Inspection on 06/01/07 for Reminiscence Neighbourhood

This inspection was carried out on 6th January 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Reminiscence Neighbourhood 10/03/09

Reminiscence Neighbourhood 07/10/08

Reminiscence Neighbourhood 19/09/07

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 6th January 2007 09:30 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.V325873.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.V325873.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 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) www.sunrise-care.co.uk Sunrise Operations Edgbaston Limited Ms Rosanna O`Mara Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The residential home provides accommodation for 25 elderly persons over the age of 65 years with Dementia. The manager completes accredited training in Dementia within 12 months of registration. The home can accommodate two service users who are under the age of 65 years, but no younger than 50 years. 3rd July 2006 Date of last inspection Brief Description of the Service: Reminiscence Neighbourhood provides residential care for up to 25 older people with dementia and included within this 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. Residential care is provided within a separate unit on the second floor within Sunrise Senior Living 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 and secure gardens for residents to enjoy. 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 gardens 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. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 5 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. 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 weekly fee to live at the Home including accommodation and a basic care package is from £1043 and this includes a weekly spa bath. An additional spa bath would cost £16.50 per hour. All new residents pay a “one off” community fee charge of £4600 and this covers the cost of maintaining the communal areas of the Home. Items not included within the packages above include hairdressing, private chiropody and outings/trips. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This report reflects the findings of an unannounced field work visit undertaken by one Inspector when there were ten residents living at the Home. The length of the visit was seven hours. This is the second key inspection undertaken by CSCI at the Home and was undertaken during a weekend. The Inspector was assisted by the Registered Manager however some information regarding staff recruitment and training was not accessible on the day of the visit. A pre inspection questionnaire was not requested by CSCI and it is recommended that this report be read in conjunction with the last key inspection undertaken at the Home, dated 3rd July 2006. Information was gathered by speaking with five residents, a number of staff and two visitors, case tracking, examining care, medication and health and safety records and observing the staff perform their duties. A tour of the Home was undertaken. All residents and visitors met during the visit expressed their satisfaction about the services provided at the Home. No immediate requirements were made on the day of the visit. Following the visit a satisfactory action plan was sent by the Registered Manager in response to the requirements made during the visit. This addressed all requirements made in a timely manner. What the service does well: The admission process is thorough. Prospective residents are invited to spend a day at the Home in order to sample what it would be like to live there. On coming to live at the Home residents are given a “welcome pack” and flowers/plant or card. Residents and relatives are involved in the planning of care and this ensures that residents’ preferences in respect of their daily lives and routines are maintained whilst living at the Home. Staff met during the visit had a good knowledge of these individual care needs. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 7 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. Residents are encouraged and supported by the staff team to maintain their independence dependent on their individual abilities. Residents are able to exercise control over their daily lives and the activities that they choose to participate in which promotes their individuality. There is a wide variety of activities and social events on offer at the Home for the residents to participate in should they choose and visitors are made to feel welcome. One visitor said “ A good standard of care is provided here. It is equal to the lovely surroundings. We are always informed about what is going on here”. Another visitor said “ It is a positive experience whenever I visit here”. There are no rigid rules or routines at the Home and residents are encouraged to maintain their preferred routines as identified within their care plans. Residents are offered a choice of wholesome meals and these meet any special dietary requirements for reasons of health, taste or cultural/religious preferences. One resident said “ Lunch was very tasty, my soup was lovely” Residents and their visitors are encouraged to voice any concerns that they may have about the service provided at the Home and complaints are investigated in an appropriate and timely manner. Residents are provided with a clean, comfortable and well maintained living environment in which they feel safe and secure and their privacy is maintained. The living environment is suitable for people with dementia, physical disabilities, sensory impairments and aids and adaptations are provided to promote the independence of these residents. A snoezelen 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. Residents are encouraged to personalise their bedrooms to reflect their individual tastes, cultural choices and interests and this ensures that they feel comfortable in their surroundings. Staff are provided in adequate numbers to meet their care needs. One resident said “ The staff are very pleasant, if I ask for anything I usually get it”. 