Inspection on 21/04/08 for Summerdale Care Home

This inspection was carried out on 21st April 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Summerdale Care Home 09/02/09

Summerdale Care Home 28/11/07

Summerdale Care Home 20/10/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Townley Road, 2-3

Orchard House Nursing Home

St Josephs Rest Home

Foxley Lane (121a)

Tudor Lodge

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

CARE HOMES FOR OLDER PEOPLE Summerdale Care Home 73 Butchers Road London E16 1PH Lead Inspector Nurcan Culleton Unannounced Inspection 10:40 21st and 22nd April 2008 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summerdale Care Home Address 73 Butchers Road London E16 1PH 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) 020 7540 2200 020 7540 2201 summerdale.court@fshc.co.uk Four Seasons (No 11) Limited Mrs Rosalind Mbaki Care Home 72 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0) Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following categories of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old Age, not falling within any other category - Code OP Dementia - Code DE 2. Mental disorder, excuding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 72 28th November 2007 Date of last inspection Brief Description of the Service: Summerdale Court is a 72 bedded nursing home in Canning Town that provides care for up to 72 older people. The service is divided into three units. Oak unit provides care for frail older people (36 rooms), Beech unit is for older people with enduring mental health problems (21 rooms), and Ash unit provides care for people who have dementia (15 rooms). Summerdale Court is owned and operated by the Four Seasons Health Care group, one of the largest groups in the UK providing care services to the elderly. The premises are purpose built and all bedrooms have en-suite facilities. The units are self-contained, but catering, laundry and parking facilities are shared. The nearest station is the DLR at Royal Victoria. The home is situated in the London Borough of Newham. Fees currently start at £601 per week and vary according to individual need. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days and was conducted by two regulatory inspectors. The inspection involved examining five files of people using the service, four staff files, documents and records used by the home as part of the management functions of the home, including complaints, health and safety records and internal audits. Interviews took place with two people living in the home, one senior care worker, the deputy manager who also a trained nurse and the manager who assisted throughout the inspection. We also spoke with people using the service throughout the two days Inspectors also spoke with the Regional Manager who visited the home on the first day of inspection. We also conducted a two hour observation in the lounge of the dementia unit using the Short Observation For Inspection method (SOFI). A further observation in the dining area of the dementia unit was conducted on the second day of the inspection. This inspection also takes into account the homes’ AQAA and five surveys received prior to this inspection, one survey from a person living in the home, three from professionals and one survey from a friend/advocate. What the service does well: What has improved since the last inspection? Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 6 Medication records have improved with increased daily checks. Hot water temperatures are better controlled to maintain safe temperatures. The pantry and dining areas have improved in cleanliness. Bathrooms have been redecorated to a more homely style. The environment is generally improving. 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. The summary of this inspection report can be made available in other formats on request. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Information is available to individuals about the home. However assessments need to ensure accuracy and more detailed quality of information. The home needs to be organised in a way which ensures more positive outcomes for people using the service. EVIDENCE: A recommendation was given at the last inspection for the Service Users Guide to be more ‘user friendly’ and available in a variety of formats, such as audiotapes, pictures and different languages, according to the needs of people who wish to access them. The format of the Service Users Guide has not altered since the last inspection and this remains a recommendation. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 9 The homes’ Depending Assessment Tool is used for pre -admission assessments. The manager informed that she is now auditing the content of the assessments more thoroughly, stating that some of the assessments that were picked by the previous inspector were incomplete. Management audits were shown to the inspectors. The home’s own assessments are reflective of assessments provided by placing authorities. When assessments were further examined, the following issues were identified: Some gaps in information about the person in pre-admission assessments were seen, such as whether a person is married/single/widowed, whether they are practising in their stated religion, sometimes very limited background history, such as hobbies, former occupation, family dynamics. This might be because assessments are often carried out on the hospital ward before admission and for reasons such as no relatives being available. Good biographies were available in some files though not in others. However it is recommended that such information is sought as soon after admission as possible in order to provide a more personal approach