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Inspection on 08/01/09 for Elroi Manor Residential and Nursing Home

Also see our care home review for Elroi Manor Residential and Nursing Home for more information

This inspection was carried out on 8th January 2009.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a welcoming atmosphere. Staff are enthusiastic and keen to learn new skills and develop the service offered at Suddon House. The owner and management have expressed their commitment to the service and there has been a significant investment in the home; this has been of benefit of people living at the home. The catering at the home has been consistently good. The presentation of the dining rooms has greatly improved. Staff have undertaken nutritional assessment training and have assessed each person using the MUST tool, this is recorded within all care plans. People receiving help at mealtimes did so in a dignified manner.

What has improved since the last inspection?

This home was judged poor in December 2007. It has been monitored throughout the past twelve months by random inspections at different times of day and a key inspection mid 2008. There has been significant management input from the company and the provider Mr Bis Oozageer. There has been management input arranged by social services to support the provider and the outcomes for people living at the home. Staff have undertaken training and have begun to work in a more cohesive manner which has been of benefit to the people living at the home. Care and care planning is much improved. There has been input from the fire service and the Health and Safety Executive with improvement notices having been issued by them and these have been complied with. The home has been decorated, repaired and cleaned. The first floor has been closed for refurbishment and the second floor has been designated for storage only. This work has made the environment safer and more homely. Efforts have been made to incorporate best dementia environmental practice with the refurbishment of the ground floor; this is making the home more suitable for people who have dementia care needs.

What the care home could do better:

The management of the home has recently been delegated to an acting manager. In the interim period their has not been a management overview of staff recruitment. This has led to a lapse in practice that potentially placed people living at the home at risk. This was remedied immediately at this inspection but reflected poorly on the management of the service. There is a need to continue with the development of care planning and activities available at the home. The home needs to work towards being a specialist dementia care home. This means having a person centered care focus and person centered care planning. The management of snacks should be monitored to ensure good practice. Biscuits should not be handled, plates or saucers should be available to place them when served at tea and coffee time. Staff supervision should incorporate some observation of care giving to ensure good practice at all times.Environmental developments now need to be more specialised, catering for dementia and mental health care. Rummage boxes, magazines, ornaments and objects that may be interesting, tactile or comforting could be used to create interest within the environment.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Suddon House Nursing & Residential Home West Hill Wincanton Somerset BA9 8BP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Barbara Ludlow     Date: 0 8 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Suddon House Nursing & Residential Home West Hill Wincanton Somerset BA9 8BP 0196333577 0196331175 suddon.house@virgin.net Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Deverill Holdings Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 43 Number of places (if applicable): Under 65 Over 65 43 29 dementia mental disorder, excluding learning disability or dementia Additional conditions: 29 29 Persons, not less than 60 years, who require nursing care by reason of progressive mental disorder. Registered for a total of 43 places in categories DE, MD, DE(E) and MD(E) Room 10Q must only be occupied by a person who is independently mobile, has a low risk of falls and can manage their personal care needs independently. The person admitted to this room must meet this criteria when they move in. This must be evidenced through the pre-admission assessment and monthly reviews. Should the person`s needs change during their stay a multi-professional and service user/representative review must be held to determine the adequacy of the accommodation to meet their needs. Up to 14 places for personal care DE(E) Up to 29 places for nursing care only in the categories DE, MD, DE(E) and MD(E) Up to five persons in the range 50-60 years, who require nursing care by reason of a Care Homes for Older People Page 4 of 33 progressive mental disorder. Date of last inspection Brief description of the care home Suddon House is a care home registered to accommodate and provide personal and nursing care services for up to forty-three people. Up to thirty-eight over the age of sixty years. Conditions have been agreed to enable up to five persons over the age of fifty years to be admitted depending on their care needs. Suddon house is approximately one mile from Wincanton town centre set in its own grounds with pleasant views onto surrounding farmers fields. The home is approached by a long private drive off the main road in West Hill. The home has two entrances with the main entrance to the front of the property. The second entrance is to the side. There is ample car parking to the front and side of the home. The main entrances are kept locked at all times for security of the home and the people who live there. The home has ample communal space and outside areas that can be accessed with the support of staff. Bedroom accommodation is provided on two floors. The home provides nursing and personal care for older people with dementia and other mental health needs. The home provides twenty-four hour nursing care by registered nurses who are experienced in mental health and general nursing. Care staff are experienced in delivering personal care. The provider stated that the fees for the service at the time of this inspection are 625.00 pounds to 845.00 pounds per week. