Inspection on 07/10/08 for Reminiscence Neighbourhood

This inspection was carried out on 7th October 2008.

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

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

Other inspections for this house

Reminiscence Neighbourhood 10/03/09

Reminiscence Neighbourhood 19/09/07

Reminiscence Neighbourhood 06/01/07

Reminiscence Neighbourhood 03/07/06

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

CARE HOMES FOR OLDER PEOPLE Reminiscence Neighbourhood Sunrise Senior Living Edgbaston 5 Church Road Edgbaston Birmingham B15 3SH Lead Inspector Lesley Webb Unannounced Inspection 7th October 2008 09:00 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.V372716.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.V372716.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Reminiscence Neighbourhood Address Sunrise Senior Living Edgbaston 5 Church Road Edgbaston Birmingham B15 3SH 0121 450 8930 0121 455 6689 edgbaston.rc@sunriseseniorliving.com www.sunrise-care.co.uk Sunrise Operations Edgbaston Limited Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Manager post vacant Care Home 25 Category(ies) of Dementia - over 65 years of age (25) registration, with number of places Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The residential home provides accommodation for 25 elderly persons over the age of 65 years with Dementia. The home can accommodate two service users who are under the age of 65 years, but no younger than 50 years. 19th September 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.V372716.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.V372716.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 include Regulation 37 notification reports of any accidents or incidents involving residents, communications with outside agencies who have a responsibility to monitor services provided by the home and information supplied by the home in the form of its Annual Quality Assurance Assessment (AQAA). Prior to the visit questionnaires had been sent to residents and their relatives. 4 were returned to us and the information from these also used when forming judgements on the quality of service residents receive. The fieldwork visit referred to in this report was undertaken over 1 day by 2 inspectors when there were 19 residents living at Reminiscence Neighbourhood (one of these was in hospital during our visit). The home was not aware that we were visiting. It was not possible to hold meaningful conversations with all residents due to their differing levels of dementia. However we did sit with residents at lunchtime and observed interactions between residents and staff. We also indirectly observed staff when supporting residents with activities. Further information was gathered by speaking with the executive director, reminiscence co-ordinator (home manager), care staff and wellness nurses. An additional method of obtaining information was ‘case tracking’ 4 residents in order to establish their individual experiences of living in the home. This involves 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. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. What the service does well: Assessment processes ensure resident’s needs are identified before they move into the home. All of the 4 residents files that we examined contained an abundance of assessments. These ensure the home is aware of individuals needs and can be confident of meeting these before offering a placement. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 7 Wellness nurses are employed at the home in an advisory role; they do not undertake any direct nursing duties and are a supplementary service provided for residents. All residents receive a monthly ‘Wellness check’, during which they are weighed and their health care needs are reviewed. Residents appeared to be supported well to maintain their personal hygiene wearing clothing, jewellery and make- up that reflected their age, gender, cultural background and the time of year. The home provides a number of items for residents to pick up and use independently, i.e. rummage boxes, ‘dressing up’ tools, dolls, games etc that offer stimulation for residents with dementia. Residents are provided with a clean, safe and secure living environment in which they can feel relaxed. Aids and adaptations provided meet the needs of residents. What has improved since the last inspection? What they could do better: The management of medication places some residents at risk of harm. Due to our concerns we issued an immediate requirement form instructing that action be taken immediately to ensure residents receive medication as per the prescribers instructions. We also copied documents under Code B of the Police and Criminal Evidence Act and informed the reminiscence co-ordinator that the commission may consider enforcement action and that we would make a safeguarding referral to Birmingham City Council due to the risk of harm posed to residents. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 8 The home must be able to demonstrate staff are competent to support residents with dementia. This must include assisting residents at mealtimes, assisting residents who become distressed, communicating with residents, and following the contents of residents care plans. This must happen to ensure that residents with dementia have their needs met safely and consistently. A number of good practice recommendations were also made (as detailed at the back of this report). These include improving monitoring systems for complaints, care plans, fluid charts, activities and accidents. 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.V372716.