Care Home: The Shires

What the care home does well The Shires provides specialist nursing care to people with very complex mental health needs. Before people move in, staff make sure they know what care the person will need. The care people need is written down and kept up to date, and people who use the service are involved with this. People say they can make their own decisions and can live independent lives. Staff help them to do so as safely as possible and allow people to take risks in, and ownership of their normal dayto-day living activities. People do training, education or work, and they do ordinary life activities like going to the gym or to see plays or bands. Daily life is not restrictive. The home provides a good variety of food and caters well for special diets. People like the food. Staff help service users to keep healthy and to feel secure. They look after medication safely and empower people to take control of their own medication and lifestyle. Staff are open to listening to any concerns. People feel comfortable with raising concerns and say the home acts on them. During the past year the CSCI has not received any complaints about The Shires. What has improved since the last inspection? Management and staff have worked extremely hard to introduce new care documentation that is more person-focused, and includes the individual within the care process (which has moved more towards supporting the individual to meet their own needs and aspirations). There has been greater emphasis placed on promoting equality and diversity issues through staff training, and there has been investment within the fabric of the building through redecoration which improves the visual appearance of the building. What the care home could do better: The only area of criticism regarding the service is in relation to the actual physical environment. The home is not purpose-built, but has been adapted from a pre-existing period building. This imposes physical limitations on usage and the management team acknowledge that little else can be done to develop the building (which is owned by Herefordshire Primary Care Trust). Opportunity is being taken to look at developing the service provided at and by The Shires, and this may mean moving away from the current physical location (particularly as the building cannot be adapted to effectively meet the needs of younger people with complex mental health needs). CARE HOME ADULTS 18-65 The Shires 116 Aylestone Hill Hereford Herefordshire HR1 1JJ Lead Inspector Nick Richards Unannounced Inspection 16th January 2009 09:00 DS0000027691.V373767.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000027691.V373767.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000027691.V373767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Shires Address 116 Aylestone Hill Hereford Herefordshire HR1 1JJ 01432 271785 01432 276806 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) Herefordshire Mind Association Mrs Andrea Jane Frater Mr Allan J Riley Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (13) DS0000027691.V373767.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19th January 2007 Brief Description of the Service: The Shires is a 3-storey Victorian house set in extensive grounds that are well maintained and easily accessible, with open views overlooking the Lugg Meadows. It is on the outskirts of Hereford, which offers shopping and recreational facilities. There is a small newsagents shop within very close walking distance. There are nine single bedrooms and two shared double bedrooms, none of which have en-suite facilities. The home is fitted with a passenger lift to all floors with the exception of the second floor. The two bedrooms on the second floor are used specifically for people with a greater degree of independent living skills. The home provides accommodation, care and nursing for up to 13 adults (some over 65) with enduring mental health needs. The Primary Care Trust owns the property. The provision of security of tenure through a Service Level Agreement with the Primary Care Trust is unresolved. The registered provider of the service is Herefordshire MIND and their General Manager, Mr Richard Kelly, is the responsible individual. There are two registered manager of the home. They are Mr Allan Riley and Mrs Andrea Frater. Mr Riley also manages a counselling & psychotherapy service and a supported living service. Ms Andrea Frater has been appointed to be in day-today charge of the home. Information about the home is available in a detailed service users’ guide. Fees for the home were unavailable at the time of inspection. DS0000027691.V373767.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. The visit was carried out over one day; the home did not know we were going to visit. This was a “key inspection”. A key inspection is where we look at those areas that we, the Commission, consider to be important when providing quality care. The focus of inspections we, the Commission, undertake is upon outcomes for people who live in the home and their views of the service provided. This process considers the care home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Prior to the fieldwork visit taking place a range of information was gathered to include notifications received from the home. This included surveys completed by the people living there, staff working within the home and professional people who visit the home. We also looked at the information submitted to us by the home in the form of an “AQAA”. This stands for “Annual Quality Assurance Assessment”. An AQAA is a document that the home has to send to us, and helps them to assess their home, identify what they do well, identify the things they are not so good at, and it tells us what they are going to do to help improve things within the home. Three people who live in the home were “case tracked”. This involves establishing individuals’ experience of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. The people who live at the home, the manager and the staff were spoken to. Some people living there were reluctant to verbally communicate