to meeting the needs of the individual receiving the service. At the last inspection it was also identified that there may be scope to look at the assessment format in use to see if more background information could be captured on admission. It was suggested that a questionnaire could be given to relatives or friends if the person is unable to volunteer this information. This suggestion is further recommended in this report. Assessments conducted by the home contained abbreviations of medical terminology which carers without specialist knowledge or training would struggle to understand. One persons’ assessment had a tick against whether they were at risk of weight loss/weight gain, without further specification as to which one applied. A continence assessment form was not signed or dated. The wrong BMI score (Body Mass Index) had been recorded in the Waterlow chart, with the effect of an incorrect overall score. A diagnosis was misspelt in one persons’ assessment and care plan. A “do not resuscitate” form contained in one persons’ file conflicted with a statement in the persons’ care plan that they did wish to be resuscitated. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 10 The quality and accuracy of information identified in pre-admission assessments need to improve and form as part of areas requiring improvement needed in management auditing. Evidence seen on the two day inspection suggests that the home has the capacity to meet people’s minimum needs, however the quality of life experienced by people in the home could improve. During the SOFI observation, it was apparent that staff act with best intentions to meet the needs of people using the service, for example, assisting people to drink cups of tea or coffee. Staff were variable in the way they were observed to engage with people. Whilst staff were generally caring and spoke with individuals in a polite and respectful manner, we observed that some staff could give offer support in a more personalised manner that is more sensitive to the needs of the individual when carrying out task-based activities. At the last inspection the inspector identified that, “ensuring occupation, engagement and wellbeing needs to be seen as a crucial part of each staff member’s role. Routines need to be continually reviewed by staff teams on each unit to make sure they are person based and not task based.” There was evidence at this inspection that progress and development is still needed in this area for the staff and management of the organisation, to enable people living in the home to experience a more positive quality of life. This inspection highlights the need for all staff to receive dementia care training. Whilst plans are underway for staff to receive this training, the effects of this training on the actual experiences of people living in the home and whether they experience positive changes in their quality of life is yet to be seen. See also Health and Personal Care section. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10, 11 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care plans remain adequate requiring further development to reflect peoples’ identified needs, to be more individualised and person centred. Arrangements for the handling, storage and administration of medication are generally good. EVIDENCE: Evidence showed some good aspects of recording and good general practice, such as the clinical knowledge of staff nurses writing the care plans was satisfactory. There was good evidence of nurses identifying when to contact PCT nurses, GP, other professionals; compliance with weekly recordings of blood pressure for people known to have high blood pressure and records of weekly weighing. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 12 One persons’ care plan identified that they liked to be chatted about West Ham football team, as observed in the communication by a staff with this person during the SOFI observation. The care plan of an Asian Muslim woman identifies that they sometimes like to join the homes’ prayer sessions for Muslim residents and she requests Halal/diabetic diet. One nephew was reported to be pleased with their relatives’ care, as reported in a social services statutory review. The sample of care plans and health care assessments selected for inspection selected also showed areas that need further development and more robust attention to detail as follows: The care plan of one person identifying skin discoloration as a result of medication had no further evaluation against it, not did it have any reference to indicate whether the condition had changed or reason to explain the absence of information. Similarly, an undated care plan of one person identified that they had a pressure sore. Whilst it could be detected from other records in the file that the pressure sore had healed, the care plan itself was confusing and had not been systematically reviewed and updated. On a positive note, daily records and visiting professionals notes did not evidence any concerns in how staff treated the pressure sore – entries were regular and descriptive by both care home nurses the nurse from the PCT. The manager informed that they had considered different approaches to monitoring progress of needs in the past. It is recommended that evaluations of progress or changes in need to those identified in care plans are clear in the reviewing or monitoring system used and are closely linked with needs identified in care plans. Some care plan agreement forms were not signed by relatives or people using the service. It is recommended that all care plans are signed by people using the service or their representatives and that all care plans are dated. Conflicting information in some files examined, such as in the assessment of one person stating the he needs two people to take him to toilet, whereas his mobility assessment states that he needs the assistance of one person. One persons’ care plan was signed by their nephew but not dated. There was use of subjective language – such as, likes to ‘dress smartly like a lady’ which could be more appropriately written. