Inspection on 10/03/09 for Reminiscence Neighbourhood

This inspection was carried out on 10th March 2009.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Reminiscence Neighbourhood 07/10/08

Reminiscence Neighbourhood 19/09/07

Reminiscence Neighbourhood 06/01/07

Reminiscence Neighbourhood 03/07/06

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Key inspection report CARE HOMES FOR OLDER PEOPLE Reminiscence Neighbourhood Sunrise Senior Living Edgbaston 5 Church Road Edgbaston Birmingham B15 3SH Lead Inspector Sally Seel Unannounced Inspection 10th March 2009 08:10 DS0000066581.V374821.R01.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Reminiscence Neighbourhood Address Sunrise Senior Living Edgbaston 5 Church Road Edgbaston Birmingham B15 3SH 0121 450 8930 0121 455 6689 edgbaston.rc@sunriseseniorliving.com www.sunrise-care.co.uk Sunrise Operations Edgbaston Limited 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) Manager post vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The residential home provides accommodation for 25 elderly persons over the age of 65 years with Dementia. The home can accommodate two service users who are under the age of 65 years, but no younger than 50 years. 7th October 2008. Date of last inspection Brief Description of the Service: Reminiscence Neighbourhood provides residential care for up to 25 older people with dementia and other related memory disorders. The Home can accommodate two people with dementia who are younger than 65 years of age. Nursing care and respite care are not provided at the Home. Reminiscence Neighbourhood is located on the second floor of the Sunrise Senior Living Of Edgbaston Community and the living environment is safe and secure. Assisted living care is provided on the ground and first floor of the building. The Home is purpose built and the first residents receiving residential care came to live there in March 2006. It is situated in Edgbaston on a main road close to central Birmingham and benefits from being close to public transport links. There is ample off road parking at the front of the building. Reminiscence neighbourhood offers spacious accommodation within bedroom suites of varying sizes and layouts. Typically each suite consists of a bedroom, living area and an en suite bathroom comprising of toilet, sink and floor level shower or bath. In addition to this there are two assisted spa baths available for communal use and staff are available to provide assistance in these areas. There is a large lounge, large dining room, kitchen and numerous smaller seating areas located around the Home. There is a laundry available for residents’ use and staff are available to provide assistance in this area. There is a bistro and further dining areas located on the ground floor of the Home and residents receiving residential care are welcome to use these facilities. The Home is in excellent decorative order and is beautifully furnished. A facility for residents who choose to smoke is not provided within the Reminiscence Neighbourhood. Two passenger lifts provide residents with access to other floors of the Home. There is a secure external patio area and this is suitable for wheelchair users. Residents also have the opportunity to access the main garden areas with assistance from staff. There is a Wellness Service Team employed at the Home consisting of two registered nurses who oversee the health care needs of residents. There is an interesting and appropriate daily activities programme on offer for residents to participate in should they choose and a hairdressing salon is located on the ground floor of the building. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 5 There is a notice board displaying forthcoming events and other information of interest to residents and their visitors. Our most recent inspection report is available in the Home for anyone interested to refer to. Residents living at the Home purchase accommodation packages, the cost of which depends on the size of accommodation chosen and in addition to this purchase care packages dependent on the level of care that they require. Therefore interested parties should make all enquiries with regards to the cost of living at this home directly to the reminiscence co-ordinator. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. The focus of our inspections is upon outcomes for people who live in the home and their views of the service provided. This process considers the care homes capacity to meet regulatory requirements, minimum standards of practice and on aspects of service provisions that need further development. Two inspectors undertook this fieldwork visit to the home over the period of one day. The manager and staff members assisted us throughout. The home did not know that we were visiting on that day. There were twenty-one people living at the home on the day of the visit with the home having five vacancies. It was not possible to hold meaningful conversations with all of the people who live in this home due to their differing levels of dementia. However we did sit with residents at lunchtime and observed interactions between residents and staff. We also indirectly observed staff when supporting residents with activities. In addition to this information was gathered from speaking with the manager, executive director and staff. Four people were “case tracked” and this involved discovering their experiences of living at the home. This was achieved by meeting people or observing them, looking at medication and care records and reviewing areas of the home relevant to these people, in order to focus upon outcomes. Case tracking helps us to understand the experiences of people who use the service. Staff files, training records and health and safety records were also reviewed. Prior to the inspection the registered manager had completed an Annual Quality Assurance Assessment (AQAA) and returned it to us. This gave us a wealth of information with good examples about the home, staff and people who live there. Improvements and plans for further improvements have been taken into consideration. Regulation 37 reports about accidents and incidents in the home were reviewed in the planning of this visit. Six completed staff surveys were returned to Commission for Social Care Inspection, (CSCI). Information from all of these sources was used when forming judgements on the quality of service provided at the home. The people who live at this home have a variety of needs. We took this into consideration when case tracking Four individual peoples care provided at the home. For example, the people chosen have differing levels of care needs. We would