their views about the home due to their health needs. Time was spent observing care practices, interactions and support from staff. We looked at the premises during a walk around the home, and we also looked at care, and health and safety records. What the service does well: DS0000027691.V373767.R01.S.doc Version 5.2 Page 6 The Shires provides specialist nursing care to people with very complex mental health needs. Before people move in, staff make sure they know what care the person will need. The care people need is written down and kept up to date, and people who use the service are involved with this. People say they can make their own decisions and can live independent lives. Staff help them to do so as safely as possible and allow people to take risks in, and ownership of their normal dayto-day living activities. People do training, education or work, and they do ordinary life activities like going to the gym or to see plays or bands. Daily life is not restrictive. The home provides a good variety of food and caters well for special diets. People like the food. Staff help service users to keep healthy and to feel secure. They look after medication safely and empower people to take control of their own medication and lifestyle. Staff are open to listening to any concerns. People feel comfortable with raising concerns and say the home acts on them. During the past year the CSCI has not received any complaints about The Shires. What has improved since the last inspection? What they could do better: The only area of criticism regarding the service is in relation to the actual physical environment. The home is not purpose-built, but has been adapted from a pre-existing period building. This imposes physical limitations on usage and the management team acknowledge that little else can be done to develop the building (which is owned by Herefordshire Primary Care Trust). Opportunity is being taken to look at developing the service provided at and by The Shires, and this may mean moving away from the current physical location (particularly as the building cannot be adapted to effectively meet the needs of younger people with complex mental health needs). DS0000027691.V373767.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000027691.V373767.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000027691.V373767.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4 and 5. Quality in this outcome area is excellent. People who show an interest in living at the home have the information they need so they can make a choice as to whether or not they want to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has produced a document called “Resident’s Guide and Information” (the “Guide”). This contains a lot of information about the service so people who are interested in moving into the home would have the information they need to make a choice as to whether or not they want to live there. It did not state the fees charged. We talked about this with the home’s manager, who agreed that this would be put into the document. Although the fees charged were not included it stated what the fees do not include such as any repair/renewals where damage is caused deliberately. The Guide is readily available, and people living there said, “I received enough information about the home before I moved in”. Each person living at the home had a copy of the Guide. Some people living in the home have problems with their eyesight. They said that staff had, and do, read the Guide to them whenever they want. One person had technology that allows documents (for example, books) to be read DS0000027691.V373767.R01.S.doc Version 5.2 Page 10 on their behalf. The manager told us that the local college for the blind was situated close by and they would be prepared to produce audio versions of the Guide for a small cost to the home. Before people move into the home, the management team check whether the person meets the home’s criteria for admission by reading a referral form – which contains background information about the person. A full needs assessment is then completed by a registered nurse, this is then typed up and sent back to the person who is given the opportunity to read, agree and amend, if necessary the assessment. The assessment includes details about what the person would like to do (their “aspirations”). Once agreed, the document is returned back to the home. We consider this to be excellent practice because people know what has been written about them and will know what care is to be provided – there are no secrets. People are then invited to visit the home and meet the staff and other people who are living at the home. Opportunity is then taken to move into the home on a trial basis to see whether the person likes the home. On successful completion of the trial period, the contract is changed to a permanent contract and this is updated regularly when there is a change in fees. This means that people using the service are kept informed of any changes to costs or terms and conditions of residency. The contracts seen were written in plain English so they were easily understandable. On admission, staff get agreement from the person that they will work together to help get better. The manager stated “It is important that you are fully committed to live at The Shires and that your stay helps you to meet your needs”. This is important because people need to work with staff to help their lives improve and, hopefully, move on to more independent living. The home has, on occasions, refused to admit people because they felt that the home could not meet the person’s needs. The documents that we viewed were exceptional and covered all the needs that anybody would present with in great detail. DS0000027691.V373767.