85 of care staff had achieved an NVQ Level 2 and five staff members had a NVQ Level 3 and this ensures that residents receive a good standard of care. There were regular maintenance checks and servicing of equipment used at the Home and this ensured that they were safe to use. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection? The statement of purpose had been updated to include all relevant information about the services provided at the Home so that prospective residents had enough information to decide whether they would like to live at the Home. Care plans identified the specific support required by staff to meet residents’ individual care needs and to ensure that their preferred routines were maintained whilst living at the Home. Residents were supported by both the “wellness nurses” and care staff team to ensure that their health care needs were being met. A system had been installed to check all new medication received into the Home from new residents and all medication was administered from a container labelled by a Pharmacist at the dose prescribed by the Doctor and this safeguards residents. Staff drug audits are undertaken before and after a drug round to confirm staff competence in medicine management. An activities review meeting had been held and this involves residents in the planning of forthcoming events. The Registered Manager had produced an informative newsletter for the Reminiscence Neighbourhood and this included information about the services provided at the Home and the ageing process. The Organisation produces a Community New Letter and this was full of interesting information for residents and their representatives about the Home, it’s services, staff and forthcoming events. The Registered Manager had written to all residents’ representatives to ensure that she is aware of all complaints and concerns raised in order to change work practices and improve the standard of care provided in response to these. Relatives’ meetings had been introduced so that any suggestions about the services provided at the Home could be put forward. Written progress reports of individual residents’ care needs were sent to their representatives every fortnight so that they were kept up to date about any changes in their care needs, activities that they had engaged in and any progress made The hot water in the laundry area had been adjusted to an acceptable level so that residents would not be scalded and this area had been locked using an appropriate key pad system so that vulnerable residents were safeguarded. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 9 What they could do better: Staff members are available to escort residents to hospital appointments, however a charge to the individual resident for this service and any additional transport costs is incurred. Further consideration must be made in respect of the fairness of this in order to meet the health and welfare care needs of residents. There is some confusion about the role and responsibilities of the “wellness nurses” and this may result in residents not receiving the appropriate medical care required. Staff did not follow the correct procedure in respect of an incident of a possible adult protection nature and this may not safeguard residents. A risk assessment in respect of the risk of vulnerable residents scalding themselves from using the kettle in the dining kitchen had not been undertaken and this may result in scalding accidents. Residents and their visitors do not have access to the findings of quality monitoring audits undertaken at the Home and this may prevent them from being informed about any improvements required or planned in respect of the services and care provided. Information of interest to residents and their visitors, for example, the last CSCI inspection report, the activities programme, minutes of relatives’ meetings and complaints procedure was not on display in the Home and this may prevent important information from being conveyed to all interested people. Residents only have access to their money held for safekeeping when a Senior Manager is on duty and this may prevent them from accessing their money at the time that they choose. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 10 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.V325873.R01.S.doc Version 5.2 Page 11 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.V325873.R01.S.doc Version 5.2 Page 12 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: The Registered Manager stated that the admission process may take a few weeks from the point of enquiry to the time that new residents actually come to live at the Home so that the appropriate care assessments could be undertaken and financial arrangements could be made. A comprehensive statement of purpose and service user guide had been produced and was included in the “welcome pack” provided in new residents’ bedrooms along with flowers, plant and a welcome card on admission to the Home. This ensures that residents feel welcomed in to their new Home and have enough information about the services provided there. The Registered Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 13 Manager stated that this information could be made available in other formats, for example large print or audio tape for people with sensory impairments. 