Inspection on 24/09/08 for Sue Ryder Care Centre

This inspection was carried out on 24th September 2008.

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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sue Ryder Care Centre 22/06/07

Sue Ryder Care Centre 13/12/05

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

Similar services:

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 19/12/2008.

CARE HOME ADULTS 18-65 Sue Ryder Care Centre Cuerden Hall Shady Lane Bamber Bridge Preston Lancashire PR5 6AZ Lead Inspector Mrs Pat White Unannounced Inspection 24th September 2008 10:00 Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 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.V368811.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 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.V368811.R01.S.doc Version 5.2 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 www.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.V368811.R01.S.doc Version 5.2 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. 22nd June 2007 5. Date of last inspection Brief Description of the Service: Sue Ryder Care Centre is situated in Bamber Bridge in a formerly stately home. The home is set in eleven acres of parklands with easy link to the motorway network. Local amenities are not within easy reach as the home is secluded within its own grounds. Sue Ryder Care Centre is a thirty-seven bedded care home, which provides residential, nursing and day care to younger physically disabled people between the ages of eighteen and sixty-five and both male and female. The home was opened 18 years ago to provide long term care for people with long term and or degenerative illnesses such as Huntingtons disease, multiple sclerosis, acquired brain injury and other neurological disorders. Accommodation is provided on three floors in single or shared rooms. There is wheelchair access and a passenger lift to all floors. Other facilities include a multi sensory room, large activities area, physiotherapy department and a range of specialist equipment tailored to meet the residents’ needs. The home has a designated activities team that provides a wide range of recreational events and activities. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 5 Current weekly fees start at £633 with no upper limit, as this is dependent upon assessment of needs. Additional extras like hairdressing, chiropody, newspapers, outings etc are paid for by the residents. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use the service experience adequate outcomes. This inspection site visit was carried out on the 24th September 2008. The site visit was part of a Key inspection to determine an overall assessment on the quality of the services provided by the home. This included checking important areas of life in the home that should be checked against the National Minimum Standards for Younger Adults, and checking the progress made on the matters that needed improving from the previous Key and Random Inspections. Two inspectors carried out this site visit. Following an accident in the home involving a resident and a specialist bed system with bed rails fitted an unannounced inspection was undertaken in June 2008 and which triggered this (early) Key Inspection. This accident had also resulted in a Health and Safety investigation that was still ongoing at the time of this inspection. A pharmacy inspector from the Commission carried out an unannounced inspection in July 2007 to assess medication management in the home, and the requirement and recommendations made at this visit were also checked at this key inspection. The inspection included: talking to residents, touring the premises, observation of life in the home, looking at residents’ care records and other documents and discussion with the registered manager and care manager. Four residents spoke in detail about their views on the home, others were spoken with in less depth. Two medical practitioners gave their views about the home - a Consultant in neurology and a General Practitioner who regularly visits the home. The views of these people are included in the report. In addition the home provided the Commission with written information, prior to the inspection, about the residents, staff and services provided, and some of this is also included in the report. What the service does well: Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 7 There was up to date information about the home that was given to prospective residents and existing residents so that they knew about the services and facilities, and what to expect when living in the home. The way people were admitted to the home ensured that their needs were assessed, and that people could visit the home before going to live there. This helped people to make a decision about whether or not the home was suitable for them, and also gave staff written information to help them understand people’s needs. The residents spoken with praised the staff and said that they were well looked after and supported. One person said he appreciated conversation with staff and “humorous banter”. Another resident said, “All the staff are very good”. They said that they were very happy with all the services provided and the way the staff treated them. The home had excellent facilities and opportunities for residents for leisure and exercise, with on site physiotherapy and occupational therapy. There was an activities team and a specific room for this purpose. There were computer facilities with an option of computer lessons. The medical practitioners said in the questionnaires that the home met the health care needs of the residents, and looked after people with complex neurological diseases very well. The home is situated in extensive pleasant grounds and residents were given the opportunity of enjoying time outside, either on their own or accompanied by staff. As a former stately home the environment was a pleasant interesting environment for the residents to live in. The residents had all the equipment that they needed for their comfort and to assist them with mobility. Staff recruitment was thorough enough to help ensure that suitable staff worked in the home, with appropriate checks being made prior to new staff starting work. There were good training opportunities with a large proportion of staff having the right qualifications for their roles, including qualified nurses and care support workers. The right numbers of staff were on duty to enable them to support people properly. What has improved since the last inspection? Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 8 The care plans had been reviewed and updated so that there was more up to date information to assist staff to support people. Also the assessments of the risk associated with the use of bed rails had improved since the last inspection and this helped to reduce the risk to the residents using this equipment (see below). Some medication practices had improved. Accurate records were being kept of medication received into the home and disposed of to ensure that there was no mishandling of medicines. The prescriptions were being checked prior to going to the chemist for dispensing so that errors in ordering and prescribing could be identified. Guards had been fitted on all the necessary radiators since the previous key inspection to eliminate the risk to residents of hot surface temperatures. The dining room had also been redecorated and made more pleasant for the residents. The equipment for use in an emergency – the staff buzzers and the resuscitation equipment - had been restocked since the previous inspection and there were new procedures for checking this equipment. This made sure that staff had access to the right equipment when needed. The equipment used in the home to protect people from falling out of bed was being made safer at the time of this key inspection and the checking processes were being improved (see below) Staff training for the safe use of bed rails had been developed to ensure that staff were better able to ensure that this equipment was safe and used properly (see below). What they could do better: Some of the care plans could be further improved with more details of residents’ preferences, psychological matters, how to communicate with residents and details of specific conditions. Some of the risk assessments for bedrails should be clearer and more accurate to help ensure that the systems in use for some people were the safest and the most comfortable for the individual. Some aspects of medication management should be further improved and residents should always be given their medicines as prescribed to ensure they worked effectively. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 9 Some parts of the building should be improved to make a more pleasant environment for residents, such as repairing damaged walls and ceiling, redecorating and replacing carpets. Staff recruitment could be further improved by using more appropriate referees who would give a more objective and accurate view on people’s suitability for work. The procedures that had been developed since the previous Random Inspection, for ensuring that the bedrail systems were safe, need to be further implemented. The system for checking that the bed rails were safe was still not fully implemented at the time of this site visit, and residents could still be at risk from faulty or ill fitting equipment. Also although staff training in the “Safe use of Bedrails” had begun, there was still a high proportion of staff who had not undertaken this training and therefore may not have all the knowledge required to ensure bed rails were fitted safely. 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. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 10 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.V368811.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There was sufficient useful written information about the home available to people. The home’s admission procedures helped to determine whether or not the home could meet people’s needs, and helped staff understand what support people needed. EVIDENCE: There was up to date information about the home available to people. However details of the last inspection were not automatically available – only on request – and there were no views of service users included in the Service User Guide. Therefore residents may not be aware of this information. The admission procedure ensured that a senior member of staff assessed people’s needs before they went to live in the home so that staff understood some of these needs and a decision could be made about whether or not the home could meet the needs. Residents and relatives were encouraged to visit the home if at all possible, to help them decide if it was a suitable place for them. If this was not possible staff visited people where they were living. Some of the residents spoken to confirmed that they had visited the home prior to going to live there and that the home met their needs. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 12 The assessment included relevant information, including medical history and assessments from relevant health and social care professionals. It also included information about most relevant matters such as mobility, the risks associated with everyday tasks, and the support and nursing care required. However several assessments viewed had been written a number of years ago and had not been updated, so the assessment did not correspond with current needs. Having out of date information may lead to misunderstandings about peoples’ needs and them not receiving the right support. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents had care plans that underpinned the support and care they needed, though not all care plans had sufficient details on all aspects of health, personal and social care. Not all risk assessments for the use of bed rails were sufficiently accurate to give staff correct guidance. Residents’ were encouraged to be as independent as possible and make choices but this was not always underpinned by written information to guide staff. EVIDENCE: The records of seven residents were viewed and they all had care plans which covered most relevant matters in health and personal care. These plans had been reviewed and updated since the previous inspection and staff had undertaken training in the development and writing of care plans. Also the plans were being developed in a “person centred way” to help ensure that care is delivered in ways that suit individual’s preferences. However the plans viewed still did not all include sufficient detailed information in all matters. For example two care plans did not include useful information on how people Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 14 with difficulties in communication made themselves understood to staff, and the individual methods used by residents and staff to assist this. One care plan seen did not have sufficient instructions re pressure area care so some staff may be unclear as to what action to take. Other care plans did not include enough detail of the complex manifestation of the specific conditions of residents including the psychological effects. Some were not as person centred as they should be and did not include sufficient information about preferences and likes and dislikes. This could mean that people were not supported in their preferred ways. Discussion with residents provided evidence that they could make choices about their lives. However these choices, and how choices may sometimes have to be restricted, were not underpinned by a written explanation of the decision making process in a person centred way, so it was not clear how decisions had been made. There was a comprehensive process of assessing the risk associated with care and every day activities, including moving and handling and pressure areas. There was also a system for assessing the risk associated with the different systems in use to prevent people from falling out of bed. At the last unannounced inspection, this system was found to be inadequate for protecting people, and the management team was required to develop and improve the risk assessment tool for this. This had been carried out by the time of this site visit but in some cases the written risk assessment was still not being completed as accurately as it should be, and therefore did not provide accurate guidance for staff in protecting people. In one file viewed the risk assessment concluded that the bed should have bed rails with bumpers. However this resident did not have a rail on one side, but a crash mat on the floor. Also there were a large number of beds without protective bumpers and the risk assessments did not show why this decision had been made, or that people were not at risk from impact injuries. Through observation and talking to people it was clear that residents were encouraged to remain as independent as possible, and could make choices about their daily lives, such as in leisure activities and routines within their capabilities. Residents were seen moving around the home in their wheelchair, or walking, and appeared to have free access to all parts of the home throughout the day. However there was no written guidance for staff about the preferred routines, and as some residents had difficulties with communication it was not clear how staff understood their preferences (see above). One resident confirmed that he was able to go out into the grounds in his wheelchair, without staff escort, and that a system had been set up that enabled him to summon help if needed. However this was not underpinned by written guidance for staff, which could mean that the resident would not get the appropriate assistance. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 15 Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home provides opportunities for residents to follow their interests and hobbies, promoting their involvement and inclusion in the local community. The meals served suited the residents needs and preferences and the menus appeared varied and appetising. Residents’ rights were respected. EVIDENCE: Residents living at the home varied in age and abilities, and some had multiple disabilities and complex needs. The home had good facilities to help meet the social and recreational needs of this diverse group of people. Throughout the site visit staff were seen assisting residents to move around the home, to take part in activities, assisting them in their bedrooms and also socialising with them in the lounge. Residents spoken with indicated that there was a variety of suitable activities Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 17 The manager said that the residents were consulted about their daily activities and were guided by the staff, where needed, to choose age appropriate and suitable activities. There was a good range of activities for the residents to choose from. These included handicrafts, computers, bingo and quizzes, film nights and trips out in the home’s adapted minibus transport. A team of activity organisers was employed to coordinate all activities and to encourage residents to participate. There was a large room available for handicraft and activities, and a computer room. A volunteer gave computer lessons twice a week and on the site visit residents were seen taking part in this. Those who were able could access and enjoy the extensive grounds, either on their own or with the help of staff. Residents were encouraged to maintain contact with family and friends and visiting was open and unrestricted. Residents were encouraged to go out with relatives if possible. Relatives can be involved in the care plan process and are invited to some meetings about the development of the facilities. There was coffee shop, a second-hand (Sue Ryder) shop, and a garden centre in the grounds of Cuerden Hall that was run by volunteers. This was a pleasant resource for residents who could act as volunteers, or visit the facilities as customers. Residents’ rights and choices were promoted in the home, and to facilitate this the Sue Ryder organisation had established a “service user involvement lead”. This should ensure that the rights and choices of the service users are heard and acted upon at local and national level. The menus were viewed, and they showed that a variety and choice of meals were provided. Looking at records and talking to people indicated that there were at least 2 choices for every meal, and each day residents were provided with a menu to choose from. At the lunch - time meal observed at least 3 different alternatives were being served. The cooks said that if residents do not like what is on the menu, they would make them something of their choice. Suitable arrangements are made in relation to offering food to meet different dietary and cultural needs. Meals were served in different forms including liquid, blended and solid, to meet the different needs of the residents. And there were sufficient staff on duty to assist all those who needed it. However some staff were observed assisting residents inappropriately. This was discussed with the manager and she subsequently informed the Commission that this had been rectified. The residents who were able to comment about the food said that it was very good, and that they had good choices and “plenty to eat and drink”. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ personal and health care needs were adequately met, though not all medication practices would ensure the correct administration of medication. EVIDENCE: Personal care and support provided by the staff was based on the assessments and care plans. Residents who were able to manage their own personal care needs were encouraged to do so, however staff would prompt and offer assistance where necessary. There was satisfactory information to assist staff about some matters requiring staff support, such as oral hygiene, moving and handling and nutrition and feeding. There was evidence that people received the physical support that they needed, and people spoken with indicated that they were well cared for. However as stated in a previous section some other support required was not always underpinned by detailed instructions to staff, such as personal preferences and psychological support. Therefore for some people with complex needs, including psychological needs, and communication difficulties it Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 19 was not clear whether or not these people were receiving all the support needed in their preferred way. Also at the time of the site visit, although most staff were seen supporting residents appropriately, some staff/ resident interactions that we observed appeared to show a lack of sensitivity to residents. These were discussed with the manager at the time of the site visit. The residents said that the routines in the home were flexible and there was evidence that residents could get up and go to bed when they wanted and also spend time in their rooms. Some residents spent considerable time in bed, and one spoken with said that the staff were attentive to her. Another resident said, “The staff are very good”. However one said and that “some staff were better than others and that people had off days”. Personal care was provided in the privacy of the resident’s bedroom or the bathroom. Residents in conversation said that the staff respected their privacy and dignity. Records and talking to people showed that additional support was available to provide total care for the residents. There was frequent involvement of Consultant doctors, specialist nurses, physiotherapist and the dietician, in addition to residents’ General Practitioners, dentists and opticians etc. The two medical practitioners who completed the questionnaires for the Commission felt that the home ensured that residents’ health needs were well promoted, and that they always followed the medical advice given and in a way that respected residents’ privacy and dignity. A unannounced inspection of medication was undertaken in August 2007 by a pharmacy inspector from the Commission, and which identified a number of areas for improvement. At this key inspection another medication inspection was undertaken that included checking the matters highlighted at the Random pharmacy inspection. This inspection involved checking 9 residents’ medication and the corresponding records. We found there were some improvements from the previous pharmacy focussed inspection. More accurate records were now being kept of all medicines received into the home and disposed of, to help ensure that there was no mishandling of medication. The prescriptions were now being checked at the home prior to going to the pharmacist for dispensing to help identify any errors in ordering and prescribing. The storage of medicines was safe and hygienic including the storage of Controlled Drugs. Controlled Drugs were also managed and administered safely. However the following matters of concern were identified, and some of these were “Recommendations” from the previous inspection. For two residents whose medication for epilepsy was checked, the amount of tablets remaining in the box was in excess of what it should have been according to the records of administration entered on the Medication Administration Records (MARs). There was no explanation given for this, so it appeared that the medication had not been given even though it had been signed as given. For another Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 20 resident 2 out of 4 doses of antibiotic had not been given. Not giving medication as prescribed can adversely affect residents’ health. There were still no clear written guidelines for the administration of “when required” and “variable dose” medication so it was not clear when, and how much, medication should be given. Written information about this would be especially useful for people with communication difficulties. Also with variable dose medication the dose given was not recorded so there was no indication of what dose was effective under which circumstances. With respect to the records kept: For some medicines that were in the original box the date of opening of the box was not written down so an audit to check whether or not this medication had been given could not be made, the hand written additions or alterations to the MARs were not always double signed and witnessed, which increases the risk of transcribing errors. On one MAR the entries for the administration of an enema were on different days to that on the prescription label without a supporting explanation. It was therefore unclear whether or not this was being given correctly as prescribed. One resident was administering some of their medication. However as identified at the last (pharmacy) inspection there was no risk assessment, or records of ongoing checks, to determine that this was safe and remained safe. Also for another staff had altered the administration of a medicine from the prescribed dose of three times each day to “when required”. There was no evidence of the General Practitioner’s authorisation of this, so it appeared that the medication was not being given as prescribed. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents knew that their concerns would be listened to and taken seriously. There were policies and procedures to help protect and safeguard people from abuse. EVIDENCE: There was a complaints procedure included in the Service User Guide and a complaints leaflet that was on display in an information rack in reception. This information was therefore available to residents and their families. The residents spoken with at the time of the site visit said that they had no complaints, but knew who to speak to if they had. Four complaints had been made to the home since the previous key inspection. The records showed that they had been investigated appropriately. The home had appropriate policies and procedures to safeguard adults from abuse including a whistle blowing policy. All staff undertook training in the Protection of Vulnerable Adults, and this was regularly reviewed and updated and included the Government guidelines about how incidents should be managed. This should further help to protect the residents from abuse. Staff spoken with confirmed that they had undertaken this training Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and clean environment for the residents. The home was adequately maintained and furnished. EVIDENCE: A tour of the building showed that the home was comfortable and adequately furnished including easy chairs and sofas in keeping with the residents’ age group. There was a choice of communal areas and extensive and attractive grounds and gardens for residents to enjoy. However we were informed that a site for a new purpose built home had been agreed and that building would start in he near future. Bedrooms were personalised and spacious, though some were shared which reduced people’s opportunities for privacy. Residents were able to furnish their rooms with some of their own personal items such as chairs and small tables. Some residents were encouraged to look after their rooms if they were able to. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 23 There had been some improvements to the premises since the last key inspection. More radiators had been covered, and there was only one that remained uncovered - in a currently empty room. This radiator was to be covered in the near future when the room concerned is decorated. The dining room and reception area had been redecorated and made brighter. However in spite of the stated rolling programme of maintenance and decorating, and regular checks being made, there were a number of areas that needed urgent repair and improvement. Outside two bedrooms there were holes in the wall that needed re plastering and decorating, there was extensive wheelchair damage to the doors and skirting boards, there were two broken sash windows in the lounge, a bedroom ceiling needed repairing and some carpets were badly worn and stained. Residents had all the equipment they needed to assist them to be comfortable, mobile and independent. There was a physiotherapy room, with equipment, and residents had specific chairs and wheelchairs for their own use. There were several adapted bathing and shower facilities. There were a number of different systems on a large proportion of the beds to prevent people from falling out and injuring themselves. Following an accident involving “bed rail” equipment the home was required to make these systems safer (See “Conduct and Management of the Home”). There were numerous systems in place to ensure the safe use of bed rails but there were still a number of systems that were not as safe as they could be. For example one bed had a gap between the mattress and the bottom of the bed rail. There was also an overlay mattress and it was not clear whether or not this was compatible with the bed or the original mattress. On another bed the protective bumpers were not positioned /secured correctly and would not protect the person from banging against the rails. Another bed with integral bed rails had a part missing from rail so that it couldn’t be released. This was repaired during the inspection. Procedures had been developed since the last random inspection to ensure the correct resuscitation equipment was always easily accessible, and to ensure that the correct number of emergency buzzers used by staff were always available. This should help to ensure that staff acted quickly and effectively in an emergency. In addition on the day of the site visit the maintenance person was checking all the bed rail systems in the home with the regional property manager (see “Conduct of Management of the Home”). There were satisfactory laundry facilities and procedures including infection control procedures. The home was clean and free from offensive odours at the time of the site visit. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s recruitment procedures were sufficiently thorough to help ensure that suitable people were employed in the home. The staff team had the appropriate qualifications and skills to help them care for the residents and understand their needs. EVIDENCE: Throughout the inspection site visit it appeared that there were enough staff to meet the needs of the resident, including cooks, activities organiser and administrative staff. Qualified nurses were on duty at the appropriate times and places in the home. Residents and staff spoken with said that they felt there were good levels of staff in the home that enabled the needs of the residents to be met and that people felt the staff had the right training and support to do their work properly. Most staff were seen interacting positively with the residents, and the residents spoken with said that staff were very good and treated them well. However as stated in above some staff interactions with staff were discussed with the manager who agreed to investgate. Records of 3 members of staff indicated that staff recruitment procedures were sufficiently thorough to help protect people from unsuitable staff. All the Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 25 necessary checks had been carried out before people started work in the home, including the Criminal Records Bureau and Protection of Vulnerable Adults checks, and references. However the references for one of these members of staff were not the most appropriate. One was from a colleague rather than the employer, and it was not clear in what capacity, or why, the second referee had been asked to give a reference, as this person was not listed as a referee on the application form. New members of staff attended a comprehensive Induction training, which was in accordance with Government guidance, and covered all the recommended topics including the Protection of Vulnerable Adults. Records on staff files confirmed this training. According to the information supplied to the Commission about 80 of care staff were qualified to at least NVQ level 2 and there were always at least 2 qualified nurses in charge of the shifts at all times. Staff spoken with felt there were given good opportunities for training and there were “study days” to assist staff understand specific neurological conditions and related effects. The unannounced inspection in June triggered by a serious incident involving a resident and a specialist bed system had indicated that some staff needed clarification and training around their responsibilities for checking, reporting and the repairing of faulty equipment. We were informed that an action plan was being implemented to rectify this. Looking at records, talking to the manager and staff showed that the following measures had and were being implemented: Training in new procedures for reporting faults on equipment including bed rails, and training on the safe use of bed rails had started at the end of August. It had been clarified that all staff are responsible for the reporting of faulty equipment (see next section). However records showed that at the time of the site visit most staff had not yet completed the training on the safe use of bed rails. The management said that this delay was because the training and the associated procedures had to be developed corporately within the Sue Ryder organisation before it could be delivered locally. The resuscitation training and emergency procedures had been updated and revised (see “Environment”) and most people had undertaken training in this. Staff spoken with confirmed that this was the case. This meant that the emergency procedures should be more effective. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A qualified and experienced person managed the home. Residents’ views were listened to and included in the planning and development of the home. However some safety aspects in the home needed to be improved to protect residents from injuries. EVIDENCE: Cuerden Hall Care Centre is owned by Sue Ryder Care and managed by trustees. A manager was employed to run the home on a day-to-day basis. This person is registered with the Commission and has the appropriate nursing and management qualifications. Other senior managers from the Sue Ryder organisation visit the home on a regular basis and support the manager and the staff. The “responsible individual” carried out monthly, unannounced visits to the home under the Care Homes Regulations to monitor all aspects of Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 27 the services and running of the home. Staff and residents meetings assisted communication of ideas and new developments. There were a number of ways of listening to residents and including their views in the planning and development of services. Residents had day-to-day contact with the manager and staff, and felt able to discuss any matters of concern or ideas. Regular residents meetings were also held. Residents’ views were then fed into staff and management meetings. The Sue Ryder organisation has recently appointed a “Service User Involvement Lead” to facilitate the involvement of residents in the planning and development of services. The Sue Ryder organisation had health and safety procedures to help protect the health and welfare of residents and staff, and information provided by the home prior to, and on, the site visit stated that all installations, appliances and some equipment had been serviced and maintained appropriately. However as stated above, since the previous key inspection there had been a serious incident involving a specialist bed system. As part of the action taken by the home to prevent such incidents happening again, and since the previous unannounced inspection, a number of policies and procedures relating to the use of bed rails had been reviewed and developed. This was part of a detailed action plan submitted to the Commission, and included new systems for risk assessments, staff training, the reporting of faulty equipment and the recording of the repairs carried out. Some of these have been highlighted above in the relevant sections of the report. In addition a report had been commissioned on the condition of the beds in the home, which had resulted in a number of beds being replaced. Looking at records showed that the procedures for the reporting and recording of repairs of faulty equipment had improved since the previous inspection and provided a more accurate and efficient way of ensuring that the faults were rectified quickly. In spite of this action there were still a number of areas of concern that could potentially put residents at risk from such systems. There had not been a specific inspection of the bed rails system in the home until the day of the site visit – about 3 months after the incident that resulted in faulty equipment being identified. The manager told us that there had been ad hoc checks of the bedrails since this time, but that nothing had been recorded, and that detailed structured inspections were to take place from the day of the site visit. A large proportion of staff had not yet undertaken training in the “Safe Use of Bedrails” and the maintenance staff had not undertaken specific training in the inspection and repairing of bed rail systems. We were informed that the reason for the delay in these parts of the home’s action plan was due to having to wait for Sue Ryder corporate policies and procedures to be developed. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 28 These new underpinning procedures were now available to the home, and further progress was assured. In addition as stated earlier in the report the risk assessments or the safe use of bed rails were not always an accurate reflection of the system in use. For example one person had a crash mat on the floor on one side, when the risk assessment stated that bedrails with bumpers should be on both sides, and a large number of people had bedrails without bumpers even though the risk assessments stated that people moved in bed and therefore could be at risk from banging limbs. This meant that in these cases staff still had no clear guidance as to what equipment to use and why and that people may not be safe. On the day of the site visit there were still a number of faults in equipment that could have put residents at risk. On two beds seen there were gaps between the mattress and the bottom of the bed rail that could potentially cause entrapment of limbs. On one of these beds there was an additional mattress and no indication of whether or not this was compatible with the original one. On the other bed it was not clear that the mattress in use was compatible with the bed frame. On another bed a release mechanism on one side of the bedrail was not working so staff may have had difficulty attending the resident. One bed had bed rails that were fitted under the mattress and the rails were unstable. This could result in them moving away from the side of the bed, creating an entrapment hazard. One bed seen had bumpers that were not fitted and secured correctly to the bed rails and would not protect people from banging themselves. Some of these faults were rectified on the day of the site visit, but the Commission was concerned that they had not been previously identified. Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 29 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 Standard No Score 1 2 2 2 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 3 26 3 27 x 28 3 29 2 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 2 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 3 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 x 3 x x 2 x Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? Some requirements not fully met 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 YA6 Regulation 13(4)(c) Requirement The written risk assessments underpinning the use of bedrails and bumpers must be accurate and reflect the needs and the system being used in order to give staff the correct guidance and to ensure people are protected. All medication should be given as prescribed and accurate records kept to show whether or not medication has been taken. Also changes to the prescribed administration of medication must only be made on the authorisation of the prescriber. Damaged areas within the home must be restored and redecorated to an acceptable standard. Bed rails and associated bumpers, must always be fitted properly and be compatible with the mattress in order to protect people from accidents. Timescale for action 30/10/08 2 YA20 13 (2) 30/10/08 3 YA24 23(b)(d) 30/11/08 4 YA29 23(2)(c) 30/10/08 5 YA35 18(1)(c)(i) All staff must be competent and trained in their respective jobs DS0000025555.V368811.R01.S.doc 30/11/08 Sue Ryder Care Centre Version 5.2 Page 31 including those involved in the maintenance of equipment. 6 YA42 13(4)(a) & The health and safety of the 30/10/08 (c) residents must be promoted and residents must be protected from risks and hazards, including when they are in bed. This must involve thorough and regular checks on all the equipment, including bed rails, and timely remedial action when faults are identified, including the use of additional mattresses and whether or not they are compatible. 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 YA1 Good Practice Recommendations The written information about the home should include information about the last inspection and some service users’ views about the home Assessments should be updated as people’s needs change so that there is accurate information that corresponds to the care plan. The care plans should be written in sufficient detail to include all aspects of health and personal care so as to give staff guidance on residents’ preferences and choices. Handwritten medicines records should be double checked and countersigned to improve their accuracy. Regular checks (audits) on medicines must be carried out to show that medicines are given to residents as prescribed and to show that staff are and remain competent. The self administration of medication should always be underpinned by a risk assessment that determines that it DS0000025555.V368811.R01.S.doc Version 5.2 Page 32 2 3 4 5 YA2 YA6 YA20 YA20 6 YA20 Sue Ryder Care Centre 7 YA20 is safe to do so, and indicates the checks and reviews that need to be in place Medicines prescribed as when required or, as a variable dose should have clear written instructions for staff to follow to ensure they are given correctly and the dose given for variable dose medicines should be recorded. The most appropriate references should always be sought and these should be genuine and verified references from employers if possible and character referees. All staff should undertake appropriate training according to their roles and responsibilities in relation to the safe use of equipment and the maintenance of equipment. 8 9 YA34 YA35 Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sue Ryder Care Centre DS0000025555.V368811.R01.S.doc Version 5.2 Page 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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