CARE HOMES FOR OLDER PEOPLE
Sunnyside Rest Home Coupland Close Whitworth Lancashire OL12 8QQ Lead Inspector
Susan Hargreaves Unannounced 04 May 2005 10:00 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 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 F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Sunnyside Rest Home Address Coupland Close Whitworth Lancashire OL12 8QQ 01706 659917 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Whitworth Elderly and Disabled Care Trust Mrs Glenys Elizabeth Thompson Care Home only 11 Category(ies) of Old age, not falling withing any other category registration, with number (OP) 11 of places Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 06 October 2004 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 service users 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 day care centre. Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 8 hours. No additional visits have been made since the last inspection. A tour of the premises took place and staff files and care records were inspected. Members of staff on duty, a student on work placement, 9 residents and 5 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? What they could do better:
The pre-admission assessment should be amended to ensure information about all the care needs of a resident are obtained prior to admission. Involving residents and their relatives in care planning and regularly reviewing all care plans would ensure that all care needs are met.
Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 6 Risk assessments must be carried out for falls, nutrition and pressure sores in order to identify the level of risk for each resident. Where a risk has been identified a care plan must be written explaining how the risk is to be managed. The manager was advised to provide written instructions about when medication should be given for individual residents prescribed ‘when required’ medication. This will ensure that residents receive their medication at exactly the right time. To reduce the risk of errors all hand written instructions on the medicines administration records should be signed and witnessed. To ensure appropriate action is taken if allegations of abuse are made the procedure should be amended to give clear guidance. Appropriate self-closing devices must be fitted to the double doors leading to the bedrooms. Resident’s safety in the event of a fire could be compromised if these doors remain fastened open with cabin hooks. This was recommended by the fire service following a visit on 18 March 2004. Recruitment procedures were not robust and potentially put residents at risk of abuse. All the required pre-employment checks must be completed prior to appointment. This problem has been ongoing for over a year and must be addressed. An effective system for monitoring and improving the quality of care and services provided at the home must be developed. This includes obtaining the views of residents and compiling an annual development plan. 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 F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 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 standard(s) 1, 2 and 3. Information about the home and the care and facilities provided are readily available to prospective residents and their relatives. The admission procedure was reasonably thorough in order to ensure the needs of the resident could be met. EVIDENCE: The statement of purpose was updated in January 2005. This contained detailed information about the care and services provided. A copy of the complaints procedure has been added to the service user guide. On admission, residents were given a statement of terms and conditions of residency in the home. This included the number of their allocated room. The files of 2 resident’s were inspected. Each file contained a pre-admission assessment of need. However, the pre-admission assessment completed by the manager did not include information relating to a number of items listed in this standard. The pre-admission assessment provided useful information for the care plan. The manager explained that all future residents would receive written confirmation that their assessed needs could be met at the home. Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9,10 and 11 Care planning has improved considerably since the last inspection. However, the lack of appropriate risk assessments meant there was the potential for health care needs not to be fully met. Care was given in a manner, which ensured the privacy and dignity of all residents. Medication was well managed promoting good health. EVIDENCE: The individual care plans of two residents were inspected. These care plans were clearly written and explained how the care needs were met. However, neither of these care plans included a falls risk assessment. A pressure sore and nutritional risk assessment had not been carried out for one of these residents and a care plan for minimising the effects of pressure was not in place. There was evidence that care plans had been reviewed but this had not been done monthly. There was no evidence to suggest that the resident or their relatives were involved in care planning. However, the relatives of one resident said that they were not bothered about seeing the care plan and had every confidence that all care needs were met. Information relating to terminal care and arrangements after death were included in the care plans. A written report about the care given to individual residents was completed during each shift.
Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 10 Members of staff were observed attending to residents in a caring and professional manner. Personal care was carried out in the privacy of the resident’s own room or the bathroom. Four members of staff consulted considered promoting privacy and dignity to be an important aspect of care. None of the residents had requested to take responsibility for self-medicating. Appropriately trained members of staff administered all medication. Medication was stored correctly and records were seen to be up to date. Hand written instructions on the medicines administration records had not been signed or witnessed. The manager was advised to develop a protocol for individual residents prescribed medication ‘when required’ Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 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 standard(s) 12, 13 and 15. The daily routine was flexible in order to meet the needs and preferences of residents. Social activities were well managed and visitors were welcomed into the home at anytime. The meals were varied and offered choice. EVIDENCE: Residents and staff confirmed that the daily routine was flexible. Residents got up and went to bed at a time of their choosing. Information relating to this was included in the care plans. One resident said, “ You can do as you like.” Several residents regularly attended the adjoining day care centre to join in activities. During the inspection residents were observed pursuing their own interests e.g. reading, watching TV, or chatting to visitors and staff. Visitors were welcomed into the home at anytime and one visitor said that she sometimes stayed for meals. Members of the local clergy visited the home regularly. One lady said, “ The vicar comes monthly and does communion.” Lunch served at the time of the inspection looked wholesome and appetising. Resident’s comments included, “food is very nice” and “meals are suitable, varied and we’re given a choice.” Members of staff were observed assisting residents to eat lunch in a patient and sensitive manner. Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 12 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 standard(s) 16 and 18 Complaints were taken seriously and investigated. Members of staff had a clear understanding of adult protection issues, which protects residents from abuse. EVIDENCE: A comprehensive complaints procedure was in place. There have been no complaints to the home or the Commission since the last inspection. One visitor said that she would discuss any problems or concerns with the manager. Policies and procedures relating to the protection of vulnerable adults were in place. However, the procedure to be followed if allegations of abuse were made was unclear and needed amending. This issue was discussed with four members of staff. They were aware of the importance of reporting any concerns immediately. Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 19 The home was clean and well maintained. This meant that service users had a comfortable and homely place to live. EVIDENCE: At the time of the inspection the home was clean, tidy and well maintained. This provided a safe and comfortable environment for the residents. One resident said, “It’s home from home because it’s small.” The garden area was well kept and accessible to all residents. Appropriate self-closing devices, as recommended by the fire service over a year ago, had not been fitted to the double doors leading to the bedrooms. At the time of the inspection these doors were kept open by means of cabin hooks. This could potentially put residents at risk in the event of a fire. Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 Staffing levels were appropriate to meet the assessed needs of the residents. Recruitment procedures were not robust potentially putting residents at risk. Training for all members of staff was actively encouraged. EVIDENCE: Examination of the duty 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 throughout the night in case of emergency. This was necessary because only one member of staff was on duty in the home during the night. Residents said, “Staff are very nice, very obliging.” “Staff are friendly, I’ve never seen any of them loose their temper.” The files of four care assistants were inspected. These indicated that all the required pre-employment checks to ensure protection of the residents had not been completed. Three of the files did not contain two written references. An old CRB check had been accepted for one employee. The reasons for several gaps in employment were not explained on the application form. It was evident from discussion with the manager and four members of staff that training was actively encouraged. This included, moving and handling, health and safety, first aid and NVQ level 2. Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36, 37 and 38 All care staff received regular supervision and training. Appropriate procedures were in place to safeguard the health, safety and welfare of residents. The system for obtaining the views of residents was inadequate. EVIDENCE: Feedback about the care and services provided was encouraged. A ‘comments book’ had been placed in the entrance hall. The relatives of several residents had completed anonymous satisfaction questionnaires. Comments included ‘the staff are always friendly and very good with the residents’ and ‘simply the best’. However, a method of formally obtaining feedback from residents was not in place. An annual development plan was not available. Members of staff said that they had an annual appraisal and regular supervision. Records to support this were available. Appropriate policies and procedures relating to health and safety were available. Safety notices were displayed in the home.
Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 16 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 x 15 3
COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x x 3 3 3 Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 17 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. 1. Standard 3 Regulation 14(1)(d) Requirement The registered person shall not provide accommodation to a service user at the care home unless, so far as it shall have been practicable to do so - (d) the registered person has confirmed in writing to the service user that having regard to the assessment the care home is suitable for the purpose of meeting the service users needs in respect of his health and welfare. The registered person shall ensure that (b) any activities in which the service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of servis users are identified and so far as possible eliminated. A falls risk assessment must be completed in respect of each resident. The registered person shall (b) keep the service users plan under review. Unless it is impracticable to carry out such consultation, the Timescale for action 24 June 2005 2. 7 13(4)(b) (c) 24 June 2005 3. 4. 7 7 15(2)(b) 15(1) 24 June 2005 24 june 2005
Page 18 Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 5. 8 12(1)(a) (b) 6. 19 23(4) 7. 29 19 Schedule 2 8. 533 24(1)(a) (b) registered person shall, after consultation with the service, or a representative of his, prepare a written plan as to how the service users needs in respect of his health and welfare are to be met. 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. The registered person shall after consultation with the fire authority - make adequate arrangements for detecting , containing and extinguishing fires. Appropriate self-closing devices must be fitted to the double doors leading to the bedrooms. (Timescale of 11 May & 31 Dec 2004 not met) Staff files must contain all the information listed in schedule 2 of the Care Homes Regulations 2001. (Timescale of 10 Dec 2003, 11 May & 6 Oct 2004 not met) The registered person shall establish and maintain a system for- (a) reviewing at appropriate intervals, and (b) improving, the quality of care provided at the care home. (Timescale of 10 Dec 2003, 11 May & 6 Oct 2004 & 28 Jan 2005 not met.) 24 June 2005 24 June 2005 24 June 2005 29 Juky 2005 Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 19 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. Refer to Standard 3 9 Good Practice Recommendations The pre-admission assessment tool should be amended to include all items listed in 3.3 of this standard. A written protocol should be developed for individual residents prescribed when required medication. All hand written instructions relating to medication on the medicines administration record should be signed and witnessed. The procedure to be followed if allegations of abuse are made should be amended to clearly explain what action needs to taken. An annual development plan should be compiled. 3. 4. 18 33 Sunnyside Rest Home F57 F07 S9487 Sunnyside V223735 040505 Stage 4.doc Version 1.30 Page 20 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road Clayton-Le-Moors, Accrington Lancashire. BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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