Inspection on 10/10/06 for Sun House

This inspection was carried out on 10th October 2006.

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

Other inspections for this house

Sun House 08/10/07

Sun House 17/02/06

Sun House 13/09/05

Sun House 08/02/05

Sun House 13/10/04

Sun House 29/03/04

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOME ADULTS 18-65 Sun House 127 Tring Road Aylesbury Bucks HP20 1LQ Lead Inspector Gill Wooldridge Unannounced Inspection 10th October 2006 10.35 Sun House DS0000023027.V308345.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 Sun House DS0000023027.V308345.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. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sun House Address 127 Tring Road Aylesbury Bucks HP20 1LQ 01296 338103 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) Hightown Praetorian & Churches Housing Association Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th February 2006 Brief Description of the Service: Sun House is a care home providing personal care and accommodation for eight people with mental health problems. It is owned and managed by Hightown Praetorian and Churches Housing Association. The home is located about one mile from the centre of Aylesbury on the main road to Tring and is conveniently situated for buses, shops, education, social and recreational facilities in the town. The home is established in the area. It is a converted property and its style is in keeping with other properties in the neighbourhood. The home is on two floors and does not have a lift. All bedrooms are single. The home is a medium to long-term service and urgent or emergency admissions are not accepted. Referrals are only accepted through the mental health care programme approach (CPA). The residents are supported by an established staff team supported by the Community Mental Health Team. The established registered manager has recently left the home there is an acting manager in post. The current scale of charges is £648.81. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by Gill Wooldridge on 10th October 2006, with a follow up visit on the 17th October as the acting manager needed to attend an important meeting on the 10th. These were quiet and uneventful days in the house. Some residents were in the lounge chatting whilst others were out, or about to go out. No new residents had been admitted since the previous inspection in February 2006. All places in the home were occupied. During the inspection the acting manager apologised as she had to leave for an important meeting so a follow up visit was arranged to assess the remainder of the key standards. The staff team facilitated the inspection. Residents and staff did not appear phased by the inspection process. The inspection methodology consisted of discussion with residents and staff, a walk around the home, and examination of three care plans – support plans and tracking the care of these residents. The inspection focussed on the key standards and perusing documentation relating to residents care. The staffing numbers were discussed with the staff team and acting manager. The environment was satisfactory. All areas of the home were generally clean and tidy. The lounge, where smoking is permitted, can retain the lingering odour of tobacco but it is difficult to see what more can be done to reduce this. This area would benefit from redecoration and a spring clean. It is acknowledged that residents and staff try hard to maintain this area. Standards of hygiene in the kitchen, bathrooms, wc’s and laundry were generally good. The home provides a pleasant environment for residents and staff. At this time the home has no manager but retains a core group of experienced staff. One of the team has recently been requested to take the role of acting manager. Further discussions are taking place to ensure the administration does not distract from resident care. Comment cards received from residents, relatives and health professionals generally praised the home. In conclusion therefore, this inspection found that this small home provides good support to residents and relates well to other elements of community mental health services in the area, this was generally confirmed by residents comments. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 6 The inspector would like to thank the residents and staff for their time and hospitality during the course of the inspection. What the service does well: What has improved since the last inspection? What they could do better: Care plans should contain a pen picture and details of points of motivation, including staff approach to aid the process of person centred planning. The staff team are to encourage further residents to access befrienders and advocates as they wish. Some risk assessments, including self medication and individual risk management plans need to be developed further. Staff competency checks and further audit systems will support the safe administration of medication and reduce the number of inconsistencies in practice. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 7 Residents should be further encouraged to self medicate and manage their own finances within a risk management framework reflecting their choices and wishes. Some areas of the environment need attention. It is recommended that the staff team continue to review menu planning to ensure residents satisfaction is guaranteed. Staffing levels need to be reviewed or staff redeployed to ensure all administration is carried out and residents needs are fully met. Recruitment procedures need to be supported by the organisation ensuring authenticity of references of prospective employees and that they are provided with a reference from the previous employer. The organisation must continue to be proactive in recruiting a manager. Quality audit records should be available during the inspection. Hightown Praetorian and Churches Housing Association provide good support to the home and maintain an ongoing training programme for staff. However, infection control training needs to be completed for all staff within the next six months. 