Care Home: Shirley View Nursing Home

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What the care home does well This home provides care for up to twenty-nine older people with dementia or other mental health problems. Although it is an older home, which would not meet new regulations in relation to room sizes, the atmosphere is very welcoming and people are happy and well cared for. Personal care is delivered using a person centred approach which means that their individual health care needs are clearly identified and there are strategies in place for dealing with any risks. Of particular note is the limited use of sedative medication to control peoples behaviour, staff have identified other ways to ensure that people are free from anxiety. Staff are also trying to find out more about residents current behaviour patterns by looking at their past lives. Relatives have helped to supply details about past interests and achievements and some of them have also supplied photographs. This has helped care staff to build a picture of the residents and understand more about them. and develop their relationships with them. The home works hard to try and involve residents relatives in their daily lives. They are encouraged to participate in the care planning process and various social events are arranged to which they are invited. They were seen to be welcomed warmly when they visited and have a good rapport with the manager and his staff. They told us "staff are very kind and caring" "residents are very well looked after" and that "we are always informed about any thing that happens". They also told us that The Registered Providers are often in the home and that they are very approachable and they could always raise any issues of concern with them. What has improved since the last inspection? Since the last inspection we have seen that the care planning process has improved. There is a greater emphasis now on trying to find out about peoples past lives in order for staff to understand more about them and build a better relationship with them. This helps care and support to become more individualised rather than just task orientated. Activities have also increased and an activities coordinator is now employed. Some sessions are arranged for people as a group and she spends time with others individually. Training is being prioritised and staff are encouraged to attend sessions which relate to the needs of the people that they are caring for. A health promotion specialist also runs regular staff training sessions in the home. What the care home could do better: Redecoration and refurbishment of the home is ongoing although there are still some areas which would benefit from attention, such as the bathrooms. Although functional they could be made to look more inviting. We have been told that all of the windows in the home are shortly to be replaced. The home provides good nursing care to its residents however, we have discussed how this might be improved in relation to their dementia. Some of the pictures that are displayed have little relevance to the people that live there and the home mightconsider providing more reality orientation such as calendars, clocks, and colour coordination for various facilities. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shirley View Nursing Home 23 Shirley Avenue South Cheam Surrey SM2 7QS     The quality rating for this care home is:   two star good service 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: Alison Ford     Date: 1 2 0 5 2 0 0 9 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. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Shirley View Nursing Home 23 Shirley Avenue South Cheam Surrey SM2 7QS 02086435680 02086427313 logan.kkallar@hotmail.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Family Star Limited care home 29 Number of places (if applicable): Under 65 Over 65 0 29 past or present drug dependence mental disorder, excluding learning disability or dementia Additional conditions: 29 0 The maximum number of service users who can be accommodated is: 29 The registered person may provide the following category of service only: Care home with nursing (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD(E) of the following age range: 65 years and over (maximum number of places: 29) Past or present drug dependence - Code D (maximum number of places: 29) Dementia - DE(E) of the following age range: 65 years and over (maximum number of places: 29) Date of last inspection Brief description of the care home Shirley View Nursing Home is a detached building in keeping with other houses on the avenue. The home is registered as a care home with nursing for up to 29 people with dementia or other mental disorder. Accommodation in the home includes bedrooms on the ground and first floors. There are five single bedrooms and twelve double all of which have wash hand basins. In Care Homes for Older People Page 4 of 26 Brief description of the care home addition to a shaft lift there is a stair lift. All baths, showers and basins have thermostatic controls and radiators have protective covers. The front door is kept locked to ensure the safety of residents. The communal areas include a through lounge laid out in two areas for different uses and an adjoining dining area. The well maintained rear garden includes a patio, which is accessible to users via a ramp and a lawn, flowerbeds and trees. There are off street parking facilities at the front of the building. At the time of this inspection fees range from £5705 - £714 per week and any extra charges would discussed prior to admission. Copies of the homes Statement of Purpose and their latest inspection report can be obtained from them and the latter can also be obtained from The Care Quality Commission from their website. Care Homes for Older People Page 5 of 26 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 Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This report follows an unannounced visit to the service. When writing the report consideration has also been given to other information that we have received since our last inspection in May 2007. This includes notifications that the home is required to send us, any comments from people who use the service and any complaints that we might have received. Additionally the home has sent us their Annual Quality Assurance Assessment. This is their own assessment of how well they believe they they are providing care for the people in the home and their plans for the future. During the visit we undertook a tour of the home and spoke with several of the people who live there. We also spoke with staff and some relatives who were visiting. We spent time with the manger of the home and looked at various documentation that the Care Homes for Older People Page 6 of 26 home is required to keep as evidence of its commitment to the health and safety of residents. What the care home does well: What has improved since the last inspection? What they could do better: Redecoration and refurbishment of the home is ongoing although there are still some areas which would benefit from attention, such as the bathrooms. Although functional they could be made to look more inviting. We have been told that all of the windows in the home are shortly to be replaced. The home provides good nursing care to its residents however, we have discussed how this might be improved in relation to their dementia. Some of the pictures that are displayed have little relevance to the people that live there and the home might Care Homes for Older People Page 8 of 26 consider providing more reality orientation such as calendars, clocks, and colour coordination for various facilities. 