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In the main people who may be considering this home and their representatives have the information needed to decide if it will meet their needs. Assessment processes ensure resident’s needs are identified before they move into the home. EVIDENCE: A comprehensive statement of purpose is available to interested parties that informs of services and facilities offered by Reminiscence Neighbourhood. Details of the costs involved in living at the Home are included and what is excluded. Before our inspection we received 4 surveys completed by relatives on behalf of residents. With regard to information and communication, 3 state they received enough information about the home before moving in and 1 that they did not. Additional comments were recorded as ‘we used to have regular Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 11 meetings every six months, but with so many staff changes these have not occurred recently’ and ‘my mother was one of the first residents so there was no information available. The proposed spec information looked perfect but hasn’t all materialised’. In relation to communication the homes Statement of Purpose states ‘we recognise that due to memory impairment, residents are not always able to tell their visitors how they have been passing their time. Every month a designated care manager will make contact to a family member by writing a short letter outlining any pleasant moments that their loved one has enjoyed supported by photographs or other relevant material’. We looked at the care records for 4 residents with none containing evidence that this aspect of the Statement of Purpose is being complied with. It is recommended this communication method with families be re-introduced to help promote communication and offer assurances that their relatives with dementia are receiving the care and support to meet their needs. All of the 4 residents files that we examined contained an abundance of assessments. These ensure the home is aware of individuals needs and can be confident of meeting these before offering a placement. These include a financial assessment to determine whether the prospective resident is able to meet the costs of living at the home and a comprehensive assessment for individual care needs. In addition to these families or representatives of prospective residents are asked to complete a ‘resident profile’ in order 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 can be met by the home. Consideration to the specific needs of people with dementia is also given during the assessment processes. For example information is obtained from relatives regarding comfort clothing, preferences for style of dress during the day and night, behaviour patterns, words or expressions used frequently and strong fears or traumatic life experiences. This is obtained in order to help build a picture of each person’s particular needs with regards to dementia. In addition to this the home undertakes a clinical dementia rating assessment that then if needed, generates a plan of care. Intermediate care is not provided at Reminiscence Neighbourhood, however short stay care can be provided. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 12 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 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The management of medication places some residents at risk of harm. In the main the health and personal care that residents receive is based on their individual needs. Improvements will ensure all residents receive intervention quickly, resulting in an improved quality of service. 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. We found that there has been an improvement to the contents of the ISP since our last inspection. For example these now include greater detail with regard to personal preferences and are now centred around the individual needs of people rather than being general. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 13 As at the last inspection 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. It was advised at the last inspection that 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. During this inspection we found evidence that this is not always happening. For example one residents assessment upon admission and subsequent ISP identifies no concerns with sleep patterns and routines during the night. We examined the daily records for this person and found that this has changed and on 8 occasions in one month they slept on a sofa or chair and could not be encouraged to sleep in bed. As we explained to the reminiscence co-ordinator systems should be in place that identify changes in residents needs so that plans are reviewed. This will help staff support residents in a consistent way. The majority of risk assessments we looked at were individualised and reflected residents’ specific needs. Assessments are undertaken for areas including falls, absconding, nutrition and moving and handling. As at the previous inspection some remain general and would benefit from further review to ensure they are person centred and do not impact on residents independence and choice. For example moving and handling assessments we looked at all stated residents use a bath hoist, even when the assessment states the person is fully independent and requires no assistance with regard to mobility. Wellness nurses are employed at the home in an advisory role; they do not undertake any direct nursing duties and are a supplementary service provided for residents. All residents receive a monthly ‘Wellness check’, during which they are weighed and their health care needs are reviewed. In the main residents have access to a range of health and social care professionals, for example, community nurses, dentists, opticians, chiropody and mental heath workers. We received 4 surveys before our inspection completed by relatives of residents. With regard to care 3 state they ‘usually’ receive this and 1 ‘sometimes’. When asked if medical support is given when needed 3 state ‘always’ and 1 ‘usually’. During our inspection one resident was observed to be in their room where they had their lunch. The resident appeared to be very slim. We discussed this person’s dietary and health needs with the reminiscence co-ordinator, as we could find no dietary sheets and/or nutrition sheets having been completed. The reminiscence co-ordinator informed us that the resident did not have any specific health or dietary needs that require monitoring. However when we examined the resident’s medication list in their care records this state Fortisip has been prescribed (a medication for weight gain). It is recommended that a review of the current system for monitoring and recording food and fluid intakes for residents is undertaken to ensure their health and wellbeing is maintained (discussed further in the daily lives section of this report). Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 14 During our inspection we case tracked 4 residents care and support. This process includes checking their medication and the practices with regard to the administration, recording and storage of medication. When doing this we found 6 residents were not administered their medication on the 6th October 2008 and the morning and afternoon of the 7th October 2008. Medication was also not available for another resident however this person was in hospital at the time. We were informed by staff and management that this was due to no medication being available for administration at the home. We found documentary evidence that prescriptions had been sent to the supplying pharmacist for other residents but not for the 6 residents identified above. The homes systems for checking medication supplied by the pharmacist did not identify the discrepancies and as a result medication was not available for administration. The reminiscence co-ordinator informed us she was not made aware of the situation regarding lack of medication until the morning of our inspection. During our inspection we observed one resident to appear quiet agitated and later found this person to be one of the residents who had not received their medication. This is of particular concern as this person is prescribed anti-psychotic medication to manage behaviour associated with dementia. The effect of this medication not being administered and then reintroduced has the potential to cause undue distress to the resident, affecting their physical and mental wellbeing. Due to our concerns we issued an immediate requirement form instructing that action be taken immediately to ensure residents receive medication as per the prescribers instructions. We also copied documents under Code B of the Police and Criminal Evidence Act and informed the reminiscence co-ordinator that the commission may consider enforcement action and that we would make a safeguarding referral to Birmingham City Council due to the risk of harm posed to residents. Residents appeared to be supported well to maintain their personal hygiene wearing clothing, jewellery and make- up that reflected their age, gender, cultural background and the time of year. 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. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 15 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 and 15. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are a range of activities that residents can participate in at their choosing but the systems for recording outcomes for individuals currently hold little value. Mealtimes are not a pleasant experience for all residents with staff showing little consideration of the needs of people with dementia. EVIDENCE: Information supplied by the home in its Annual Quality Assurance Assessment (AQAA) states ‘We have a full activities calender with a minimum of 5 activities a day. We maintain contact with the local community and take residents out at least 2 times a week to place of interest to them. We have entertainers in at regular intervals, church services and personnel from different churches visit on request. We have a range of life skill centres that reflect the interest of people. These are linked to what the residents might have done for a living or their interests. We offer many individualised activites and residents are encouraged to participate, but we respect their right to Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 16 refuse. Residents are also encouraged to assist around the neighbourhood if they are interested with laying the tables for meals, folding laundry or other household tasks -this all encourages wellbeing’. In the main we found evidence to support this statement. For example of the 4 surveys completed by relatives of residents and returned to use 3 state activities are ‘always’ arranged and 1 ‘sometimes’. One comment made to us was ‘but most activities are designed for women – there’s not much for men’. It is acknowledged that the majority of residents are female but the home should consider expanding activities for its male residents to ensure no one is disadvantaged. The home employs an activities coordinator and activities assistants for the whole building. The reminiscence neighbourhood has its own activity programme, but residents can also take part in activities going on in the rest of the home. The programme we saw on display offered 5 events during the day, however we did not observe all of these taking place. The home provides a number of items for residents to pick up and use independently, i.e. rummage boxes, ‘dressing up’ tools, dolls, games etc that offer stimulation for residents with dementia. During the morning we observed several residents sitting making pom-poms with a member of staff and after lunch witnessed some residents being taken out on the mini bus on a trip to Stratford. When assessing activities provided by the home we asked the reminiscence co-ordinator for the activity records of individuals. These were not produced for over 1 hour. When walking through the lounge we saw the activity co-ordinator and a care manager sitting at a table with these documents. We observed the member of staff signing a months records in one go. We explained to the reminiscence co-ordinator that this detracts from their value, as they should be signed as accurate on day of completion. We also questioned if the records for the month had been completed on that day as all were in the same handwriting and pen. When looking at the activity records we found that they have not been completed for all activities as described on the activity timetable and in the main consist of a tick to indicate if a resident participated or not. We recommended to the reminiscence coordinator that the system for recording and evaluating activities is reviewed so that they can be used to monitor outcomes for residents. She agreed with this suggestion. With regard to meals the homes statement