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. Prior to admission comprehensive assessments of prospective residents’ individual care needs are undertaken by the Registered Manager and wellness nurse. This consists of two separate assessments and covers all information required in order to determine whether their care needs could be met whilst living at the Home. Prospective residents are encouraged to spend a day at the Home in order to sample what life would be like to live there. Following this a letter is sent by the organisation confirming if prospective residents’ care needs could be met by the Home. New residents come to live at the Home on a thirty day trial period and following this time a care review involving the resident, their family and Home’s senior staff is undertaken. This provides all involved with the opportunity to discuss whether the resident’s individual care needs could continue to be met whilst living at the Home and whether the resident wished to remain there. Respite care and intermediate care are not provided at the Home. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 14 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. Care planning and delivery is good. Confusion about the role of the “wellness nurses” may prevent residents from receiving the appropriate medical care. Residents are cared for in a respectful manner and this ensures that their self esteem and dignity are maintained. EVIDENCE: Since the last key inspection good progress had been made regarding the care planning system used at the Home. On admission to the Home, comprehensive assessments of residents’ individual physical and mental health care needs, preferences in respect of their daily lives and any interests and hobbies they may have were undertaken and care plans were derived from this information. The care plans were in an easy to read format and included much personalised information about residents’ individual care needs. These included good detail Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 15 about the specific support required by the staff team and identified the importance of promoting the independence of residents within the limitations of their health and well being. The Registered Manager stated that residents and their representatives were involved in the planning and agreeing of care plans to ensure that their preferred routines in respect of their daily lives were maintained whilst living at the Home and this is normally undertaken during the care review thirty days following admission. A behaviour care plan sampled gave very good detail about the factors that triggered agitation and anxiety in respect of a resident and information about the specific management techniques required by staff in order to relieve this were clearly identified. Staff were observed to be providing this support in a sensitive and respectful manner during the visit. Comprehensive personal risk assessments had been undertaken including the risk of abuse, mini bus outings, walking around the Home and moving and handling. Risk assessments were not signed as agreed by residents or their representatives. Daily reports included good detail of the activities that residents had engaged in and their health and well being. There was evidence of input being received by the multi disciplinary team and residents being encouraged to eat and drink well. One daily report did not include the surname of the resident that it was pertaining to and this must be included as evidence of who it is referring to. Residents’ health care needs were overseen by “wellness nurses” who work in an advisory capacity to the rest of the staff team. These are registered nurses and both had recently commenced employment at the Home and it was apparent that their roles were developing within the team at the Home. They were available to provide advice to the staff team and provide on call support. The wellness nurse role and responsibilities included the ordering and receipt of medication in to the Home, residents’ monthly physical health checks and liaising with Health Care Professionals. The care staff met during the visit had mixed views about this role, however all agreed that this role was still in the developmental stage. One daily report pertaining to a resident’s care identified that the Registered Manager had liaised with a Health Care Professional direct instead of referring via the wellness nurse as the resident was ill and staff met during the visit stated that they would not hesitate to seek the appropriate medical assistance direct if required. The wellness nurse met during the visit had good knowledge about the residents living at the Home and was enthusiastic about their new role. Residents had the option of retaining their own General Practitioner on admission to the Home (if the GP is in agreement) and care files identified that residents had regular access to other Health Professionals for example an Optician, Chiropodist and community nurse support. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 16 Staff members were available to escort residents to their Doctor and hospital appointments, however residents were charged at a rate of £16 per hour for this service and any taxi fares that were incurred were charged in addition to this. The Home is responsible for promoting and making proper provision for the health and welfare of residents and to charge for this service may not be considered to be appropriate. Since the last key inspection there had been improvements in respect of the management of medication at the Home however the care staff team had mixed views about the wellness nurses having responsibility for the ordering and receiving of medication as the staff team met during the visit felt that they were best placed to do this as they administered the medication. Staff drug audits were undertaken each week before and after a drug round to confirm staff competence in medicine management and this is considered to be good practice. Medication administration charts (MAR) were generally well maintained and all staff responsible for the administration of medication had received appropriate training. Staff provided assistance for all residents in this area to ensure that they received the correct medication as prescribed. An additional drugs trolley for the storage of surplus medication had been purchased since the last