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is excellent. Staff have the information they need in support plans and risk assessments so they know how to support individuals to meet their needs whilst ensuring their safety and well being. The people living there are supported to make choices and decisions about their day-to-day lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of three people living at The Shires were looked at. These included individual support plans that detailed how staff are to support people to meet their needs. Since the time of the previous inspection the home has put a lot of time and effort into redesigning their care records. This has resulted in a vast improvement in their quality of recording, and also demonstrates the philosophy of the service whereby staff work to support people to become more independent in all aspects of their life. Where appropriate, support plans cross-referenced to other documents such as medication charts and behaviour management strategies so that it was clear to staff how to support the person DS0000027691.V373767.R01.S.doc Version 5.2 Page 12 in all areas of their life. Every person we case-tracked had signed their support plan to say that they agreed to it. The people we case-tracked said, “You have all the support here”, “Staff always give the support or care that we expect or agree”, “The staff have the right skills and experience to look after us properly”, and (the staff) “have gone through the care plans with me”. Support plans were easy to understand, and it was clear that the person had been involved in it. They stated the goals that the person wanted to achieve. These were short-term and longer-term aspirations. Support plans showed that people using the service were being supported to achieve their short and longer-term goals. Key workers had met with individuals regularly to talk about their progress. All support plans seen had been countersigned by the individual to indicate agreement and ownership of the plan. This is important because when people are involved in their support plan, there is a greater chance that they will achieve their aspirations with the support identified. The people we spoke with said they were happy with the activities they were doing, they were happy with the menu, and we saw one person being helped by a member of the staff team to make their own sandwich. One person said that the staff “bend over backwards to go out their way (to help)”. Meetings are held each Monday with the people living there. This is used as an information-sharing opportunity so that people who use the service are aware of any changes happening within the service and can contribute to any plans for the development of the service. People’s care records included individual risk assessments. These detailed how staff support people to be as independent as possible whilst minimising any risks to their health, safety and welfare. Risk assessments had been regularly reviewed and updated if necessary. Staff had signed the risk assessments to say they had read them and agree to follow them so there is consistency of care. DS0000027691.V373767.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living at The Shires experience a meaningful lifestyle and have a healthy diet, which improves their health and well being. EVIDENCE: Throughout the day people were observed going out with staff to do individual activities or doing activities in the home. People using the service had a range of activities that they took part in during the week. One person told us that it was “unusual for you to catch me – I’m usually out today”, while another person said “My “diary” is always packed with outside activities – I have little opportunity to participate in things organised by the home”. Staff work hard to respond to the social, recreational, educational and leisure needs and aspirations of the people using the service. One person said that they wanted to access an Open University degree, and this was reflected in DS0000027691.V373767.R01.S.doc Version 5.2 Page 14 their support plan. The person gave examples of how staff had responded to their leisure and recreational interests. As the person enjoys music, the staff had recently taken them to see a tribute band play live in Worcester. Staff had also provided support to help the person visit the West Midlands Safari Park and had also taken them on holiday to Spain last year – which was described by the individual as “great, a fantastic holiday”. The person had use of a laptop, broadband and a personal telephone line to help with their recreational, social, educational and leisure aspirations. A lot of people using the service have their own mobile telephones, and everybody has internet access through the use of a communal personal computer. Records sampled showed and it was observed that the people living there are supported to be as independent as possible. This included doing their laundry, cleaning their bedrooms, changing their bed, going shopping, emptying the bins, being helped to prepare food and putting out the rubbish. Menus and food records showed that people ate food that reflected their cultural background and they had a choice of what they ate. The four week menu system included a daily vegetarian option, while the main meal served on the day was fish pie and vegetables. One person who is vegan said “the quality of food is great. I’m always asked what I want on the day”, and went on to give examples of the food provided for her. This included tofu, houmous, rice and pasta. Another person said “the food – I can’t knock it”, and then continued by humorously adding “…maybe (I get) too much of it”. All people who were case-tracked were maintaining close contact with people who are significant to them outside of the service (whether these were family members or friends), and restrictions on visiting or contact were at the discretion of the person themselves. DS0000027691.V373767.