of purpose states ‘‘food and drink play an important part in the social life of the home. We endeavour to provide meals in a pleasant, unhurried atmosphere providing opportunity for social interaction as well as nourishment. We provide three cooked meals a day with a choice of menu. Diabetic and low salt diets can be catered for and for those having difficulty eating we can provide a soft diet. Care staff are in attendance at all meals to provide discreet, sensitive and individual help with eating and drinking. Independence is encouraged and sunrise has a range of crockery especially adapted to the varying needs of our residents. We aim to make all the food and drink that we provide attractive, appealing and appetising and to Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 17 arks special occasions and festivals’. We sat and ate lunch with residents in the dining room and found many aspects of this statement not to be reflected in practice. For example staff were observed assisting residents at lunchtime. They did not appear to understand the needs of people with dementia. For example they did not prioritse assisting residents who were becoming distressed waiting for meals, they did not sit and support those requiring help to eat and for those that they did support this was not carried out in a discreet and respectful way (staff were seen standing over residents and giving 2 spoonfuls of food before moving away to undertake other tasks). It was also concerning to observe a member of staff take a starter away from a resident before they had finished resulting in the resident attempting to pull the food from the plate. Lunch felt rushed and staff did not take the time to communicate with residents. One resident was asked if they wanted chicken pie or ratatouille for lunch and choose ratatouille however the member of staff gave the resident chicken pie, which they then left. One resident was given a soft option and we observed their dentures appeared loose. We discussed this with the reminiscence co-ordinator who explained due to a physical disability better fitting dentures cannot be obtained. It was pleasing to find this information reflected in the residents care plan. During the lunch no member of staff was seen offering support to this resident and much of the meal was left uneaten. We also observed that other residents sitting at the same table became distressed when the resident started hitting the table with a spoon. When examining the residents care plan it states ‘X has a healthy appetite but will require care managers to bring her to the dining room at mealtimes and may need some prompting during her meal as she sometime loses interest…ensure drinks at least 1.5 – 2 litres of fluids every day’. The plan also states ‘care managers should sit with X during meals and particularly whilst she is waiting for her meal and between courses’. We raised our concerns with the reminiscence co-ordinator, as staff did not follow the contents of this persons care plan. This impacts on both the individual resident and others dining with them. Our concern increased when fluid charts were not available for this resident despite the plan giving instructions for fluid intake. We observed many residents not eating their meals and strongly advised the reminiscence co-ordinator to review the current system for fluid and food monitoring to ensure the health and wellbeing of individuals is promoted. It was positive to see some staff bring two plates showing different options to some residents. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 18 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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most residents’ representatives know how to raise concerns on their behalf. Records relating to complaints do not evidence these are always acted upon within agreed timescales. EVIDENCE: 4 residents surveys were returned to us before our inspection. All have been completed by relatives on the behalf of residents. When asked if they know who to speak to if not happy all 4 give different responses. 1 states ‘always’, 1 was left blank, 1 states ‘sometimes’ and 1 ‘usually’. The complaints procedure is on display within the home for residents and their visitors to refer to and is also included with residents’ contracts of residency. Since the last inspection the home have placed trays near the lift, which people who visit the home, such as, family and friends are able to place any comments, complaints and/or suggestions. The trays have people’s names on who live in the home for easy reference purposes. We examined the complaints log and found 1 complaint recorded for this year relating to the care of a resident. The complaint was originally sent to the home in July but a response not received by the complainant. We were Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 19 informed this was due to a previous manager leaving resulting in an apology letter being sent and the investigation process starting again. The records we were shown do not include a copy of the apology letter or of dates when the process was started again. Without clear and accurate records it is difficult to monitor if appropriate action is being taken. The investigation records that were available indicate that some aspects of the complaint are upheld and others not. When examining the care records of another resident we found evidence of another concern raised by the family of a resident in February. This was not recorded in the complaints log. We were shown a training tracker that identifies 18 of the 21 staff currently employed at Reminiscence Living having undertaken protection of vulnerable adults training. This helps protect residents from abuse. There has been 1 safeguarding investigation at the home since the last inspection. This is currently ongoing. As mentioned earlier in this report, as a result of our concerns with regard to the lack of prescribed medication for some residents we informed the home we would be making a safeguarding referral to ensure residents are not at risk. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 20 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): 19,23 and 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 can feel relaxed. 