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was carried out by two inspectors for Commission for Social Care Inspection. The inspection took place between 10:15am and 5pm. The acting manager and head of care were on duty. The visit coincided with a visit from the Health and Safety Executive inspector, who was making a compliance checking visit. A tour of the ground floor communal rooms and a sample of bedrooms was made. The bedrooms seen included those where problems were identified at the last random inspection in November 2008. Care Homes for Older People Page 6 of 33 The first floor has been closed for refurbishment. Time was spent in the communal rooms to meet with the people in residence and their visitors. Staff were spoken with and were observed as they worked. Activities were observed and mealtimes. Breakfast was concluding at the start of the inspection and tea was starting at the conclusion. Records were checked these included care plans, peoples money held at the home, duty rotas, staff recruitment files and a thank you letter. Questionnaires were sent to people living at the home and half of those returned were completed with the help of relatives. Staff also completed questionnaires and returned them to the commission. Feedback was received from visiting health and social care professionals. Feedback was given to the acting manager at the close of the visit. The inspectors were welcomed and would like to thank the staff and the people living at the home and their visitors, for their assistance with the inspection process. What the care home does well: What has improved since the last inspection? What they could do better: The management of the home has recently been delegated to an acting manager. In the interim period their has not been a management overview of staff recruitment. This has led to a lapse in practice that potentially placed people living at the home at risk. This was remedied immediately at this inspection but reflected poorly on the management of the service. There is a need to continue with the development of care planning and activities available at the home. The home needs to work towards being a specialist dementia care home. This means having a person centered care focus and person centered care planning. The management of snacks should be monitored to ensure good practice. Biscuits should not be handled, plates or saucers should be available to place them when served at tea and coffee time. Staff supervision should incorporate some observation of care giving to ensure good practice at all times. Care Homes for Older People Page 8 of 33 Environmental developments now need to be more specialised, catering for dementia and mental health care. Rummage boxes, magazines, ornaments and objects that may be interesting, tactile or comforting could be used to create interest within the environment. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home have information in place and an up to date statement of purpose, this will enable people and their families to make an informed choice of home placement. There is a trial period of one month that allows someone to change their mind about coming into Suddon House, if they so wish. Evidence: The home has a statement of purpose and helpful information available to share with prospective people and families making enquiry at the home. The acting manager and the head of care are both clear about the assessment requirements that will need to be made prior to a person being admitted to the home. CSCI wish to be notified when new admissions are accepted, for monitoring purposes Care Homes for Older People Page 11 of 33 Evidence: as the home begins to take in new admissions. Eight people responded to the commissions questionnaires, four people had received help from their relatives. We heard that six people have received a contract. Seven people felt they had enough information to make an informed decision when they chose this care home. People said they made visits to the home and there was a good atmosphere. All said yes they receive the care and support they need, staff are reported to be attentive and supportive. The admission process will be assessed in detail at the next inspection when the home has taken in some new admissions. Care Homes for Older People Page 12 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care plans are improving in their content and assessment of care needs, there is room for more personalisation of these documents. The physical health care needs of the people in residence are met. Medication is safely managed. Evidence: Each person has a care plan, these documents were sampled. All documentation is now kept together in the care plan. The care plans contain appropriate risk assessments, details of care needs and how these can be met with staff help. The care planning has improved. Feedback was given to the two nurses on duty during the afternoon, to explain where they could be improved further and be more person centered in style. The health care needs of people at the home are met. People have received medical and nursing interventions as required, risks are assessed, monitoring