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. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 8 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 Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home liaises closely with the local Community Mental Health Team in planning returns to the home through the Care Programme Approach (CPA) process. This should ensure that the home has the necessary information to conduct a thorough assessment, and that the particular risks associated with transition from one care setting to another are well managed. EVIDENCE: There have been no new admissions to the home since the previous inspection. However, two residents have returned to the home from a different care setting supported by the CPA process involving the residents and the staff team. Ongoing support from the Community Mental Health Team and liaison by staff seen during the inspection with care managers and community psychiatric nurses (CPN’s) should ensure all residents’ needs are met. At the previous inspection it was noted that there had been some falling off of contact with the CMHT, over the period prior to the inspection. Staff confirmed that communication had generally improved since this time, and so support for residents was good. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 10 At the previous inspection it was recommended that the Registered Manager in conjunction with the Responsible Individual and others as appropriate should either amend the Associations present licence agreement or draw up a separate contract for residents which fully meets this standard. This recommendation is re set as the acting manager stated that she was unaware that this had been actioned. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Support plans are generally based on assessed needs and are updated as needs change. Support plans are developed in liaison with the resident and the Community Mental Health Team as appropriate which should benefit their care. Some risk assessments need to be developed further which will further encourage residents independence within a risk management framework. EVIDENCE: Three support plans were examined. There are three records for each resident; A file for health information and monthly summaries, a file holding the current support plan, and a file for financial information. One file examined did not contain a photograph of the resident. Staff explained that this was in hand. Support plans are based on the assessment information obtained prior to admission together with that acquired during the course of a residents stay in the home. Key workers work closely with residents in drawing up care plans. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 12 Resident’s benefit from being involved in developing a plan of care which is based on a thorough assessment of their needs; which is developed at a pace which suits them, which is detailed, and which aims to support them in working towards their aspirations. Residents signatures were noted and confirm their involvement in the process. Residents described being involved in the process and stated that they had positive relationships with their key worker. Liaison with the CMHT and with the CPA (Care Programme Approach) care plan is maintained. Care plans seen were reviewed regularly with one oversight where a resident had returned from another care setting, a review of this care plan would have been prudent. Residents seemed settled and supported in the home and two residents praised the staff team. Support plans address a range of needs and list the areas where support is required. They include detailed action plans. The support plans should contain a pen picture and the approach needed to motivate residents would also be a useful addition. It is strongly recommended that the staff team encourage residents to write their daily logs if they choose. Comment cards received from residents described their not wanting to live in the home and wanting to be more or less involved in decision making. One resident stated that they felt unsafe. These comments need to be considered in the process of residents perhaps feeling unwell, staff encouraging independence and individuals lacking in self-motivation. Several residents commented negatively on the food through their comment cards however, in conversation they changed their minds and in conclusion commented that the food was good. Risk assessments were generally clear with some advice given during the inspection to further develop some documents. This needs to be supported by staff training to ensure all identified risks are supported in a risk management plan. There was no risk management plan in place for a resident taking home their medication. Support plans and risk assessments interrelate. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents participate in a wide range of activities, both within and outside of the home. This provides opportunities for pursuing individual interests and maintaining personal development. The home is conveniently located to facilitate the use by residents of a wide range of local amenities, thus providing opportunities to resume or to continue to participate in community based activities. Residents are involved in menu planning, shopping and cooking and the home aims to meet both individual resident’s preferences and nutritional needs by providing a varied menu and to develop individual skills where required. This helps to promote independence. EVIDENCE: Residents described participating in a wide range of activities including tasks in the home, attending day activities outside of the home, going to drop-in Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 14 centres and attending appointments with health and social care practitioners. Residents may attend local colleges, work schemes, and part-time employment. One resident described considering voluntary work. Residents also described light gardening, or pursuing their interests through the