Care Home: The Shires

What the care home does well The Shires offers residents a homely and comfortable place to live. Staff involved in the inspection said that they work well together and aim to offer residents the support they need and want. Residents and visitors comments were equally positive saying the `staff are very good`, `the food is tasty` and `we can decide what we want to do`. What has improved since the last inspection? The requirements made following the last inspection have been met or partially met. The Statement of Purpose has been reviewed and updated to enable prospective residents to decide if the home can meet their needs. Care plans are focused on the individual needs of each resident, a programme of activities is being developed and the meals offered vary depending on the preferences of the residents. Staffing levels have been reviewed and additional staff are to be employed, with mandatory and specific training arranged to ensure the staff are aware of their roles and responsibilities. What the care home could do better: One requirement has been made regarding the Regulation 26 visits by the provider, to assess the service offered at the home, as part of the quality assurance and monitoring system. Key inspection report Care homes for older people Name: Address: The Shires 12 - 13 Gorringe Road Eastbourne East Sussex BN22 8XL     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Kathy Flynn     Date: 1 3 0 5 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: The Shires 12 - 13 Gorringe Road Eastbourne East Sussex BN22 8XL 01323721032 01323646771 christineb66669@aol.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Eaglecrest Care Management Ltd Name of registered manager (if applicable) Mr David John Short Type of registration: Number of places registered: care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Dementia - DE Date of last inspection Brief description of the care home The Shires is a care home registered to provide accommodation and care for twentyseven older people with a dementia type illness. Intermediate care is not provided. The home is situated in a residential area of Eastbourne, approximately two miles from the town centre. The Shires provides twenty-four single rooms, fourteen of which have ensuite toilet and hand basin facilities. There are three double bedrooms. There are two assisted baths and two assisted shower facilities. The home provides a range of communal space, including a conservatory and a large, accessible rear garden. There is a stair lift to access the first floor accommodation. More information about the Care Homes for Older People Page 4 of 24 Over 65 0 0 Brief description of the care home services provided by the home, including the current range of fees can be found in the homes Statement of Purpose and Service Users Guide. Copies of both these documents can be obtained directly from the Provider. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This unannounced inspection was carried on the 13th May 2010 and included a review of pre admission assessments, care plans, staff records and training, medication records, activities, and menus. 8 residents were involved in the inspection and six visitors to the home were happy to discuss the support provided. The manager and care staff on duty discussed the care and support they provide at the home. The reader should be aware that the Care Standards Act 2000 and the Care Homes Regulations 2001 use the term service user to describe those living in care home settings. However for the purposes of this report those living at The shires will be Care Homes for Older People Page 6 of 24 referred to as residents. The Annual Quality Assurance Assessment AQAA was completed by the manager within the required timescale, and was used as part of the information collected for the inspection. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: 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. Care Homes for Older People Page 8 of 24 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Information about the services offered at The Shires is available, and people who wish to move in are assessed to ensure the home can meet their individual needs. Evidence: The homes Statement of Purpose and Service Users Guide have been reviewed and most of the information required is included. Details of the accommodation available and staff qualifications will be added, to enable people to decide if the home offers the services they want. The manager advised that before anyone is offered a place in the home their needs are assessed, through a process of consultation with them and their relatives or representatives, and if required their GP and other allied health professionals. Four assessments were viewed and found to contain the residents medical history, individual care needs, mobility needs, including risk of falls, nutritional needs, social Care Homes for Older People Page 10 of 24 Evidence: contacts, with the information used to form the basis of their care plans. The manager is concerned about the staffing levels at the home, and confirmed that she will be unable to offer places to people until this has been resolved. Visitors to the home said that they were involved in the assessment of their relatives needs, and visited the home to make sure that it could offer the homely atmosphere they were looking for. The home does not provide intermediate care, therefore Standard 6 is not applicable. Care Homes for Older People Page 11 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning system has been reviewed with care plans now based on the individual needs of people living in The Shires, and medication training is provided for staff to protect residents. Evidence: The manager said that the care plans have been reviewed and a number of changes made to ensure that they record the individual physical, social and psychological needs of the people living there, and how these can be met. Four care plans were examined and they contained specific information about the residents personal care needs, including mobility, risk assessments for personal safety and falls, communication, continence, skin care, diet and weight. There was some evidence that the care plans are reviewed with the involvement of residents and relatives. However two of the care plans had not been recently reviewed and a risk assessment for one resident had not been updated following a fall. Care Homes for Older People Page 12 of 24 Evidence: Daily records of care are completed and although they have some information about the support offered it is limited. When well written they can help ensure a consistent approach and that quality support and care is offered. It is in the homes interest to be able to show what they have done, along with providing the evidence on which to base the monthly review, and to record that they are following the assessment of need for each of the residents. The manager is aware that additional training is needed to ensure staff feel more comfortable reviewing the care plans and recording the care that people living in the home want and need, and this has been arranged. Training is provided for staff who are responsible for administering medicines, and the manager is developing individual care plans for medicines that are prescribed for only when needed. Some of the staff involved in the inspection said that they have attended that training, they have read the homes policies and procedures, and were able to demonstrate an understanding of how they assess the residents needs through changes in behaviour. Residents are registered with GPs and records are kept of their visits and those of allied health professionals, including any changes in care and support that has been agreed. Staff were noted to treat residents with respect, and ensuring that residents privacy was respected when they needed assistance with personal care. The atmosphere in the home was relaxed, with communication between residents, visitors and staff friendly and on first name terms. Residents and visitors who took part in the inspection said that the