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Arrangements ensure that the personal care and health needs of individuals are met. People get their prescribed medication at the right time so their health needs are met. EVIDENCE: One person who was going to a pre-arranged engagement had been well supported with their personal care and clothing. They looked very smart and this was appropriate to their age. All the people living there were well dressed in individual styles that were reflective of their age, their cultural background, the weather and the activities they were doing. Records sampled showed that people had been regularly weighed to ensure they were not gaining or losing a significant amount of weight, which could be an indicator of an underlying health need. DS0000027691.V373767.R01.S.doc Version 5.2 Page 16 Records sampled showed that each person is registered with a local GP (general practitioner), who they are supported to visit if they are unwell. Where appropriate health professionals (such as psychologists, dentists, audiologists, chiropodists, community nurses) are involved in the care of individuals. The outcome of any health appointments are recorded and records showed that staff follow the advice given to ensure individual’s health and well being. One visiting healthcare professional returned a survey to us and confirmed that staff within the home “have contacted mental health services for advice and discussion on improving residents’ health care needs…They have sought advice and involved other professionals when additional skills and experience are required”. Several people who use the service confirmed that their physical and emotional health needs were being very well met. One person said, “In my adult life it’s (here that I’ve) been the happiest”. The service works well to promote equality and diversity within the home. Each person is respected as an individual and staff work hard to ensure that their wishes are upheld or promoted. The vast number of staff within the home are female while the majority of people using the service are male. The home has ensured that people’s preferences about the gender of staff providing care has been sought and respected. An example of this relates to one person who has been informed that a female member of staff will be available on-call if ever there are only male staff on duty within the home. This was documented within the person’s support plan and was confirmed verbally to us by the individual concerned. Within the home, registered nurses help people who use the service to take their prescribed medication. Several people prefer to take responsibility for their own medication and have been risk assessed by the staff to ensure that they are safe to manage their own medication. This maximises the independence of the individual and ensures that the home is satisfied that the health and safety of individuals is also promoted and protected. We saw the comprehensive risk assessments on people’s care files. One visiting healthcare professional told us “They appear to respond positively to individuals’ wishes with regard to being responsible for their own medication”. All medication is administered in accordance with the home’s policies and procedures. This ensures that people receive their prescribed medication safely. When people receive their medication, the registered nurses sign a drug administration record. This allows people to know that their medication has been managed safely, it also shows when, and why, medication has not been given to people. People using the service said that staff allow them to control their own medication and, if they do not want to take their medication, they do not have to. The home’s manager said that people had the right to refuse medication and, when this happened, the staff would monitor closely the person’s health condition to ensure that, if they became ill, a doctor could be contacted to review the individual. DS0000027691.V373767.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that the people living at The Shires feel their views are listened to and acted on. The people living there are protected from abuse, neglect and self-harm. EVIDENCE: The procedure for making complaints was available in the Guide, and had been made available to all the people who are using the service. It was written in plain English and was easy to understand. Staff had explained the procedure verbally to people who are visually impaired. The people living there said, “I know who to speak to if I am unhappy and how to make a complaint.” Since the previous inspection we have not received any complaints about the home or the service it provides. The home has investigated two complaints, both of which have been upheld. Appropriate action was taken to resolve the concerns raised by people who use the service. The manager explained how the home carefully observes the interactions of people using the service to ensure that people living within the service do not become aggressive due to personality differences. This process is part of the home’s screening procedure when people are referred to the home. This helps to prevent any conflict of personality and helps to keep the home a “happy” place to live. This was confirmed by people using the service who said that DS0000027691.V373767.R01.S.doc Version 5.2 Page 18 living in the home was like being in one big family and “everyone looks out for everybody”. 10 people who use the service responded to the surveys we sent out, and all said they knew who to talk to if they had a concern, and they were aware of the complaints procedure. Each person spoken with said that they knew what to do if they had any concerns, and they felt that their concerns would be listened to and taken seriously. One member of staff told us that “The Shires is a warm, homely environment with a great deal of laughter and happiness”. This opinion was demonstrated when we visited the home and saw members of staff joking with people who use the service. One visiting healthcare professional told us that the home always responded appropriately if they had concerns about the care provided. All staff have completed training in adult protection and the prevention of abuse so they know how to protect the people living there from abuse, neglect and self-harm. Staff had also received training in equality and diversity issues – this helps to respect the person as an individual and ensures that race, gender identity, disability, sexual orientation, age, religion and belief are promoted and incorporated into what the home does. From sampling records and talking to staff