like to thank everyone for his or her assistance and co-operation throughout the day we visited. What the service does well: Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 7 An wealth of information is produced by the organisation for individuals who are considering whether the home is right for them and people are encouraged to spend some time at Sunrise to ‘get a feel’ for the home. There are some good ‘social profiles’ that provide staff with some background knowledge of individuals past lives, relationships that are important to them together with the persons hobbies/interests so that staff are able to have meaningful conversations with people and stimulation can be provided around a persons interests. There are a number of items for people to pick up and use independently, i.e. rummage boxes, ‘dressing up’ clothes, carpenters bench and tools, desk and typewriter, games and so on. These offer an interactive and stimulating environment for people who experience dementia. The home is clean, tidy, and comfortable with aids so that people live in a home that meets there needs. People commented that they are impressed with the standards of cleanliness in the home and it has been rewarded for their efforts with a five star rating which is the highest that can be given from the Environmental Health Officer. What has improved since the last inspection? What they could do better: A small numbers of areas needing attention to ensure safeguards for the medication system have been identified at this visit:• The right medicine must be administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice. This is to ensure that the service user’s clinical needs are met. All new service users’ medication must be checked against either the discharge summary from hospital or a copy of the prescription. Any discrepancy must be rectified in a timely way and fully documented in the records. This is to ensure that the service users are administered their medication as prescribed. DS0000066581.V374821.R01.S.doc Version 5.2 Page 8 • Reminiscence Neighbourhood Care plans and risk assessments must be improved in the following areas:• All care plans and risk assessments must identify the needs of people who live in the home together with how these are to be met and any risks involved in meeting these. This will ensure staff have guidance to follow and practices are consistent so that individual’s health and safety is not compromised by poor staff practices. The care plans must be improved and detail the service users clinical needs and medication and any healthcare professional visits. This is to ensure that all staff have full access to information required to meet their clinical needs. • There have been some good practice recommendations made at the end of this report if the reader wishes to read these. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 9 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 Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 10 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have sufficient information about the home to enable them to make an informed decision about whether they would like to live there. Pre admission assessments are completed but do not reflect who has been involved in completing these so that individual’s needs are adequately met with choices promoted. EVIDENCE: The organisation has produced a statement of purpose and service user guide that contains lots of information about what the home is like, the staffing group and what services can be offered. Visitors have stated that they would have liked the direct contact number for the reminiscence unit. It would be useful if this was documented in the statement of purpose and service user guide. This would enable family members and friends to make contact from Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 11 the first day the person moves into the home. The statement of purpose and service user guide is available in the main reception area of the home which ensures easy access for people who are considering living there. We recommend that these information guides are produced in other formats, such as, large print and audio cassette. This will ensure that individuals are able to read the contents of these should they wish to. The reminiscence co-ordinator in the Annual Quality Assurance Assessment (AQAA) recognises that this is something that needs to be done. We were told that people considering whether the home is the right place for them are able to visit and the organisation has produced a, ‘moving in’ pack. This enables individuals to gain an insight into what ‘Sunrise’ can offer them and staff are able to demonstrate whether the people’s needs are able to be met. In the AQAA it states, ‘Prospective residents are encouraged to visit Sunrise before they move in. Many come for lunch with their family, and may stay for our afternoon tea and social event’. People told us:“Mum very settled here – in fact she is a different mother to when she came in“. “They look after me very well“. “I like it her“. Two care records were reviewed of people who had recently moved into the home. These had pre admission assessments that were completed prior to the individuals moving into the home. However, we could not clearly identify who had been involved in writing the assessments as they were typed and signed by the reminiscence co-ordinator. The reminiscence co-ordinator has acknowledged this and in the AQAA confirms, ‘Residents could sign assessment forms to confirm that it is a true record’. This practice will ensure that individuals and or their representatives are involved in confirming their needs and how they would prefer to have these met so that all care provided by staff is person centred. Staff told us:“Not always aware of new admission“. “Like working here, nice people and try hard to look after you“. A request is made to families and or representatives to complete personal profiles of individuals who are moving in to the home. These are good ‘social profiles’ which provide staff with information about the person’s life, achievements, relationships and interests/hobbies. This will assist staff to have meaningful conversations with individuals where possible and ensure activities are purposeful to the person. This is important as people living in the reminiscence part of the home experience dementia type illnesses which mean that they may have some memory difficulties and need help to express their Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 12 own feelings. The AQAA confirms, ‘We will be training one member of our team to be a Dementia Champion; she will attend training sessions