and care strategies are in place to meet individuals needs to ensure they are comfortable and Care Homes for Older People Page 13 of 33 Evidence: their health is maintained. Medication management, administration and storage was examined. The treatment room was clean and medications were safely stored. A small number of the vacutainer blood collection bottles were found to be out of date, this was brought to the attention of the nurse, who immediately arranged to replace them. The medication administration records were examined, there was one entry where a medication had been hand transcribed but not signed. Staff will be reminded of the best practice of signing and obtaining a counter signature to verify the accuracy of a hand transcribed entry. The home has a new medications fridge, the temperature was maintained within the safe temperature range. All controlled medication was safely stored and records were accurate. Care Homes for Older People Page 14 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are organised activities each day but specialised dementia social care should be developed. The dining rooms are well presented and the quality of food is very good. Visitors are made welcome at the home. Evidence: The people living at the home were up and dressed at the start of this inspection and were finishing breakfast. During the morning the inspectors joined the people who were seated in the lounge, the television was on and a small group of people were sitting nearby. Tea was served with biscuits, mugs are used and digestive biscuits for some were offered by hand and were placed on a side table, others were offered the biscuit container and were given a tea plate. This mixed practice should be refined to best practice and choice offered at all times by all staff. A music activity was planned and went ahead, people if they wanted could take a percussion instrument to play. The activity was disorganised, the television remained switched on throughout and people seemed unsure about what was expected of them. One person who had been sat quietly near the television left the lounge saying it was Care Homes for Older People Page 15 of 33 Evidence: too noisy. This area of care needs to be developed and more opportunities for casual interaction within the environment such as with rummage boxes, magazines, objects of interest or tactile comfort such as soft toys. Two visitors were seen at this inspection. They were happy with the care their relative was receiving and were impressed with the catering. A pot of tea was served to them on a tray during their visit. Visitors can see their relatives in private in their rooms or a quiet communal area if they wish. Families have been invited to recent organised events at the home such as the Halloween party and a Christmas party. People living at the home said they had enjoyed the parties held at the home. Surveys were returned to CSCI, two people said that activities are always arranged, two said usually and four said sometimes. One person said that activities are on the increase, people reflected that they like to talk to other residents and to staff. Visiting professionals told the commission there is a good atmosphere in the communal areas, it is calm with people chatting together. Professionals said that the home does well with communication of residents needs. One person said the home has improved recently, another said it had improved under the leadership of the present owner and another has witnessed great improvements in the last three months. There was not clear evidence of choice being exercised in daily living and activities. The people living at the home are very settled and are compliant with staff and set routines. More care has been taken to address the accommodation where it was not adequate and door signs have been put up to help people recognise their own rooms. There is scope for further development of the personalisation of bedrooms, to make them more homely and inviting. Care Homes for Older People Page 16 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure in place and people using the service know how to raise their concerns. Staff recruitment processes had not been overseen by senior management to ensure safe practice. Evidence: Staff have received training about the protection of vulnerable adults and the home has a whistle blowing policy. At the last inspection it was highlighted that staff need to have access to the Somerset Safeguarding procedure for protecting people in their care. The home now has this document for staff to read and to inform their practice. There have been no complaints made to the home since the last inspection. CSCI have received concerns about the management of the care home and these have been addressed through random inspection visits and the regulatory processes. At the last random inspection CSCI required that the home confirmed trained staff professional registration numbers. At this inspection we found three staff were working with the PoVA First check prior to the full criminal record bureau check being returned. For two staff their supervisor was not indicated on the duty rota and for the trained staff they worked in an unsupervised capacity. An immediate requirement was made Care Homes for Older People Page 17 of 33 Evidence: and this practice was stopped at the inspection. CSCI have been reassured that this misunderstanding has been addressed and checks and procedures for safe recruitment are now in place. The feedback through eight comment cards returned to CSCI, indicated that seven respondents knew how to make a complaint, one said it had not been necessary to date. Other comments included their relative would go to Bis, never had to complain and another said they would speak to the nurse. Staff