Care Home: The Shaw

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What the care home does well Generally the people who use this service consider that it meets their needs in a homely and comfortable way. They tell us that the staff are very kind and they enjoy the food that they are served. Typical comments that were made by residents included “it’s very nice here”, “I am very happy” and “the food is lovely now, we have a very good cook”. They are consulted about menu choices and they particularly like the cakes that are now being made for them. All the bedrooms are for single occupancy, some have en-suite facilities, and some residents invited us to see their rooms. They are comfortable and they The Shaw DS0000025855.V378194.R01.S.doc Version 5.2 have been able to personalise them with photographs, pictures and small items of furniture from home. There are communal areas on both floors with comfortable seating and televisions and separate dining rooms. On the day that we visited there were enough staff on duty to meet the needs of the residents who said there was always someone around to help them and they never had to wait long for someone to come. We were told though that staff were often used from an agency and they didn’t always know what to do. Pre-employment checks are in place so that residents are protected from people who have been judged as not being suitable to work with vulnerable adults. There is an ongoing programme of staff training. A range of activities are arranged for people to join in with if they wish and entertainers also visit the home. Some trips out are arranged; the organisation has a minibus. What has improved since the last inspection? All of the requirements that were issued at the last inspection have been complied with. Staffing levels at night have increased and staff have received some training in supporting people with dementia. Regular meetings are now being held solely for the residents so that they are free to comment on the services that are being provided. Health and safety issues have been complied with and the home has had a visit from the Environmental Health Officer which resulted in a four star score for kitchen practices. What the care home could do better: Although people tell us that they find the home comfortable some areas now look very tired and worn, paintwork is scuffed, some carpets and soft furnishings need replacing and some of the toilets are quite stained. We have recommended that the home should implement a programme of improvement in order to ensure that it remains a pleasant place for people to live in. We have also recommended that they should seek some advice about improving the environment on the dementia unit in relation to introducing pictures etc. which would help with reality orientation. We were told that activities are arranged for residents but some people that we spoke with told us that there was very little to do. Feedback that we received included “its very boring, with nothing to do” and “the days seem very long here”. We were also told that staff participate in activities with residents but there was no evidence of this on the day that we visited. In fact we considered that interaction between staff and residents was very limited.The ShawDS0000025855.V378194.R01.S.doc Version 5.2 The homes manager told us that trips are arranged out of the home however, one of the survey forms that we received stated “I would like to go somewhere else, other than flower centres”. Therefore we have made a recommendation for the home to consult people about the activities they would like to participate in. Generally people are able to exercise choices in their daily lives however; in order for staff to understand that this may also include decisions that they may not consider to be wise, we have recommended that they should all attend training regarding the Mental Capacity Act and Deprivation of Liberty Safeguards. We raised several concerns about medication practices in the home. When we first arrived, we found two tablets on the sitting room floor. Medication administration practices should include making sure that residents have taken their medication before leaving them to attend to another resident. When we looked at medication records, on the ground floor, there was no list of signatures of those deemed competent to administer medicine although one was later produced. Where medication has been prescribed to be given “as required” there are no clear guidelines regarding when this should be considered. We would have expected to see information about when this should be given, how often, whether it had been effective and any side effects that had occurred. The records of one resident showed that he had been refusing antihypertensive medication, to control his blood pressure, frequently during the last month. However, there was no evidence to show that his doctor had been informed of this. We have made requirements for the home to improve their medication procedures and we will monitor this in the future. Key inspection report CARE HOMES FOR OLDER PEOPLE The Shaw 169 Tollers Lane Old Coulsdon Surrey CR5 1BJ Lead Inspector Alison Ford Key Unannounced Inspection 20th October 2009 10:00 DS0000025855.V378194.R01.S.do c Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. The Shaw DS0000025855.V378194.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address The Shaw DS0000025855.V378194.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Shaw Address 169 Tollers Lane Old Coulsdon Surrey CR5 1BJ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 556 577 F/P 01737 556 386 marian.drake@ccht.org.uk Central & Cecil Housing Trust Olukemi Omotola Akinloye Manager post vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (12) of places The Shaw DS0000025855.V378194.