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.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 26 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. No one is admitted in to the home until a full and detailed assessment has been undertaken of their needs to ensure that the home will be able to meet them. The home does not offer intermediate care facilities so this standard does not apply. Evidence: A new Statement of Purpose, Service User Guide and brochure have been developed and copies of these are available in residents bedrooms and for any one making enquiries about coming to live in the home. Since our last visit 4 people have been admitted in to the home. We were able to look at their care plans and could see that, in addition to a Care Managers assessment, the manager had met with the person and undertaken his own assessment. This includes considering how they might react to the admission and the risk for any potential Care Homes for Older People Page 11 of 26 Evidence: problems that might arise. Most people are too frail to visit the home themselves so, having met with them, the manager would then discuss their health care needs with the staff to make sure that everyone was aware how they should be supported. This process helps to make sure that residents needs can be met, problems will be minimised and that the placement will be suitable for them. The information that is gathered from this process then forms the basis for future care planning. Care Homes for Older People Page 12 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal and health care support in a way which is responsive to their individual needs. Staff treat them with respect and dignity and ensure that they are free from anxiety. Medication procedures are all in order in the home. Evidence: We considered that people are receiving excellent personal and health care support and the home is using a person centred approach towards planning the support that they need. Their health care needs are clearly identified in their care plans which are easy to understand and comprehensive. We looked at four of them during this inspection. They were well organised and gave us a lot of information about how people were being supported. Potential risks are identified along with strategies to manage these. Factors which may indicate a deterioration in health and a predisposition to pressure sore formation are monitored regularly and acted upon. Residents diets are boosted with drinks such as Complan if their appetite is poor and Care Homes for Older People Page 13 of 26 Evidence: supplementary preparations are prescribed where necessary. Other health care professionals such as the dietitian and tissue viability nurse are involved as necessary and residents have access to domiciliary services such as the dentist, hygienist, optician and chiropodist. Of particular note was the work that has been started to gather information about residents past lives so that staff can begin to understand more about them. This has included collecting pictures of some of the residents when they were younger and of important events in their lives. A key worker system is in place and staff regularly present their residents to their colleagues sharing the information that they have gained about them. We discussed how the home can continue to build on this work. Relatives are closely involved in the care planning process to make sure that support is delivered according to residents preferences. We could see that they have been invited to sign the care plans to show that they understand and agree with what the home is trying to do. We looked at the medication storage and administration procedures in the home. These were all in order. A monitored dosage scheme is in use and there are daily audits undertaken. We were particularly pleased to see that medication to sedate residents is limited in its use both during the day or at night. Some people have quite complex needs and they are all very confused however, staff are responsive to their needs and manage to employ other strategies to keep them calm. Care Homes for Older People Page 14 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The daily life in this home suits the people who live here. There are activities for them to join in with and their visitors are always welcomed. They enjoy the meals that are served to them. Evidence: The majority of people who use this service are very confused and it is difficult to engage them in structured activities. However, staff try very hard to interest and stimulate them. They spend time chatting with them, play games and they take them into the garden and for short walks. The home has now employed an activities coordinator, 4 days a week. She has undertaken specialist training and is working on providing more structured sessions and also individual attention to some residents. All of the residents look happy and well cared for and they are able to walk around the home in safety. There is a very cheerful atmosphere and we saw several visitors arriving. They were all welcomed warmly and obviously had a good rapport with the manager and his staff. We saw lots of photographs around the home of various social events that had taken place and relatives had been invited to join in with these. Residents pastoral needs are met, there are regular visits from church representatives Care Homes for Older People Page 15 of 26 Evidence: and weekly services. The lunch time meal was served during the inspection. It is served from a trolley in the dining area so that staff can monitor what people are eating. Records are also kept. The majority of people need to have their food pureed for them and several need help to eat. This was done sensitively and people seemed to enjoy their meals. A board is on the wall so that everyone will know what will be served and a choice is always available. Residents are all