Internet, tv, music or DVDs. Residents make use of local amenities including pubs, the local garage, the supermarket, local clubs, entertainment in Aylesbury civic centre or at theatres in High Wycombe or Milton Keynes. Weekend trips are going to be planned and residents recently discussed these at a residents meeting choosing their favourite destination. One resident described a visit to the Thame show where they had purchased plants for the garden. Staff were heard to describe how they would support a resident to attend a local balloon club. Advocates are used by residents. One resident’s situation regarding their finances was discussed and it was advised that an advocate be introduced to support the resident. One resident also discussed that they had been offered a befriender and had decided to follow this through with their key worker. Hightown has a policy with regard to personal relationships and staff have access to advice either within the organisation or through the CMHT where required. Some residents described regular contact with their families. The daily routine of the home promotes independence and residents pursue a range of activities both within and outside of the home. Residents have their own keys although one resident appeared to have lost their front door key. Staff and residents interact naturally and residents can have time alone or be with others as desired. Smoking is allowed in the front lounge and in the garden. Some residents go to the pub for a drink as desired. Staff and residents agree household tasks. House rules on smoking, alcohol and illicit drugs are clear. A small number of residents store money in the office and although there has been progress in this area some residents need to be encouraged further in their self management of their monies with the support of staff as they wish. Staff must review holding residents monies as this could be construed as a restriction of liberty and should be reviewed as part of the CPA process. Breakfast was described by residents as help yourself, and usually cereal, fruit and bread although residents are welcome to cook a hot meal if they wish. Residents described being involved in the menus which have a five week cycle with lots of choices and alternatives offered. Residents are involved in the shopping, preparation, cooking and clearing up. Lunch is a snack as wished. Dinner in the evening is the main meal of the day. Residents are free to snack or eat out at other times. The home tries to encourage healthy eating but perhaps with mixed results. Menus were supplied for the inspection Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 15 Several residents commented negatively on the food via their comment cards and in conversation during the inspection, although they changed their minds, and in conclusion commented that the food was good. It is recommended that the staff team continue to review the process of meal times to ensure residents satisfaction is guaranteed. Residents are from more than one ethnic group and are supported by a culturally diverse staff team. The staff team described some strain at times in trying to maintain the balance of the interests of individual residents within the context of those of the group. Some statements from residents supported this view. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Each resident has a personal support plan based on assessed needs which incorporates key aspects of the CPA care plan and the advice of medical staff or other health professionals. This aims to ensure that each resident receives the type and level of personal and healthcare support which meets their needs. Arrangements for the storage, control and administration of medicines are designed to ensure correct administration by trained staff and to minimise the potential for errors. EVIDENCE: Healthcare needs of residents are assessed and needs met in liaison with the resident’s GP and other community health services. Residents receive support in accessing services as required. Consultations with health staff visiting the home take place in private. The arrangements for providing care and support are summarised in the care plans of individual residents. These include Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 17 residents preferences. Additional specialist services, include specialist nursing most often community psychiatric nurses (CPNs) Within the group dynamics, some residents appear vulnerable, the staff team are supporting all residents emotionally to ensure they have a forum to discuss their concerns. One resident appears inappropriately placed and this has an impact on all the individuals living at the home. Hightown has a policy governing the storage, control and administration of medicines. Staff attend an in-house training programme and are supervised until they achieve competence, this includes bank staff. This is achieved during the six month probationary period. The home has a contract with Boots for the supply of medicines. The home’s system for administration is supported by a second member of staff checking the Medication Administration Records sheets. Some inconsistencies in practice were noted although these had been identified by other staff with messages left to support the safe administration of medication as seen in the message book. It was noted that there were some concerns raised by staff on the return of a resident with their medication from another care setting. The acting manager stated that this error was made at the previous care setting. Staff confirmed that medication training is due in the coming week. This should further support best practice. Hand written entries on Medication Administration Records sheets need to be dated supported by two staff signatures. One resident who takes home his medication had no formal risk assessment in place. The acting manager described the practice of pre dispensing residents night time medication. This practice must cease. A further audit system and competency checks for all staff should facilitate best practice. A significant incident