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 13 The manager has attended a specialist trainers course on dementia designed to enable them to cascade training about good practice in dementia to all staff in the home. The manager believes that this will result in staff compiling care plans in a more person-centred way. Overall it was recommended that the home uses a more streamlined and comprehensive model of care planning, as adopted by some other similar providers, as the care plans used were considered to be long, cumbersome and taking a long time to read, hence making it easy to miss essential information. There is evidence in records available that people have access to health care professionals in the local community to meet their health care needs, though chiropodists are only available privately due to the high level of demands for this service. In the home, there is no evidence to suggest that peoples’ health care needs are not being met, and some good practise was seen, such as a letter of referral to a consultant geriatrician to examine one person who was experiencing weight loss. However records monitoring peoples’ health care have gaps or inconsistencies in information, which in some cases affected the results of health care assessments or charts used. For example, one person who had a catheter-insitu did not have this reflected in their Waterlow chart, recording that they were incontinent of urine, thus affecting the overall rating of the chart. Another person who was diabetic had gaps of several from mid March to mid April where there were no records to evidence that they had any weekly blood monitoring checks. The manager did not know the reason for this absence of information though it was clear that the checks should have been completed. An incorrect Body Mass Index (BMI) score was recorded on one persons’ Waterlow assessment for their susceptibility to pressure sores. One page of a continence assessment had been completed out of five. Whilst the manager had stated in earlier discussions with the inspectors that there was a system of monitoring peoples’ files ‘as and when’ issues arose, it is required that clinical observation charts are more robustly and systematically audited to ensure that peoples’ health care needs are accurately assessed in their clinical observation and recording charts. It was noted that one person who slept in an armchair refusing to sleep in her bed had been an ongoing issue of concern for several months. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 14 Whilst it had been appropriately reported to health professionals and her family, the inspector was concerned at the length of time it was taking for the plan to buy the person a special reclining chair that will support her pressure areas given her skin is vulnerable to breaking down. We discussed medication practises with the manager and examined medication administration and records on one of the units. A requirement had been given concerning the need to keep accurate records at the last inspection. Medication practises are generally good in the home. Controlled medications for two residents were checked. The recording and storage of the medicines were appropriate, in tablet form for one person and liquid for the other and corresponded with the controlled medication book. A dosette system is used to store the majority of medication administered in the home. The manager informed these medicines are now counted and examined on a daily basis as part of a daily audited which has improved recording on this issue. Care workers do not administer medication and therefore do not receive medication training. All the qualified nurses have received medication training updates. The medication fridge temperatures are recorded daily. The thermometer was checked to see if it was working. The record sheet for temperatures advised nurses of the acceptable range of temps. All recordings were within the acceptable ranges; staff were guided to re-check temperatures if they were not acceptable. Medications were discussed with the unit manager. The manager was able to explain the purpose and common side effects of medication when asked. There were no concerns with how staff are recording balances, medications brought forward from previous month. The unit manager administer medication to one person, appropriately dispensing and signing after they had taken their medication. The topical creams were stored in a secure place within residents’ bedrooms. A limited number of topical creams were stored in the refrigerator, in accordance to specific instructions by the manufacturer. There was good evidence that staff are viglilant about applying creams - for example, if a cream was opened a week earlier and needed to last approximately a month – the cream looked as if approximately a quarter had been used. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 15 Some exceptions to good practise were observed, for example, a prescribed topical lotion without a pharmacy label which was discontinued was found in one persons’ bedroom and should have been collected for disposal as is the home’s policy. The label on the Sudocream seen in one person’s bedroom was recorded as being open on the date of the inspection when in fact it had not been used. This gave a wrong impression of when the cream had been administered and should not have been recorded as being opened on the label if it had not been used. It was noted that some topical creams did state the location to apply the cream but this tended to be for very specific creams that for example are applied as eye ointments. The more general creams that are used for dry skin conditions or for people with fragile skin to prevent the skin breaking down tended to have apply as directed’ on the label. The manager acknowledged this as being a problem and that she had raised this as an issue with the GP. However the concern is that care workers may apply the general without clear guidance on the pharmacy labels. Discontinued medicines must be disposed accorded to the home’s policy; medicines must be recorded as being opened only when the medicines have been used and general topical creams should have clear guidance on pharmacy labels. Observations undertaken in the lounge and kitchen of the dementia unit showed that staff generally treated people with respect. However, some improvements could be made to the way some staff interact and engage people to make their interactions less task- based and more person centred, thereby encouraging more positive experiences and outcomes for people living in the home. See staffing section. The home operates an End of Life policy and the manager informed that End of Life training had been delivered by the GP and primary care trust liaison nurse in September 2007. Support is offered by the liaison nurse in preparing staff to assist people with End of Life care. The preferred place of care document for End of Life was completed for one person, stating that the person wished to be resuscitated, with a supporting statement from her nephew. However there was no evidence of this being a multi-disciplinary decision as there was no written agreement with the GP. In another person’s file, there was conflicting information about their wish to be resuscitated. In one form it was recorded that they wished to be resuscitated and in another it was stated that they did not. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 16 Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 17 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. People living in the home lack sufficient engagement and stimulation and are disadvantaged by the lack of suitable activities. People need more support to access community facilities. The mealtime experience could improve further. EVIDENCE: An activities co-ordinator alternates between units providing activities such as bingo, skittles, board games and singalongs and runs a shop each day to people who live there. The manager stated it is hoped that the money raised will go towards purchasing a minibus adding that the organisation is not committed to purchasing transport for the home and that a vehicle is available from one of the other homes run by the organisation if it is needed. However with only small items purchased in the shop, purchasing a vehicle could take a long time. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 18 One person goes to an Asian day centre with community transport as arranged prior to their admission. Two people have applied to use dial-a-ride. Whilst community transport is available, the activities coordinator informed that she used to go together with people to day centres using the transport, however she stopped going due to the need to provide activities for others in the home and that people have since refused to go out without her. It is required that the home provides sufficient support, including persons as well as transport as may be necessary, to enable residents to access day centres or other community facilities of their choice. We were considered at the lack of suitable and appropriate activities for people particularly in the dementia unit. At the time of our SOFI observation, the activities coordinator was playing bingo with residents on the unit for people with mental health needs. An invitation was open to all people in the home to join in however people in the dementia unit declined. As a result, they had no further activities in the unit for the duration of the two hour period of the observation. Instead some people were engaged in holding dolls as part of Dolls Therapy which has successfully been introduced into the dementia unit, though some people sat withdrawn without any occupation and little if any interaction with staff available. As the activities in the home are not tailored to the individual in the home or even to the group needs of the people on each unit, it is essential that suitable activities are further developed which are closely linked to the needs of people in the home. This is aimed at improving the overall quality of life and general state of wellbeing experienced by people living in the home. Life Story work has been introduced with two being completed by the manager. Staff are beginning to collect information about people in the home and the activities coordinator will also be more involved. However as this process may take some time, the engagement and occupation of suitable and adequate activities both inside and outside of the home needs urgent action for people in the home. Staff must also see the engagement, occupation and wellbeing of people in the home as an integral part of their role and responsibilities rather than something which is separate to the functions of the activities coordinator. The activities coordinator for example, highlighted that staff were not completing the Napa Pool Activity forms designed to gather information about individuals and their engagement with activities, and that staff needed to be involved in this process. The activities coordinator is clearly