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: 12 Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP (maximum number of places: 12) Dementia - Code DE(E) of the following age range: over 65 years (maximum number of places: 13) The maximum number of service users who can be accommodated is: 25 29th October 2007 2. Date of last inspection Brief Description of the Service: The Shaw, located in a semi rural residential area of Old Coulsdon, is a detached property situated in its own grounds and within easy reach of the local village. An organisation called Central and Cecil Housing Trust owns the home, this being a registered charitable organisation. The home provides residential care for 25 older people who may have dementia. Nursing care is not provided. The home’s accommodation is set out over two floors with a lift to service each. Bedrooms are all single occupancy, they all have wash basins and some have en-suite facilities. There is a lounge and dining room on each floor and communal bathrooms and toilets. A loop system has been installed for the benefit of those residents who have hearing impairments. There is a large well-maintained garden to the rear of the home and parking space to the front of the property. The home is situated within easy reach of nearby transport links such as buses. At the time of this inspection fees charged range from £400.61 to £603.75 per The Shaw DS0000025855.V378194.R01.S.doc Version 5.2 Page 5 week. Additional charges may be payable for some extras such as hairdressing newspapers and chiropody but would be discussed prior to admission. Funding arrangements would be different for people who are paying for their placement privately as opposed to those placed by the local authority. A copy of the homes Statement of Purpose can be obtained from them and their latest inspection reports can be downloaded from the website of The Care Quality Commission at enquiries@cqc.org.uk. The Shaw DS0000025855.V378194.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate, quality outcomes. This report follows an unannounced visit to the service. For part of the visit we were accompanied by an “Expert by Experience” who is not an inspector but has an interest and some experience in working with older people. We asked her to talk with some of the residents and ask them about what it was like for them living in the home and how they spent their days. She also spent some time sitting chatting with people while they ate their lunch. During our visit we undertook a tour of the home and the garden, spoke with residents and some of their relatives that were visiting and also some of the staff. We looked at medication procedures, a sample of care plans and to other documentation that the home is required to keep as evidence of their commitment to the health and safety of the people who live there. When writing the report we also took into consideration other information that we have asked for or been given since our last inspection which was in October 2007. This included the homes annual quality assurance assessment (AQAA) which is a self assessment in which they tell us how they are meeting the aims and objectives of the home and about their plans for the future. We also looked at what the home has told us about things that have happened there; notifications. Before we visited, we distributed some survey forms to the people who live in the home asking about their views of the service. We have considered their responses when making a judgement about how well their needs are being met. What the service does well: Generally the people who use this service consider that it meets their needs in a homely and comfortable way. They tell us that the staff are very kind and they enjoy the food that they are served. Typical comments that were made by residents included “it’s very nice here”, “I am very happy” and “the food is lovely now, we have a very good cook”. They are consulted about menu choices and they particularly like the cakes that are now being made for them. All the bedrooms are for single occupancy, some have en-suite facilities, and some residents invited us to see their rooms. They are comfortable and they The Shaw DS0000025855.V378194.R01.S.doc Version 5.2 Page 7 have been able to personalise them with photographs, pictures and small items of furniture from home. There are communal areas on both floors with comfortable seating and televisions and separate dining rooms. On the day that we visited there were enough staff on duty to meet the needs of the residents who said there was always someone around to help them and they never had to wait long for someone to come. We were told though that staff were often used from an agency and they didn’t always know what to do. Pre-employment checks are in place so that residents are protected from people who have been judged as not being suitable to work with vulnerable adults. There is an ongoing programme of staff training. A range of activities are arranged for people to join in with if they wish and entertainers also visit the home. Some trips out are arranged; the organisation has a minibus. What has improved since the last inspection? What they could do better: Although people tell us that they find the home comfortable some areas now look very tired and worn, paintwork is scuffed, some carpets and soft furnishings need replacing and some of the toilets are quite stained. We have recommended that the home should implement a programme of improvement in order to ensure that it remains a pleasant place for people to live in. We have also recommended that they should seek some advice about improving the environment on the dementia unit in relation to introducing pictures etc. which would help with reality orientation. We were told that activities are arranged for residents but some people that we spoke with told us that there was very little to do. Feedback that we received included “its very boring, with nothing to do” and “the days seem very long here”. We were also told that staff participate in activities with residents but there was no evidence of this on the day that we visited. In fact we considered that interaction between staff and residents was very limited. The Shaw DS0000025855.V378194.R01.S.doc Version 5.2 Page 8 The homes manager told us that trips are arranged out of the home however, one of the survey forms that we received stated “I would like to go somewhere else, other than flower centres”. Therefore we have made a recommendation for the home to consult people about the activities they would like to participate in. Generally people are able to exercise choices in their daily lives however; in order for staff to understand that this may also include decisions that they may not consider to be wise, we have recommended that they should all attend training regarding the Mental Capacity Act and Deprivation of Liberty Safeguards. We raised several concerns about medication practices in the home. When we first arrived, we found two tablets on the sitting room floor. Medication administration practices should include making sure that residents have taken their medication before leaving them to attend to another resident. When we looked at medication records, on the ground floor, there was no list of signatures of those deemed competent to administer medicine although one was later produced. Where medication has been prescribed to be given “as required” there are no clear guidelines regarding when this should be considered. We would have expected to see information about when this should be given, how often, whether it had been effective and any side effects that had occurred. The records of one resident showed that he had been refusing antihypertensive medication, to control his blood pressure, frequently during the last month. However, there was no evidence to show that his doctor had been informed of this. We have made requirements for the home to improve their medication procedures and we will monitor this in the future. 