and conferences and cascade her knowledge to the rest of the team’. This is a positive approach and shows that the reminiscence co-ordinator is keen for staff to promote and learn from examples of good practices of care regardless of a person’s mental health, social background or religion. Contracts of terms and conditions of stay at the home were available, and included the fees to be paid so that individuals are informed about conditions of stay at the home and the room they are to occupy. The reminiscence coordinator confirms in the AQAA, ‘Residents come to live at the home on a trial period of 30 days and this gives them the opportunity to decide if they would like to live there on a permanent basis’. The certificates of registration and liability insurance are on display in the lobby area of the home which enables anyone to see them when visiting the home. Copies of previous inspection reports are available from the reminiscence coordinator and this ensures that information is available to people living in the home and their representatives. The home does not offer intermediate care but respite stays are welcomed. This is where people come to live at the home for short periods of time, such as, convalescence, to have a break and or give their carer a break from their caring role. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 13 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans and risk assessments do not always promote peoples health, social, psychological and emotional wellbeing. Medication administration and practices require some improvement so that people who live in this home have their health and safety protected. EVIDENCE: Each person had a written care plan and in this home they are referred to as Individual Service Plans (SP). This is an individualised plan about what the person is able to do independently and states what assistance is required from staff in order for the person to maintain their needs. We looked at two peoples care records in detail and two records were partly reviewed. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 14 There was some good information about individuals’ personal care needs and preferences so that people should receive care in a manner they need and like. Care plans described people’s skills so that they remain as independent as possible, for example, ‘Is keen and able to dress herself but will need assistance from staff to decide what clothes she may wish to wear for the day and look with X through her wardrobe for choice of day wear which is normally a skirt blouse cardigan and most days a hat which may come from the ‘dressing up’ section in the communal areas’. Another record confirmed, ‘encourage to be independent and only intervene if necessary. Ensure doors are kept closed or locked when attending to X’s hygiene needs’. From our observations throughout the day we found that individuals appeared to be well supported by staff to choose clothing appropriate for the time of year, some people wore jewellery and make up which reflected individual cultural, gender and personal preferences. Some of the information to help staff to provide the right care to individuals was not always correct. For example, we found in one care record that the person’s profile confirmed their interest in, ‘watching songs of praise, knitting and crocheting’. This person was previously active in the church, had shingles and used a heat pack for pain and had loose teeth. However, the care plan stated that this individual was not practising their religion, to encourage with activities in the home and no mention of pain or loose teeth. We were told by the manager that they had only received this persons profile last week and they were on leave. In another care record it was documented, ‘aid sleep likes to have three pillows on her bed. Staff should offer a hot drink and encourage to rest and also encourage elevating her legs to reduce fluid retention’. We established that this person sleeps in a chair all night but we could find no care plan or risk assessment for staff to follow as guidance. We also noted that this persons legs were attended to by district nurses. Therefore it would be an important to have the knowledge as to whether this persons legs were elevated whilst sleeping in a chair to aid their healing and prevent them from getting worse. We also observed one person spending long periods of time, alone, in the ‘snoozelan’ room. This room is unlocked and the person was unsupervised. The equipment in this room could pose a potential hazard to individuals who have dementia as they may not have an awareness of risks or dangers that surround equipment in this room if they are not supervised by staff when in there. For example, there are trailing lights on the floor which are potentially a tripping hazard and individuals could become entangled in these resulting in injuries. However, we could not find any care plans and risk assessments which provide staff with guidance in relation to individuals being unsupervised in the ‘snoozelan’. Therefore individual’s health and safety is not protected by the homes procedures and practices. Risk assessments are undertaken for falls, nutrition and skin soreness but these also have shortfalls which mean that people could be placed at risk by inappropriate intervention from staff. For example, in one falls risk assessment it confirmed that the person needed help to get up from the dining Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 15 room chair and the person’s mental health meant that they may display challenging behaviour on occasions. We could not find any information that would support staff in managing this persons needs to keep them safe from falling and injuries. We found a nutritional risk assessment tool that provided a score of 9 which should have been 12 which could impact upon how staff determines their interventions with this person. We also found a tool used to measure a persons skin integrity which indicated that this individual was at risk but did not indicate that this individual had a neurological deficit and broken skin. Also we could not find any care plan that identified the person’s broken skin. Therefore a requirement has been made for all care plans and risk assessments to be written to meet all individuals care needs with risks detailed for staff to follow. This means that staff have guidance to follow and a consistent approach to care planning and risk management to protect individuals health and safety. As at the previous inspection wellness nurses are employed at the home in an advisory role; they do not undertake any direct nursing duties and are a supplementary service