offered a drink after their meal and drinks are also available to them throughout the day. Care Homes for Older People Page 16 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use this service are protected from abuse and any concerns that might be raised would be dealt with promptly. Evidence: The homes complaints policy is displayed on the wall and can also be found in the service user guide. Most of the people who use the service would find it difficult to raise a complaint according to the policy however, visitors that we spoke with were confident that any issues would be addressed promptly. No complaints have been made about the service since the last inspection and we saw that several complimentary and thank you letters had been received. All necessary pre-employment checks as are undertaken on new members of staff to ensure that residents are protected from those who have been judged as not suitable to care for vulnerable adults. All of the staff have received training about recognising and reporting adult abuse and those that we spoke with had a good understanding of how they would report any concerns. Care Homes for Older People Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service live in a clean comfortable home which suits their needs. Evidence: This home would not meet the requirements of a new home, some bedrooms are shared and others are smaller than would now be acceptable. However, it seems to suit the people who live there who are able to walk around safely. It is clean and tidy and warm and on the day of the visit it was free from malodour. Some areas would benefit from redecoration and bathrooms although functional could be made pleasanter and more relaxing. There is an ongoing refurbishment plan in place. Residents are encouraged to personalise their rooms with their own possessions and pictures and photographs and we saw that some of them had been made really homely. There are pictures on the wall however, they are not particularly relevant to the client group who are all elderly and have been brought up in Great Britain. We have suggested that there could be some consideration given to putting up pictures and photographs that would be more meaningful to the people who live there. Given their degree of dementia people might also benefit from reality orientation aids such as increased signage, clocks and calenders and colour coordination of the various facilties in the home. Care Homes for Older People Page 18 of 26 Care Homes for Older People Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service can be sure that there will always be enough staff on duty to support them and that they are all appropriately trained. Pre-employment checks are all in place to help protect resident from those who have been judged as being unsuitable to work with vulnerable people,. Evidence: The home is staffed 24 hours a day by both trained nurses and care staff. On the day of the inspection there were enough staff to meet the needs of the residents and we looked at rotas which showed that this was always so. All of the staff are able to attend regular training which is relevant to the work that they do. This has included training in dementia awareness, infection control, food hygiene, health and safety and fire safety. The home employs a health promotion specialist whose role includes delivering training sessions in house on a regular basis. We also looked at the induction programme that is in place for new staff some of whom may not have had experience of working in this environment before. Staff turnover is low in the home and this helps to provide continuity of care and familiarity for residents. Both male and female nurses and carers are employed in order that residents may have some choices about who delivers their personal care. We looked at the personnel files of the four people employed since our last visit. These Care Homes for Older People Page 20 of 26 Evidence: contained all of the information that is required to ensure the safety of the people who use the service, including clearance from the Criminal Records Bureau. People that we spoke with during the visit were all very complimentary about the staff in the home. They told us that staff are very friendly and welcoming they are always very kind and they keep us informed about everything that is happening. Care Homes for Older People Page 21 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a safe well managed service in which their views are considered and used to influence the care that is provided. Evidence: Since the last inspection the Registered Manager has resigned from the home. His deputy has been appointed to the role and is currently going through the registration process with The Commission. He has worked in the home for several years, is undertaking the Registered Managers Award and displays a good understanding of the problems of those people who use the service. We could see that he had a good rapport with residents,their relatives and staff. Staff meetings are held monthly so that they are all aware of what is happening in the home and they receive regular supervision to monitor their performance and identify any training needs. Care Homes for Older People Page 22 of 26 Evidence: Relatives also told us that the registered providers are often in the home and that they are very approachable and they feel able to raise any concerns that they might have with them. We saw the records that are kept detailing their visits. A residents and relatives meeting is held every year followed by a garden party. This is an enjoyable occasion giving the providers and their families an opportunity to meet with everyone on an informal basis. A questionnaire is also distributed yearly in order to gain the views of those using the service and the results are used to influence the way that care is provided. We did suggest that the results could be displayed in the home for everyone to see. Regular audits are also undertaken of catering and cleaning services in the home. The home does not take responsibility for any finances belonging to residents. They all have family or representatives to do this. The home tells us that equipment is appropriately serviced and maintained. A recent inspection of the kitchen facilities by the environmental health office resulted in a 4 star rating being awarded to the home. Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 19 It is recommended there could be some consideration given to putting up pictures and photographs that would be more relevant to the people who live in the home. It is reccommended that the results of quality assurance surveys should be displayed for interested people to see. 2 33 Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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