enthusiastic and has some good ideas about how to develop the programme for the people living there. She is planning a gardening club for people in the home to be involved in. Minutes of residents’ meetings showed that three people would like to participate with the gardening. She has now applied to NAPA to begin training. The organisation Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 19 needs to ensure that they will support the activities co-ordinator with this training. The manager informed that they are now waiting for approval for additional hours for another activities coordinator. It is clear that activities are needed in order to improve the engagement, occupation, individual and social interests and general wellbeing of people living in the home. At the last inspection, mealtimes in the unit for people with dementia was observed not to be a very positive for anybody involved and that it was clinical in approach. It was suggested that the focus should be on positive social occasion for all involved - an opportunity for people to talk and interact. We observed mealtimes on the dementia unit to assess progress. When assisting people, staff were supporting and encouraging people to eat though it took a long time for people sitting waiting at tables to be served and occasionally a long time for staff to support people if they required assistance, as they were engaged with others. The manager stated that she assists the units at lunch times when she is available, and the activities coordinator informed that she assists also. However on the day of inspection, it was clear that a further person was needed to assist people. The manager stated that staff do have tea with people at lunchtimes, however we did not see this happening during our observation. The environment in which people sat did not appear to be very comfortable for people whilst they waited. Additionally a radio played pop music which we considered not to be conducive to a positive experience at mealtime or appropriate to the needs of people on the unit. This was observed throughout the units in the home, including the lounges. It is recommended that the home considers investing in CDs of appropriate music as chosen by the people living in the home. The menus displayed were not presented in large print and photographic formats as previously recommended as the manager stated that these would not be suitable for people with dementia on the unit as they would be too confusing. The menu displayed reflected the meals served on the day and separate requests, such as for halal food, had been recorded in the kitchen. One person chooses entirely his own menu once a week and this is accommodated for him. Meals were on the whole nutritious and varied, though the manager was waiting to hear about whether there would be more hours for a chef to enable more home cooked cakes as requested by people living in the home. However it was observed during the two- day inspection that there were biscuits left out on trolleys in the dining areas in their packets. The inspector also sampled a biscuit when later offered one and observed that the biscuit was stale. It was pointed out to the manager that people living in the home were likely to have had a similar unsatisfactory experience and recommended air tight containers. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 20 It has been suggested to the home to consider ideas such as the use of memory boxes, rummage boxes and other interactive objects such as dressing tables, hat stands and typewriters as suitable to the previous experiences of individuals. Relatives meetings takes place three monthly, the last taking place in March. At the last meeting relatives were encouraged to read the last CSCI inspection report. Separate residents ‘committee’ meetings have only recently been introduced. The manager informed they were previously integrated with relatives meetings. In the last meeting, one person expressed that they did not like the food and preferred to have curries for lunch. Another person preferred to have rice cooked in a Nigerian style. The manager responded that she would be happy to arrange this, and menu were observed displayed in the kitchen showing the individual requests for culturally specific food. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 21 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Peoples’ complaints are listened to and acted upon. A complaints and adult protection procedure is in place and staff receiving training to ensure that people are safeguarded from abuse. EVIDENCE: Records are kept of any concerns or complaints received and we saw that these were well maintained. One person spoken to in the home stated that he did not know how to complain but that he had no complaints. The service could consider ways of making the procedure more accessible to the people living there – i.e. displaying in large print / photographic format. The complaints folder contained details of the name of the person, the date received, date head office acknowledged, investigation (ticked), outcome (ticked), and date resolved. There were no details about who the complainant was (the person in the home, relative etc), or brief details about the nature of the complaint or whether the complaint was substantiated or not. To obtain this information one had to refer through pages in the file, which was felt to be cumbersome. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 22 It is recommended that the complaints log is revamped to include this missing information in the form for the sake of clarity and ease of access to information. The complaints policy and procedure is displayed and is part of the guide for the people living in the home. All policies, procedures, including the complaints procedure, must be updated with the new contact details of the Commission. Care staff receive training that teaches them how to recognise and report abuse. Staff training records showed that people have undertaken POVA (Protection of Vulnerable Adults) training. There is an organisational procedure for staff to follow in the event of any allegations being made. People in the home receive their personal allowance and their finances are managed either by relatives or the local authority. The home also acts as signatories for some people. It became apparent during the inspection that the home inherited a situation, following referral by the primary care trust, where they have been managing the money of a person living in the home. We advised the manager to enter into formal arrangements in handling this persons’ money due to the vulnerable position this presented to the person in the home as well as the manager as created by this current situation The bank was contacted about this during the course of the inspection. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is generally kept clean and well maintained and bathrooms are suitably decorated. People enjoy a pleasant comfortable and safe living environment. The appearance of some areas could improve further to provide a more homely environment. EVIDENCE: The people we spoke to were happy with the home environment in general. One person said they liked the home very much. The home generally provides a pleasant, comfortable and well-maintained place for people to live. New furniture and flooring has been provided in many communal areas over the past year. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 24 Bedrooms seen were generally personalised to the individual with many containing people’s own furniture and pictures. There is a programme in place throughout the home to replace all the divan beds with beds which are designed to minimise falls using a remote control to adjust the height of the beds. The environment has improved further since the last inspection to make it more homely and user friendly for the people living there. The bathrooms were redecorated with suitable bathroom motifs. One new ‘wet room’ on the ground floor had been renovated and was brighter in appearance. All new mixer valves are now in place in bedrooms and bathrooms making it easier to control water temperatures. Water temperatures are taken regularly. The smoking room was observed to be particularly cold in appearance. We were informed that some residents visit the smoking room more than four times a day and it was felt that the room could be redecorated to be more pleasant for the people who use it. The maintenance man had decorated it more suitably by the second day of inspection. However the room is extremely smoke filled and particularly unhealthy for people using the room and a more effective extractor is recommended. The hairdressing room walls were bare and painted in a bright garish yellow. It was pointed out that this room could provide an opportunity for people to feel like they are being pampered. It was recommended that the room is suitably redecorated and walls adorned with posters or pictures to create a more pleasant environment. Corridors could also be improved to have less staff notices and include more pictures and objects for people to look at and use whilst walking from place to place. The manager pointed out some extra plants placed in corridors, however there is scope for further improvement. In the garden we also observed that the garden ducks could be substituted for more traditional garden ornaments. Observations of the environment and improvements which could be made reinforce the need for dementia training. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff generally treat people with care and respect, the home needs to ensure that staff receive adequate support to deliver a more person-centred service to individuals. People living at the home are protected by good recruitment procedures. There is a staff training and development programme in place. EVIDENCE: There are qualified nurses and carers on each unit headed by a registered general nurse on every shift. More than 50 of care workers have and NVQ Level 2 or 3 qualification. Staff are are offered mandatory training in a number of topics such as moving and handling, customer care, fire safety, food hygiene, infection control, first aid and Protection of Vulnerable Adults. Whilst training records were available, they were not easily accessible and the home could consider better organisation of them. Newly recruited staff follow an induction workbook using the Skills for Care induction programme. It is recommended that a record is kept of when staff Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 26 successfully complete their induction in their files. We think it is a priority that the activities co-ordinator is provided with specialist training to help them in their job role as part of the culture shift that is needed in the home. Staff we spoke to felt there were generally enough staff on duty but they would welcome more opportunities to spend quality time with individuals. Our SOFI observation concurred with this view as staff had less time to spend talking and interacting with people when they were not engaged in task based activities with individuals. A small increase of staff numbers would provide more opportunities for positive social interactions between staff and people in the home. At the last inspection, it was stated that there is scope to look at the role of carers to ensure that social and emotional care is seen as an important part of their job. It was recommended that the