Care Home: Shouldham Hall Nursing Home

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What the care home does well Two residents said they were happy in the home and that staff work hard. When asked, both residents said that staff always help when needed. While eating lunch another person said the food is always good. On the day of the inspection it was fish in batter or scampi for lunch with creamed potatoes or chips and vegetables. There were strawberries and cream, fruit, peaches, or jelly as choices for dessert. The cook explained that staff always feed back what has been enjoyed to make sure the cook knows what residents prefer. New staff are appropriately inducted into their role and staff said they are fully supported by the manager and have regular supervision and training. Two staff members said that the staff team support one another and work well together. Observations at this time did show that staff consider the dignity of people living in the home. The preferences of residents were encouraged by the staff and people were seen to be chatting and laughing with members of staff. What has improved since the last inspection? Redecoration has been completed in various areas of the home since the last inspection and is currently being continued. New curtains are being purchased for each room with matching bed linen. The general environment and rooms were mostly clean and each room seen was very personalised and individual. Two people were happy to show us their room and talk about the pictures they have on display. What the care home could do better: The environment was welcoming and calm in the home, however, stimulation is needed to ensure people are not just spending their days sleeping in an armchair or watching staff. The manager explained that a new music system is on order and one visitor did discuss the fact that she feels her relative and other residents do not get enough stimulation. Staff were busy supporting residents during this inspection and observations and conversations highlighted the need for more staffing hours. This would enable staff to provide stimulation, staff would also be able to spend some time talking to residents and would also give each person who needs support, the opportunity to enjoy meal times on a one to one basis. While major decoration is ongoing, there are areas that have been decorated that already look tired and in need of attention. This was discussed with the manager at this time and further details are included in the body of this report. Residents would benefit from a section of the garden being made safe to encourage independent walks and this will also mean that residents would not have to wait for staff to be free to accompany them. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Shouldham Hall Nursing Home Shouldham Hall Nursing Home Shouldham Norfolk PE33 0DF     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: Brenda Pears     Date: 0 1 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 25 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 25 Information about the care home Name of care home: Address: Shouldham Hall Nursing Home Shouldham Hall Nursing Home Shouldham Norfolk PE33 0DF 01366347276 01366347658 shouldham@btconnect.com 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) : Shouldham Hall (Registration) Limited care home 48 Number of places (if applicable): Under 65 Over 65 0 14 dementia old age, not falling within any other category Additional conditions: 1 0 One Service User under the age of 65 years who has dementia and is named in the Commission`s records may be accommodated. To accommodate forty-eight (48) people in total, all of who are older people. Of these, thirty-four (34) Service Users will fall in the category of dementia and fourteen (14) Service Users will have needs associated with old age, not falling in any other category. Date of last inspection Brief description of the care home Shouldham Hall is a 48-bedded care home with nursing for the elderly, and elderly mentally frail. The home consists of two wings, the original hall, and the new wing. There are a total of 44 single rooms and 2 double rooms on the ground and first floors. The home receives its medical services from the local G.P. centre. There is an enclosed garden and large grounds, and ample car parking on the front drive to the home. The home is situated at the edge of the village of Shouldham which is 10 miles from Kings Lynn. Care Homes for Older People Page 4 of 25 Brief description of the care home Care Homes for Older People Page 5 of 25 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: 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 inspection undertaken on the 1st May 2009 and started at 8.00 am. The focus of this inspection was on the previous requirements, on the core national minimum standards and on the quality of life for people who receive support in the home. The methods used to complete this inspection consisted of looking at the care a resident receives and the records that support this. Information was provided to us by the home on an assessment form known as an Annual Quality Assurance Assessment Care Homes for Older People Page 6 of 25 (AQAA). During the visit to the home we spoke to the manager, with members of staff, one visitor and also with four residents. We undertook a tour of the building while making observations. These methods and previous findings all inform the outcomes of this report. What the care home does well: What has improved since the last inspection? What they could do better: The environment was welcoming and calm in the home, however, stimulation is needed to ensure people are not just spending their days sleeping in an armchair or watching staff. The manager explained that a new music system is on order and one visitor did discuss the fact that she feels her relative and other residents do not get enough stimulation. Staff were busy supporting residents during this inspection and observations and conversations highlighted the need for more staffing hours. This would enable staff to provide stimulation, staff would also be able to spend some time talking to residents and would also give each person who needs support, the opportunity to enjoy meal times on a one to one basis. While major decoration is ongoing, there are areas that have been decorated that already look tired and in need of attention. This was discussed with the manager at this time and further details are included in the body of this report. Residents would benefit from a section of the garden being made safe to encourage independent walks and this will also mean that residents would not have to wait for staff to be free to accompany them. Care Homes for Older People Page 8 of 25 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 25 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 25 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. The home does assess the needs of any new client to make sure individuals can be fully supported before an agreement is undertaken. Evidence: A full assessment is undertaken before support is agreed to ensure individual needs can be met. This was confirmed through discussions undertaken at this time and by looking at care plans that contain pre admission assessment details. Care Homes for Older People Page 11 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans contain clear information that enables staff to meet individual needs. Medication is handled correctly for the safety and well being of those living in the home. Evidence: We looked at three care plans and these confirmed the information in the AQAA that stated that the care plans and risk assessments are regularly reviewed. The care plan format has detailed sections of information that shows both doctors and district nurses provide support and other healthcare services are accessed when necessary. Pressure areas needing attention are recorded and the district nurse contacted to make sure these skin areas are dealt with before they become a problem. Risk assessments were completed and reviewed on care plans and the outcomes of any healthcare appointment are fully recorded. Care Homes for Older People Page 12 of 25 Evidence: Full information was seen when we looked at daily records. These contained detailed information about how the person had spent their day. When the accident book was checked, we found these details on the daily record and on the medical sheet when a health check had been necessary, showing that staff had clearly recorded all areas of this information. The medication trolley was found fixed to the wall and locked at this inspection. Records of the administration of medication were clearly completed, up to date and medication was in date and stored in an orderly way. The manager said that regular audits are carried out to make sure medication is handled correctly. At the time of this inspection a domestic fridge was being used for medication in one area of the home. This was discussed and before the end of this inspection the manager had ordered a lockable medication fridge that can be temperature controlled. Care Homes for Older People Page 13 of 25 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. Residents are supported to take part in a variety of leisure activities and to maintain contact with family and friends. However, there is a lack of continued stimulation in the home that would greatly benefit all residents. Evidence: There is an activities person working in the home and care plans contained details of individual activities undertaken. During this inspection we did not see any group or general activities but did see the activity person talking to residents and assisting with meals. The daily menu was on display and the food looked and smelt appetising at lunch time and people appeared to be enjoying their food. Some meals are pureed and these meals were set out in an appetising way and each selection of food was presented separately and food was not mixed up together, providing a pleasant looking meal. Special diets are catered for and diabetic needs are met. Staffing levels do not allow for each person to have individual support at meal times. Care Homes for Older People Page 14 of 25 Evidence: This means that staff are feeding two, sometimes three, people at once. It was discussed with the manager that this is not providing a personal experience for meal times and can be difficult for staff at the current levels to manage. The manager explained that the home enjoys a good relationship with family members and visitors. Regular comments are also encouraged about the food on the menu and other areas of the home. There is a regular newsletter with information about coming events in the home and also to welcome new residents into the home. While activities are undertaken, the three care plans reviewed mainly showed one to one discussions. A family member who was visiting the home said that there is no stimulation for people during the day. It was also noted that there was a quiet and calm atmosphere that may suit some people but did not provide an energetic environment. The manager explained that following a recent meeting with family and friends, the home is getting a new music system to provide music during the day. The home has also had a large donation that will enable the purchase of a minibus to take people out on regular trips. While staff were meeting needs, there is no time for them to stop and talk to people in the home. During this inspection staff were continually assisting residents and one person takes their own breaks with residents to allow for some talking and interaction to be carried out. People were also seen sleeping in chairs and in the conservatory. One person was seen walking around the corridors and then on three occasions asleep in the conservatory. With no radio, music or continued staff interaction people are in need of more stimulation. Care Homes for Older People Page 15 of 25 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. There is a complaints procedure on display and regular meetings to encourage comments and regular monitoring. Staff have training regarding adult abuse. Evidence: There have previously been matters raised that have needed contact with the adult protection team. The home handled these matters appropriately and quickly, working closely with other professionals to come to a satisfactory conclusion. The manager explained that regular meetings are held for residents and family members, providing opportunity for discussions about any areas of concern. Staff have regular training on adult abuse, have had training following the introduction of the mental capacity act and are also booked to have training regarding the deprivation of liberty. Care Homes for Older People Page 16 of 25 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does provide a safe, clean environment with personalised rooms, however, a deep clean and day to day maintenance must be regularly undertaken as some areas show where this has not been undertaken. Evidence: The home has a calm atmosphere and in the main, is clean and tidy. Rooms are personalised and two people were happy to show us their rooms. The redecoration and refurbishment is ongoing but there are areas that are still in need of attention. One area was discussed with the manager as the paintwork needed refreshing and the skirting boards were badly scuffed. The manager stated that this particular area had been decorated last year, however, the use of wheelchairs has obviously made most of the scuff marks and a carpeted staffing area was very stained. This staffing station has bars to lock across care plans, but these were not locked at this time. This area is also very disorganised and does not present a professional, orderly area for residents or visitors. Discussions were undertaken with the manager about having new cupboards all around this area, providing lockable space and also storage for some of the items that are left about. The maintenance person was painting in another area of the home, but it is noted that Care Homes for Older People Page 17 of 25 Evidence: he was undertaking driving tasks for the greater part of the day. The routine is for him to collect visitors who would otherwise not be able to get to the home. Discussions with the manager highlighted the fact that one person is not able to complete such large areas of redecoration alone and be responsible for day to day maintenance tasks. The decorated areas also need continued attention and repainting when marks appear, but this is not possible with other areas requiring major redecoration. New curtains are being purchased for each room with matching bed