provided for people who live at this home. All individuals receive a monthly ‘Wellness check’, during which they are weighed and their health care needs are reviewed. Care records that we sampled showed that people have regular appointments with healthcare professionals such as the district nurse and doctor. We found guidance for staff to follow when people became unwell and needed a doctor. For example, ‘X would find a visit to the GP surgery very distressing therefore all consultations, should be held at Sunrise if possible. A care manager and or X must accompany to hospital’. However, we also found that in some of the care records documentation was lacking around consistent weight checks of some people who live at the home. This was pointed out to the reminiscence coordinator. Therefore we recommend that weight records are updated consistently in care records. This will ensure that weight information is easily retrievable so that individual’s weights can be monitored so that underlying medical conditions do not go undetected. One healthcare professional told us. “Visits every Thursday, someone available, to meet and greet, they carry out instructions and it is a pleasure to visit“. Staff told us:“Communication – sometimes good and sometimes not good“. “Communication – communication book, daily log, daily notes and handovers that occur at change of shift“. At lunchtime we observed a staff member giving one person medication using their fingers to take each medication out of the medicine pot. This practice must stop as it does not promote good hygiene practices and puts people at risk from infections. The staff member also answered the telephone whilst administering medication to people who live in the home. We recommend that this is reviewed as it could distract staff away from their medication duties and Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 16 lead to medication errors being made. We spoke with the staff member and found that they did not know what the two tablets that they were administering to a person were for but did get the British National Formulary (BNF), (which provides a guide to all current drugs, doses and side effects), and looked them up. We recommend that staff have some knowledge of the medication they are administering to people living in the home together with any side effects that may arise so that people are protected by safe medication practices. The pharmacist inspection lasted two hours. Four people who live in the home medicines were looked at, together with their Medicine Administration Record (MAR) chart, care plans and daily records. The medicine management has improved since the last inspection. The majority of the medicines had been administered as recorded on the MAR chart and records reflected practice. However some errors were seen due to staff not following the systems installed in the home or not accurately recording what they had done. Some medicines had been signed as administered when they could not have been and others were unaccounted for. Staff had failed to check in the medication properly upon receipt to the home. This had resulted in the medicines running out and new supplies not obtained in time. One resident was being administered warfarin at a dose not checked by the warfarin clinic due to a missed appointment. Staff had failed to obtain a new appointment. Documentation was missing from the daily records and care plans. These lacked information, for example, why a medicine had been prescribed, when blood samples should be taken or any communication with external healthcare professionals. This is of concern as the staff would be unaware of any important changes or be able to use this information to fully support the clinical needs of the residents. The medication round was observed. This had improved since the main inspection on the 10th March and the lead care manager treated the residents with respect at all times. Good practice was observed in preparing and administering the medication as well as recording what had occurred. However knowledge regarding what the medicines were for was very poor. The care assistant would not be able to support the resident’s clinical needs at all. The controlled drug register was incorrect at the time of the inspection. Staff had checked in and recorded one medicine as a strength of 20mg, but the supply contained 8 x 10mg tablets as well as 20mg tablets. This had been checked by another member of staff but they too had failed to recognise the error. This was to be rectified after the inspection. The home has installed a quality assurance system to check the administration and recording of medication. Random audits are undertaken for six resident’s Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 17 medicines and MAR charts on a regular basis and a full monthly audit is also done. We observed staff using individuals preferred names and introduced people to the inspectors in a respectful manner, such as, ‘this is doctor X and they enjoy talking with people, like holding surgery as they did in their working lives’. All individuals preferred names were documented in the care records that we sampled. People can have their own telephones in their rooms at an additional cost or a mobile telephone can be provided for people to use in the privacy of their own room. Also people can hold their own room keys if they wish. People told us:“100 happy, Mother is well cared for and always clean“. “It is much better since Christmas“. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Activities and social stimulation could be further enhanced by ensuring they meet people’s individual needs, interests and abilities so that individuals are not disadvantaged. The meals provided are wholesome and satisfying. EVIDENCE: The home has a dedicated activities coordinator and has developed an activity programme which consists of, newspaper discussion, dominoes, card games, progressive mobility, picture cards – talk about ‘Famous People’ with care managers, crosswords and word search challenges, craft activities and painting and colouring. The programme is displayed on notice boards within the home and in the lift area for people to refer to as they choose. We were told that events/ festivals are celebrated, such as, St. Patrick’s Day, Burns Night and so on. On the day of our visit we observed flower arranging in the morning and an outing took place in the afternoon whereby transport took people for a drive out. Transport is readily available two afternoons per week but can also be Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 19 booked for day trips. It was positive to note that one person who enjoys