key inspection and this was found to be well organised. A robust system for the ordering of medication for residents coming to live at the Home had been introduced so that they received the correct medication when living there. Stock balances of medication checked during the visit were correct. One medication no longer required remained on a MAR chart and this may result in medication being administered in error. Residents appeared to be well supported to choose clothing, jewellery and make up appropriate for their age, gender, culture and the time of year. Residents were supported by the staff team to ensure they were wearing their hearing aids and spectacles so to improve their quality of life. Despite a number of residents having moderate dementia, the atmosphere at the Home was calm and relaxed and staff were interacting with residents in an appropriate, respectful and soothing manner. Residents exhibiting agitation were promptly calmed by the staff team. Residents’ care plans identified the preferred names of residents and staff were observed to be greeting them by these. Privacy locks that could be overridden in the event of an emergency were fitted to bedroom doors, no residents chose to hold the keys for these. The Registered Manager stated that residents were given the option of holding these keys however a written record of this was not available. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 17 Residents had 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 were stored securely and this upholds residents’ confidentiality. Reminiscence Neighbourhood DS0000066581.V325873.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. 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 all residents living at the Home and residents are not expected to follow any rigid rules or routines. The choice of wholesome and well presented meals meet any special dietary needs of residents for reasons of health or cultural/religious beliefs. EVIDENCE: The Home employs an activities co ordinator and an assistant activities organiser and there were a variety of interesting and appropriate activities on offer for residents to participate in should they choose including arts and crafts, flower arranging, board games and keep fit. Residents living in the Reminiscence Neighbourhood could use the facilities throughout the Home including the bistro located on the ground floor. An afternoon social was arranged every afternoon and all residents living at the Home were invited so that they had the opportunity to make friends with Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 19 people living elsewhere in the Sunrise Community. The hairdressing salon located on the ground floor of the building was open weekly. A number of residents preferred not to participate in group activities and benefited from one to one sessions, relevant to their particular interests and abilities. There were weekly trips outside of the Home including local parks, the Botanical Gardens and the Home has a season ticket for a local theatre. On the day of the visit, the care staff were assisting residents to participate in arts and crafts, games and the afternoon social event. A selection of daily newspapers are delivered to the Home for residents to enjoy. A written record of activities arranged, the names of residents who participated and the success of each was maintained. One resident had come to live at the Home with his dog. Risk assessments had been completed in respect of this and other residents had benefited from the comfort of this pet. There were opportunities for religious worship both within and outside of the Home. One resident chose to visit their local church in order to maintain their independence and links with the community. Holy Communion is held at the Home every fortnight. There were currently no residents of other faiths living at the Home, however the Registered Manager stated that they would provide support in this area as and when required. There was an open visiting policy at the Home and visitors confirmed that they were made to feel welcome at the Home. There were a number of quiet areas throughout the Home for residents to meet their visitors in private if they did not wish to use their bedrooms. On the day of the visit two visitors had come to have lunch with a resident and a dining table had been laid attractively for their use in a private area of the Home. One visitor said “ A good standard of care is provided here. It is equal to the lovely surroundings. We are always informed about what is going on here”. Another visitor said “ It is a positive experience whenever I visit here”. Communication between the Home’s staff and residents’ representatives had improved since the last visit. Written progress reports of individual residents’ care needs were sent to their representatives every fortnight so that they were kept up to date about any changes in their care needs, activities that they had engaged in and any progress made. A successful “Fine Wine and Dine” evening had recently been enjoyed at the Home and this was an opportunity for residents, their visitors and staff to enjoy a social event together. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 20 There were no rigid rules and routines at the Home and residents were able to choose how they spent their day. Residents were able to go outside of the Home with their friends and families as they chose. A notice board for displaying information of interest to residents and their visitors was not provided at the Home, a copy of the last CSCI inspection report, page two of the certificate of registration, the activities programme and complaints procedure were not on display and this may prevent important information from being conveyed. Three cooked meals were provided daily and a snack meal was available at suppertime and during the night to ensure that residents were not hungry. The main meal options for lunch were carrot and coriander soup or chilled grapefruit, steak and kidney pie or a vegetable stir fry and residents were offered the choice of either meal. St Clement’s sponge pudding or fresh fruit was available. The lunch time meal was served hot and was well presented, dining tables were laid attractively, table linen, crockery and cutlery was of a good quality and cold drinks or an alcoholic beverage was served with the meal. Appropriate music was being played in the dining room whilst lunch was served and staff were appropriately assisting residents with their meal if required. Staff were enjoying a meal with the residents, having interesting conversations and this promotes a family atmosphere. Residents expressed their satisfaction about the food provided at the Home. One resident said “ Lunch was very tasty, my soup was lovely” Special diets can be arranged for reasons of taste, health, religious or cultural preferences. All staff were aware that two residents had food allergies and ensured that these were not served to the identified residents. Adapted cutlery was available to promote the independence of residents that experienced difficulty with feeding themselves and this maintained their dignity. Reminiscence Neighbourhood DS0000066581.V325873.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaints are investigated thoroughly in a timely and appropriate manner so that the services provided at the Home are improved. A failure to follow the adult protection procedure on one occasion may not safeguard residents. EVIDENCE: The complaints procedure was not on display however a comprehensive policy was included within the service user guide and contract of terms and conditions of residency. CSCI had not received any complaints about the service provided at the Home since the last key inspection and the complaints register identified three complaints made directly to the Home. These were regarding poor cleanliness and hygiene issues and staff working excessive hours each week. A comprehensive record of written correspondence, complaint investigations and any action taken as a result of these was available. These were resolved to the satisfaction of the complainants. The Registered Manager had formally written to all residents’ representatives ensuring that they were aware that she had the overall responsibility for the services provided at the Home and therefore would have the responsibility for Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 22 investigating any concerns or complaints raised and taking remedial action to improve the standard of care for residents. Staff had access to a flow chart identifying the correct procedure for staff to follow in respect of the protection of vulnerable adults and this must be amended to identify that Social Care and Health are the lead agency for adult protection as per local agency guidelines. Staff met during the visit confirmed that they had undertaken recent training about adult protection and had a good knowledge about this however training certificates were not available so this could not be evidenced during the visit. Since the last key inspection senior staff had taken appropriate action pertaining to two incidents of an adult protection perpetrated by a former resident living at the Home and this safeguarded the residents living there at that time. The daily reports identified unexplained facial injuries being sustained by a resident, remedial action in respect of the rearranging of the bedroom furniture had been taken and a repeat injury of a similar nature had not occurred. However, an investigation in to the cause of the injuries had not been undertaken and an adult protection referral had not been instigated and this may not safeguard residents. Reminiscence Neighbourhood DS0000066581.V325873.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are provided with a spacious and well designed living environment in which they are safe and secure. Aids/adaptations and facilities provided promote the independence of residents living there. 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.V325873.R01.S.doc Version 5.2 Page 24 There is a secure external patio area and this is suitable for wheelchair users. 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. There were two hoists available at the Home, a stand aid hoist and a regular transfer hoist. There was however only one sling available for the regular hoist and slings of varying sizes and purposes must be available in order to meet residents’ needs. None of the residents required a hoist as a mobility aid on a daily basis. A snoezelen 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. Each bedroom had either a shower or bath facility and in addition to this there were two assisted spa bath facilities. The communal bathrooms were decorated in a homely style to a high standard and were found to be clean. 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. Satellite television was available for residents to enjoy. All meals were prepared in the main kitchen located on the ground floor of the building and served from a bain-marie from the well equipped dining kitchen provided adjoining the main dining room. Residents’ snacks and hot beverages were prepared by staff within this area and staff stated that residents do not use this area unsupervised, however on the day of the visit a resident was sitting at the kitchen table alone. Risk assessments had been undertaken regarding the kitchen, however as this was an open plan facility within the dining area of Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 25 the Home, this must be extended to include the risk of residents’ accidentally scalding themselves by using the kettle. Not all food stored in the fridge within the kitchen area was labelled and dated and this may result in residents eating out of date food. On admission to the Home, carpets, curtains and all bedroom furniture as listed in