linen. The general environment and rooms were mostly clean. However, a visitor had previously mentioned about a mattress being very dirty and needing cleaning. The mattress is kept under the bed for use if the person has a fall from the bed. On the day of the inspection the visitor had said that the mattress had been cleaned, but on close inspection, there was still dust around the leg of the bed and the mattress had obviously not been totally cleaned. It was stated that it was better than when seen the day before. The manager was asked about a deep cleaning schedule, she stated that these were in place but not monitored. The manager said that she would be looking into this. The garden and surrounding area provides space for staff to accompany residents on walks. Previous inspections have identified the need for this area to be made secure and allow residents to walk independently. The manager explained that this project is currently being put on hold while other interior decoration works are being completed and external areas identified for development. Care Homes for Older People Page 18 of 25 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. People living in the home have their needs met by a consistent staff team who are well trained and regularly supervised, providing stability and continuity of care. However, staffing levels must allow for time with residents to ensure all needs are being fully met. Evidence: At the time of this inspection the staff team on duty consisted of one trained nurse and deputy, four care staff, a staff nurse, an NVQ apprentice who was being shadowed, one person who deals with the dining area, one laundry person who works part time, one housekeeper, two domestics who cover alternate weekends, one activities person, one cook, one kitchen assistant and one maintenance person. Staff were seen to be providing support in a calm manner and not rushing anyone and there was relaxed conversations between residents and staff. We looked at two staff files that showed appropriate recruitment procedures are undertaken in the home to protect residents. Safety checks included a criminal record check, proof of identification and references. The manager does provide regular supervision sessions and staff said that they feel Care Homes for Older People Page 19 of 25 Evidence: supported and do discuss personal development as well as the needs of residents. There is a programme of training in place that includes diabetes and wound care, protection of vulnerable adults, sensory deprivation awareness, first aid, dementia distance learning and food and nutrition. Staff who spoke to us said that they receive adequate training that they feel is relevant to meeting the needs of people living in the home. While staff were meeting needs and providing support, it was evident that there is not enough staffing hours to allow for one to one time during the day. One visitor said that further stimulation is needed for her relative and staffing hours do not currently support this. One person was seen walking around the corridors and interacting with staff, but when seated, this person was found to be sleeping on three occasions during the morning. At least four other residents were asleep in chairs and one person who is prone to crying was found upset in the lounge with no staff about. The manager did spend time with this person, but care staff were busy in rooms assisting people to get dressed. In this same area, another resident had come out of their room with nothing on their feet, again, the manager went to get some slippers. There were eventually five people in the lounge area and no staff available. As the home is divided into areas known as Rose Walk, Jasmin, Wisteria and Clematis, we had to wait some considerable time before a staff member came by to allow access into alternative areas of the home. This shows that staffing is not sufficient to support those needing assistance in the morning and still allow for staff to be in attendance in lounge areas to support those already dressed. This again was the case during the lunch time period as staff have to assist with meal times. Individual staff had two, and said there could sometimes be three, people needing support with their meal. Another example is that one care plan stated that the person needed regular one to one interaction as much as possible. On checking the activity record this showed one to one time had been undertaken once a month. However, with staff being needed to provide support and complete their duties on a daily basis, there is no time to meet one to one needs. Care Homes for Older People Page 20 of 25 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. Residents live in a home that is managed by a suitable person and is run in their best interests. Evidence: The manager is a suitable person to be managing the home and operates an open door policy that means residents, visitors or staff are able to discuss any matters with her. This was confirmed through discussions with staff, residents and one visitor carried out at this time. There is a record of up to date servicing certificates for electrical items (PAT), hoists and all fire extinguishers. The fire alarm is tested regularly and a current insurance certificate is on display in the home. Regular checks are undertaken and recorded for safety including hot water temperatures and the emergency call system. There are written policies and procedures in place that cover areas including concerns and Care Homes for Older People Page 21 of 25 Evidence: complaints, bullying, dealing with aggression and missing persons. The manager confirmed that satisfaction surveys for the monitoring of quality assurance are regularly issued. These are sent out to families, visitors and residents and discussions were undertaken about asking these to also be completed by GPs, social services departments and to district nurses. There is an induction programme in place to provide staff with information that will assist them in their roles. Staff said that the manager does support them and that she always has time to listen to staff and residents. Staff who spoke to us said they can always ask for training or support when needed. Care Homes for Older People Page 22 of 25 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 23 of 25 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 1 12 16 The routines of daily living 06/08/2009 and activities made available are flexible and varied to suit the expectations, preferences and capacity of residents. There must be individual consultation and planned activities to meet the needs of residents and to provide continued stimulation inside and outside the home. 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 That an ongoing programme is in place for a deep clean of all areas, particularly individual rooms. To prove a clean and hygienic environment at all times. That the day to day maintenance of the building is ongoing and staffing allows for the continued upkeep of the building to maintain an acceptable standard throughout. (Particularly in those areas that have continual use, in this instance the corridors). Page 24 of 25 2 19 Care Homes for Older People 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). 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. 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