playing bridge was enabled to go to another part of the home where this is played. However, meeting individual’s expectations in relation to social stimulation and activities is not always consistent for all people who live at the home. For example, we looked at activity records for one male and two females who live in the home and found that they were almost identical. These confirmed 3pm social, morning papers, baking and jigsaw. One person’s interests were listed as watching songs of praise, knitting, crochet, Music – hymns and coral music. As at the previous inspection it is recommended that activities should be person centred which means they should be based upon the individual’s gender, preferences and abilities. This will ensure that people have the opportunity of engaging in meaningful activities of their choice which is an important factor for people who experience dementia. The hairdresser visits and we noted on the activity planner, ‘Church service at St. George’s’ for those people who wish to participate. People are able to have their newspapers and magazines delivered so that can continue to read articles, which interest them. Some newspapers are also supplied by the organisation. People can go out with their families as they choose and this encourages their independence and assists them to maintain links with the community. The home has an open visiting policy and this enables people to see their visitors as they choose, enhancing their quality of life. On the day we visited we observed family members and friends visiting people who live at the home. People told us: “Can come any time“. “There are a lot of activities – exercise, painting baking cakes, hair is done weekly“. “Can visit when it suits me“. The home has a four week cyclical menu in place and people who live in the home can have their own individual copies and we also found a copy available in the lift area. The AQAA confirms, ‘There is a choice of at least two dishes at every meal, and all 3 meals in the day provide hot food. Our Chef changes his menu regularly, according to the season, and makes good use of seasonal fruits and vegetables. There is the opportunity for snacks and drinks throughout the day. A regular daily event is our 3pm social, where tea / coffee and cakes are served both in reminiscence and downstairs in the Bistro’. People were observed to have their meals in the dining room, which was nicely presented and it was positive to see that people were offered salt and pepper with their meals as at the previous inspection these seasonings were not offered. Individuals were asked if they had finished their meals before staff removed plates. When people had finished their main meals they were offered extras if they wished. We observed people being assisted with their meals where required with dignity and respect which is a significant improvement Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 20 from the previous inspection. Although lunchtime continues to feel as though staff did not always take the time to engage in conversation with people as with some patience is needed. We were informed that this may because staff were nervous due to the inspectors visiting the home. The two inspectors had meals at lunchtime but found these to be cold and due to some individuals needing a long time to eat their meals these would also be cold. However, the reminiscence co-ordinator told us that they had offered to warm individual’s meals but they declined. We observed one person being brought to eat their meal in a wheelchair and was not transferred into a chair which would have been more comfortable for them. We did see staff sit down with people to have their meals but this did not appear to be coordinated as most people had finished their main courses and then had to wait for their next course. People were offered coffee after they had eaten their meals by the reminiscence co-ordinator but choices of tea; water and or juice were not offered. The reminiscence co-ordinator acknowledged this but confirmed that they knew what people liked. There are no records maintained in relation to recording individual’s food intake but it is recommended that a consideration is made in recording people’s fruit and vegetable portions daily. This will ensure the recommended ‘five a day’ is being offered to people to maintain a healthy diet. People told us: “Likes her room and says the food is nice“. “Food very good – better than boarding school“. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The complaints procedure is comprehensive and is accessible to people who live at the home and their representatives should they wish to make a complaint. The home has policies, procedures and staff training, which should safeguard residents from harm. EVIDENCE: The home has a comprehensive complaints procedure for people living in the home and their representatives to use if they need to make a complaint. This is on display in the home and is included in the statement of purpose, service user’s guide and contracts of residency. The AQAA states, ‘Comments forms are located in the lobby, and a comments book is available outside the dining room’. There are also trays which are situated by the lift which have the names of people who live at the home for easy reference purposes. These trays enable families and representatives of the people who live at the home are able to place any comments, complaints and/or suggestions. Another good forum for discussing any complaints and or suggestions is the residents and family meetings that are held monthly at the home. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 22 Since the last visit to the home, CSCI had received one complaint but through negotiations with the providers this was resolved. We found that all previous complaints have been investigated and details of the actions that had been taken to prevent a similar occurrence. A letter was sent to the complainant advising of the outcome of the investigation and the action, which would be taken. People told us: “Relatives meeting – timing variable, if I had any problems I would tell the manager“. “I would go to the ward sister“. “I would tell staff“. These comments suggest that people who live in the home and their family members know how to make a complaint and feel confident that their views would be listened to. The home have an adult protection policy in place and had the local multi agency guidelines to follow; this ensures that staff have guidelines to follow in the event of any situation occurring. We were told the majority of staff have received training in the Protection of Vulnerable Adults (POVA) and this is documented on the training tracker that we were shown. This should ensure that staff have the knowledge to safeguard people who live in this home from harm if an allegation should arise. As at the previous inspection one safeguarding matter continues to be ongoing. Six staff surveys were returned to us. When asked if they know who to speak to if not happy, all six responded ‘yes’. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 24, 25 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a physical environment that is appropriate to the specific needs of the people who live there. The home is well-maintained, decorated and furnished to a high standard. EVIDENCE: ‘Sunrise’ is a very large and prominent building with many historical features. It has a large parking area to the front of the building and access to the home is via the main reception which is on the ground floor. A person is seated in this area, known as a ‘concierge’ and they ensure that people are greeted when they come into the home. A signing in and out book is provided so that people’s safety is promoted. There is also a buzzer system which if pressed Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 24 outside by visitors staff can then let them in but the main doors were open on the day we visited. The external grounds include terraced patio areas and an abundance of plants and decorative ornaments. The reminiscence unit is situated on the second floor of the building and provides residential care to people who have dementia or varying levels of memory loss. Assisted living is provided on the ground and first floor of the building. A partial tour of the reminiscence unit was completed to review areas which were relevant to the people we case tracked, such as, communal areas of the home, and some bedrooms. Corridors are wide and people were seen moving around the home as they chose to. We could see that there had been a lot of thought in respect of providing and an interactive environment for people with dementia to make it more meaningful. For example, within the wide corridors there are black and white photographs, a dressing up space with dressing table, clothes and costume jewellery, a carpenter’s workbench had been created so that people can identify with these familiar items. We did mention to the reminiscence coordinator that a desk which has an old typewriter for people to use if they wish had no chair to facilitate this. Also the carpenter’s bench did have objects that may pose a risk to people living in the home, such as, pliers. The reminiscence co-ordinator and executive director would look at these items and replace with alternatives. Toilet doors are colour coded and door signs are in a large print with Braille for residents with sight impairments and this assists in orientating residents living at the home thus promoting their independence. We did find that in one communal toilet the call bell was connected to a rather short cord which would mean that people requiring any assistance could not reach this. We were told that this is being addressed. Also in one bathroom we found incontinent pads and bottles of cleansing lotion on the floor area and we found toiletries, such as, liquid soap and cleansing lotions for all people in the home to use. These practices do not promote good infection control and places individuals who live in the home at risk from potential cross infections. We pointed this out to the reminiscence co-ordinator who will address these issues. It was positive to see that push button locks that can be overridden in the event of an emergency are fitted on to the communal bathroom doors so that individual’s privacy is respected whilst maintaining their safety. Corridors are wide and suitable for both independently mobile residents and wheelchairs users, handrails are provided and the home is well lit. There are lounges and smaller seating areas where people can choose to be quiet and read or watch the world go by as they wish. Chairs have been arranged to promote social interaction as far as possible. All of the areas we Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 25 looked at including the dining room are decorated and furnished to a high standard. Personalised memory boxes, containing personal items relevant to individual’s lives were situated outside of people’s bedroom doors. These are used as an aid to assists people to identify their own rooms. They also highlight to staff and other people who live in the home what is important to individuals to provide stimulating conversations. Bedrooms can accommodate single or double occupancy and have kitchenettes. There are also walk in shower rooms and people could choose to have a spa bath. People are encouraged to bring in their own possessions in order to have familiar items around them to make their rooms as homely as possible. If people who live in the home would like lockable facilities then they are able to request this but we did note that this is not referred to in the service user guide so that people are aware of this from the time they move into the home. A snoozelan, as mentioned earlier in this report is a room, where people are able to relax in and stimulate their senses. It contains visual and tactile equipment which is known to benefit people and aid calmness. However, as individuals care plans and risk assessments must reflect the equipment in this room that could be potentially hazardous to people if they were to use it without staff supervision. For example there are trailing lights that could pose a potential tripping or an entanglement hazard. People told us: “The home is always spotless“. “Very nice, it is beautifully furnished and elegant“. The home was clean and there were no offensive odours. The environmental health officer has undertaken a recent visit and awarded the home five stars for cleanliness and hygiene, this is the highest rating that can be given. This means that the home should have good hygiene procedures in relation to food handling and this will minimise the risk of any cross contamination occurring. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 26 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home maintains adequate staffing levels to meet the needs of the people living at the home. Recruitment procedures ensure that individuals are safeguarded form harm. Staff undertake training so that they should have the knowledge to perform competently within their roles. EVIDENCE: The reminiscence co-ordinator informed us that twenty-three staff make up the team which consists of, senior lead care manager, lead care managers and care managers. Agency staff are used to cover when required. We were told that staffing levels are, five staff in the mornings, in the afternoon there are four staff and five in the evenings, with two staff working during the night. We viewed the staff rotas for some of February and March up until the day of our visit and found that in the main staffing levels have been maintained. However, at the homes last inspection we were told that the staffing numbers for the morning shifts were, six, in the afternoon between four or five with a minimum of four and in the evening at least four staff on duty. There were nineteen people living at the home at our last inspection and at this inspection there were twenty-one people living at the home. Also we have received a mixture of comments from completed staff surveys. When we asked, ‘Are Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 27 there enough staff to meet the individuals needs of all the people who use the service?’ two responded, ‘usually’, and four responded, ‘sometimes’. Additional comments were recorded, ‘I feel we need more staff in the morning.’ ‘It would be better if we had someone who comes in for a few hours to do breakfast for the residents, and then carers would have an extra person to help get residents up.’ These perceptions of staffing levels need to be taken into account by the reminiscence co-ordinator and organisation so that staffing levels are not potentially impacting upon people living in the home receiving individualised person centred support. In the AQQA it confirms that over 50 of staff had completed National Vocational Qualification (NVQ) Level 2. This should ensure that skilled and knowledgeable staff support people living in the home to meet their identified needs. People told us: “Staff are lovely“. “Can visit when is suits me- seen more staff today than the last time I came“. Three staff records were reviewed and were found to contain all of the relevant information including two written references, POVA first checks (Protection of Vulnerable Adults), CRB checks (Criminal Records Bureau). Staff have been provided with job descriptions and people receive a comprehensive induction into the home so that they are aware of their responsibilities. This includes training in health and safety issues so that they should work in a safe and competent manner. The reminiscence co-ordinator informed us that all staff undertake within the first 90 days of employment a ‘Core training’ programme. Information in the AQAA confirms the contents of this as, ‘Sunrise Fundamentals, Moving and Handling, Activities of Daily Living, Wellness Fundamentals, Activities, Dining Services/food hygiene, Housekeeping, Customer Relations, Safeguarding Adults, and dementia training’. We were given two training trackers to examine staff training but it was difficult to retrieve clear information from these as some staff names on the one did not always correspond with the other. Therefore this would be difficult to use as a monitoring and reviewing tool. However, we found that in the main staff have received mandatory training together with more specialist training. For example, food hygiene, health and safety, first aid, infection control, moving and handling, fire training, medication training, knowledge of dementia, adult protection and so on. This training should ensure that staff has the knowledge and skills to meet the needs of the people living in the home both individually and collectively. Although we received a variety of responses from staff that we spoke with on the day we visited which places into question whether staff are retaining the knowledge they receive when completing training courses to provide reassurance that people living in the home are in safe hands at all times. One staff member when we asked about their knowledge in relation to fire safety and safeguarding vulnerable adults did Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 28 not show that they had a good awareness around these subjects. Another member of staff confirmed that they had completed Sunrise training but no basic food hygiene or infection control. In answer to the fire procedure one response was, “Don’t move anyone, get walky talky from office and communicate with downstairs, they will guide us – no panel on unit“. Another staff member was not aware of the ‘whistle blowing’ policy. Also on the day we visited we observed one member of staff walking around home and into dining room with disposable gloves on. The reminiscence co-ordinator informed us that this was a new member of staff. When we asked in the staff surveys, ‘Do you feel you have the right support, experience and knowledge to meet the different needs of people who use services?’, three responded ‘usually’, two said, ‘sometimes’ and one, ‘always’. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 29 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management and administration of the home is based upon openness and respect. Further improvements need to be made so that people’s health and safety is consistently maintained. EVIDENCE: The reminiscence co-ordinator, Cheryl Talbot is employed to manage the reminiscence unit and as at the previous inspection they are currently in the process of making an application for registration with us. Ms Talbot has previously been a registered manager in Wales for two years and has experience in dementia care and is a registered nurse. We were also informed Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 30 that Ms Talbot started the registered manager’s award when working in Wales and she intends to start this again when registered. This shows that Ms Talbot is committed to her role as manager in order to lead the staff team. The reminiscence co-ordinator is supported by a new executive director who has extensive experience of working in care homes for the organisation. We were told by the reminiscence coordinator and the executive director that they will be looking to make further improvements to the services within the home so that good outcomes for the people living at Sunrise can be gained. The manager holds staff and residents meetings in order to enable people to voice their opinions and make suggestions about how the service could be further improved. We were able to view minutes from these meetings and we found that discussions take place around, staffing; any changes to the organisation, training any suggestions for improvements are made. Information supplied by the home prior to our visit in its Annual Quality Assurance Assessment (AQAA) informs that internal monitoring systems for quality assurance include an annual quality inspection, a Gallup Poll and monthly Regulation 26 visits. In