staff teams on each unit look at the routines in place and see how they could move away from task based care to a more person led approach. We reached the same conclusions during this inspection and recommend that the home continue to develop in this area. Whilst staff are generally caring and spoke with individuals in a polite and respectful manner, we observed that some staff could give offer support in a more personalised manner that is more sensitive to the needs of the individual when carrying out task-based activities. As also found at the last inspection, this may require further training and support from the organisation to facilitate a culture change at the home. The manager believes that this culture change has started to happen following her training in dementia care which she will cascade to all staff over the coming year. We looked at the recruitment records for four members of staff. These were very well maintained and contained all the necessary checks including Criminal Records Bureau (CRB) checks. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 27 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31-38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Health and safety procedures are well managed. Plans to develop the service need to be fully implemented and their overall effect needs to be measured against improved outcomes and the quality of service provision experienced by people living in the home. EVIDENCE: Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 28 The manager is a registered nurse, has completed the Registered Managers’ Award and is an NVQ assessor. She has worked in the home for nearly five years. The manager has shown commitment to ensure that all staff receive more training in dementia and person-centred care planning in order to improve the outcomes for people living in the home. A Quality assurance system is in place, involving the managers and other staff to complete audits, including on medication, health and safety and health care records. Action plans are produced where required, for example, it was highlighted by a relative that ornaments and pictures were poor in the sitting room and dining areas and this has since been addressed, as observed during the inspection. Risk monitoring reports are also produced on a weekly basis for any significant events affecting the wellbeing of people and sent to the head office. Regulation 37 notices are completed and kept in a separate folder. A more robust quality monitoring of systems, procedures, and records that picks up on the shortfalls identified in the service is required. Surveys are sent from head office to people using the service and their representatives on an annual basis. A report of the findings, the latest completed this month, is sent to the home. The overall satisfaction rating was up to 79 compared with 73 last year. It is recommended that professionals and other stakeholders’ views are also consulted for their views in the quality monitoring of the service. A ‘residents committee’ has been set up and resident and relative meetings are held quarterly. It is recommended that the service keeps looking at ways that people living there can be involved in the daily life of the home. Improved mealtimes or other social occasions such as coffee mornings or tea parties remain as opportunities for people to give their opinions on how the service is run, as also identified at the last inspection. Staff spoken to confirmed they receive regular supervision with their line manager. Staff members spoken to were happy with the way the home is run and were positive about the service being provided to the people living there. Health and safety is generally well managed and good records are kept of important checks around gas, electrical and fire safety. Hot water temperatures are taken regularly. The pantry was checked, having previously been identified as a area which needed cleaning. The manager informed that this has been resolve as there is more thorough monitoring. A business development plan was completed by the manager in November 2007. A current public liability insurance is on display and good procedures are Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 29 in place to manage the financial transactions for people living in the home which are checked on a monthly basis by the regional administrator. The manager shows commitment and enthusiasm in her role and has plans in place to develop the service. These plans need to be implemented and to take effect in order for the changes to be observed to the outcomes and improved quality of service provision experienced by people living in the home. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 3 3 3 3 3 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 2 3 2 3 Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP3 OP8 Regulation 14 15 Requirement Ensure improved quality and accuracy of information in preadmission assessments. People’s health care needs must be accurately assessed in their clinical observation and recording charts. Discontinued medicines must be disposed accorded to the home’s policy; medicines must be recorded as being opened only when the medicines have been used and general topical creams should have clear guidance on pharmacy labels. Ensure accurate recording of people’s expressed End of Life wishes. The service must provide suitable activities which are closely linked to individual needs and aimed at improving the overall quality of life and general state of wellbeing experienced by people living in the home. Timescale for action 30/05/08 30/05/08 3. OP9 13(2) 30/05/08 4. 