CARE HOME ADULTS 18-65
9 Sunnyfield Avenue 9 Sunnyfield Avenue Morecambe Lancashire LA4 6EU Lead Inspector
Mrs Marie Cordingley Unannounced Inspection 24th April 2007 13:00 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service 9 Sunnyfield Avenue Address 9 Sunnyfield Avenue Morecambe Lancashire LA4 6EU 01524 410678 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) Mrs Heather Cottingham vacant post Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19/02/06 Brief Description of the Service: 9 Sunnyfield Ave is situated in the Bare area of Morecambe. It is typical of the houses in that area and as such does not detract from the community presence of the people who live there. It is registered with the Commission for Social Care Inspection to care for up to 6 adults with a learning disability. 9 Sunnyfield Ave is owned and managed by Mrs Heather Cottingham. The bedrooms are all of a single type and reflect the interests and personality of the current occupants. There is a lounge and a separate diner/kitchen. The home has a well-maintained rear/side garden and a small garden to the front of the home. At the time of the inspection the charges of this home were £515 weekly. This charge excludes private chiropody and hairdressing. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of this home included a site visit, which was carried out over an afternoon and early evening. During the visit we talked to the people who live at the home, several staff members and the manager. We looked at a variety of documents, including residents’ individual plans and staff members’ personnel files. We looked around all areas of the home including residents’ private accommodation. Prior to the visit we sent written surveys out to all of the people who live at the home and their relatives, asking their opinions on all aspects of daily life there. We also received a completed questionnaire form the manager giving us lots of information about the running of the home such as staff training, staffing levels and dates of recent health and safety checks. As part of the inspection we carried out a case tracking exercise. This involved us looking very closely at selected peoples’ care from the point that they moved into the home. What the service does well:
Sunnyfield Avenue is a very busy home where residents spend much time carrying out activities of their own choosing. When we arrived at the home all of the residents were out carrying out individual activities. Two people were travelling home from a trip away where they had been taking part in a national pool competition, one person was out horse riding, one person was on a shopping trip and the remaining two people were at college. When we talked to residents on their return they told us that this was a typical day and that they were able to enjoy their activities on a regular basis. Several of the residents spoke about a holiday they had planned and were looking forward to this very much. l When people returned home we observed them to be very happy and relaxed in their surroundings. There was a very nice atmosphere in the home as they all got along well with each other, the staff and the manager. The two people who had been away on a trip seemed very excited to be home and especially pleased to see the manager. When we talked to residents they all told us that they were very happy living at Sunnyfield Avenue and spoke highly of staff and the manager. One resident
9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 6 said ‘‘this is the best place I have ever lived, I never want to live anywhere else.’’ Sunnyfield Avenue is a home where people are encouraged to be as independent as possible and to make everyday choices in their lives. Residents spoke of many examples of how they made everyday choices. One resident said ‘’I can make my own mind up about things and I can tell Heather (the manager) what I think.’’ When we looked around the home we noted that every resident had a key to his or her own private bedroom. We looked at peoples’ bedrooms and saw that they were all very personal. In discussion, people told us that they had been encouraged to personalise their rooms by choosing colours of walls and carpets for instance, and displaying their personal possessions such as posters, soft toys and ornaments. People who live at Sunnyfield are encouraged to be involved in the every day running of the home. The manager has a number of processes in place to ensure residents have their say, such as regular meetings where people can discuss issues such as activities or menus. In addition, residents are actively involved in the recruitment of new staff and take part in staff interviews. They are asked to express their opinions about candidates and are also asked to give their feedback for staff members’ probationary reviews and annual appraisals. One staff member said ‘’I think it’s brilliant that the residents get involved in choosing staff. After all it’s their home and they should have a say who comes in it.’’ The manager of this home works very hard to ensure that people are supported to access services outside of the home. When we looked at peoples’ individual plans we found that a number of external professionals were involved in their support, for example, professionals from the Behaviour Intervention Team. Where such professionals were involved the manager had ensured that any advice they had given was clearly written in the relevant person’s individual plan. What has improved since the last inspection?
