CARE HOMES FOR OLDER PEOPLE
Sunnyside Rest Home Coupland Close Whitworth Lancashire OL12 8QQ Lead Inspector
Mrs Susan Hargreaves Unannounced Inspection 10th September 2007 09:30 X10015.doc Version 1.40 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 Sunnyside Rest Home DS0000009487.V345144.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 Older People. 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. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sunnyside Rest Home Address Coupland Close Whitworth Lancashire OL12 8QQ 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) 01706 659917 Whitworth Elderly And Disabled Care Trust Vacant Post xxxx Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 24th July 2006 Brief Description of the Service: Sunnyside is a purpose built care home situated near to the local amenities in Whitworth. The home has a small garden for residents who wish to sit outside when the weather permits. There is also a small car park for staff and visitors. Sunnyside offers 24-hour personal care for up to 11 residents. Accommodation is provided in single and twin-bedded rooms. Communal rooms include a lounge and dining room. Sunnyside is linked to a busy and thriving day care centre, which plays an active part in the ‘close knit’ local community. Residents from Sunnyside are invited to participate in the activities available at the cay care centre. The current fees charged at Sunnyside are £310 per week. Additional charges are payable for hairdressing and newspapers. A copy of the statement of purpose and service user guide is available to prospective service users and their relatives on request. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Sunnyside Rest Home on the 10th September 2007. An inspection by the pharmacist inspector took place on 28th March 2007. Five completed surveys were received from residents, four from the relatives of residents, six from members of staff and one from a GP. At the time of this inspection 10 residents were living at the home. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty and residents were spoken to. Discussions also took place with the manager regarding issues raised during the inspection. What the service does well: What has improved since the last inspection?
The management of medication has improved considerably since the introduction of a new monitored dose system. A criminal records bureau check was obtained before new employees started working at the home. This helps to safeguard residents from abuse. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 6 The manager has taken action to obtain the views of residents about the care and facilities provided. Residents were asked to complete satisfaction questionnaires in July and August this year. Improvements to the premises include new laminate flooring in the corridor, the office and the area outside the kitchen. New carpets have been fitted in all the bedrooms and most have been redecorated. What they could do better:
Urgent action must be taken to improve care planning in order to provide person centred care for all residents. Care plans must clearly identify and address the individual needs of each resident. Risk assessments about falls, nutrition and pressure sores must be carried out for each resident. Care plans and risk assessments must be reviewed monthly. It is also important to involve the resident or their relatives in these reviews. It is essential for the health and wellbeing of residents to ensure medication is managed correctly. The resident’s medication administration record must not be signed to indicate medication has been taken when they have not done so. All handwritten instructions on the medication administration records should be signed and witnessed. It is of serious concern that the manager did not follow the correct procedure when allegations of abuse were made. To ensure residents are protected from abuse training in safeguarding vulnerable adults must be provided for all care workers without NVQ qualifications and included in the induction programme for new employees. To ensure care workers have the knowledge they need in order to provide effective care for the resident’s induction training should meet the ‘Skills for Care’ standards. It is essential for the manager to have support and supervision from the responsible person. This must involve making an unannounced visit to the home every month and writing a brief report for the manager about the standard of care and conduct of the home. A requirement made at the last two inspections about this issue has not been addressed. It is important to ensure all residents are receiving a well balanced diet. A record of the food provided for individual residents must be kept. It is of serious concern that a requirement made on two previous occasions for all members of staff to have fire safety training has not been addressed. Urgent action must also be taken to ensure fire drills take place regularly. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 7 Staff attendance records should be kept to ensure all members of staff receive this training. 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. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 8 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 Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A thorough admissions procedure ensured sufficient information was obtained in order to identify the needs of each resident. EVIDENCE: The individual records of two residents were inspected. Each contained a detailed pre-admission assessment. Prospective residents were visited in hospital or their own home prior to admission. The pre-assessment provided important information for the care plan. Prospective residents or their relatives received confirmation in writing that their needs could be met at the home. Standard 6 is not applicable to this service. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Deficiencies in care planning means the needs of all residents are not identified. Privacy and dignity was promoted for all residents. EVIDENCE: The individual care plans of two residents were inspected. These plans did not identify and address all the care needs of each resident. Some care plans did not provide clear guidance for staff to follow to ensure the needs of the resident were met. The care plan about personal hygiene for one resident stated ‘requires assistance’ but did not explain what this meant. A risk assessment about falls had been carried out for only one of these residents. This was completed in January and had not been reviewed. Risk assessments for nutrition and pressure sores were not in place for either of these residents.
Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 11 One care plan indicated the resident had lost some weight. However, there was no evidence that any action been taken and a care plan was not in place to address this problem. The care plans for one resident had not been reviewed since July. There was no evidence to suggest that residents or their relatives were involved in care planning. A written report about the care given to individual residents was completed during each shift. Residents were registered with a GP and had access to other healthcare professionals. Records for the management of medication were in place. However, hand written instructions on the medication administration records were not signed or witnessed. The medication administration record for one resident indicated that on one occasion she had taken her medication when the tablets were still in the blister pack. Medication was stored in a locked trolley. The manager was advised to check and record the temperature of this trolley daily in order to prevent deterioration of medication if the temperature exceeded 25 degrees Celsius. Members of staff responsible for the administration of medication had received appropriate training and two more care workers had been booked the course. Personal care was carried out in the privacy of the resident’s own room or the bathroom. Members of staff were observed attending to residents in a friendly and professional manner. One resident said, “The staff were wonderful.” Another resident said, “The staff are very good.” Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s decisions were respected and they were supported by care workers to have a fulfilling lifestyle. EVIDENCE: Resident’s interests and hobbies were recorded in their individual care plans. One resident regularly attended the adjoining day care centre for lunch and to take part in activities. A variety of leisure activities were also provided at the home. These included snakes and ladders, ludo, listening to music, watching television and craft activities. The manager said residents were making items to sell at an Autum Fayre which was being planned at the home. One member of staff said she chatted with the residents. One resident said, “The staff are very good they sit and talk to us.” An outside entertainer regularly visited the home. Local clergy visited the home monthly for a prayer meeting and communion. Visitors were welcomed into the home at anytime and offered refreshments. Residents and staff said the daily routine was flexible. Two residents said they
Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 13 could get up and go to bed when they wanted. Residents were encouraged to personalise their rooms with photographs, ornaments etc. The meal served at lunchtime on the day of the inspection looked appetising and wholesome. Although a choice of meal was not offered alternatives were readily available. The mealtime was unhurried allowing residents time to chat and enjoy their meal. All the residents asked said the meals were good. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents felt able to express their concerns. Some care workers had not been given the training necessary to ensure they understood the principles of safeguarding of vulnerable adults. EVIDENCE: A copy of the complaints procedure was displayed in the home and included in the statement of purpose and service user guide. The manager had investigated one complaint since the last inspection. A record of the complaint and investigation was available. The complaint was resolved following an apology to the complainant. No complaints have been made to the commission. Policies and procedures about the safeguarding of vulnerable adults were in place. The manager said new employees were asked to read these procedures as part of the induction programme but were not given further training. This issue was also discussed with a care worker who said she would report any concerns to the manager. The manager explained that allegations of abusive behaviour by a care worker had been made recently. However, she had failed to follow correct procedure and had dealt with the allegations herself. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises are well maintained and provide a comfortable and ‘homely’ environment for the residents. EVIDENCE: At the time of the inspection the home was clean, tidy, free from offensive odour and well maintained. All the residents who completed the survey indicated that the home was always clean. To further improve the premises laminate flooring has been fitted in the bedroom corridor, the office and the area outside the kitchen. New carpets have been fitted in all the bedrooms and most have been redecorated. The garden area was well kept and accessible to all residents. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 16 Laundry facilities were appropriate for the size of the home. An infection control policy was in place. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Members of staff were encouraged to acquire the skills and knowledge needed to provide effective care for the residents. Recruitment procedures were thorough. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to ensure the needs of the residents were met. A senior member of staff was on call for emergencies during the night when only one care assistant was on duty. The file of one care worker appointed since the last inspection was examined. This indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. It was evident from discussion with the manager and three care workers that training opportunities were available. Eight (66 ) members of staff had an NVQ level 2 in care. Induction training for new employees took place but this did not meet the ‘Skills for Care’ standard. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is effectively managed and the views of residents considered. However, a lack of training for care workers in some areas of health and safety could put residents at risk. EVIDENCE: The manager has experience of caring for older people and has obtained the NVQ registered manager’s award. She also keeps up to date with current practice by reading a variety of care journals. The manager explained that it was difficult to meet all the managerial responsibilities without any supernumerary time on duty. Members of staff said the manager was helpful and supportive. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 19 Residents and their relatives were encouraged to give feedback about the care and services provided at anytime. The role of the key worker involved spending time chatting to residents relatives. Residents had completed anonymous satisfaction questionnaires in July and August 2007. An annual development plan to help monitor the quality of the service and further improve outcomes for residents was not available. Records of financial transactions involving resident’s money were seen to be well maintained and up to date. The manager said that staff appraisals were taking place and a system for formal supervision was being implemented. The registered provider has not completed reports for the manager or the commission under regulation 26. A record of the food taken by individual residents was not kept. Fire alarms, emergency lighting and fire doors were checked weekly. A fire risk assessment was in place but this was dated 10/05/05 and should be reviewed. There was no evidence to suggest that regular fire drills were being held. One member of staff said she had not done fire safety training and had never been on duty when a fire drill had taken place. Records of the routine servicing of equipment were seen including an electrical installation certificate dated 17/11/05. The gas safety certificate, which must be renewed annually, was dated 13/10/05. The manager said the testing of small electrical appliances had taken place last year and was next due in October. Records maintained in the kitchen included fridge and freezer temperatures. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 20 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 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 2 Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15(1) Requirement Timescale for action 26/10/07 2 OP7 15(2)(b) 3 OP7 13(4)(c) 4 OP8 12(1)(a) (b) To ensure the care needs of residents are met. Care plans must accurately identify and address all the care needs of each resident. 24/06/05, 30/12/05 and 01/09/06 not met. To ensure staff have the 26/10/07 information necessary in order to meet the needs of all residents care plans and risk assessments must be reviewed monthly. Residents or their relatives must be involved in these reviews. To promote the safety of all 26/10/07 residents’ individual falls risk assessments must be carried out. Timescale of 01/09/06 not met. To ensure appropriate action is 26/10/07 taken to prevent residents from developing pressure sores or becoming malnourished risk assessments must be completed for each resident. Timescale of 24/06/05, 25/11/05 and 01/09/06 not met. When a resident is losing weight appropriate action must be
DS0000009487.V345144.R01.S.doc Version 5.2 Sunnyside Rest Home Page 22 taken. And a care plan developed. 5 OP9 13(2) To ensure medication is 05/10/07 managed correctly the medication administration record must not be signed to indicate a resident has taken their medication when they have not done so. To ensure all residents are 30/11/07 protected from abuse all members of staff must have training in safeguarding vulnerable adults. The manager must ensure that correct procedure is followed if allegations of abuse are made. 26/10/07 To ensure the manager receives proper support and supervision the registered person must make an unannounced visit to the home every month and provide a report for the manager under regulation 26. A copy of this report should be supplied to the commission. Timescale of 30/12/05 and 29/09/06 not met To ensure residents are receiving 26/10/07 a well balanced diet a record of the food provided for individual residents must be kept. To ensure all members of staff 30/11/07 understand the procedure to follow in the event of a fire regular fire drills must be held. Staff attendance records should also be kept to ensure all members of staff receive this training. To ensure all members of staff 30/11/07 understand how to promote the health and safety of residents training in fire safety must be provided. Timescale of 24/02/06 and 29/09/06 not met.
DS0000009487.V345144.R01.S.doc Version 5.2 Page 23 6 OP18 13(6) 7 OP37 26 Schedule 4 (5) 8 OP37 17(2) Schedule 4 (13) 23(4)(e) 9 OP38 10 OP38 23(4)(d) Sunnyside Rest Home 11 OP38 13(4)(a) To promote the health and safety of residents and staff an up to gas safety certificate must be obtained. 30/11/07 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 2 3 3 4 Refer to Standard OP9 OP30 OP31 OP33 OP38 Good Practice Recommendations Handwritten instructions on the medicines administration records should be signed and witnessed. Induction training for new care workers should meet the ‘Skills for Care’ standards. To ensure the manager has time to meet all her managerial responsibilities she should be allocated some supernumerary hours for this purpose. An annual development plan should be compiled. The fire risk assessment should be reviewed annually and up dated when required. Sunnyside Rest Home DS0000009487.V345144.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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
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