Inspection on 19/09/07 for Reminiscence Neighbourhood

This inspection was carried out on 19th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 10/03/09

Reminiscence Neighbourhood 07/10/08

Reminiscence Neighbourhood 06/01/07

Reminiscence Neighbourhood 03/07/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Reminiscence Neighbourhood Sunrise Senior Living Edgbaston Church Road Edgbaston Birmingham B15 3SH Lead Inspector Amanda Lyndon Key Unannounced Inspection 19th September 2007 09:10 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Reminiscence Neighbourhood Address Sunrise Senior Living Edgbaston 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) Dorothy Fagan (Reminiscence Co Ordinator) Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Currently under review 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. 6th January 2007 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.V345252.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. The basic weekly fee to live at the Home is from £1008 for a private room in a shared suite and from £1071 for a private studio suite. This includes all food, staff on duty, monthly health and wellness checks, assistance with administration of medicines, promotion of life skills, use of “Snoezelen” equipment and a weekly spa bath. Additional services include a “Reminiscence Plus Care Service”, “Reminiscence Care Plus Plus Programme” and a “Continence Management Programme”. The costs of these are available at the Home. All new residents pay a one off community fee charge of between £5760 and £6120 and this covers the cost of maintaining the communal areas of the Home. Items not included within the packages above include hairdressing, private chiropody, outings/trips, staff escorts for outings or hospital visits and guest meals. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by us is upon outcomes for people who live in the Home and their views of the service provided. This process considers the Care Home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provision that need further development. Information obtained and used in the planning of this field work visit included Regulation 37 notification reports of any accidents or incidents involving residents and one complaint received since the last visit. The Home Manager had completed a self- assessment document, giving some information about the Home, residents and staff which was also taken into consideration. Prior to the visit questionnaires had been sent to residents and their relatives however these had not been returned at the time of writing this report. The field work visit referred to in this report was undertaken over one day by two Inspectors when there were eleven residents living at Reminiscence Neighbourhood, one of these was in hospital. The Home was not aware that we were visiting. Information was gathered by speaking with all residents, the Home Manager, three care staff and the “wellness” nurse. An additional method of obtaining information was “case tracking” two residents in order to establish their individual experiences of living in the Care Home. This involved meeting and observing them, discussing their care with staff, looking at care files and focussing on their outcomes. A partial tour of the Home relevant for these people was also undertaken. Tracking residents’ care helps us understand the experiences of residents. No immediate requirements were made on the day of the visit What the service does well: Prior to coming to stay at the Home prospective residents are encouraged to sample what life would be like to live there. Following an assessment of prospective residents’ care needs a letter is sent out to residents or their families confirming whether their care needs could be met at Reminiscence Neighbourhood. Residents have access to a wide range of health and social care professionals so that their health care needs are met. Residents are cared for in a respectful manner by staff working at the Home and this ensures that their self- esteem and dignity are maintained Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 7 The staff team have a good knowledge about residents’ individual care needs and staff approach residents in an understanding and sensitive manner so that residents feel calm and relaxed. A wide variety of activities are available for residents to participate in that should meet all their interests. Residents are supported to form friendships with each other so that they can share their experiences. Residents, relatives and staff are involved in producing an interesting newsletter. Visitors are made to feel welcome at the Home and are encouraged to spend time there. Residents are supported to continue to practice their chosen religions and this ensures that their beliefs and individuality are respected. Residents are served a variety of healthy meals that meet any special dietary requirements for reasons of health, cultural background or taste. Complaints are investigated in an appropriate and timely manner so that residents and their relatives are confident that their views are listened to. The living environment is suitable for residents with dementia, physical disabilities and sensory impairments. A “snozelen room” containing visual and tactile equipment/aids designed to either calm or stimulate the senses is provided for residents deemed to benefit from this environment. Aids and adaptations are provided so that the independence, choice and dignity of residents are promoted whilst maintaining their safety. Regular maintenance checks of this equipment ensure that it is safe to use. The gender mix of care staff reflects the gender mix of residents so that care is provided in an understanding manner. Comprehensive staff training is provided so that staff should have the appropriate skills and knowledge to work safely and effectively in order to provide a good standard of care to residents. The Home Manager has a good understanding of individual residents’ care needs and positive comments were received about her management style. She ensures that staff feel supported within their job roles. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? What they could do better: Each resident should have a personalised plan of care outlining the specific support required by staff in order to meet their care needs based on their personal preferences in respect of their daily lives, their health and their abilities. Care plans should be reviewed at any time that residents’ care needs should change in order to ensure that they receive the care that they require. Residents should be consulted about whether they wish to participate in large group activities so that they are not expected to join in activities that they may not enjoy. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 9 A review of the system in place for the serving of meals should be reviewed so that residents are served the meals of their choice. A lapse in recruitment procedure on one occasion does not safeguard residents. A fire drill should be arranged so that staff have the necessary skills and knowledge to act safely in the event of an emergency. Bed safety rails must not be used without bed safety rail protectors in place as this places residents at risk of serious injuries. The system in place for the safekeeping of residents’ money must improve in order to safeguard residents. 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. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 10 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.V345252.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Admission processes are thorough and prospective residents have enough information in order to decide whether they would like to live there. EVIDENCE: A revised comprehensive statement of purpose and service user guide had been produced and was included in the “welcome pack” provided in new residents’ bedrooms. These were easy to understand and available in a large print format for ease of reading for people with poor eye sight. Details of the costs involved in living at the Home and the services provided were included. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 12 Residents or their families are given a contract of terms and conditions of residency and these identified the fees included and excluded within the weekly care package purchased by individual residents, the cost being dependent on the level of care that they required. This also included detail of the “one off” community fee charge that covered the cost of maintaining the communal areas of the Home. All residents currently living at the Home were privately funded. The Home Manager outlined the comprehensive admission process starting with a financial assessment to determine whether the prospective resident is able to meet the costs of living at the Home. Following this a comprehensive assessment of their individual care needs are undertaken by the Registered Manager and “Wellness nurse”. This consists of two separate assessments, normally undertaken in individuals’ own home environments and covers all information required in order to determine whether their individual care needs could be met whilst living at the Home. “ Resident profiles” are completed by prospective residents or their representatives to obtain information about their social, cultural and leisure interests. A medical history is obtained from the residents’ Doctor as part of this process. Following this a letter is sent by the Organisation confirming if prospective residents’ care needs could be met by the Home. Prospective residents are encouraged to spend time at the Home in order to sample what life would be like to live there. Residents come to live at the Home on a thirty day trial period and following this a review is held involving the resident, their family (or other significant person), the “wellness” team and the care staff. This provides all present with the opportunity to put forward their views about whether the person’s individual care needs are being met at the Home and whether they wish to continue to live there. Intermediate care is not provided at Reminiscence Neighbourhood however short stay care can be provided. Reminiscence Neighbourhood DS0000066581.V345252.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health provision is good however inconsistencies regarding the content of care plans may prevent residents from receiving care in the way that they prefer. Residents receive their medication in a safe manner at the times that they require. Residents are supported to take risks so that they lead fulfilling lives. Residents are cared for in a respectful manner and this ensures that their self esteem and dignity are maintained. EVIDENCE: Each resident has an “Individual Service Plan” (ISP). This is a written plan outlining the care and support that they require based on their individual care needs. Information used in the planning of these included comprehensive and interesting “Life Stories” of the two residents case tracked. This should ensure Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 14 that any preferences that individual residents have regarding their daily lives can be maintained whilst living at the Home. Some inconsistencies were noted within the content of care plans, some had been personalised yet others did not reflect the preferences of residents and were general in nature. For example one care plan identified that a resident wore a pendant so that she could call for help if she fell, however this was found to not be the case as she did not have the ability to use one. Another ISP stated that a resident would be encouraged to participate in social activities but did not identify what her particular interests or abilities are. An ISP had not been written regarding the support required by staff in relation to a resident with limited communication despite this being her primary care need. A comprehensive ISP had been written regarding the support required by staff to reduce a resident’s anxiety. This included detail of