responding in writing said they would know what to do if there were concerns. Two health professionals also confirmed that the care service would respond correctly if concerns are raised. One GP said they have not received any complaints about the home. Care Homes for Older People Page 18 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The ground floor is clean and well decorated. The communal rooms and facilities are comfortable. Personal rooms / bedrooms varied some are personalised others would benefit from more attention to detail. Infection control is well managed. Odour control could be improved. Evidence: Concerns had been raised by the Health and Safety Executive (HSE) officer and an action plan was in place to meet the improvement notices served by them. In November 2008 at a random inspection visit we found that most people had moved to the ground floor and the first floor was empty bar one and their move was planned. A tour of the premises was made and improvements in the environment were seen at this time. However people had been moved from the first to the ground floor and the inspectors identified some areas where changes were needed. We found one unstable wardrobe in a room that was an unsuitable layout. Two rooms had curtains that did not adequately cover the windows. These areas of deficit were raised at a meeting with CSCI, the home owner, the acting manager and the management consultant who has Care Homes for Older People Page 19 of 33 Evidence: been engaged to improve the service. CSCI were given assurances about the environmental improvements and an action plan for improvement with timescales. The home has a variety of communal space but the large lounge adjacent to the dining room remains the hub of the home. At this key inspection we saw fourteen of the nineteen people in residence seated in this lounge at the start of the visit. At this inspection we found that the the improvements have continued and all the areas of concern raised at the meeting with CSCI had been addressed. This included redecoration of the shower room, bedroom curtains being replaced and attention to the condition of the furniture in the bedrooms. The first floor has been closed for refurbishment. The Health and Safety Executive (HSE) officer was visiting the premises on the day of this inspection and was satisfied with the improvements made. The first floor where the integrity of the windows/ frames had been assessed as unsafe, is to remain closed for refurbishment. The HSE officer has made clear to the provider the areas requiring attention prior to the first floor being reopened. The lift has been locked for staff access only during this period of closure of the first floor. CSCI will monitor the reopening of this floor. The dining room looked very pleasant and tables were nicely laid for meals. Linen tablecloths now being used without the creased thin plastic covers previously seen placed over the tablecloths at mealtimes. This looked much more pleasant and is more dignified. The bedrooms seen on the ground floor at this key inspection had name boards on doors, some with pictures. Bedrooms were clean and comfortable but some had only a few personal items or pictures. This could be improved, the rooms could be personalised and made more homely. Two rooms were malodorous, in one other room there was a missing cupboard handle and hot exposed radiator pipes. One bed had one very thin pillow and looked uncomfortable, this must have been overlooked at many bed changes. All these issues were identified when feedback was given to the acting home manager. There was decorating in progress in one room that was occupied. This was being undertaken a wall at a time for the convenience of the person occupying the room. The fire safety officer has visited the home recently and confirmed that requirements have been addressed. The home has improved fire safety precautionary measures and Care Homes for Older People Page 20 of 33 Evidence: staff have received fire training. The fire safety officer has since contacted CSCI to confirm that the requirements made have been complied with. The commission acknowledges the attention given to improve the ground floor accommodation. The garden and outdoor areas are not safe for people to access independently . The grounds will require attention in the warmer weather and this is included in the managements action plan for the home. The home has laundry and sluice facilities, these were clean and infection control equipment such as the bedpan washer had been repaired. There are hand washing facilities throughout the home. The sluice and laundry rooms do not have separate hand washing facilities. Staff have access to latex gloves and aprons. The HSE officer has requested that the home use latex gloves with care. There is a risk of allergic reaction to them by staff and people living at and visiting the home. An alternative glove was recommended for general use, immediate action was taken to address this. In response to the HSE notice the home has addressed the risk of legionella infection and is monitoring the water temperatures and the flushing of plumbing that is not currently in use. Catering staff wear protective clothing in the kitchen. Waste is appropriately managed. Care Homes for Older People Page 21 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Suddon House has a skill mixed staff team and there are enough staff employed and deployed to each shift or department to meet the personal and nursing care needs of the people living at the home. The service would benefit from the allocation of more dedicated activity staff hours. Staff recruitment was poorly managed. Staff training has improved and there are opportunities for staff to learn and develop the skills required