report indicated clear actions of staff regarding a potential overdose. Staff meeting minutes of 5th September 2006 indicated that staff were not always checking in residents medication on the day of its arrival in the home. This is unacceptable practice. Medicines are stored in locked metal cabinets in the office. The home has a procedure for returning medicines no longer required. A number of residents are now self medicating and are supported by clear risk assessments although no spot check was included. Staff must ensure that this practice takes place. During the follow up visit staff stated that the resident had been consulted with and agreed to have a spot check included in their risk management plan. Further to this the homes self medication should be developed to ensure all residents are encouraged to self medicate as they wish, in consultation with health professionals and within a risk management framework. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 18 Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The organisation’s policies with regard to complaints and the protection of vulnerable adults are accessible, supported by staff training and are designed to ensure the protection of residents. This helps to provide a safe environment for residents. EVIDENCE: The home is required to conform to Hightown’s complaints policy and procedures. A copy of the policy is provided to each resident in their individual service user guide folder. Complaints are recorded in a complaints folder which is kept in the office. In comment cards received from relatives some described not being aware of how to complain however, the information is available in the entrance lobby of the home. The acting manager is advised to remind relatives of the process. The organisation has a policy on abuse and the protection of vulnerable adults. Training on ‘Abuse Awareness’ is provided at intervals throughout the year. The home is planning to run a session for residents and staff in the coming weeks. Staff have attended recent multi-agency POVA update training. The home had a copy of the most recent Buckinghamshire County Council’s multi agency protocol. Training is provided on understanding aggression. Bank staff spoken with were generally aware of the homes procedure for whistle blowing. Adult protection information was available on the notice board in the hallway. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 20 The organisation has a policy governing resident’s monies and secure facilities for the storage of money are available. Three residents finances were checked and the monies tallied with the records seen. Staff were overheard to say that an amount of money received had not been added to the total by a previous member of staff. Staff are to be reminded to follow the organisations policy regarding residents finances. As stated earlier in the report residents should be encouraged to self manage their finances as they wish. Following the inspection the acting manager advised the inspector that she had liaised with care management regarding the behaviour of one resident which impacts on others, this had been discussed during the inspection. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 21 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 & 30 The Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home provides a comfortable, warm, tidy and generally clean environment for residents. It is in a good location for public transport and the amenities of Aylesbury. Residents benefit from living in a well managed environment and have relatively easy access to a wide range of amenities and services. EVIDENCE: The home is located on a main road about a mile from Aylesbury town centre. It is in a good location for buses and for the amenities of Aylesbury. The house is in keeping with the style of others in the local community. Wheelchair access is only possible on the ground floor and the sleeping accommodation is on the first floor. The home is therefore not suitable for residents with wheelchairs. There is a small garden to the front and a larger garden to the side. The entrance hall leads to the staff office, living room, small lounge (or quiet room), kitchen, dining room, wc, laundry, and stairs to the rest of the house. Smoking is allowed only in the living room. An extractor fan has been fitted but the smell of tobacco is unavoidable in such a room. The room is comfortably Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 22 furnished but is in need of a spring clean and redecoration. It is acknowledged that staff work hard to maintain this area and that there is a cleaning schedule in place. The small lounge is a quiet room which is also used for staff meetings, this had a slight musty odour which needs to be eliminated. This too is comfortably furnished and suitable for those who want to get away from the activity of the living room. The kitchen and dining room are suitable for the level of activity generated by the number of residents and staff. Both areas were clean and tidy. A copy of the house rules was on display on the dining room notice board. Bedrooms are single but do not have en-suite facilities. Hallways were tidy and clean although some paint has peeled off the mural in the hallway downstairs and this must be investigated and remedied. Bathrooms, showers and wc’s were clean and tidy. There are two wc’s on the ground floor and three on the first floor. There is one shower on the ground floor and one on the first floor. There are two bathrooms on the first floor. These are sufficient for the current number of staff and residents. Locks can be overridden by staff in an emergency. The laundry is adequate for the needs of this type of home. It is located on the ground floor. There is one washing machine and one dryer. The main garden is to the rear and side of the house. The garden is divided into two areas. To the rear is an area of lawn, gravel and flower beds. There is a small patio area with garden furniture and flower and plant tubs. The area to the front has a bird table and other items. As part of case tracking the inspector viewed two residents bedrooms, with their permission, which the residents described as comfortable. These rooms were well decorated and were reflective of the residents interests and personalities. Staff stated that all residents are encouraged to maintain their own space with support as necessary. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a core group of experienced and skilled staff who are familiar with the local network of community mental health services. This should ensure that residents receive an appropriate level of support in the home and in everyday activities, but which can be supplemented by input from community mental health staff where necessary. Procedures for the recruitment of staff appear thorough but records do not provide evidence that all references have been authenticated. This could potentially expose residents to risk. The staff team are experienced, qualified and appear well supported through supervision, staff meetings, appraisal and Hightown’s training and development programme. This provides a staff team who are aware of resident’s needs and who endeavour to assist residents in meeting those. Staffing numbers need to be regularly reviewed to ensure residents have the appropriate support they need. EVIDENCE: Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 24 All staff have job descriptions and are provided with a copy of the GSCC codes of practice on appointment. Staff skills and limitations are discussed at supervision. Staff who were consulted appeared committed to the ethos and aims of the home. The qualities of prospective staff are assessed at interview. Induction, the probationary period, training, supervision and appraisal aim to ensure that staff qualities and skills are consistent with the aims of the home. Hightown maintain a comprehensive and varied training and development programme that is valued by staff. A copy of the 2006 training brochure was perused during the inspection. Mandatory training is reviewed annually. The programme includes training on ‘Mental Health Awareness’ and ‘Preventing and Responding to Violence’. It is apparent from staff training records that staff have not been trained in infection control. All staff must be trained in infection control within six months. The manager had left two months prior to this inspection and a senior member of staff had, in the two weeks prior to the inspection, taken on the responsibility of acting manager. Staffing levels and completing all the management tasks were discussed with all levels of staff and it is considered that more administration time for the acting manager is necessary. It is noted that on occasions staff are stretched and that residents appointments and activities may impinge on the needs of the resident group as a whole. Several staff have gained NVQ qualifications in care. Staff canvassed described a thorough recruitment, induction and probation process. The home was described as efficient and friendly and the organisation as good and supportive. Individual supervision takes place regularly. From discussions with bank staff it is not clear that they have received a recorded induction. Records need to be maintained of all staff inductions. Vacancies are currently covered by Hightown in-house bank staff which generally ensures that temporary staff are familiar with the organisation, the specialty and the home. Recruitment of new staff is carried out through the organisations human resources department. Applicants are required to complete an application form, to supply two references and to have an enhanced CRB certificate. Two files were examined, both had a copy of the individuals’ CV, two references, CRB summary info, details of the three month probationary review and supervision notes. References were not authenticated in one instance and it was not clear from one file that the organisation had approached the previous employer for a reference. Since the inspection the acting manager has advised the inspector that the organisation is now approaching the previous employer and this appears to have been an oversight which is now being rectified. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 25 Sun House DS0000023027.V308345.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 The Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. At the time of this inspection the acting manager had been in post for just two weeks. Continued support by the organisations senior manager should ensure the care of residents. Regular in-house audits are carried out which should ensure residents are involved in the homes systems. Health and safety records are generally well maintained which indicate that the home is a safe environment for residents. EVIDENCE: The registered manager had left the organisation and a senior member of staff has taken on the responsibility of ‘acting manager’ in the two weeks prior to this inspection. She is supported by a consultant employed by the organisation who is available once a week. The administration time given to the acting Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 27 manager is not the same as for the previous manager as she was supernumerary. It is also unclear that the acting manger had a thorough induction and although she is familiar with many of the systems a formal induction is advised. The ethos of the home seems clear. The home aims to support residents to maintain independence while living in the community. There is no pressure on residents to move on before they feel ready. At the time of this inspection no resident was planning to move into independent accommodation. The ethos of the home is maintained through discussion with staff and residents in a number of meetings. Such meetings include staff handover, staff business meetings, link worker sessions with individual residents, house meetings between staff and residents, staff supervision and appraisal. Residents are involved in the running of the home. The home has developed meetings in which staff can reflect