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 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. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 3, 6 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Before any one moves in to the home a full assessment of their needs is supplied by their care manager, if they have one. All prospective residents would be visited by a member of staff to ensure that the home will be suitable for their needs and there are opportunities for people to visit to see if they like it. This home does not offer intermediate care facilities so standard 6 does not apply. EVIDENCE: In the care plans that we looked at we could see that for those people who are admitted under care management arrangements the home had received a needs assessment for people prior to them coming to live in the home. This The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 11 had been supplied by their care manger. The manager told us that someone from the home would also visit the person to undertake an assessment. This is so that they can assure themselves that they will be able to meet the person’s needs and minimise the risk of unsuitable placements. Prospective residents would be encouraged to visit the home as well and perhaps stay for a meal, to see what living there might be like. There is information available to people in the form of a service user guide. The last inspection noted that the information available is not particularly best suited to the abilities of the people who live in the home and we were told that it has not been changed. Also, the new handbook that was in the process of being produced is not yet available. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10 People using the 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 live in this home generally consider that it is meeting their needs. They consider that they are treated with respect and their rights to privacy are upheld. However, they are not always protected by medication procedures in the home. EVIDENCE: Each resident has an individual care plan which details all of the health and support that they need. This provides the guidance that care staff need to help them support people as they prefer. We could see that residents had been involved in compiling them and that they are reviewed regularly. Other healthcare professionals are involved where necessary. Although the information that is needed is all available, the way it is organised makes it quite difficult to find everything. There is one file which holds details The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 13 regarding contracts, financial information etc. Another has the actual care planning documentation and past notes, while a third file has the most recent daily notes. We then discovered details regarding doctor’s visits in another folder. In two of the folders we found information that actually related to another resident. A new computerised system is being introduced which will make it much easier to retrieve the information that is needed and we were given a quick demonstration. There are sufficient computer terminals that can be used and staff are currently being trained in how to use them. This is quite an innovative idea and we will monitor the process carefully. Residents told us that staff help and support them in a way which suits them and that they are kind and caring. One lady told us “it’s so nice here they are all so kind”. We did note however, that there was limited interaction between care staff and residents. They may have been inhibited by the presence of the inspector’s but we considered that they could have spent more time chatting or even just passing the time of day with people. We raised a number of concerns regarding medication practices in the home. When we first arrived, we found two tablets on the sitting room floor. Medication administration practices should include making sure that residents have taken their medication before leaving them to attend to another resident. When we looked at medication records, on the ground floor, there was no list of signatures of those deemed competent to administer medicine although one was later produced. Where medication has been prescribed to be given “as required” there are no clear guidelines regarding when this should be considered. One resident had been prescribed an anxiolytic, a medicine prescribed to relieve agitation, in this way. We were told that her daily notes would indicate when and why this had been needed. However the notes indicated that she had been well and settled. We also noted that this had been signed for as being given twice on one day although it is only prescribed to be given once. The following day her notes indicated that she had been a little confused, a side effect of this medication in the elderly. The records of one resident showed that he had been refusing antihypertensive medication, to control his blood pressure, frequently during the last month. However, there was no evidence to show that his doctor had been informed of this. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 14 We have issued four requirements to ensure that medication in the home is administered according to Royal Pharmaceutical Society guidelines for good practice. 1) All staff who have been judged as competent to administer medication must have their competence reassessed on a regular basis, by someone who is qualified to do so. 2) There must be clear guidance in place indicating when medication prescribed to be given “as required” is administered. We would expect to see an indication as to when and how often this should be considered, and also some information about how well it had worked. 3) Where residents are regularly refusing their medication there must be evidence to show that their doctor has been informed of this. 4) An identified person should undertake regular audits of medication practices within the home. We have also issued 2 recommendations in line with good practice. 