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 and nursing 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.V372716.R01.S.doc Version 5.2 Page 21 The external grounds include terraced patio areas and an abundance of plans and decorative ornaments. There is also a large car park to the front of the building. 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 workbench had been created so that residents can reminisce and be comfortable within familiar surroundings. Toilet doors are colour coded and door signs are in a large print with Braille for residents with sight impairments and this assists in orientating residents living at the home thus promoting their independence. Push button locks that can be overridden in the event of an emergency are fitted on to the communal bathroom doors so that residents’ privacy is respected whilst maintaining their safety. Corridors are wide and suitable for both independently mobile residents and wheelchairs users, handrails are provided and the home is well lit. Residents have a choice of lounges and smaller sitting areas. Chairs within the communal lounge and seating areas are arranged to promote social interactions between residents and these rooms are 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. There is a mix of suites, for both single and double occupancy. All have a foyer area and kitchenette. With regard to double occupancy suites the homes statement of purpose states ‘companion suites provide accommodation for people who positively seek to live as a couple, partners or just for companionship. The sharing of the facilities is undertaken with the express wishes of the resident and/or their families’. We observed the interactions of 2 residents sharing a suite and questioned their compatibility with the reminiscence co-ordinator. One resident does not speak English and the other resident was seen wandering in and out of the resident’s bedroom, which is an intrusion on their privacy. The reminiscence co-ordinator confirmed that compatibility assessments are not undertaken and that in this instance the shared room option was decided by the funding authority due to being the “cheapest option”. Personalised memory boxes, containing personal items relevant to individual residents’ lives are 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. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 22 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 sensory 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. The Home was clean and fresh on the day of the visit. Of the 4 residents surveys we received 3 state the home is ‘usually’ fresh and clean and 1 ‘always’. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 23 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 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not always supported by staff with sufficient knowledge to meet their individual needs. Staffing levels are not maintained to a consistent level during some parts of the day. This could result in residents receiving inconsistent levels of care. In the main recruitment practices offer protection to residents. EVIDENCE: Relatives completed 4 surveys on behalf of residents and returned them to us before our inspection. When asked ‘do staff listen and act on what you say’ 3 state yes and 1 did not give a response. When asked ‘are the staff available when you need them’, all for responded ‘usually’. Additional comments were recorded ‘communication can be difficult with the staff changes and shift patterns. Most care staff are very good and extremely caring’ ‘staffing has been an issue at times but usually someone is around to support if needed. High staff turnover has been challenging for regular staff’ ‘staffing levels are sometimes below required standard’ ‘the high staff turnover has been disruptive at times. Overall the level of care is good and most of the residents appear settled and happy’. Due to the variety of comments made we examined Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 24 in detail the homes systems with regard to staffing and found that these do not always ensure residents are supported by a competent staff team. For example the reminiscence co-ordinator informed us staffing levels are 6 staff in the mornings from 7.30am or 8am until 2pm, between 2pm and 6pm the home “tries to have between 4 or 5, minimum of 4 staff” and during the evening between 6pm and 9pm “at least 4 staff”. We viewed the staff rotas for September up until the day of our visit and found that on some instances staffing levels have been below this stated information with 2 or 3 staff on duty on some afternoons and evening shifts. There are currently 19 residents living at the home, all with varying degrees of dementia. Reduced staffing levels have the potential to impact on them receiving individualised person centred support. We asked to view a staff training matrix or other documentation that would give us an insight of training undertaken by the staff team as a whole. This took over 2 hours to be produced. The reminiscence co-ordinator informed us this was due to records for both the reminiscence and assisted living units being combined. We asked how she could be confident that suitable numbers of staff employed on the reminiscence living unit are qualified in all areas and were informed she is reliant on the human resource department monitoring this. She advised us that she would like to take greater control and responsibility for monitoring anything that relates to the reminiscence unit. The training overview document details 17 staff having undertaken Alzheimer’s and dementia training (levels 1 and 2), 8 staff having achieved a National Vocational Qualification (NVQ) level 2 and 3 and also indicates training with regards to activities and mealtimes is undertaken as part of the homes induction process. We also examined 4 staff files and found additional certificates in place on one persons file for further training with regards to dementia and diabetes. The training documentation that we viewed would indicate that sufficient numbers of staff have received training in dementia and that