on their work and consider different ways of dealing with issues. The organisation has a policy on equal opportunities. The home is represented on Hightown’s staff forum. The acting manager confirmed that a residents survey had taken place which should lead to an action plan. Eight comment cards were received in connection with this inspection from residents, three from relatives and two from health professionals. Residents had mixed views regarding the home, a number were dissatisfied with the food and did not like living there, one resident felt unsafe. These issues were discussed with residents and staff and on the whole residents praised the staff team. Staff described a lack of motivation whereby residents expected every thing to be done for them. The philosophy of the home is to maintain independence within a safe environment. The food issue is discussed under standard 17. Relatives who commented were satisfied with the overall care provided, found the home welcoming, said that they were kept informed of important matters and are appropriately consulted on aspects of care. Some relatives were unclear of how to complain. Professionals also expressed satisfaction with the overall care provided. The home has an extensive policy manual which is regularly updated by Hightowns head office. The manual is stored in the office and is available to residents as required. Records were stored in the office and there are facilities for storing confidential records in locked filing cabinets. Data protection guidelines should be available for staff as a reminder in case residents request to see any document that makes reference to them. The training programme of Hightown ensures that staff receive mandatory training at basic and refresher levels in moving & handling, fire safety, first aid, Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 28 food hygiene. Infection control training was not detailed as part of the organisations mandatory training. This must be rectified. COSHH guidelines and data sheets were stored in the office and COSH products kept in a locked cupboard. Risk assessments had been carried out for cleaning products not locked away. The cleaning cupboard is locked when not in use and there is a locked cupboard under a sink. The home was last inspected by the fire authority in June 2006, all matters were found to be satisfactory. Information received in the pre inspection questionnaire indicated that the home checks it fire points weekly and fire drills are conducted three monthly. Emergency lights are checked monthly. Bank staff who accompanied the inspector when viewing the communal areas confirmed a good induction and pointed out the fire exits. Residents confirmed that fire bells are heard weekly. The acting manager could not confirm when the last Legionella test had taken place. Since the inspection the acting manager has contacted the maintenance department regarding this matter. Accident records seen indicated clear recording although it was not always clear that there was a risk management review following an accident. Sun House DS0000023027.V308345.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 X 2 3 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 3 25 X 26 X 27 X 28 X 29 X 30 2 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 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 3 X Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 30 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 3 Standard YA9 YA20 YA35 Regulation 13 (4) 13 (2) 18 (1) Requirement Risk assessments must be developed further and supported by staff training. Medication must not be predispensed. The proprietor must ensure that all staff attend infection control training. Timescale for action 31/03/07 30/11/06 30/04/07 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 YA5 Good Practice Recommendations The Registered Manager, in conjunction with the Responsible Individual and others as appropriate should either amend the Associations present licence agreement or draw up a separate contract for residents which fully meets this standard. It is strongly recommended that all care plans contain a pen picture and the approach needed by staff to motivate residents. It is strongly recommended that the staff team encourage DS0000023027.V308345.R01.S.doc Version 5.2 Page 31 2 3 YA6 YA6 Sun House 4 5 6 7 8 9 10 11 12 YA7 YA9 YA17 YA22 YA24 YA30 YA30 YA33 YA34 13 YA41 residents to write their daily logs if they choose It is strongly recommended that any perceived restriction of liberty is discussed and recorded in a multi disciplinarily forum It is strongly recommended that residents are given the opportunity to self medicate and manage their own finances within a risk management framework. It is recommended that the staff team continue to review the process of menu planning to ensure residents satisfaction is guaranteed. It is recommended that the acting manager remind relatives of the process of making a complaint. It is strongly recommended that the proprietor and acting manager explore and rectify the damp in the hallway. It is strongly recommended that the proprietor and acting manager spring clean and or redecorate the smoking room to maintain a pleasant environment. It is strongly recommended that the proprietor and acting manager explore and rectify the musty odour in the small lounge. It is strongly recommended that the proprietor ensures that staffing levels are reviewed to ensure residents needs are met. It is strongly recommended that the proprietor ensures that staff records maintained in the home include authenticated references and a reference from the employees previous employer. It is strongly recommended that the staff team develop guidelines to ensure residents have access to their records if requested. Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 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 Sun House DS0000023027.V308345.R01.S.doc Version 5.2 Page 33 - 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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