new people come to live in the home. Evidence: We discussed with the manager people having access to the local Advocacy Services. This has yet to be established. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There were arrangements in place to enable people to maintain and develop appropriate relationships, and to participate in activities both in the home and outside in the wider community in accordance with their preferences and wishes. Evidence: The care records of one person from the home seen provided detailed needs assessment and care planning information regarding their social, recreational, educational and occupational activities both within the home and outside in the community. The registered manager confirmed they have taken people from the home away on holiday and are looking to arrange further holidays. The registered manager stated they are building a good relationship with the person at the home, however relationships can be difficult when they is only one living there. The home has developed daily routines, which enable the person to have outside contact with people. They attend the local day centre four days a week. The person living at the home has been involved in the planning of all activities during house meetings. Activities include going swimming, day trip to Lincoln and attending the local church. The person living at the home has been encouraged to be as independent as possible taking responsibility for some of the household tasks, like tidying their room and Evidence: keeping the communal living area tidy. The person living at the home is unable to work. Their personal goals, choices and preferences have been identified and properly recorded risk assessments were in place regarding the activities they have been engaged in. Holidays and day trips should be included in the risk assessment format. Information on records indicated that contact with family and friends were appropriate. Any restrictions on contact are recorded in care plans. People at the home can speak with family, friends by telephone and receive mail From examination of the menus the home is providing a healthy well-balanced and nutritious diet. The person at the home made positive comments about the meals and said their likes and dislikes are taken into account. The home is not maintaining a full current record of all meals taken. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Peoples living at the home receive personal and health care support in a way, which promotes their independence and is in accordance with their preferences and wishes. Evidence: Records seen and discussions with staff indicated that peoples health and personal needs were being met People living at the home were generally healthy and records showed that staff promptly contacted the appropriate medical services. People living at the home are registered and attended services within the community including doctor optician, podiatry, dentist, and audiologist. Discussions with the manager confirmed that any specialist services are accessed for the people living at the home should they be required. The home maintains records of all hospital and doctors visits. The home maintains a record of peoples weight as part of maintaining a health lifestyle. The medication administration practices of the service were assessed. Only care staff who have received medication training are responsible for administering people medication. People photographs were in place on medication administration records confirming their identity. The home operates and monitors peoples medication. The home is responsible for ordering the medication and records it in. The arrangements for receipt, storage, administration and disposal of medication were examined. Shirebrook Care Group has Evidence: a contract with a large pharmaceutical company who regularly carry out audits. The home had no Controlled Drugs in use on the day of the site visit and there are no people who self medicate. Information in the AQAA and from discussions with the registered manager confirmed that people living at the home do not have an end of life plan in place. The registered manager agreed to address this issue. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Arrangements are in place to safeguard peoples welfare and ensure that their concerns are listened to and acted upon. Evidence: People living at the home are made aware of the homes complaints procedure through the service user guide and via their key worker. A copy is displayed on the homes notice board in an easy to read format. Any concerns and complaints made by people living at the home or their relatives are investigated within the agreed time scales. The manager maintains a record of all complaints made by service users, details of the investigation action and outcome. The policy informs the complainants that they are able to contact the Commission at any stage of the complaints process if they wish to do so. However the complaints procedure did not show the correct contact regional details for the Commission for Social Care Inspection. We have not received any formal complaints from people or their relatives about their care since the home was registered. The home has received no complaints about its service. Discussions with the registered manager and records seen indicate that there has been one reported allegation under the safeguarding of adults procedure since registration. This has been passed to the local Social Services Adults department to investigate. The allegation did not relate to the home or the care staff. The home has a safeguarding adult protection policy and procedures however this does not make show local contact details for social services. This was raised with the registered manager. Staff training records confirmed that all but two care staff had received training on safeguarding of adults. Evidence: The registered manager has implemented satisfactory procedures regarding peoples monies and administering their finances. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is clean, well equipped and maintained, which prompts peoples independence. Evidence: We carried out a full tour of the home, accompanied by the registered manager. All communal areas were seen. As there is only on person living at the home we viewed the unoccupied rooms. Information from the registered manager confirmed that the one room occupied had been personalised to the persons requirements. All of the bedrooms are single with en-suite facilities. The home was clean, well maintained, well furnished, equipped and well lit and heated. The home has had two kitchens, which gives people the opportunity to be independent and cook their own meals should they wish to. Information from the questionnaires indicated that people living at the home were happy with their bedrooms and the home. There are no major outstanding maintenance issues. The home was free of any unpleasant odours or smells on the day of the visit. The home has effective infection control procedures in place. Records indicated all staff had received training on infection control. The home has a separate laundry and people from the home are assisted by care staff to do their own laundry. A low stimulus room complete with padded walls, viewing window and camera has been fitted in the home. This is not highlighted in the AQAA and at present there is no protocols for its use. Following discussions with the responsible individual the room will not be used, the equipment is being removed and until that happens the room is being locked off. Evidence: Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has recruitment and selection procedures in place to ensure that the appropriate staff are employed to care for vulnerable people. Evidence: Rotas showed that two staff work in the day and evening with one waking and one sleeping night staff. The registered manager is not recorded in the staffing hours. Information received from the AQAA shows that the home has a total of seven staff. Currently the home has two staff holding a NVQ level 2 or above with the remainder of the staff being registered for a NVQ level 2. The home currently does not meet the fifty-percent qualified staff as 32. 5.required in the National Minimum Standards for Younger Adults. The home does not employ any ancillary staff. The home has a recruitment procedure in place, which ensures that staff appointed are suitable to work with vulnerable people. Several staff personnel records were examined which confirmed that thorough employment checks were carried out. All new staff are required to provide two references, a full employment history, have a clear Criminal Records Bureau clearance and complete a probationary period. From records seen staff were not always proving a full employmnet historty. This area of shortfall was discussed with the registered manager. The home maintains records of staff interviews. These were signed and dated. The staff personnel records were well presented From discussions with the registered manager and from examination of records all staff have completed induction training, with several staff also undertaking further Evidence: training in physical invention. Records examined and discussions with the staff confirmed that the home has a formal structure for supervision of staff. Annual staff appraisals are scheduled. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is generally well managed; with staff seeking the views of the people ensuring the home is run in the best interest of the people who live there. However this could be further strengthen by external quality assurance systems are being in place. Evidence: The registered manager has been in post since the home opened in July of this year and is registered with the Commission for Social Care Inspection. The registered manager stated she has a relevant job description setting out her roles and responsibilities. The registered manager has a number of years experience in the care sector and has a qualification in working with people who have a learning disability. Completed staff questionnaires stated the manager was approachable and supportive and open to discussion. The manager has completed a recognised managers award. The registered manager has stated that a process for monitoring care and services provided by the home is in line with the policy operated within Shirebrook Care Group. The AQAA indicates there is regular feedback obtained from house meetings and regulation 26 visits. However currently there are no external quality assurance systems in operation. There was evidence to show that two regulation 26 visits have been undertaken since the home been came operational, however we have not received copies of these reports. A sample of service/maintenance records was examined (including gas and electricity services) and there was confirmation that all the equipment had been properly maintained. Evidence of checks having been carried out was provided to us by way of the AQAA. The homes lift is waiting repair to a safe catch. Evidence: Systems were in place for the monitoring and maintaining the hot water temperatures. These were examined and found to be within a safe range. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 15 Care plans must be formally 31/12/2008 reviewed at regular intervals and be clearly shown as such. This is to ensure peoples changing needs are fully reflected in the care plan. 2 17 16 There should be accurate 31/12/2008 record of all meals taken and to include any changes made to the menu . This is to ensure people have a balance diet . 3 32 18 The home must have fifty per cent of its care staff holding a NVQ level two or above. 31/12/2008 This is to ensure staff are fully competent to met the needs of the people they care for. 4 39 26 The home must provide the Commission for Social Care Inspection copies of any visits made to the home. 31/12/2008 This is to ensure that regular visits and reports following the visits are made by the provider Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 3 4 5 6 7 8 7 9 14 22 23 23 34 39 All people at the home should have access to Advocacy Services Risk assessments should be dated at regular intervals. Risk assessments should be place for all social and leisure activities The complaints policy should show the current contact details for the Commission for Social Care Inspection. All staff should receive training on safeguarding vulnerable adults. The safeguarding vulnerable adults policy should show contact for the local social services office. All applicants should provide the days date month year when providing a full employment history. The home should consider seeking feedback from outside professionals as part of its quality assurance procedures. Helpline: 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 We want people to be able to access this information. 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