any “trigger factors” that may cause her to become anxious and it was evident that staff had a good understanding of their role regarding this in order to reduce her anxiety. ISPs are reviewed with the resident, their family and the Home’s staff thirty days following the residents’ admission to the Home and then each month thereafter. They should be reviewed at any time that an individual’s care needs change, so that staff are aware of what support is required in order to meet their needs. An exception to this was that the ISP of a resident whose care needs had changed greatly during their trial visit had not been updated to reflect her current care needs and this may prevent her care needs from being met. This was brought to the attention of the Home Manager and a revised ISP was sent to us shortly after the visit. Residents are supported to take risks as part of their daily lives and written documentation regarding this was available. A number of these were found to be generic in nature and had not been personalised to reflect the needs of individual residents. Other risk assessments had been hand written and included good detail of the particular risks relevant to individual residents and the safety measures to be implemented, for example regarding moving and handling residents. Daily reports were recorded in good detail and identified the activities that residents had participated in during that day. “Wellness nurses” are employed at the Home in an advisory role, they do not undertake any “hands on” duties and are a supplementary service provided for residents. All residents receive a monthly “Wellness check”, during which they are weighed and their health care needs are reviewed. Since the last visit the care staff team have a better understanding of the role and responsibilities of the “wellness nurse” and communications between these teams appear to have improved. The “Wellness nurses have undertaken recent training relevant to their job roles including infection control, health and safety and medication. Residents have access to a range of Health and Social Care Professionals, for example, Community Nurses, Dentists, Opticians, Chiropody and Mental Heath Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 15 Care Workers. Daily reports identified that one resident had complained of toothache and there was evidence that she was examined by a dentist the following day. Residents can retain their own Doctor on admission to the Home (if the Doctor is in agreement). Since the last visit, improvements have been made regarding the management of medication so that residents should receive their medication in a safe manner. None of the residents have been assessed as having the ability to self administer their own medication and all are supported by the care staff regarding this. The “Wellness nurses” are responsible for the ordering, receipt, storage and auditing of medication and in addition to this the care staff also “check in” medication received into the Home. Staff responsible for the administration of medication have undertaken relevant training so that they should have the necessary skills and knowledge to undertake this safely. Medication administration charts (MAR) were generally well maintained and copies of prescriptions were available so that staff could check that all medication supplied was the same as what was ordered. MAR charts clearly identified all medicines that had been discontinued or courses completed so that they were not administered in error. Two staff signatures were not obtained for all hand written entries onto MAR charts and this may result in writing errors. Stock balances of medication sampled were correct. Residents appeared to be supported well to maintain their personal hygiene and choose clothing, jewellery and make- up that reflected their age, gender, cultural background and the time of year. The “Life Story” of one resident stated that she liked a shower every day and written records confirmed that the care staff were supporting her to do this on the vast majority of days. Residents have the option of holding the key for their bedroom doors in order to maintain their privacy. One resident has currently chosen to use this facility. Residents confirmed that staff knock their doors before entering and this ensures that their privacy is respected. Residents’ post is either delivered to them unopened or to their families. The preferred names of residents are recorded in their care plans and staff were observed greeting them by these names. Residents have the option of using the Home’s portable phone in order to make telephone calls in private or have a private telephone line installed in to their bedroom. Care records are stored securely and this upholds residents’ confidentiality. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities on offer and opportunities for social stimulation meet the needs and expectations of the majority of residents living at the Home. There are good systems in place to ensure that relatives have up to date information regarding residents’ care. The choice of wholesome and well presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. EVIDENCE: An activities co ordinator is employed by Sunrise, and she has the overall responsibility of arranging activities for all residents within the building (including those people receiving assisted living support). In addition, the care staff employed at Reminiscence Neighbourhood and a team of volunteers organise activities at all times of the day and week. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 17 There are a wide variety of activities on offer for residents to participate in should they choose to do so and a programme of these was on display so that residents and their visitors could choose which they wished to participate in. These included, handi crafts, letter writing, nail pampering, discussion topics and “music special to me”. A number of residents chose to have a newspaper delivered and staff spent time reading these with them, discussing any articles of interest. The Home has good links with the Alzheimers Society and social events are arranged by them for residents living at the Home. Residents living in the Reminiscence Neighbourhood can use the facilities throughout the Home including the bistro located on the ground floor. An afternoon social is arranged every afternoon and all residents living at the Home are invited so that they had the opportunity to make friends with people living elsewhere in the Sunrise Community. Residents are able to participate in activities within the community and a minibus is available for this use. A news letter “Sunrise Special” is produced and a copy of this was available on display for residents, relatives and staff to read. Residents and their relatives are encouraged to be involved in the production of this and it contained interesting information. Residents are supported to maintain their individual life skills and this upholds their dignity and self esteem. This includes dusting and clearing of the dining tables. One resident has a particular interest in cats so she is supported to take care of the Home’s resident cat. Residents’ preferences regarding their religion are supported and respected. Religious ministers attend for services. A Church service is held at the Home each month and Holy Communion is available every week. There is an open visiting policy at the Home and a number of quiet areas throughout the Home for residents to meet their visitors in private if they did not wish to use their private suites. Since the last visit, communications between the Home’s staff and relatives has improved, and there are systems in place for relatives to put forward their views about the services provided, for example during group meetings, during care reviews and the “Comments/Suggestions Book”. There are no rigid rules or routines at the Homes and residents can generally choose what they would like to do. An exception to this was that on the day of the visit a themed lunch time meal had been arranged in the ground floor restaurant for all residents living within the Sunrise Community. All residents from the Reminiscence Neighbourhood were escorted by staff to the event and the Inspector joined them for lunch, there was no evidence that residents had Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 18 been consulted about this. Musical entertainment was provided and staff served residents wearing historical costumes in order to re create the particular time in history. We observed that despite the Home’s staff attempting to act in the best interests of residents, a number of residents did not appear to be enjoying the event, one resident was not eating her meal and another resident was evidently distressed about being surrounded by so many people in a noisy environment. The ISP for this person identified that she did not enjoy group activities. This was brought to the attention of the Home Manager who advised that she would be discussing this with the staff team so that individual assessments were undertaken prior to future events. Menus were available on dining tables and in the passenger lift and identified a variety of nutritionally balanced meals, offering both meat/fish and vegetable options. Staff stated that residents were presented with a choice of two meal options at lunchtime so that they could choose what they wanted to eat, however although two options were available, residents were not actually presented with a choice on the day of the visit. Menus identified a choice of cream of watercress soup or grapefruit for starter, grilled fillet of Dover sole with parsley butter or vegetable pie for the main course and fresh cream strawberry trifle for dessert. The Chef advised that there were a number of further alternatives available if residents did not like the two main meal options. The food was well presented, tasty and served hot so that it can be enjoyed. Residents are served up to two glasses of wine each day if they enjoy this. Adapted cutlery was available to promote the independence of residents that experienced difficulty with feeding themselves and this maintained their dignity. Staff are encouraged to eat with residents thus promoting a family atmosphere at mealtimes. Residents confirmed that they liked the food served to them at the Home and relatives stated that they enjoyed the “themed evening events” held at the Home. Menus identified that a cooked breakfast is available and residents confirmed that they were enjoying this on the day of the visit. Menus identified that the meals provided reflected the cultural backgrounds of residents. Special diets could be prepared for reasons of health or taste, however there was no need for this at the current time. There is a facility for residents to have snacks at any time within the Home, either prepared by themselves with the support of staff or made by the staff on their behalf. Food stocks on the day of the visit were low and the Home Manager advised that these would be replenished before the end of the day. An environmental health visit had not been undertaken since May 2006 and since this time regular cleaning of the extractors in the main kitchen had been undertaken to prevent the build up of dirt. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 19 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and relatives are confident that any concerns raised are acted upon for their benefit. There are systems in place that should protect residents from harm. EVIDENCE: A number of “Thank You” notes had been received by the Home’s staff about the standard of service provided there. The complaints procedure was on display on the notice board within the Home for residents and their visitors to refer to. Our contact details identified on this were incorrect and needs to be amended. In addition a “Comments/Suggestions Book” was available in the dining room for residents, visitors and staff to record their comments and put forward any suggestions for improvements. Since our last visit the Home has received one complaint and this is regarding breakdown in communications between the Home’s staff and a resident’s family. A written record of the actions taken in response to this was available. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 20 This includes the implementation of monthly correspondence between staff and relatives via telephone, letter or email and the importance of improving communications has been discussed during staff meetings. CSCI have received one complaint about the Home since the last visit there. This was in relation to a lapse in procedures regarding staff pre recruitment checks. This was referred to the Provider for investigation and no evidence of this was found, however a concern of a similar nature was detected at the time of this visit. It must be noted that this was prior to the current Manager being in post. A small number of staff had undertaken recent training about the protection of vulnerable adults and as a result of this, the Manager has arranged for a further training session to be available during an evening so that staff members with other day time commitments can attend. The training includes information about local multi agency guidelines and an adult protection procedure “flow chart” which has been amended so that staff are aware of the correct procedure to follow. A copy of the local multi agency guidelines was available within the building and it is recommended that a copy be available in the actual Home for staff to refer to if needed. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a clean, safe and secure living environment in which they feel relaxed and their privacy and independence are promoted. Aids and adaptations provided meet the needs of residents. EVIDENCE: Reminiscence Neighbourhood (residential care) is located on the second floor within Sunrise Senior Living Community and is a separate unit. Assisted living care is provided on the ground and first floor of the building. The Home is purpose built and decorated and furnished to a very high standard. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 22 Since the last visit there has been an improvement regarding the secure external living environment. Residents have been involved in improving the outside terrace patio, by planting herbs, beans and flowers, weeding and watering so that it is a pleasant area to enjoy. Residents also have the opportunity to access the main gardens areas with assistance from staff. The internal environment is designed to promote the independence and freedom of residents within a safe environment. The communal and private accommodation areas of the Home are spacious yet furnished to create smaller private areas in which residents feel safe and secure. Furnishings and decoration throughout the Home are appropriate to meet the needs of residents with dementia. Black and white photographs, a traditional children’s nursery and carpenter’s work bench had been created so that residents could reminisce and be comfortable within familiar surroundings. Toilet doors were colour coded and door signs were 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. Infra red motion sensors were fitted to communal toilet and bathroom doors that automatically turned on the light so that residents could use the toilet independently. Push button locks that could be overridden in the event of an emergency were fitted on to the communal bathroom doors so that residents’ privacy was respected whilst maintaining their safety. Corridors were wide and suitable for both independently mobile residents and wheelchairs users, hand rails were provided and the Home was well lit. Residents have a choice of lounges and smaller sitting areas and a larger television has been ordered for the main lounge following a request made by relatives. Satellite television was available for residents to enjoy. Chairs within the communal lounge and seating areas were arranged to promote social interactions between residents and these rooms were decorated in an appropriate homely style in order for residents to feel comfortable and relaxed. There is a spacious dining area and this is decorated in a homely style so that residents can enjoy their meals in comfort. All meals are prepared in the main kitchen located on the ground floor of the building and served from a hot trolley from the well equipped dining kitchen provided adjoining the main dining room. All “suites” include a spacious “walk in” shower and in addition to this residents have the option of using the Spa Bath facility. This should provide a relaxing experience for residents who choose to use this facility. A weekly “Spa Bath Experience” is included within the basic care package available. A “Snoozelem” room is available for residents’ use. This contains visual and tactile equipment/aids designed to either calm or stimulate the senses and is provided for residents deemed to benefit from this environment. Staff stated that residents do not access this room unaccompanied however it was brought Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 23 to our attention that a resident had been found in there with the lights off and trailing lights were on the floor, posing as a trip hazard. A risk assessment must be undertaken in respect of this to ensure the safety of residents. There is a mix of “suites”, for both single and double occupancy. All have a foyer area and kitchenette. One resident showed us her “suite” and this was decorated and furnished to a high standard and contained personal items to reflect her interests, age, gender and cultural background. The “suite” was spacious and light and a lovely view was provided from the large windows. Personalised memory boxes, containing personal items relevant to individual residents’ lives were provided outside their “suites”. This assists residents to identify their own suites and enables staff and other residents to have an insight into what is important to individual residents. The Home was clean and fresh on their independence, the care staff their own personal laundry. Other is undertaken by the Home’s staff the day of the visit. In order to promote support a number of residents to undertake personal laundry and heavy or soiled laundry in the main laundry. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by an adequate number of appropriately recruited and trained staff however a lapse in recruitment procedure on one occasion does not safeguard residents. EVIDENCE: A “staff profile” folder was on display in the Home for residents and their visitors to refer to. This gave some information about the role of each staff member and included their photograph so that they could be identified. The gender mix of staff reflected that of residents so that care could be provided in an understanding manner. The Home Manager stated that there are currently two staff vacancies however recruiting in to these posts is underway. Agency staff are used as required in order to ensure that residents are supported by an adequate number of staff and the Home Manager requests the same staff to promote continuity of care for residents. The Home Manager advised that prior to completing their first shift at the Home, all agency staff undertake training about health and safety Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 25 procedures relevant to the Home so that they can act in a safe manner in the event of an emergency. Written records in relation to this were not available on the day of the visit. Staff employed elsewhere in the Sunrise Community are able to provide shift cover at short notice should the need arise. The Home Manager advised that there are three care staff on duty during day time hours and two waking care staff on duty overnight. Management and Housekeeping staff are provided in addition to this. The Home Manager stated that the care staffing levels are determined by the care dependencies of residents at any time and that she is satisfied with the current staffing levels. Since the last visit the Home Manager now has access to staff files and this is important as these will contain information that she may require at any time. Two staff recruitment files were sampled and one of these pertaining to a new worker included all information required by regulations. New workers are deemed to be safe to work with vulnerable residents and this safeguards residents. An exception to this was that a Protection of Vulnerable Adults Check (POVA) had not been obtained for one new worker prior to staring work at the Home and this may place residents at risk of harm. It was noted, however, that this lapse in procedures occurred prior to the current Home Manager coming into post. Pre employment health screening is undertaken for all prospective workers in order to determine whether they are fit to carry out the tasks involved within the job role. All new workers undertake induction training and this includes training in health and safety issues so that they should work in a safe and competent manner. A rolling programme of on going staff training was in place and the training matrix was up to date so that staff received refresher training at the times that they required. Staff had undertaken training about dementia care, first aid, fire safety, moving and handling and health and safety. A fire drill was due so that were aware of the how to act in the event of an emergency. 60 of care staff have achieved a NVQ level 2 care qualification so that they should have the necessary skills and knowledge to provide a good standard of care. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 26 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home is generally run in the best interests of the residents living there and the systems in place for quality monitoring is good. Staff are supported well within their job roles and this should ensure that they are confident to provide a good standard of care for residents. Residents’ health and safety is protected by regular maintenance checks of equipment used at the Home, however some improvements are required regarding work practices in order to safeguard residents. EVIDENCE: Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 27 The Home Manager has been working within her current role since 1st July 2007. She has a wealth of experience and knowledge of working with people with dementia and has obtained a number of qualifications in order to lead the team in a competent manner. On the day of the visit, positive comments were received about her management style as she is accessible to residents if they wish to speak with her. She was due to undertake her interview with us on the day after this visit in order to register as Manager of the Home. The Home Manager is supported by a team of “Department Heads”, for example, the “Wellness Co- Ordinator”, Catering Manager and Activities Co Ordinator. Since the last visit methods had been introduced to improve communications between this team for the benefit of residents living at the Home. One negative comment was made regarding the length of time it took for the Home Manager to make a decision due to her having to consult with the rest of the management team. Regular quality monitoring visits are undertaken by external managers and the reports of the findings of these visits were available. These included positive feedback from the staff team regarding the new Home Manager, a tour of the premises was undertaken and medication charts were examined. Actions required in response to these visits were clearly identified and the Home Manager confirmed that these had been undertaken. A copy of the minutes of the last staff meeting were available and these included discussions on ways to improve communications between the staff team. “Residents/Relatives” meetings are held every other month and copies of the minutes of these are sent to relatives. The Home Manager advised that there is normally a copy of this on the notice board in a large print format however this had been removed on the day of the visit. During a meeting, relatives had requested