this will help them support people living at the home. However some of the practices we observed bring into question if staff are putting this knowledge to good practice. As already discussed earlier in this report staff were observed assisting residents at lunchtime. They did not appear to understand the needs of people with dementia. They did not prioritse assisting residents who were becoming distressed waiting for meals, they did not sit and support those requiring help to eat and for those that they did support this was not carried out in a discreet and respectful way. Lunch felt rushed and staff did not take the time to communicate with residents. When giving feedback on our findings to the reminiscence co-ordinator she expressed disappointment, explaining that when she first took up position at the home she had identified similar issues at mealtimes and had spent a lot of time working with staff and thought these had improved. During our visit we met and spent time with a resident. A member of staff informed us that the resident does not speak any English. The member of Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 25 staff was heard to speak 2 words of another language to the resident and informed us “these mean yes and no”. The reminiscence co-ordinator informed us that the resident previously spoke and understood English but with the progression of dementia has lost all comprehension and only understands their native language. We were informed no staff work at the home that are fluent in this language. An A4 paper was produced with some words and their English definitions on it. This is very basic and does not include words for happy, sad, hungry, personal care and meals. We asked how staff know the correct pronunciation of these and were informed, “It is guess work”. We questioned how staff can understand the needs of this particular resident due to the communication barrier and having dementia. We expressed concern that the resident could be isolated and their human rights with regard to fairness, equality and autonomy compromised. The reminiscence co-ordinator agreed, stating the placement at the home “is not ideal” but that the local authority funding the placement know there are no staff who speak the residents language. As we explained, if the home accepts the placement of a resident it is their responsibility to ensure staff have sufficient knowledge and skills to meet their individual needs. We examined the recruitment records of the 4 newest staff members to commence work at the home. In the main evidence finds that recruitment practices offer sufficient safeguards to residents. For example all contained application forms and 2 written references. It was noted that the homes application form asks for 10 years employment history. We recommend the form be reviewed to ask for a full employment history and for any gaps in employment to be explained. This would comply with Department of Health advice for recruitment of care workers and offer further safeguards to residents. A Protection of Vulnerable Adults (POVA) check was also on all 4 staff files we sampled along with evidence that 3 of the staff commenced working at the home before receipt of a full Criminal Records Bureau (CRB) disclosure. Risk assessments were also in place on 2 of the staff files for this practice. Risk assessments should be completed for anyone who commenced work with a full CRB disclosure so that the risk to residents is reduced. 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. The reminiscence co-ordinator informed us that all staff undertake within the first 90 days of employment a ‘Core training’ programme. This includes training on the principles of care, the organisations and workers roles. Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 26 Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 27 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): 31,33,35,37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Not all management practices ensure the safety of residents is maintained. Monitoring systems do not always identify shortfalls in service provision. EVIDENCE: The reminiscence co-ordinator employed to manage the unit has been working at the home for several months and is currently in the process of submitting an application for registration with us. She informed us she has previously been a registered manager in Wales for 2 years and has experience in dementia care and is a registered nurse. We were also informed that she started the registered managers award when working in Wales but that this is Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 28 “on hold at the moment” and that she intends to start this again when registered. The reminiscence co-ordinator is supported by a team of ‘Department Heads’, for example, the wellness co-ordinator, catering manager and activities coordinator. Evidence sited in this report suggests work should be undertaken to improve communication between some of these parties to ensure residents receive a consistent quality service (for example medication and training). Information supplied by the home prior to our visit in its Annual Quality Assurance Assessment (AQAA) informs that internal monitoring systems for quality assurance include quarterly audits and monthly Regulation 26 visits. In addition questionnaries to gain the views of residents, relatives and staff are sent out. During our visit we had a discussion with the executive director for the service about services provided on the site. There are 2 registered units on site. The ground floor unit is known as assisted living. This incorporates nursing care but also provides non-care services. The reminisce unit is located on the second floor and provides residential dementia care. We informed the executive director that correspondence sent to ourselves and outside agencies states sunrise assisted living even when relating to the reminiscence unit. Contact we have had from relatives of people receiving a service also indicates they are not fully aware of the specific unit their relative lives in and see the site as one service. The executive director said she would discuss this with the responsible individual for the organisation, but until resolved would ensure all future correspondence identifies which unit it relates to. We were informed the homes 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. 