it was evident that staff spend time looking at the causes of individual’s behaviour to see if anything can be done to improve their well being. An example being one person whose alcohol intake had made them unwell recently. Staff were looking at ways to reduce the person’s need to consume alcohol. All people (with the exception of one person) manage their own finances. The home maintains good financial records for the one person who currently has problems and difficulties managing their own finances. This is done with the agreement of the person involved. Staff have not completed training in the Mental Capacity Act and how this affects the people living there. This Act came into force in April 2007 and states that each person’s capacity will be assessed as to whether or not they can make a decision about their life. If they are assessed as not having the capacity other people including an Independent Mental Capacity Advocate (IMCA) can make that decision for them in their ‘best interests.’ The managers said they are going to gain training on this for themselves and the staff team. DS0000027691.V373767.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 28 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the home was clean and tidy, some parts of the home are not homely, which could impact on the well being of the people living there. EVIDENCE: The Shires provides accommodation on three floors. The building is not purpose-built but adapted. This means that the physical environment has not been designed around the needs of the people who are using it. The registered manager made reference to this in the AQAA that was submitted to us: “The constraints of the building we believe are no longer conducive to the type of care that we would like to provide for residents with enduring mental health needs. We have made significant modifications to the building to meet a rapidly changing client group but feel that we cannot make any further improvements with the existing building”. DS0000027691.V373767.R01.S.doc Version 5.2 Page 20 During our visit, we toured the home and saw some bedrooms and the communal areas. The home was clean and well maintained, and staff had made sure that people’s safety had been promoted, e.g. harmful chemicals were stored safely and securely and windows above ground floor level had restricted openings so that people were not at risk of falling out of them. The house had a very therapeutic atmosphere. One person who sent a survey back to us commented “Some aspects of internal décor and rooms could improve”. Two bedrooms are shared by people who use the service. Although the people sharing stated that they didn’t mind sharing with another person, the use of shared bedrooms is not considered to be good practice as it potentially compromises privacy. Bedrooms did not have any en-suite facilities, which means that everybody has to use communal toilets, bathrooms and showers. This potentially restricts choice. We discussed these issues with the home’s management during our visit. We were told that the organisation is looking at possible ways of developing the service to improve environmental standards. Both rooms that are shared had appropriate screening in place to give the people using the bedrooms some privacy. Individual bedrooms were furnished according to the tastes of the person occupying the room. One bedroom had been stripped of most of its furnishings by the occupant, and the staff had respected the person’s actions and choices. All bedrooms are lockable and people hold keys for their rooms. This means that people can enjoy the privacy and security of their own personal space. The home’s shared areas were a lounge, a dining room and a “quiet lounge” which had been converted from a smoking room. As the home is subject to legislation that prohibits smoking in public spaces, a smoking area has been provided outside for people to use. We took the opportunity to use the quiet lounge during our visit to meet with people. The lounge was comfortable, private and peaceful. We noticed that a free-standing electric heater was being used to warm the room. This potentially posed a health and safety risk to people who use the service as the temperature of the heater means that, should somebody fall over against the heater, they could suffer burns. This was explained to one of the managers who told us that they would remove the heater and look at other, safer ways of heating the room. At the moment, the home provides a service for some people who have problems with their eyesight. As we toured the building and spoke to people using the service, it became apparent that they did have some problems finding their way around the home. There were no visual or tactile clues (i.e. signs or marks that could be felt or seen) that would help people with limited eyesight know where they are in the home. DS0000027691.V373767.R01.S.doc Version 5.2 Page 21 The home was clean and free from unpleasant odours during our visit. This means that people have a pleasant environment in which they can live. There are policies covering infection control and disposal of clinical waste, and the laundry was suitably equipped and was situated well away from any food storage or preparation areas. This helps to safeguard people from infectious outbreaks. DS0000027691.V373767.