that they are kept informed of current and upcoming social events. In response to this the staff team ensure that relatives are advised of this via the monthly correspondence sent to them and a copy of the activity programme is now on display. An annual quality monitoring review is undertaken and this includes seeking the views of residents, relatives and staff about the services provided at the Home. A copy of a report based on the findings of this was on display for anyone interested to refer to. In addition, a system for the regular auditing of work practices, including care plans, medication and activities provided was also in place so that the quality of care and support provided was monitored and so that improvements could be made if necessary. The Home’s staff do not manage the personal finances of residents however there is a facility for the safe keeping of small amounts of residents’ money should they choose to use this facility. Since the last visit this has Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 28 been further developed, enabling residents to obtain small amounts of their money at the times that they require. Inconsistencies were found regarding the hand written records held in relation to this. Some receipts were kept for money in and out of residents’ accounts but not for all, and only one signature was obtained for transactions on occasions, therefore an accurate audit of residents’ money could not be undertaken. It was of serious concern that money had been taken out of a vulnerable residents’ cash account and given to another resident who was in need of the money. This had not been recorded on the residents’ transaction record and there was no evidence that she had given consent for this. It was noted however that the money was paid back to the resident and the person responsible for this no longer worked at the Home. The Administrator advised that this was not Company Policy and a further incident of the same nature would not occur again. The costs of private chiropody and hairdressing are added onto residents’ fee invoices so that they are aware of costs incurred regarding these. Money balances sampled on the day of the visit were correct and the Administrator advised that this system is audited at least once every month in order for errors to be detected. The Home Manager had introduced a system for formal staff supervision so that staff are supported within their job roles. This was found to be up to date and should ensure that any support or training needs of individual staff members are identified in order to provide a good standard of care. Maintenance checks of equipment are undertaken regularly so that they are safe to use. Risk assessments had been written in respect of fire safety so that any hazards could be identified in this area so that safety measures could be put in place. Accident and incident records were generally well maintained and are audited by the Home Manager so that any trends in these could be identified. The Home Manager stated that the staff seek advice from external agencies, for example the “falls clinic” if residents are deemed to be at risk of falling. A “Wander Guard” has been ordered one resident who fell recently in order to alert the staff team if she leaves her bedroom, so that they could support her and reduce the risk of her falling. It was of concern that an accident report identified that a resident had been found with their legs through the bars of bed rails as they had been used without bed rail protectors being in place. Although there were no injuries on this occasion, there would have been a high risk of the resident sustaining an entrapment injury. The Home Manager advised that bed rail protectors were now used in conjunction with bed rails at all times. Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 29 Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 30 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 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 3 3 x 3 x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 x 2 3 x 2 Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Each resident must have a care plan outlining the specific support required by staff to meet their current care needs so that they receive care in the way that they prefer. Each resident must have a written plan outlining risks specific to their daily lives and the support required by staff in order to maintain their safety. Measures must be introduced to ensure that residents’ safety is maintained within the “snoozelem”. New workers must not commence employment at the Home without all necessary checks being undertaken in order to safeguard residents. A fire drill must be arranged so that staff should have the necessary skills and knowledge to act safely in the event of a fire. The system for the safekeeping of residents’ money must be further developed in order to safeguard residents. DS0000066581.V345252.R01.S.doc Timescale for action 01/12/07 2 OP7 13(4) 01/12/07 3 OP19 13(4) 24/10/07 4 OP29 19(1) 24/10/07 5 OP30 23(4) 15/11/07 6 OP35 16(2)(l) 31/10/07 Reminiscence Neighbourhood Version 5.2 Page 32 7 OP38 23(2) Equipment must be used according to manufacturers’ instructions in order to maintain the health and safety of residents. 24/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP9 Good Practice Recommendations The system for the recording of handwritten entries onto medication administration charts should be reviewed in order to reduce the risk of medication administration errors. Further consideration should be given to the systems in place for resident consultation regarding the activities on offer so that residents do not join in with activities that they do not enjoy. Further consideration should be given to the system in place for residents to choose their meals so that they are served meals of their choice. 2 OP12 3 OP15 Reminiscence Neighbourhood DS0000066581.V345252.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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