Inspection on 13/12/05 for Sue Ryder Care Centre

This inspection was carried out on 13th December 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sue Ryder Care Centre 24/09/08

Sue Ryder Care Centre 22/06/07

Sue Ryder Care Centre 12/05/05

Sue Ryder Care Centre 30/11/04

Sue Ryder Care Centre 06/05/04

Sue Ryder Care Centre 21/01/04

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Ruskin Lodge

Dystlegh Grange

The Good Companions

Springfield Cottage

Cuerden Grange Rest Home

Cornmill Nursing Home

Vitalise Sandpipers Centre

Sue Ryder Care Birchley Hall

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

CARE HOME ADULTS 18-65 Sue Ryder Care Centre Cuerden Hall Shady Lane Bamber Bridge Preston Lancashire PR5 6AZ Lead Inspector Anne Taylor Unannounced Inspection 13th December 2005 09:30 Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 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 Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 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 Adults 18-65. 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. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sue Ryder Care Centre Address 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) Cuerden Hall Shady Lane Bamber Bridge Preston Lancashire PR5 6AZ 01772 627374 01772 629290 anne-marie.potter@suerydercare.org Sue Ryder Care Mrs Anne-Marie Potter Care Home 37 Category(ies) of Physical disability (37), Terminally ill (6) registration, with number of places Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home is registered for a maximum of 37 service users to include: Up to 37 service users in the category PD - Physical Disability Up to 6 service users in the category TI - Terminally Ill The Registered Provider should, at all times, employ a suitably qualified and experienced Manager who is registered with the National Care Standards Commission. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the National Care Standards Commission regarding staffing levels in care homes. 5. Date of last inspection Brief Description of the Service: Sue Ryder Care Centre is a 37-bedded unit, which provides residential and nursing care to young physically disabled people. It is a mixed gender home that takes residents between the ages of eighteen and sixty-five. At the time of inspection thirty-five people were living in the home. Thirty-four were receiving nursing care and two receiving personal care. The home was set up ten years ago to provide long term care for people with life threatening conditions and illnesses such as Huntington’s disease, multiple sclerosis, acquired brain injury, cancer and other neurological disorders. The Sue Ryder Charitable Trust owns it, although the day-to-day management of the home is the responsibility of the registered manager, Ann-Marie Potter. Formerly a stately home, the Sue Ryder Centre is set in eleven acres of parkland close to motorway network and Bamber Bridge. Accommodation is provided over three floors in single or shared rooms. The home has wheelchair access and a passenger lift. Other facilities include a multi sensory room, large activities area, physiotherapy department and specialist equipment to meet the needs of people living at the home. The home has a designated activities team that provides a wide range of recreational events and activities for residents. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in December 2005. The majority of National Minimum Standards assessed had been met and for those not fully met only minor shortfalls were identified. The overall standard of care provided was good and the management team had addressed issues raised at the last inspection with good effect. The inspection involved discussion with the people who lived and worked at the home, examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection? The number of care staff with a national vocational training qualification at level 2 or above has increased so that the home now exceeds the minimum expected. It also helps to make sure that staff have received training appropriate to the job they do and are given the underpinning knowledge to support their day to day practice. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 6 The organisation has developed and introduced a set of company values, like a code of practice that staff are expected to follow so that care is provided professionally. It also helps staff understand how they can contribute to making sure the home meet its stated aims and objectives. Some carpets have been replaced and two large communal areas redecorated so that the environment for people that live at the home is well maintained and comfortable. What they could do better: 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. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The key Standard 2 was not assessed at this inspection. It was assessed at the last inspection and considered fully met. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The key standards 6,7 and 9 were not assessed at this inspection. They were assessed at the last inspection and considered fully met. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,17 The home provided opportunities for residents to follow their interests and hobbies, promoting their involvement and inclusion in the local community. The importance of providing a well balanced diet was recognised by the home so that residents were able to eat healthily and given a choice about what they ate. EVIDENCE: Discussion with residents and staff indicated that people living at the home were actively encouraged to take part in age, peer and culturally appropriate activities. They were provided with a range of opportunities and social activities, in accordance with their abilities, which gave them an opportunity for personal development and some involvement in the local community. A range of leaflets was provided in the reception area, which gave residents information about local activities support and resources available. If they wished to attend any of these staff support was provided. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 11 A nutritional assessment was completed for each resident and weights checked regularly as part of the care process so that any problems or concerns could be identified and action taken. Residents spoken to say that they were given a menu slip each day so they could chose the meal for the next day. They also said that if they didn’t like the menu choice the cook would make something else. Staff and residents confirmed that meal times could be flexible to take into account residents’ lifestyle and choice. A brief record of food served to residents was kept in the kitchen. The cook was advised to include more detail particularly if an alternative was served. The lunchtime meal was relaxed and unhurried with staff available to assist if needed. Some residents had chosen to eat in the dining room, others in their bedroom. One resident said, “I have breakfast and tea in my room and lunch in the dining room”. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20 EVIDENCE: Policies and procedures in relation to the safe handling of medicines were in place and accessible to staff for guidance and advice if needed. The policies and procedures are reviewed and updated by the parent company. Policies on relation to the safe handling of medication should have been reviewed in 2004 but this had not taken place. The manager said that the review of policies was ongoing. She was advised that any new polices should include up to date information about the disposal of medicines, which reflects new changes in legislation. Issues of capacity and consent to being administered medication had been dealt with by the home so that residents, wherever possible, or their representative could make informed decisions about this aspect of their care. One service user had chosen to self medicate and a risk assessment had been carried out so that this could be done safely. The Medication Administration Records (MAR) examined were generally up-todate but there were some ‘blanks’ where administration or the reason for nonadministration was not recorded. Handwritten MAR entries and amendments to Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 13 the pre-printed dosage instructions were not generally signed, nor independently checked and countersigned. As discussed any additions or alterations should be signed and dated. Medicines were stored safely in locked cupboards within a locked room with access restricted to trained nursing staff. Stock levels were excessive and included medication that had been dispensed several months ago. There was also an excessive quantity of some ‘when required’ tablets and creams. The registered manager should ensure that the systems in place for reordering stock are reviewed so that unnecessary amounts of medication are not ordered and all unwanted medication is promptly segregated for disposal. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The home had a clear complaints procedure that ensured residents knew how and who to complain to. Complaints were managed effectively so that residents were confident that any issues they raised would be acted upon. Management processes in relation to abuse were thorough enough to make sure people living at the home were protected. EVIDENCE: The complaints procedure was included in the statement of purpose and service user guide. Each resident had a copy of the service user guide in his or her bedroom. Resident’s spoken to felt that they were encouraged to raise any concerns they might have about the home, that they would be listened to and action would be taken on any issues raised. The home had received five complaints since the last inspection all of which had been resolved. The Commission for Social care Inspection had investigated one of these. In order to improve the management of complaints more detailed records of the investigation, any action taken and final outcome should be kept. The home should also consider separating documented incidents and accidents, which are currently kept in one file, so that the differentiation is clear. Discussion with the manager and staff showed that residents and relatives were actively encouraged to use the complaints procedure as a means of improving the service. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 15 The home had an adult abuse policy and whistle blowing policy, in addition to a copy of guidance issued by the department of health. Discussion with staff showed that they were aware of the above documentation and were quite clear about what they would do if an allegation or suspicion of abuse came to their attention. The manager was aware of her responsibilities in relation to protecting people living at the home and making sure staff were appropriately trained to recognise and act upon any signs of possible abuse. Induction training records for new staff included information and guidance about abuse so that all new staff were familiar with the subject and how to respond to any allegation or suspicion of abuse. Staff confirmed that they received regular updates so that they continued to be made aware of the need to protect the people they care for. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The key environmental standards were not assessed at this inspection, however, two requirements were made at the last inspection and progress in meeting the requirements was assessed. Some parts of the home were looking a little tired and shabby. Paintwork was chipped and some furniture dated. There were one or two large holes in the corridor ceiling on the first floor and the floor covering in bedrooms 31 and 33a needed attention to rectify staining or frayed edges. The manager was aware of this and a planned programme for maintenance and refurbishment was in place so that furnishings and fittings could be renewed and areas redecorated when needed. Most of the radiators had been appropriately covered, however, a small number remained unguarded and did not have a guaranteed low surface temperature. Unprotected radiators present a possible health and safety risk to residents and steps must be taken to remove or reduce this risk. The manager said that she would make sure that the home’s programme of maintenance, which included completion of fitting radiator guards, is implemented as soon as possible. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 17 Since the last inspection some carpets had been replaced and the main lounge and library room had been redecorated. The programme of renewal and refurbishment should continue, as a tour of the premises showed that parts of the home still need upgrading. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 The home had an effective staff team that was appropriately trained and had the skills and experience to manage and meet the needs of residents. EVIDENCE: The home had a training and development programme linked to the service provided and the needs of residents. Individual training records were kept so that training needs could be identified and relevant training provided. Discussion with staff showed that they had received induction training and training specific to the work they were expected to carry out. Staff felt that training opportunities, both formal and informal were good. Comments included “There is lots of training and we are encouraged to go on lots of courses and it helps us understand what is expected of us and how best to look after people”. “We get help from trained staff and if we want to know anything you just have to ask and they either have it or will find out”. National vocational training (NVQ) was available to care staff and a significant number of care staff had already achieved level two or three so that the home exceeded the fifty per cent needed to meet the national minimum standard. Residents spoken to were satisfied with the staffing arrangements and indicated that they were well looked after by staff that understood their needs and provided help when it was needed. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 Residents lived in a well run home, managed by a responsible person who was able to make sure the home met its stated purpose, aims and objectives. The home was managed and organised in a way that helped make sure the service was run in the best interests of residents. EVIDENCE: Records showed that the registered manager is a first level registered nurse who has extensive experience of running and managing a care home for this client group. The registered manager had also completed a relevant management qualification and continued to meet the professional registration requirements of the Nursing and Midwifery Council so that she keeps up to date with current good practice. Discussion with staff showed that the manager provided leadership and direction so that every one knew what their role was and what was expected of them. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 20 The home was able to meet its stated purpose and included residents in the decision making process as much as possible so that they felt involved in the running of the home. This was demonstrated by comments from residents, which included, “everything is fine, there are no problems” and “ I go to all the residents meetings and we can have our say, we get minutes of what has been said and what is to be done”. The manager had recently introduced a resident’s forum that allowed smaller groups to discuss issues. This was particularly beneficial for residents that might feel intimidated in a larger group. A system was in place to monitor the quality of service delivered so that the home could be made aware of their strengths, weaknesses and whether residents were satisfied with the service they received or not. This was achieved by sending out satisfaction questionnaires. Discussion with the management team showed that feedback from the survey was used as a means of improving and developing the service. The results of the surveys were made available to residents so that they could be reassured that their views were acknowledged and contributed to the running of the home. Residents spoken to say that they remembered completing a recent questionnaire about the development of the service and felt they were listened to if they had any concerns or requests. The home had been accredited with a nationally recognised quality assurance award that was reviewed regularly. The management team carried out a quality audit of the operational systems in place at the home. Both systems made sure that the home was complying with company policies and procedures, current legislation and best practice. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score X X X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X x LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X X X CONDUCT AND MANAGEMENT OF THE HOME 3 Standard No 37 38 39 40 41 42 43 Score PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sue Ryder Care Centre Score X X 2 x 3 X 3 X X X x DS0000025555.V257985.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Unwanted medication must be promptly, securely segregated from that in use and safely disposed of. All medication administration records must be complete, clear, accurate and up-to-date. Worn furniture and fittings must be replaced. Damaged areas within the home must be redecorated and maintained to an appropriate standard. This includes the floor coverings in the bedrooms identified at inspection and the holes in the corridor ceiling on the first floor. Radiators must be appropriately guarded or of a guaranteed low surface temperature. (Timescale of 30th September 2005 not met). Timescale for action 28/02/06 2 3 YA20 YA24 13(2). 23(b)(d) 31/01/06 31/03/06 4 YA24 13(4)(a) 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Sue Ryder Care Centre DS0000025555.V257985.R01.S.doc Version 5.0 Page 23 No. 1 2 3 4 Refer to Standard YA17 YA20 YA20 YA22 Good Practice Recommendations More detailed records of food served should be kept, particularly if an alternative to the menu is served. Handwritten additions or alterations to the MAR should be signed, independently checked and countersigned. The procedures for the ordering and stock control of medication should be reviewed. More detailed records of complaint investigations, any action taken and final outcome should be kept. The home should also consider separating documented incidents and accidents, which are currently kept in one file, so that the differentiation is clear. 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