1) Although there is a list of medication that residents are allergic to available it is on the wall in the office. We would recommend that it should be kept with the administration sheets so that staff can refer to it when they are administering medication. 2) We would also recommend that a list of medication currently in use, its effects and side effects should be with these records. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Generally, the people who live in this home say that it suits them however, some of them would like more activities arranged for them. They tell us that the food has improved lately and they enjoy the meals that they are served. Staff must ensure that they are familiar with guidance regarding people being able to exercise choices within their lives. EVIDENCE: During the course of the inspection we spoke to several of the people who live in the home and our “Expert by Experience” sat with three of them while they had their lunch. People told us that they were quite happy living in the home and that they felt safe and well looked after. The home tells us that there are some activities arranged for people and also trips out of the home; the organisation has a minibus. However, this was not The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 16 backed up by conversations we had with residents and the only thing taking place on the day we visited was a visit by the hairdresser. Some people we spoke with told us that they would like to participate in more activities with one resident telling us that “she was very bored” and that “time went very slowly”. One of the survey forms that was returned to us also mentioned the trips out, commenting “I would like to go somewhere else other than flower centres”. We were told that some daily activities are organised by care staff although this is dependent on their workload. We have recommended that work should be undertaken to try and find out what sort of activities people would like to participate in and then arrange things to interest them. During our visit we noticed that interaction between care staff and residents was very limited. We didn’t see any carers pause for a chat or pass the time of day. This may have been because they were particularly busy or they may have been inhibited by our presence but care staff need to understand the importance of this engagement with people rather than just delivering personal care. The people we spoke with all told us that the food in the home was very good and in fact had improved a lot recently. We met with the chef and found that he had only been working in the home for six weeks. He likes to go out of the kitchen and meet with the residents to see if they have enjoyed their meals and the “Expert by Experience was in the dining room when this happened. He told us is trying to introduce more fresh produce onto the menu rather than frozen and he is making cakes and pastries for afternoon tea. He has started to make birthday cakes for residents as well and recently baked a special one for a lady with diabetes which was much appreciated by both her and her family. Our expert noted that a special meal was prepared for one resident who prefers to eat more spicy food. The lunchtime meal seemed to be a pleasant experience for people; the dining tables were laid with salt and pepper and table napkins and there was help available for those people who needed it. We did note that one person was unable to purchase sweets from the trolley shop in the afternoon. Whilst it is accepted that this was because it would be detrimental to her health, The Mental Health Act and The Deprivation of Liberty Safeguards highlight the fact that people may sometimes make unwise decisions that are not in their best interests. All of the staff need to have training in order to help them understand the relevant issues and a recommendation has been made with regard to this. The home has its own resident cat “Arnie” who strolls around and seems to be very friendly. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16,18 People using the 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 are confident that any concerns that they might raise will be treated seriously and acted upon. Policies and procedures are in place to help protect people from abuse. EVIDENCE: The people that we spoke with told us that they felt that if they had any concerns they would be able to raise them with the staff or the manager and something would be done about it. Then complaints process is displayed around the home and anyone visiting would be able to see it. We have not been made aware of any concerns since we last visited and the manager told us there has been one issue which is currently being addressed. Staff told us that they have received training in recognising and reporting suspected abuse and no one is employed with out clearance from The Criminal Records Bureau. The people who use the service say that they feel safe however; we have already made a recommendation for all of the staff to attend training to help them understand The Mental Capacity Act and Deprivation of Liberty The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 18 Safeguard. This will help to ensure that resident’s rights to choice and autonomy are recognised and promoted. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,26 People using the 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 live in this home say that it suits them and they are comfortable, however some areas would benefit from redecoration. They tell us that it is always clean and free from odour. EVIDENCE: The home consists of an older style property which has been extended to provide accommodation for twelve elderly frail people on the ground floor and thirteen people with dementia on the first floor. A passenger lift ensures accessibility throughout the home and keypad entry is on the doors to the first floor to ensure the safety of the residents there. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 20 All bedrooms are for single occupancy. Some people invited us to look at their rooms and we could see that they have been encouraged to bring in pictures, ornaments and small pieces of furniture in order to make them homely. There are dining rooms on both floors and communal areas equipped with televisions and comfortable chairs. It was disappointing to see that chairs are all arranged around the outside of the room rather than being grouped although we noted that many of the residents seem to stay in their rooms. There are flowers around the home however they are all artificial. The home was clean and free from malodour but it would benefit from redecoration in places. Some of the paintwork is scuffed and cushions in the dining room need to be replaced. Stair carpet is worn and stained. One resident pointed out quite large cracks in her bedroom wall. There are sufficient toilet and bathroom facilities, with adaptations to help those with limited mobility, although some of the toilet bowls are quite stained. We have recommended that a redecoration and improvement plan should be implemented to address these issues and ensure that the home remains a pleasant place for people to live in. The first floor of the home is dedicated to the care of people with dementia. However, we saw that there is a lack of items that would help with reality orientation for theses people. Examples of this might include pictures that would have a particular interest for older people, calendars, clocks or boards informing them of the date and weather. We have recommended that advice should be sought regarding ways that this could be improved. The home was clean and free from odour on the day we visited, although there was only one member of domestic staff on duty. We considered that ensuring the cleanliness of the home was a big job for one person but we were told that this was due to sickness and there should have been two. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29,30 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough staff on duty to meet the needs of the people who live there and recruitment checks are in place to help ensure their safety. The home is aware of the importance of encouraging ongoing training for staff. EVIDENCE: On the day that we visited there were enough staff on duty to meet the needs of the residents and since we last visited night time staffing levels have been increased. There is some reliance on agency staff to cover the current staffing vacancies although the home uses the same ones wherever possible. They are currently trying to recruit more staff. The information that we have from the home tells us that less than 50 of their care staff have an NVQ level 2 however it is their intention to encourage others to complete this. The staff we spoke with were able to tell us about training that they had completed recently which has included fire safety, health and safety, food hygiene, moving and handling and supporting people with challenging behaviour. Senior care staff have all undertaken training in first aid and there has been training in caring for people with dementia. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 22 Staff confirmed that they have regular supervision and appraisal. The staff personnel files that we saw showed that no new member of staff is employed before all of the relevant checks have been completed. In this way residents are protected from those who have been judged as being unsuitable to be working with vulnerable adults. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards31,33,35,38 People using the 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 managed by a person who is fit to be in charge and in the best interests of those who live there. There are opportunities for people to comment on and influence the service provision and policies and procedures are in place to protect them. EVIDENCE: The home is currently managed by Olukemi Omotola Akinloye who is currently working towards her NVQ level 4 qualification. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 24 Residents have the opportunity to comment on the running of the home and the services that are provided at regular meetings held every two months. There are also meetings held for their relatives twice a year. In addition the company conducts a yearly satisfaction survey although the results of this are not published. It was recommended that these should be displayed in the home for people, who visit, to see. The home keeps some money on behalf of residents and we were able to see this. The accounts were accurate and easy to understand. They are regularly checked and audited. Records that the home is required to keep as evidence of their commitment to the health and safety of residents and staff were all in order. The information that we have from the home tells us that equipment and services are all appropriately serviced and maintained. Health and safety procedures are all complied with. Staff were able to tell us that they had all attended fire drills recently. The last Environmental Health Officers visit resulted in a score of four stars for kitchen practices. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Requirement Timescale for action 30/11/09 2 OP9 13(2) 3 OP9 13(2) 4 OP9 13(2) Staff who administer medication must have their competence reassessed on a regular basis to ensure that their practice remains up to date. If residents are refusing their 30/11/09 medication there must be evidence available to show that their doctor has been informed in order to monitor their health condition. There must be evidence of 30/11/09 regular medication audits being undertaken in order to identify errors and minimise risks. There must be clear guidance in 30/11/09 place regarding the protocols for administering “as required” medication. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 27 No. 1 2 Refer to Standard OP9 OP9 Good Practice Recommendations It is recommended that the list of medication that residents are allergic to is kept with their medication administration records, for ease of reference. It is recommended that there should be a list of medication currently being administered with their uses, effects and side effects, kept with the administration records. It is recommended that future staff training should include ensuring that they are familiar with issues in relation to the Mental Capacity Act and The Deprivation of Liberty Safeguards. It is recommended that the views of residents should be sought regarding the activities that they would like to participate in. It is recommended that a redecoration and refurbishment plan should be implemented in order to ensure that the home remains a pleasant place for people to live in. It is recommended that advice should be sought about ensuring that the dementia unit includes features that help with reality orientation for these residents. 3 OP14 4 5 6 OP12 OP19 OP19 The Shaw DS0000025855.V378194.R01.S.doc Version 5.3 Page 28 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 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) Care Quality Commission (CQC). 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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