the National Minimum Standards is provided by the Organisation, however most residents choose to bring their own furniture in to the Home and this ensures that they are familiar and comfortable within their surroundings. Residents’ bedrooms were personalised to reflect their interests, gender, culture and age. A call bell system was located in each bedroom for residents’ use to summon assistance from staff or to be used in the event of an emergency and a lockable storage facility was provided in each residents’ bedroom for the safekeeping of any valuable or private items. Since the last visit hot water outlet temperature records identified that these were within safe limits and this safeguards residents from scalding accidents. The Home was found to be clean and fresh and there was an effective and hygienic system for the laundry of residents’ personal clothing and bed linen. A number of residents were supported by the staff team to wash their own clothing and this maintains their independence. Reminiscence Neighbourhood DS0000066581.V325873.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This outcome area was not assessed in full. Residents are supported by an adequate number of appropriately trained staff. EVIDENCE: There were three members of staff on duty during the waking hours to support ten residents and staff met during the visit stated that they felt that this was adequate. The Registered Manager stated that the staffing level during the morning period was due to increase the week following the visit as a new resident was due to come to live at the Home. There were two staff members on duty during night time hours so that residents were safeguarded and received a good standard of care at that time. One resident said “ The staff are very pleasant, If I ask for anything I usually get it”. The staffing rotas identified that a number of staff worked a long day by choice, however none of the staff worked an excessive amount of hours per week. The Management team provide on call support to the person in charge of the shift and this ensures that the staff on duty feel supported at all times. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 27 The night staff were responsible for the cleaning of the communal areas of the Home however due to the increasing occupancy, a part time cleaner was due to be employed. Kitchen and laundry staff were provided to support the care team. There were no staff vacancies at the current time and this ensures continuity of care for residents. The Registered Manager was unable to access the staff training or recruitment files on the day of the visit as these were locked away in a separate office and the key for this office was not available, therefore this outcome group was not assessed in full on this occasion. A robust system for staff recruitment was in place during the last key inspection visit undertaken at the Home. Staff met during the visit confirmed that they had undertaken recent training about the safe management of medication, moving and handling, fire safety and food hygiene and this safeguards residents. The Registered Manager stated that all new staff have twelve days training within the first thirty days of being employed at the Home and the induction training was in line with “Skills For Care”, ensuring that staff have the appropriate knowledge to work in a competent manner. One new staff member met during the visit confirmed that she had enjoyed a comprehensive induction training programme. 85 of care staff had achieved an NVQ Level 2 and five staff members had a NVQ Level 3 and this ensures that residents receive a good standard of care. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 28 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 & 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 run in the best interests of the residents living there and the systems in place for quality monitoring is good. Residents’ health and safety is protected by staff training and regular maintenance checks of equipment used at the Home. EVIDENCE: The Registered Manager has been in post since the Home opened in early 2006. She has completed the Registered Managers Award and has had previous experience of working with older people in a managerial role. She is a qualified Moving and Handling trainer and First Aider and this ensures that residents and staff are safeguarded. She is due to undertake training about dementia care in the near future. There are five other “Managers” employed at Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 29 the Home and each of these people have responsibility for their departments within the Organisation. The Registered Manager has overall responsibility for Reminiscence Neighbourhood and has introduced methods to improve communication between the senior staff team in order to improve the service provided for residents. Head of Department meetings are held regularly so that all senior staff were aware of any new procedures introduced in to the Home and so that the standard of services provided at the Home could be regularly reviewed. It was of concern that on the day of the visit the Registered Manager was unable to access the staff recruitment and training records despite her request for access to these. Relatives’ meetings were held regularly so that relatives have the opportunity to put forward their suggestions about the services provided. These included “guest speakers” about topics of interest including the progression of dementia. The minutes of these were not accessible to residents or visitors of the Home unable to attend the meeting and this prevents people from having information about the content of these and any suggestions put forward. An activities review meeting had recently been undertaken involving residents in the planning of forthcoming events. The Registered Manager had produced an informative newsletter for the Reminiscence Neighbourhood and this included