to work safely and promote good care. Evidence: At the random inspection in November a small number of staff were found to be working excessively long hours and they were taking only nine hours between some shifts. This has been addressed and staff have been recruited. Five staff recruitment files were sampled. For three staff their full criminal record bureau checks had not been returned. Two of these staff were working under supervision although it was not specified on the duty rota who was responsible for them on each shift. One staff was covering as person in charge of a shift and was therefore not supervised. An immediate requirement was issued and assurances were given to rectify these deficits immediately. There had been no managerial overview of the recruitment process, this had been delegated and not supervised. Care Homes for Older People Page 22 of 33 Evidence: Staff were seen from all departments and were spoken with during the inspection. They were observed to be polite and pleasant with the people who in turn seemed content and happy in their care. Staff wear uniforms purchased themselves, all looked smart. Staff have access to personal protective clothing such as gloves and aprons and wore these appropriately. Staff spoke positively about the progress of the home in recent months, and are looking forward to having new admissions to the home. It is acknowledged that staff have worked hard over the past year to improve the service delivery. Staff have undertaken training and the benefits of this were evident in the care and care planning. There is still some work to do to move to person centered care and care planning, this was discussed with the nurses on duty at this inspection. There is also work to do to develop meaningful specialist dementia care social activities. There are plans for continuing staff training, development and further recruitment. Progress will be monitored through the regulatory inspection process. The fire service is satisfied with the fire training for staff and manual handling training has been developed with more focus on practical skills and not solely video based training. People living at the home spoke highly of members of staff . A letter of compliment from a relative was seen, this gave thanks to staff for the good care given to their relative whilst at the home. There was a good response to CSCI comment cards sent to staff. We heard from seven and they reported that employment checks were carried out before they started work. The induction they were given covered all aspects of their work. Six staff said they receive appropriate training to keep them up to date, one said no. Staff said they would know how to raise concerns. Three staff said that the communications work well, three said usually and one said sometimes. Many comments were made, we heard that it is a changed home, a great environment to work in , the home feels different, residents and staff are much happier, we need a manager, we need more dementia training and there is improvement at Suddon House, a better atmosphere. One staff felt that the home is undervalued by CSCI and another said it offers the best care and a good choice of food. One member of staff had observed that staff are now asked for ideas and not just told. Professionals said there is good staff observation of peoples well being and we heard that people are correctly supported with their medication and staff follow Care Homes for Older People Page 23 of 33 Evidence: instructions. All people living at the home reported that staff listen and act on what they say. One comment included that always willing to help at anytime, staff are sometimes very busy, staff are generally available and always support me. Care Homes for Older People Page 24 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There has been no registered manager at this home for a significant length of time. Whilst there has been a lot of management input at the home the management responsibility for the home is not clearly defined. This has left room for error and omission with a delegated management task. The management are receiving feedback from people using the service and there is evidence that the home is judged by them to be improving. Personal money held for safekeeping is safely managed. Health and safety, maintenance and servicing within the premises is being well managed. Evidence: There has been no registered manager at this home under the present provider and Care Homes for Older People Page 25 of 33 Evidence: for in excsss of three years. There has been input to the management of the home from outside agencies and currently a management company are working with the provider to address the shortfalls identified at the last key and subsequent random inspection visits by CSCI. The home has an acting manager and they made themselves available to support the regulatory inspection process. The nurses have been supporting the ongoing management and have been updating care records, staff training and supervision. One registered nurse is responsible as the clinical lead, this is not a supernumerary role. Quality assurance remains an informal process but contact with relatives and families is being addressed and there is regular contact. The feedback to the commission indicated that people know who to speak to if they have concerns and people were encouraged with the improvements they have seen this year. The records for money and valuables were sampled. Small amounts of money are held for four individuals and the sums of money tallied with receipts and balances. Staff recruitment is not formally monitored and supervised, this was the case at the last key inspection, the latest random and this key inspection. An immediate requirement was made at this