Since the last inspection a number of areas within the home have been redecorated. The residents’ lounge has been refurbished and has new furniture. Residents were involved in choosing the furniture and the colour scheme for the room. Two of the residents’ bathrooms have been updated to a good standard. Staffing hours at the home are now planned in accordance with each resident’s individual activities. Staffing is very flexible to ensure that every person’s individual needs can be met. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 7 In line with a recommendation made following the last inspection, the manager has now provided all of the residents with a pre-stamped postcard addressed to the Commission for Social Care Inspection, therefore enabling residents to contact an inspector easily and quickly should they wish to. 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. The summary of this inspection report can be made available in other formats on request. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are provided with enough information about the home to decide if they want to live there. The manager ensures that staff have enough information about new people to meet their needs properly. EVIDENCE: When responding to the written survey, all of the residents said that they had received enough information to help them decide if they wanted to move to the home. In further discussion, people also told us that they had been able to visit the home before they moved in to meet staff, other residents and the manager. The home currently provides a Service User Guide to prospective residents that gives them information about daily life at the home such as activities, meals provided and staffing. The manager is currently looking at various formats for the Service User Guide (such as audio) for the benefit of those people who do not read. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 10 When we looked at selected residents’ individual plans we found that prior to them moving into the home, the manager had completed a thorough assessment detailing all their daily care needs, likes and dislikes and how these would be met at Sunnyfield Avenue. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Peoples’ care is carefully planned in line with their own individual needs and preferences. People are encouraged to make choices and be involved in their own care planning. EVIDENCE: All the residents at the home have a written individual plan which details their care needs, likes and preferences and how they would like to be supported. It was evident when reading these plans that residents had been involved in their development and had regularly expressed their opinions in their review. Plans were very individual to the person they related to and covered areas such as health care needs, preferred activities and every day likes and dislikes. Throughout the visit we found lots of evidence that residents were encouraged to make choices and be as independent as possible.
9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 12 One person told us how she had recently made a significant decision and that the manager had supported her greatly through this process. In discussion the manager and staff demonstrated a good approach to risk taking and were aware that well managed risk taking is an important part of personal development. A good process has been developed to ensure that risk assessments are carried out to help keep people safe when they are trying new experiences, for example. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 13 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 &17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living at Sunnyfield Avenue are encouraged to take part in their preferred hobbies and pastimes. EVIDENCE: We talked to people who told us that they had lots of opportunities to enjoy their favourite hobbies and activities. One person said ‘’I am always out doing something. I like going out.’’ Records of activities showed that there were lots of pastimes available for people including yoga, horse riding, discos and shopping trips. In addition, a number of people who live at the home attend college on a regular basis. Throughout our visit we observed people looking very content and relaxed in their surroundings and moving freely around the home.
9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 14 All residents confirmed that staff respected their privacy and that they had keys to their bedrooms. When two people arrived home from a trip we observed the manager giving them their unopened mail, which she had kept safe for them. In discussion, the manager demonstrated a genuine commitment to enable residents to express their views and opinions and to be involved in the daily running of this home. This is done in a number of ways including regular residents’ meetings in which they are encouraged to express their opinions and make suggestions. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are supported to access health care whenever they need it. Peoples’ medication is safely managed. EVIDENCE: When we viewed residents’ individual plans we found many examples of people being supported to access health care professionals such as GP’s or community nurses whenever they needed to. We were also able to confirm that routine health care such as dental and chiropody appointments are arranged to meet each individual resident’s needs. When completing surveys residents expressed satisfaction with standards of care and this was also reflected in our discussions with them during the visit. One resident said ‘’I know that if I have any problems I can talk to Heather (manager). I like talking to Heather she always listens and helps me sort things out.’’ 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 16 We viewed a selection of mars (medication administration records) and examined the stock of medication held within the home. Mar sheets were completed to a good standard with no errors or omissions noted. Medication was found to be safely and appropriately stored. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The manager ensures that the people living at this home are protected from all forms of abuse. EVIDENCE: In discussion with the manager and staff we were able to confirm that the home has clear guidance in place telling staff what they must do if they suspect that a resident has been harmed in any way. In discussion managers and staff demonstrated a good understanding of the procedures and their role in protecting vulnerable adults. Since the last inspection the manager has had cause to refer one casual staff member to the POVA register (a list of people barred from working in care by the Secretary of State). However, this was not in relation to an incident occurring within the home. When viewing records we were able to confirm that the manager had dealt with the situation very well and carried out all her legal obligations. The home has a complaints procedure in place that explains how to make a complaint and how this complaint will be managed. This procedure is provided in written and video format. After speaking to residents we were satisfied that if they were to make a complaint it would be dealt with in an appropriate and timely fashion.