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were enough staff in the home, and they had good working relationships with people who use the service. Appropriate checks were carried out on staff before they began work in the home, to reduce the risk of employing unsuitable staff. Staff held qualifications suited to their work, and undertook further training. EVIDENCE: Staff in the home had good competencies and qualities to meet people’s needs. In addition to the managers, there were other registered nurses who hold different qualifications. The nursing team have general nursing, mental health nursing and learning disability nursing qualifications. This means that the nursing team have the skills and training to meet the diverse needs of the people using the service. Of the support workers, 5 out of 8 held NVQs (National Vocational Qualifications in Care) at level 2 or 3 and some had some counselling training. This means that the majority of care staff have formal training that allows them to effectively provide help and support to the people who use the service. DS0000027691.V373767.R01.S.doc Version 5.2 Page 23 We saw the staff on duty interacting with people in a professional, respectful, friendly and approachable way. Of the ten people who replied to our survey, all said the staff always or usually treated them well. During our visit, people who used the service were positive about staff, with comments such as “they’re excellent”. Surveys were returned to us from staff, and included comments such as: “The Shires gives excellent day-to-day support for all our residents. Residents clearly feel able to make individual choices about their lives and the diverse needs and expectations of our residents is respected”. There were differing opinions from people about staffing numbers. While some made comments such as: “We have enough staff”, some people commented that the staff within the home appeared stretched at times. This view was shared by some staff who returned surveys to us. Having looked at the staffing levels, observed care practice, analysed people’s needs and discussed these with the management of the home, the home had sufficient staff on duty to meet the needs of people using the service. This however, needs to be kept under review and staffing levels may have to be adjusted as, and if, people’s needs change. A registered nurse is in charge of each shift, day and night. This means that people’s health needs are closely monitored by registered nurses throughout the 24-hour period. There are also two support workers and a housekeeper on duty during the day, and a support worker on duty with the registered nurse at night so that support can be provided to people whenever necessary. There was a stable staff team and staff meetings were held regularly. The home carried out appropriate pre-employment checks on staff, including ensuring full, satisfactory CRB (Criminal Records Bureau) checks were received before staff worked in the home. This helps the home’s management team to protect people using the service by preventing individuals who may not be appropriate to work with vulnerable people due to previous criminal convictions gaining employment within the home. Employment records were kept in the MIND office, not in the home, we were told that we would be given access to the records whenever necessary. People using the service are involved with staff recruitment, and a representative of the people using the service sits on the staff interview panel. This means that people are included in choosing whether somebody is to be employed at the home within a support/caring role. The home kept full and up to date records of staff training. These records showed that basic training took place in a range of topics, including Protection of Vulnerable Adults, Moving and Handling, Health and Safety, Food Hygiene, Managing Aggression, First Aid, Fire Safety and Equality and Diversity. The training provided helps equip staff to effectively and safely support people who use the service. DS0000027691.V373767.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management arrangements ensure that the people living at The Shires benefit from a well run home and their views are considered. The health, safety and welfare of the people living there is promoted and protected so ensuring their safety and well being. EVIDENCE: The management arrangements for the home are slightly unusual as the home has two registered managers as opposed to the usual one. Both managers are registered mental health nurses. Allan Riley manages other “MIND” projects so has limited time in the home. His responsibilities cover overall management of the home, administration such as policy reviews, and auditing while the other DS0000027691.V373767.R01.S.doc Version 5.2 Page 25 joint manager, Andrea Frater, is in charge of the day-to-day management of the home. During our visit, Mr Riley told us that he would be applying to be de-registered as manager following our visit so as to focus on his other projects. This will give Mrs Frater full management responsibility for the home. People who use the service and staff spoke highly of both managers and felt the management arangements were working well. One staff member told us: “We have supervision with a qualified member of staff every month or when required. The manager is always willing to listen to any problems that we might be experiencing and is very helpful in offering advice when needed”. Health and safety in the home is well managed. The home has up-to-date records detailing how it’s responsibility to ensure the health and safety of people using the service has been met. A six monthly health and safety audit is conducted. Risk assessments are conducted on a specific basis for each person using the service and there are generic risk assessment s available within the home. All accidents and incidents are monitored and a monthly analysis of all accidents and incidents is produced. This helps to ensure that people are protected from avoidable harm, but are allowed to take risks which promote independence. One person said “Staff allow me to do what I want to do, but are there if I need help”. DS0000027691.V373767.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 4 3 X 4 4 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 4 23 4 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 3 X X 4 X DS0000027691.V373767.R01.S.doc Version 5.2 Page 27 No Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA29 Good Practice Recommendations Expert advice should be sought about sensory cues and signs that could be used to help people who have visual problems move around the home without getting lost or disorientated. DS0000027691.V373767.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI DS0000027691.V373767.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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