inspection and the home responded immediately and have committed to ensuring future management for safe recruitment practice. The AQAA did not provide information about the servicing of the equipment for the last key inspection. Therefore at the July 2008 key inspection servicing records were examined to verify maintenance of the lift, hoists, fire safety equipment and portable electrical appliances. The home has two maintenance personnel who manage the in house checks for the fire alarm, hot water and on going maintenance and repairs at the home. Fire training has been organised for staff to update their skills beyond the video training. The Fire Safety officer has reported that this is satisfactory. Video learning is used for infection control and food hygiene. The provider has undertaken manual handling training in order to train staff practically, video learning is used to support this. Care Homes for Older People Page 26 of 33 Care Homes for Older People Page 27 of 33 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 14 12 (2) (3) The registered person must 31/08/2008 ensure that service users are given opportunities to make choices. Evidence seen did not support that this requirement was met. 30/04/08 2 19 13 (4)(a)(c) The premises 11/01/2009 should be safely maintained. This refers to the window frames on the first floor and the health and safty requirments made by the HSE. 3 19 13 (4)(a)(c) The wardrobe that was not secured must be fixed and made secure. To prevent the risk of injury should the wardrobe topple forwards. 11/01/2009 4 24 16 (2)(c) Bedrooms must be equipped to meet the needs of people using them. This refers to missing or broken bedside cabinets, lack of bedside lighting provision. Curtain or curtains that do not fully close, this compromises the respect, 11/01/2009 Care Homes for Older People Page 28 of 33 dignity and privacy of people using these rooms. 5 26 16 (2)(k) Malodour must be well 11/01/2009 controlled. One bedroom was malodourous and should be addressed with sufficient cleansing. 6 27 18 (1)(a) The registered provider must ensure that staff do not work for long periods without a break or without a suffient break between shifts. To ensure safe working practices and ensure that staff do not become overtired by their work patterns. 7 31 12(1)(a) 12 (5)(a) There must be clear leadership and clear lines of accountability in the home. 11/08/2008 11/01/2009 Care Homes for Older People Page 29 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 3 14 1) All new admissions must 28/04/2009 be assessed thoroughly by a suitably qualified or trained person pre admission.CSCI must be notified as new admissions are made to the home. The home does not have a registered manager and there have been no new admissions over the past year. New admissions must be carefully assessed for placement suitability and their care needs be well planned and managed. 2 8 17 (1) Schedule 3. 27/04/2009 Care plans must be person centered and have meaningful assessments and specialist care planning in place. Assessment tools were in use that had scores without reference to the meaning of the scores. Care Homes for Older People Page 30 of 33 3 18 19 (1) Staff recruitment procedure must be robust and must be consistently applied. Recruitment procedures must be robust in order to protect people from the risk of harm from unsuitable people being allowed to work at the home. 27/02/2009 4 29 19 Staff recruitment must be 27/02/2009 robust and completed before new staff commence working at the home. The management must take responsibility for ensuring this is complied with in all future practice. Staff recruitment procedures have been found to be weak in different areas over the past year. Management must take control of this for the safety of people living at the home who are put at risk when this happens. 5 32 18 (2)The home must have a 26/02/2009 delegated person taking overall control of the running of the home to oversee all the management tasks and responsibilities. There has been evidence of management not having an overview of recruitment practice that had been delegated within the care and administration team. Care Homes for Older People Page 31 of 33 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 8 9 Work should continue to develop the care planning in a person centred and meaningful format. Staff should be reminded to sign hand transcribed entries and obtain a countersignature to verify that the entry has been checked and is accurate. Nursing equipment such as vacutainer bottles for venous blood sampling should be regularly checked for expiry dates and replaced as necessary. Staff supervision should include observed care practice to identify and make improvements with some of the mixed standards of care practices. The personalisation of individual accommodation should be made, some bedrooms are quite bare of personal items. The grounds should be made safe and accessible for use in warmer weather, in line with the management action plan for the home. Bedrooms should be personalised, made homely and be safe. Beds should be comfortable with a quality of pillows and bedding that will provide comfort and promote rest and relaxation. Older bedding and flat pillows should be replaced. Malodour identified in two bedrooms should be better controlled. The home should have a Quality Assurance system in place to regularly monitor the quality of the care provision and service delivery to ensure the homes ongoing development as a specialist dementia care service. 3 9 4 12 5 6 14 19 7 24 8 9 26 33 Care Homes for Older People Page 32 of 33 Helpline: 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 We want people to be able to access this information. 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