5. OP11 OP12 12 12 30/07/08 30/07/08 Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 32 6. OP13 12 7. OP15 12 (4) (5) The home must provide 30/07/08 sufficient support, including persons as well as transport as may be necessary, to enable residents to access day centres or other community facilities of their choice. Mealtimes need to be a positive 30/07/08 occasion for the people living there. This is with regard to ensuring there are always adequate numbers of staff available to assist individuals and looking at the way people receive this assistance. The timescale of 01/03/08 has not been met. A more robust and systematic 30/07/08 quality monitoring of procedures, and records that picks up on the shortfalls identified in the service is required. 8. OP33 14 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP1 OP3 Good Practice Recommendations The user guide to the home should be made available in a variety of formats such as audiotape or pictures. The service ensure that it captures good quality person centred information in their pre-admission assessments. A questionnaire could be developed for relatives or friends of individuals to be used where appropriate. The home should look at ways to make the care plans more person centred and better reflect the individual’s life and preferences. The plan in place should direct the care to be person orientated and less task based. 3. OP7 Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 33 Care plans need to give specific information about how the person likes the care and support to be delivered. Staff to receive sufficient training, supervision and support to produce good quality person-centred care plans. Better background information about the person and their life should be recorded. The home should have a clearer system of evaluating care plan objectives identified for individuals. Evaluations of progress of individual needs or changes to needs identified in care plans to be clearly recorded in the systems used to review or monitor care plans. All care plans to be signed and dated by people or their representatives using the service or their representatives. Language identified to describe peoples’ needs to be less subjective and more appropriately recorded. Adopt a more streamlined and comprehensive model of care planning documentation. Ensure that peoples’ ‘end of life’ wishes are part of a multidisciplinary consultation and agreement. Life story books should be developed with the individual and their family or friends. These books should be used to help communication and engagement. Staff may wish to develop their own life story books to share. The organisation should seriously consider employing an additional activities co-ordinator for the home. Care staff could also be assigned to support activities each day. It is strongly recommended that the home has its own minibus or similar vehicle available. The home considers investing in CDs of appropriate music as chosen by the people living in the home. The service should look at the mealtime experience for the people living there and ideas to enrich this further. This could be through protected mealtimes, different ways of serving meals (buffets, tea parties, finger foods) and staff eating alongside the people who live there. Menus need to be presented in large print or picture formats. Ensure biscuits are kept fresh and stored in air tight Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 34 4. 5. OP11 OP12 6. OP12 7. 8. OP12 OP15 9. 10. OP16 OP19 containers. Revamp the complaints log to include the additional information referred to in this report and to ensure easy access to complaints information. The home should continue to improve the environment for the people living there. The use of improved signage, memory boxes, rummage boxes and other interactive objects should be considered. Corridors could be made more interesting with pictures and objects provided. The hairdressing room to be more suitably decorated and walls adorned with posters or pictures to create a more pleasant environment for a ‘pampering’ experience. Substitute garden ducks with more traditional garden ornaments. Bathrooms should be made more homely and less clinical in appearance. The smoking room to have installed a more effective extractor. Ensure that staff numbers are sufficient in the home to develop a more person-centred approach to working with individual people. The staff teams in each unit should look at the daily routines in place and how they could be changed to keep moving away from task based care. The home to ensure a record is kept in staff files when staff complete their inductions. All staff to receive mandatory training in dementia care of at least three days in length. The organisation should look at how this training could support culture change within the home. Ongoing training around person centred care and care planning should be provided. Dementia Care Mapping should take place within the home to look more closely at the care being provided. The service should look at creative ways of involving people in the running of the home. Events such as coffee mornings and tea parties could be used to consult people more informally. All policies and procedures to be updated with the new DS0000068286.V362165.R01.S.doc Version 5.2 Page 35 11. 12. 13. OP21 OP25 OP27 14. OP30 15. OP33 16. OP36 Summerdale Care Home 17. OP38 contact details of the Commission. Professionals and other stakeholders should be consulted for their views in monitoring the quality of service provision. Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection London Regional Contact Team 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Summerdale Care Home DS0000068286.V362165.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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