staff are very good, they look after everyone very well, and they talk to us about everything, so we know what is going on. Care Homes for Older People Page 13 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of the home are flexible, enabling residents to make choices about how and where they spend their time. The food is good, choices are offered, and the needs of residents with special dietary needs are met. Evidence: Some activities are provided at The Shires, including weekly visits by an entertainer who sings and plays the piano, and fortnightly exercise classes. Feedback from some of the residents involved in the inspection was very positive and a number enjoy singing along to the music, while others prefer to sit quietly in the conservatory or their own rooms. Some visitors would like more activities to be available, although they also said that often residents choose not to take part when they are offered. The manager is aware that the home needs a varied programme of activities, which is based on how the residents want to spend their time. To ensure that this is developed she is employing staff who have an interest in, or have attended relevant training. Relatives and friends can visit at any time, and those who took part in the inspection said that they are made to feel very welcome, and are offered a drink or something Care Homes for Older People Page 14 of 24 Evidence: to eat, if they are there during meals, when they arrive. The staff said that they encourage residents to make choices about all aspects of their day to day lives, and they were noted to be supporting residents, who need assistance, to decide where they wanted to spend their time. Residents involved in the inspection said that we are very comfortable, the staff are very friendly, the food is very tasty and we can decide what we want to do. The food at the home is good, choices are offered and residents can have their meals at times that suit them. Staff assist residents as required and specific diets are provided, including diabetic meals and finger foods. Care Homes for Older People Page 15 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has policies and procedures in place to enable residents or their relatives and friends to make complaints. Training in protecting vulnerable people is provided for staff to protect residents. Evidence: The manager confirmed that policies and procedures are in place to enable residents and visitors to raise concerns about the home and the services it offers. Her aim is to be proactive and address any issues when the first arise, so that people living in the home and their relatives and friends can be confident that she takes their concerns seriously. Feedback from visitors was positive, they felt that the manager listens to them if they have any concerns, although most said that they have nothing to complain about. Staff involved in the inspection said they have attended training in protecting vulnerable adults. They were able to demonstrate an understanding of the vulnerability of the residents living at The Shires, and what action they would take if they had any concerns. Care Homes for Older People Page 16 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Shires provides residents with a comfortable and homely place to live. Training in the control of infection is provided for staff to protect residents. Evidence: The Shires is a large detached property in a residential area of Eastbourne, with an attractive garden to the rear, and within walking distance of the town centre. There is a large lounge on the ground floor, a separate seating area and conservatory, that residents can use if they wish. The home was clean, well decorated and there is ongoing maintenance as required. Residents rooms are on two floors, and a stair lift enables residents to access their rooms on the second floor. Residents are encouraged to personalise their rooms and many have done so with small pieces of furniture, pictures and ornaments. Training in the control of infection is provided for staff, and those involved in the inspection said they have attended. Care Homes for Older People Page 17 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Robust recruitment procedures are used when employing staff to protect residents. Training is provided for staff to ensure they are aware of their roles and responsibilities. Evidence: The manager advised that the current level of staff is appropriate for the level of occupancy at the home. The feedback from staff and visitors during the inspection was that there are enough staff working in the home to support the residents. A training programme is in place, first aid, safeguarding, health and safety, medication and infection control have been provided, to ensure that the staff have the relevant skills. Additional courses, including dementia care, have been arranged and staff are required to attend these. An induction programme is in place and new staff involved in the inspection said that they are working through this at the moment. There are opportunities to work toward National Vocational Qualifications NVQ, and the manager advised that just under 50 percent of staff have NVQ level 2 or equivalent. Care Homes for Older People Page 18 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management approach encourages residents, relatives, visitors and staff to be involved in decisions about the development of services offered at the home. Evidence: The manager has considerable experience of supporting older people, she has completed the Registered Managers award and has NVQ level 4 in care and management. She has been responsible for the day to day management of the home since December 2009, and is currently applying to register with the Commission. Her management approach is to enable residents, relatives and staff to be involved in deciding how the home offers care. This is to ensure that residents continue to be independent in a supportive environment. Feedback from residents, visitors and staff taking part in the inspection was very positive, they felt they could talk to the manager and any suggestions they had are well received. Care Homes for Older People Page 19 of 24 Evidence: A requirement was made following the last inspection regarding the development of a quality assurance and monitoring system. This requirement has been partially met as the manager has already audited some of the services offered, including the care plans and staffing levels. However an essential part of the monitoring includes Regulation 26 visits from the provider, and although these are carried out they do not include discussions with residents and visitors to the home. A requirement has been made to develop this process and ensure all aspects of the support and care offered are assessed. The manager confirmed that the home does not take responsibility for the residents finances. The manager advised that staff appraisals have already been completed, and she expects to start a process of supervision in the next few weeks. Therefore a requirement has not been made at this time. Health and safety systems are in place in the home, regular checks are made throughout the home, and as the manager confirmed there is an ongoing maintenance programme and outside contractors are used to provide appropriate certificates. Care Homes for Older People Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 The Registered Person must 16/08/2010 ensure that the care plans are reviewed with the involvement of the residents and/or their representatives. To ensure that care plans identify the residents needs and guide staff to provide appropriate care and support. 2 33 26 The Responsible Person to visit the home to review the services and facilities offered. To discuss these with residents, visitors and staff, and produce a written report. To ensure the services offered, and the environment, are appropriate to meet the needs of the people living there. 01/09/2010 Care Homes for Older People Page 22 of 24 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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