CARE HOMES FOR OLDER PEOPLE
Sunnyside Rest Home Coupland Close Whitworth Lancashire OL12 8QQ Lead Inspector
Mrs Susan Hargreaves Key Unannounced Inspection 10:00 24th July 2006 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.V289119.R01.S.doc Version 5.1 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.V289119.R01.S.doc Version 5.1 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 Mrs Glenys Elizabeth Thomson Care Home 11 Category(ies) of Old age, not falling within any other category registration, with number (11) of places Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18th October 2005 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 £253.50 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.V289119.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This key unannounced inspection took place over six hours. At the time of this inspection nine residents were living at the home. One additional visit was made since in January to monitor recruitments practices. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, residents and visitors 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?
Since the last inspection residents received confirmation in writing, prior to admission, that their needs could be met at the home. A sufficient number of staff have received training in first aid to ensure a first aider is on duty for all shifts. To provide a safer environment for the residents an up to date electrical installation certificate has been obtained. Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 6 What they could do better: 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. Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 7 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.V289119.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. 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. Admission procedures were thorough. A pre-admission assessment was completed for each resident prior to admission. 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 received confirmation in writing that their needs could met at the home. Standard 6 is not applicable to this service. Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. 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. Privacy and dignity was promoted for all residents. Care plans were not in place for all residents. Risk assessments for nutrition and pressure sores were not carried out. Some procedures relating to medication were not managed correctly. EVIDENCE: The individual care records of two residents were inspected. The care plans for one of these residents identified the personal care needs of the resident and explained how these needs were met. A risk assessment relating to moving and handling was in place. However, the falls risk assessment did not clearly identify the risk factors. There were no risk assessments in place for nutrition and pressure sores. These care plans were reviewed monthly. A care plan and appropriate risk assessments were not in place for the other resident. 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.
Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 10 Residents were registered with a GP and had access to other healthcare professionals. At the time of the inspection none of the residents were self-medicating. Appropriately trained members of staff administered all medication. Records for the management of medication were in place. However, hand written instructions on the medication administration records were not signed or witnessed. Records of medication received into the home were not kept. A record of medication returned to the chemist was seen. Medication was stored in a locked filing cabinet in the office. The temperature of this room was checked and recorded daily. It was evident from these records that the temperature of this room had been 25 degrees Celsius or above for several weeks. The manager was advised to put the thermometer in the drawer where medication was stored and contact the chemist for advice if the temperature continued to be 25 degrees Celsius or above. Personal care was carried out in private. Members of staff were observed attending to residents in a friendly and professional manner. One member of staff explained in detail how she promoted dignity for all residents. One resident said, “The staff are very nice.” A visitor said, “The staff are friendly.” Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. 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. Leisure activities were well managed and suited residents needs. Visitors were welcomed into the home at anytime. The daily routine was flexible in order to meet the needs and preferences of residents. Meals were wholesome and appetising. EVIDENCE: Resident’s interests and hobbies were recorded in their individual care plans. Several residents regularly attended the adjoining day care centre to join in activities. Special events were also celebrated e.g. birthdays. On these occasions arrangements were made for an entertainer to visit the home. Resident’s were enabled to practice their chosen religion. A prayer meeting was held monthly and a local vicar visited regularly to give communion. Visitors were welcomed into the home at anytime and offered refreshments. Residents and staff said the daily routine was flexible. One resident said, “I get up and go to bed when I want.” 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
Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 12 and enjoy their meal. A care assistant was observed offering assistance to the residents in a caring and sensitive manner. All the residents asked said the meals were good. Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints would be taken seriously and investigated to further improve the service. Appropriate procedures and training were in place to ensure the protection of residents at the home. EVIDENCE: A comprehensive complaints procedure was available. No complaints had been made to the home or the commission since the last inspection. Policies and procedures relating to the protection of vulnerable adults were in place. This issue was discussed with one member of staff. They were aware of the procedure and said they would report any concerns immediately. Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was clean and comfortable and provided a homely environment for the residents. Laundry facilities were appropriate for the size of the home. EVIDENCE: At the time of the inspection the home clean and tidy. Although the home was generally well maintained the decorations in some areas especially the dining room were beginning to look tired. A planned programme for the routine maintenance and redecoration of the premises was not in place. The garden area was well kept and accessible to all residents. Laundry facilities were appropriate for the size of the home. Policies and procedures for the control of infection were in place. Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were thorough. More than 50 of care assistants had NVQ qualifications. Induction training needed further development to ensure consistency in the delivery of care. EVIDENCE: Examination of the duty rota confirmed that a sufficient number of staff were on duty for all shifts to meet the assessed needs of the residents. A senior member of staff was on call for emergencies during the night when only one care assistant was on duty. The files of two members of staff appointed since the last inspection were inspected. One of these indicated that all the required pre-employment checks to ensure protection of the residents had been completed prior to appointment. It was evident from the other file that this member of staff had started working before a CRB or POVA check had been obtained. It was evident from discussion with the manager and a care assistant that training opportunities were available. Eight (61 ) care assistants 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.V289119.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. 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 has an experienced and competent manager. There was no effective system for obtaining the views of residents. Formal supervision for all care staff does not take place regularly. Unsafe moving and handling techniques are used. All members of staff need training in fire prevention. EVIDENCE: The registered manager has an NVQ level 3 in care and has many years experience of caring for older people. Members of staff said she was helpful and supportive. Residents and their relatives were encouraged to give feedback about the care and services provided at anytime. A ‘comments book’ was available in the entrance hall but there were no recent entries. Anonymous satisfaction questionnaires were distributed occasionally but this had not been done for more than a year. The manager was advised to develop a more formal system
Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 17 for obtaining the views of residents and their relatives. An annual development plan was not available and the registered provider has not completed reports for the manager or the commission under regulation 26. Records of financial transactions involving resident’s money were seen to be well maintained and up to date. Discussion with one member of staff and examination of two staff files confirmed that regular formal supervision was not taking place. Fire alarms and emergency lighting were tested monthly. Records of fire drills confirmed that these took place regularly. Not all members of staff had received up to date training in fire safety. A fire risk assessment was in place. A member of staff qualified to administer first aid was on duty for all shifts. Records of the routine servicing of equipment were seen including an electrical installation certificate dated 17/11/05 and gas safety certificate dated 13/10/05. The testing of small electrical appliances took place on 27/06/06. During the inspection members of staff were observed using an inappropriate moving and handling technique. Wheel chairs without footplates were also in use. Where service users do not wish to use footplates, this must be subject to a risk assessment and recorded in individual care plans. Appropriate policies and procedures relating to health and safety were available. Safety notices were displayed in the home. Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 18 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 X 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 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 2 2 Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 19 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) Timescale for action Unless it is impracticable to carry 01/09/06 out such consultation, the registered person shall, after consultation with the service user, or a representative of his, prepare a written plan as to how the service user’s needs in respect of his health and welfare are to be met. Residents and or their relatives must be involved in planning care. Timescale of 24/06/05 and 30/12/05 not met. A care plan must be in place for 24/07/06 each resident from the day of admission. 01/09/06 The registered person shall ensure that - (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks and (c) unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. A falls risk assessment must be completed for each resident. Falls risk assessments must clearly identify the risk factors.
DS0000009487.V289119.R01.S.doc Version 5.1 Page 20 Requirement 2 3. OP7 OP7 15(1) 13(4)(b) (c) Sunnyside Rest Home 4. OP8 12(1)(a) (b) 5. OP9 13(2) 6. OP29 19(1)(b) Schedule 2 7. OP33 24(1)(a) (b)(2)(3) The registered person shall ensure that the care home is conducted so as (a) to promote and make proper provision for the health and welfare of service users; (b) to make proper provision for the care and, where appropriate treatment, education and supervision of service users. Risk assessments relating to pressure sores and nutrition must be carried out for all residents. Timescale of 24/06/05 and 25/11/05 not met. The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. A record of all medication received into the home must be kept. Medication must be stored in accordance with manufacturers instructions below 25 degrees Celsius. The registered person shall not employ a person to work at the care home unless (b) he has obtained in respect of that person the information and documents specified in (i) paragraphs 1 to 7 of schedule 2 A satisfactory POVA/CRB check must be obtained before a new employee starts work. Timescale of 24/06/05 and 25/11/05 not met The registered person shall establish and maintain a system for (a) reviewing at appropriate intervals; and (b) improving, the quality of the care provided at the care home. (2) The registered person shall supply to the Commission a report in respect of any review conducted
DS0000009487.V289119.R01.S.doc 01/09/06 01/09/06 24/07/06 29/09/06 Sunnyside Rest Home Version 5.1 Page 21 8. OP36 18(2) 9. OP37 17(2) Schedule 4 (5) 10. OP38 23(4)(d) (e) 11. OP38 13(5) by him for the purpose of paragraph (1), and make a copy of the report available to service users. (3) the system referred to in paragraph (1) shall provide consultation with service users and their representatives. The registered person shall ensure that persons working at the care home are appropriately supervised. All care staff must have formal supervision six times a year. The registered person shall maintain in the care home the records specified in Schedule 4. A copy of any report made under regulation 26. A copy of this report must be supplied to the commission. Timescale of 30/12/05 not met The registered person shall after consultation with the fire authority - (d) make arrangements for persons working at the care home to receive suitable training in fire prevention. Timescale of 24/02/06 not met. The registered person shall make arrangements for provide a safe system for moving and handling service users. Correct moving and handling techniques must always be used. Wheelchairs with footplates must be used unless a risk assessment states otherwise. 29/09/06 29/09/06 29/09/06 24/07/06 Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 22 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. Refer to Standard OP9 OP19 OP33 Good Practice Recommendations Hand written instructions on the medicines administration records should be signed and witnessed. A plan for the routine maintenance and renewal of the fabric and redecoration of the premises should be produced. An annual development plan should be compiled. Sunnyside Rest Home DS0000009487.V289119.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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