9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 18 However, we found that the home did not have a formal method of recording complaints. We advised the manager that a complaints book should be implemented, which details any complaint made, action taken and the outcome of any related investigation. In line with a recommendation made at the last inspection, the home has now provided every resident with a postcard stamped and pre addressed to the commission to enable the resident to contact an inspector quickly and easily. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at this home are provided with a good standard of accommodation that is homely and comfortable. EVIDENCE: We viewed all areas of the home including peoples’ private bedrooms and found that the home was generally very well maintained. All the areas we viewed were warm, comfortable and clean. Residents’ bedrooms were decorated to a nice standard and several residents told us that they had chosen the colour schemes in their rooms. In addition, people told us that they had been encouraged to personalise their rooms with their treasured possessions such as photographs, soft toys and ornaments. All the people who live at this home have keys to their bedrooms. One resident said ‘’I like having my own room and when I lock it I know that no one else will go in there.’’
9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 20 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is careful to ensure that only suitable people work in the home so that residents’ wellbeing is protected. Residents are involved in the selection of new staff so that they have a greater say in the running of the home. EVIDENCE: Staff at this home are well trained to carry out their role. Training such as person centred planning and abuse awareness is regularly provided. In addition, records we viewed confirmed that all staff members had completed their mandatory health and safety training such as first aid and moving and handling. There are 7 care staff members employed at the home and 3 of them hold National Vocational Qualifications in care. The home are working towards the national target of 50 qualified staff. The manager has a very good approach to recruitment and there are robust procedures in place to ensure that only people who are suitable to work in the
9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 21 care field are employed. All potential staff members must provide a full employment history and provide explanation for any gaps that exist. In addition, two references must be provided, wherever possible one being from the last inspector. Prospective staff must also agree to a Criminal Records and POVA check prior to their employments. When we talked to residents and staff we also heard of how residents were fully involved in the recruitment of new staff members. Residents are on the initial interview panel for new staff members and are also involved in staff members’ probationary reviews and annual appraisals. Staff at this home receive good support from their manager who is available at all times to provide advice and guidance. In addition, staff benefit from individual meetings with their manager (often called supervision) where they can discuss areas such as training, personal development or any concerns that they may have. Formal supervision does not take place as often as is recommended (6 times per year) however we are satisfied that the manager has close daily contact with the staff and as such carries out informal supervision on a regular basis. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Sunnyfield Avenue is a well managed home which is run in the best interests of the people who live there. EVIDENCE: In discussion the manager demonstrated a genuine commitment to upholding peoples’ rights and safeguarding the well being of residents. The manager also demonstrated that she constantly updates her own knowledge by taking part in external training courses. In addition, we found evidence when reading peoples’ individual care plans that the manager is very good at working with other professionals and ensures that any advice given is clearly stated in residents’ individual plans.
9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 23 The manager also showed a commitment to making ongoing improvements to the service provided and has implemented a number of quality assurance processes in place which involve residents and give them the opportunity to express their view and opinions and say whether they are satisfied with aspects of daily life at the home. The manager works hard to ensure that the health and safety of residents, staff and visitors is protected. This is reflected in the home’s health and safety policy and large number of supporting procedures such as fire safety, infection control and COSHH (control of substances hazardous to health). In addition, we were also able to confirm that all staff members were provided with the health and safety mandatory training such as moving and handling and first aid, following their appointment. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 4 X 3 X X 3 x 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 25 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard Good Practice Recommendations A record of all complaints and subsequent action taken should be maintained within the home. All notifiable incidents (as described in Regulation 37) should be reported to the Commission without delay. 50 of care staff should hold National Vocational Qualifications in care at level 2 or above. Staff should receive formal one to one supervision at least six times each year. 9 Sunnyfield Avenue DS0000009879.V331868.R01.S.doc Version 5.2 Page 26 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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