information about the services provided at the Home and the ageing process. The Organisation produces a Community News Letter and this was full of interesting information for residents and their representatives about the Home, it’s services, staff and forthcoming events. Quality monitoring visits are undertaken by Senior External Managers each month and reports of these visits are sent to CSCI ensuring that residents receive a good standard of service. A comprehensive system for quality assurance was in place and this included in depth auditing of the policies and procedures in place at the Home. An annual report of the findings of this was not accessible to residents and their visitors and this prevents them from having important information about the monitoring of the services provided. A robust system for the safe keeping of residents’ money was in place however the safe facility is located within the ground floor of the Sunrise Community and it is recommended that a safe facility is located within the Home itself and that residents have access to their money at all reasonable times. Areas of the Home that were deemed to be unsafe for vulnerable residents for example, staircases and the laundry were inaccessible to vulnerable residents Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 30 using a key code system and any substances harmful to health were stored securely. Regular maintenance checks of equipment used at the Home was undertaken so that they were safe to use. Accident records were well maintained and a system for the auditing of these was undertaken in order to recognise trends in accidents thus reduce the risk of further occurrences of the same. Two accident reports were missing pertaining to a resident falling on two occasions and one of these was not recorded within the falls monitoring documentation and this may prevent the appropriate action from being undertaken following these accidents and does not meet regulations. Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 31 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 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 2 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement Personal risk assessments pertaining to residents must be signed by residents or their representatives in order to confirm their involvement in the undertaking and reviewing of these. Daily reports must identify the full name of the resident that they are pertaining to A further review of the role and responsibilities of the “wellness nurses” must be undertaken The Home must be conducted so as to promote and make proper provision for the health, welfare and treatment of residents 3 4 OP9 OP18 13(2) 13(6) Medication administration charts must clearly identify when medication is discontinued The Registered Manager must ensure that all staff involved in the protection of vulnerable adults are aware of procedures in this area and ensure in cases where residents are put at risk DS0000066581.V325873.R01.S.doc Timescale for action 28/02/07 2 OP8 12 (1) 28/02/07 01/02/07 28/02/07 Reminiscence Neighbourhood Version 5.2 Page 33 the appropriate action is taken to safe guard residents immediately. (timescale of 03/08/06 not met) The adult protection procedure “flow chart” must be amended to include local multi agency guidelines 5 OP20 13(4) A risk assessment must be undertaken in respect of the risk of residents’ accidentally scalding themselves by using the kettle located in the dining kitchen. All food stored in the fridge within the dining kitchen must be labelled and dated. Staff recruitment and training records must be available for inspection within the Home at all times. The Registered Manager must ensure all staff involved in residents’ health and well being are suitable qualified to offer the correct support, advice and guidance. All staff must be fully trained and competent to carry out their duties. (records not available, not assessed on this occasion) 9 OP33 24(2) Residents must have access to a report based on any findings following quality assurance programmes being undertaken. All staff who have a direct role in the care and support of residents must be appropriately supervised at all times, and a record must be kept of all supervision sessions. DS0000066581.V325873.R01.S.doc 01/02/07 6 7 OP20 OP29 OP30 16(2)(j) 17(3)(b) 01/02/07 01/02/07 8 OP30 12(1)(a) 18(1) 31/03/07 01/06/07 10 OP36 18(2) 31/03/07 Reminiscence Neighbourhood Version 5.2 Page 34 11 OP38 17(2) (not assessed on this occasion) Records must be available pertaining to all accidents involving residents occurring at the Home. 01/02/07 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 2 Refer to Standard OP10 Good Practice Recommendations A written record should be maintained as evidence that residents are consulted about whether they would like to hold the key for their bedroom door A notice board for displaying information of interest to residents and their visitors should be provided at the Home, a copy of the last CSCI inspection report, page two of the certificate of registration, the activities programme and complaints procedure should be on display. It is recommended that the manager ensure copies of all staff’s interview notes are kept on the individual staff files. (records not available, not assessed on this occasion) 4 5 OP32 OP35 The minutes of relatives’ meetings should be on display within the Home and be available in different formats It is recommended that a safe facility is located within the Home itself and that residents have access to their money at all reasonable times. OP14 3 OP29 Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 35 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. Extracts may not be used or reproduced without the express permission of CSCI Reminiscence Neighbourhood DS0000066581.V325873.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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