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. We looked at records pertaining to fire drills and training. These evidence 7 of the 21 staff having attended fire training and 2 a fire drill. The reminiscence co-ordinator informed us that it is procedure for staff working in the reminiscence unit not to evacuate the building when a fire drill takes place. They stay in the unit with residents and communicate via radio with staff in the rest of the building and this is why they do not sign to say they have participated in a drill. We advised that if this the fire procedure for safeguarding residents a record should be maintained of those involved. We also advised that greater numbers of staff should participate in fire training to safeguard residents from harm in the event of a fire. Good numbers of staff have undertaken moving and handling training. This helps ensure residents are supported safely. It is recommended greater Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 29 numbers of staff undertake first aid, food hygiene and infection control training to promote the health and wellbeing of residents. Accident and incident records are generally well maintained. We asked to view the accident analysis records with the reminiscence co-ordinator informing us these have not been completed for 2 months due to a new wellness nurse taking up position. The wellness nurse has responsibility for completing monthly assessments of residents and giving advice on weight, falls assessments and nutrition. Later during our visit incident report analyses were given to us for August and September 2008 detailing no corrective actions needed. We noted that both forms have been signed and dated by a wellness nurse who was not working at the home at the dates the forms were completed. This brings into question their authenticity. Reminiscence Neighbourhood DS0000066581.V372716.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 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X X X 2 X X 3 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X 2 2 Reminiscence Neighbourhood DS0000066581.V372716.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 OP9 Regulation 13(2) Requirement Timescale for action 07/10/08 2 OP9 12(1) 3 OP27 18(1) With immediate effect systems for the management of medication must improve in order that residents receive medication as per the prescribers instructions. 10/10/08 An action plan must be submitted to CSCI Birmingham no later than 09.00 hours on the 10th October 2008 detailing how medication systems will ensure residents health and wellbeing is not compromised. 01/12/08 The home must be able to demonstrate staff are competent to support residents with dementia. This must include – Assisting residents at mealtimes, assisting residents who become distressed, communicating with residents, and following the contents of residents care plans. This must happen to ensure that residents with dementia have their needs met safely and Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 32 consistently. 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 OP4 Good Practice Recommendations It is recommended communication methods with families be re-introduced (as detailed in the homes statement of purpose) to help promote communication and offer assurances that their relatives with dementia are receiving the care and support to meet their needs. Care plans 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. This will help staff support residents in a consistent way. Some risk assessments would benefit from further review to ensure they are person centred and do not impact on residents independence and choice. For example moving and handling assessments. The home should consider expanding activities for its male residents to ensure no one is disadvantaged. The system for recording and evaluating activities should be reviewed so that they can be used to monitor outcomes for residents. It is recommended that a review of the current system for monitoring and recording food and fluid intakes for residents is undertaken to ensure their health and wellbeing is maintained. The system for recording and monitoring complaints should be reviewed to ensure appropriate action is taken for all concerns raised with the home. Compatibility assessments should be undertaken and records maintained that evidence the decision for people to share a room is made with their best interests in mind. Staffing levels should be maintained to levels that ensure the assessed needs of residents are met. That the homes staff application form be reviewed to ask for a full employment history and for any gaps in employment to be explained. This would comply with Department of Health advice for recruitment of care DS0000066581.V372716.R01.S.doc Version 5.2 Page 33 2 OP7 3 OP7 4 OP12 5 OP15 6 7 8 9 OP16 OP23 OP27 OP29 Reminiscence Neighbourhood workers and offer further safeguards to residents. Risk assessments should be completed for anyone who commenced work with a full CRB disclosure so that the risk to residents is reduced. Work should be undertaken to improve communication between various management departments within the home to ensure residents receive a consistent quality service. Records such as accident analyses and activity monitoring should be completed accurately and by the person undertaking the task. This will help evidence their authenticity. A record should be maintained of all staff involved in fire drills that reflects the homes fire procedure. Greater numbers of staff should participate in fire training to safeguard residents from harm in the event of a fire. 12 OP38 Greater numbers of staff undertake first aid, food hygiene and infection control training to promote the health and wellbeing of residents. 10 OP31 11 OP37 11 OP38 Reminiscence Neighbourhood DS0000066581.V372716.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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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