addition questionnaries to gain the views of residents, relatives and staff are sent out. During a discussion with the manager they explained that a comprehensive quality audit of the home is completed each year by staff coming from America to complete this. We were told that, people who live in the home, relatives and staff are spoken with, environment is looked at and equipment, and replacements are made where needed. However, the reminiscence co-ordinator is also considering completing monthly audits. This will compliment the yearly audits so that systems that are in place ensure that views of people who live in the home and visitors are sought and plans put in place for future development of the home. As at the previous inspection the homes staff do not manage the personal finances of people who live there however there is a facility for the safe keeping of small amounts of residents’ money should they choose to use this facility. Improvements need to be made in relation to staff receiving regular supervision as we found in the staff files that we sampled this is not happening. The reminiscence co-ordinator has recognised this in the AQAA as something the home could do better. It is recommended that staff receive formal supervision as a minimum six times per year. Formal supervision ensures that staff are given the appropriate support they require and identifies any training, which may be required in order to meet the needs of people living in the home, individually and collectively. This is important due to the shortfalls in care plans and risk assessments that have been discussed earlier in this report. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 31 Staff told us: “Managers approachable and get support“ “Staff meeting and supervision – not very often“ Health and safety and maintenance checks had been undertaken in the home to ensure that the equipment was in safe and full working order. Also monthly health and safety meetings take place which ensures the home is well maintained and all equipment is in good working order. Regular fire checks of the system and fire doors are undertaken to ensure that they are in full working order. Fire drills are undertaken regularly and the names of staff attending are recorded to ensure that all staff attends two fire drills per year. This should ensure that staff have the knowledge to act appropriately to safeguard the residents in the event of a fire. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 32 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 3 3 3 3 3 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 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 33 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 OP9 Regulation 13(2) 12(1) Requirement The right medicine must be administered to the right service user at the right time and at the right dose as prescribed and records must reflect practice. This is to ensure that the service user’s clinical needs are met. All new service users’ medication must be checked against either the discharge summary from hospital or a copy of the prescription. Any discrepancy must be rectified in a timely way and fully documented in the records. This is to ensure that the service users are administered their medication as prescribed. All care plans and risk assessments must identify how resident’s needs are to be met and the risks involved for staff to follow so that resident’s health and safety is not compromised by poor staff practices. Timescale for action 31/03/09 2. OP9 13(2) 31/03/09 3. OP7 13(4) 24/03/09 4. OP8 12(1) The care plans must be improved 31/03/09 and detail the service users clinical needs and medication DS0000066581.V374821.R01.S.doc Version 5.2 Page 34 Reminiscence Neighbourhood and any healthcare professional visits. This is to ensure that all staff have full access to information required to meet their clinical needs. 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. Refer to Standard OP1 Good Practice Recommendations The statement of purpose and service user guide is produced in alternative formats to ensure it is accessible to all people regardless of their sight abilities. All information gathered in assessments should identify who has been involved in this process to ensure individuals and or their representatives are having their say in what their needs are and how they would like their needs to be met. The weight records of people who live in the home must be consistently detailed in retrievable care records so that individuals weights, any losses and or gains, can be monitored at a glance by all staff so that any underlying medical conditions do not go undetected. It is advised that all staff receive further training in the clinical indications and general side effects of the medicines they handle. The home should consider expanding activities so that these meet peoples individual needs to include gender differences to ensure that no one is disadvantaged. The system for recording and evaluating activities should be reviewed so that they can be used to monitor outcomes for people who live in this home. It is recommended that a review of the current system for monitoring and recording fruit and vegetable portions that individuals are offered the recommended ‘five a day’ to ensure their health and wellbeing is maintained. The items in the ‘life skills’ sections of the home, such as, DS0000066581.V374821.R01.S.doc Version 5.2 Page 35 2. OP3 3. OP8 4. 5. OP9 OP12 6. 7. OP12 OP15 8. OP22 Reminiscence Neighbourhood 9. OP36 10. OP38 the carpenters bench and ‘snoozelan’ room need to be risk assessed for use of the individuals who live at the home to ensure that it does not compromise peoples health and safety with risks managed appropriately. The manager must ensure that all staff receive regular formal supervision minimum of six per year so that people who live in the home are assured that staff who provide care to them have their practices and performances regularly reviewed and monitored. A record should be maintained of all staff involved in fire drills that reflects the homes fire procedure. Greater numbers of staff should participate in fire training to safeguard residents from harm in the event of a fire. 11. OP38 Greater numbers of staff undertake first aid, food hygiene and infection control training to promote the health and wellbeing of residents. Reminiscence Neighbourhood DS0000066581.V374821.R01.S.doc Version 5.2 Page 36 Care Quality Commission West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway, Birmingham B1 2DT National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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