CARE HOMES FOR OLDER PEOPLE
Sunbridge Care Centre 108 Hickory Close London N9 7PZ Lead Inspector
Tony Brennan Key Unannounced Inspection 11th July 2006 10:00 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 Sunbridge Care Centre DS0000010682.V301100.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. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sunbridge Care Centre Address 108 Hickory Close London N9 7PZ 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 8804 3354 020 8804 2316 Ashbourne Healthcare Limited (Southern Division) Ms Diane Burgess Care Home 43 Category(ies) of Old age, not falling within any other category registration, with number (43) of places Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Four specified service users who have dementia may remain accommodated in the home. The home must advise the regulating authority at such times as any of the specified service users vacate the home. One specified service user who is under 65 years of age may be accommodated in the home. The home must advise the registering authority at such times as the specified service user attains 65 years or vacates the home. 25th October 2005 Date of last inspection Brief Description of the Service: Sunbridge Care Centre is a modern purpose built care home registered to care for 43 older people. The home has recently become part of the Southern Cross Health Care. All bedrooms are single with en-suite facilities. There are lounge/dining areas on each floor, assisted bathrooms and a shaft lift. The home is in a pleasant residential area of Edmonton near a park and local shops. The fees range between £398 and £460 dependent on the source of funding. This report is available through the internet. Copies may also be obtained from the provider of this service. Sunbridge Care Centre DS0000010682.V301100.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 undertaken as part of the annual inspection programme. The inspector also sought to confirm that the one area for improvement identified at the last inspection was addressed. The inspection took place over one day. Tracey Wilson, the registered manager, assisted the inspector with the inspection. The inspector spoke with eight people who live at Sunbridge Care Centre, two relatives and four staff. The inspector observed care practice and interaction between service users and staff. The inspector toured the building and examined a number of records relating to the care, health and safety and management of the home. The home has recently become part of Southern Cross Health Care. The home is adjusting to the changes in policies and the new organisation. The inspector would like to thank the registered manager and staff who assist him by answering questions about the running of the home. The inspector would also like to thank those people who live at the home who discussed their views of the service they receive. What the service does well: What has improved since the last inspection?
Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 6 One area for improvement was identified at the last inspection and this was found to have been met. The inspector found that a survey of the views of service users and their representatives had been carried out and action taken to address any issues raised. 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. Sunbridge Care Centre DS0000010682.V301100.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 Sunbridge Care Centre DS0000010682.V301100.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users needs are assessed prior to admission to the home to ensure they receive the care and support they require. EVIDENCE: A service user said, “they know how to look after me”. There were assessments carried out by care management and the homes initial assessments of service users. These assessments provided detailed information on the needs of service users. The registered manager explained that the home is about to introduce a new initial assessment form. Assessments covered mental health, nutrition, falls and general risks. This will further aid the home in ensuring that there is detailed information on the needs of service users. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Not all service users personal, social and medical care needs are set out in their plans of care and so are not met. Service users are not fully protected by safe procedure for handling medication. Service users right to privacy are supported. EVIDENCE: A service user said, “staff understand what I need help to do”. The inspector found that care plans for new service users did not give details of all the needs highlighted in the initial assessments. Care plans had been reviewed. Assessments had been carried out of service users risks from falls, manual handling and nutritional needs. Daily notes showed that service users had received care from health professionals. A service user said, “they arranged a visit to the hospital and one of the staff came with me”. The inspector checked the medicines policy and found this was complete. The record of medication received and returned were in place. The inspector checked the medication for a number of service users and found that there were gaps in the medication administration record. The inspector found that the administration of creams had not been recorded. Medicines prescribed on
Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 10 the charts were checked against the medicines for these service users and these were the same. The GP had signed the medication records to confirm any changes to service user’s medication. Training records showed staff, who administer medication, had all received training on the safe administration of medicines. Medication was stored below 25°c. A service user said, “staff let you be, but are there when you need them”. The inspector observed staff and saw that they knock on service user bedroom doors before entering. A service user said, “staff do show interest in you, but don’t bother you unnecessarily”. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are provided with sufficient and varied activities to meet their needs. Service users are supported to maintain contact with relatives and other representatives of their choice. Service users are able to make choices about how they live in the home. Service users are provided with varied diet, but service users need to be provided with more fresh fruit. EVIDENCE: A service user said, “there are a range of things happening each week”. The inspector observed activities taking place on the day of the inspection. The inspector observed a keep fit group, which service users enjoyed. On the day of the inspection service users and staff were preparing for a cultural food day being held on the following Saturday. Service users spoken to were looking forward to the event. A service user said, “the staff have helped me to keep in touch with my church”. The inspector found that this was highlighted in their care plan. The inspector spoke with the activities organiser who explained that a range of activities were provided and Thursdays is used for trips out. A service user spoken to confirmed that, “I went to a restaurant recently”. A relative said, “we come and visit when ever we like”. The inspector observed that visitors were able to come and go as they wish and staff ensure that
Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 12 service users were aware of who wished to see them. The registered manager explained that the home has an open door policy. A service user said, “the food is very good”. Another service user said that ”the staff ask you what you want to eat”. The inspector observed staff asking service users what they would like for their lunch the following day. The cook explained that staff ask service users daily what they would like to eat. The menus showed that a range of meals were offered. The inspector spoke with the cook who explained that she was in consultation with service users to review the menu. The aim is to create menus that reflect the cultural and ethnic backgrounds of service users. The inspector saw that meals were well presented and they were provided in a relaxed environment. Sufficient staff were available and when necessary service users were observed being assisted to eat. The inspector spoke with service users and relatives who commented that fresh fruit is not provided regularly. The inspector observed that no fresh fruit was available in the units. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: A service user said, “if I am not happy about anything I feel I can tell them to sort it out”. The complaints policy explained how to make a complaint and how it would be dealt with. The complaints record showed actions taken to resolve complaints. There were no complaints to the Commission regarding the home since the last inspection. Service users said that they felt safe and could approach staff if they had any concerns regarding how they are treated. There were comprehensive policies on handling abuse and protection. Staff spoken to were clear about the signs of abuse and how suspected abuse should be handled. The registered manager provides regular training on POVA and training records showed staff had attended external training. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home does not provided an environment that meets the needs of servcie users. Not all areas of the home is a clean and hygienic EVIDENCE: The inspector toured the building and within the home there was chipped paint and walls looked in need of redecoration in the hallways. This was discussed with the registered manager who agreed that the home should be redecorated. The inspector saw that bedrooms had been redecorated. The inspector found that in bedroom 24 the carpet was smelly and in need of cleaning. The shower head in this bedroom was taken off, this needs to be replaced. The inspector observed that the showers in service users bedroom were small and given the needs of service users regarding mobility would find it difficult to use the showers even with the assistance of staff. The inspector asked that the shower facilities be assessed by an occupational therapist to ensure that appropriate facilities are provided for service users. The registered manager explained that new work surfaces had been put in the small kitchens on all floors.
Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 15 The inspector found that there were paper towels and liquid soap available in all toilets and bathrooms. Policies were in place to prevent cross infection and staff spoken to understood how cross infection can be prevented. The sluice rooms were clean and well organised. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Sufficient staff are available at all times to meet service users needs. Staff do not have all the skills to meet all the assessed needs of service users. Service users are protected by the home’s recruitment practices. EVIDENCE: A service user said, “there are always staff around when I need them”. The inspector examined the rota and found that a consistent staffing level is maintained. The registered manager explained that times of working had been changed in line with the new owners policy. This has not affected the number of staff available throughout the day. The inspector spoke with staff who confirmed that the staffing level was maintained consistently. The Pre Inspection Questionnaire showed that only two members of staff currently hold the National Vocational Qualification in care at level 2. This was confirmed by the registered manager who explained that all staff has been enrolled for the qualification. The registered manager also explained that there had been a number of problems with the assessors visiting to support staff with this. Staff need to obtain this qualification to ensure that they all the necessary skills to met the needs of service users. The training records for five staff were examined, all were found to have had induction training. The inspector found that staff had had training on statutory-required training. Staff spoken to confirmed that they had relevant training. The training coordinator for the home explained that a range of
Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 17 training had been organised. The inspector spoke with staff about their understanding of equalities and diversity issues and found that they had only a partial understanding of these issues. The records of training also showed that no training had been provided on equalities issues. The registered manager agreed to ensure that staff received training on this area. The inspector discussed the needs of service user with staff and tended to focus on the physical needs of service users. The inspector discussed this with the registered manager and recommended training in person centre care to ensure that staff are able to understand all the needs of service users. The inspector examined files of staff that had recently started work at the home. These were found to be complete and contained all the required information. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 33 35 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The registered manager does have the necessary understanding to manage the home effectively and in the best interests of service users. Service users are consulted about the quality of the service provided and encouraged to make suggestions for improvement. Service users financial interests are protected by the home’s procedures. Service users and staff are protected by the home’s health and safety procedures. EVIDENCE: A relative confirmed, “I can approach the manager and she responds to my concerns”. The registered manager has a number of years of experience in care and management. The registered manager explained that she is currently completing the Registered Manager’s Award. Another relative told the inspector, “I can approach the manager about any issues that may arise”. The inspector observed the registered manager’s interaction with both staff and
Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 19 service users. The inspector found that the registered manager responded in a friendly and open manner. The home has a system for obtaining the views of the quality of the service it provides and ensures that any areas for improvement are addressed. Since the last inspection a survey of the views of service users has been carried out as to the quality of the service provided. The registered manager explained that she has started to hold meetings with relatives and service users to discuss issues and how improvements can be made in the service. A relative said, “the meetings with the manager are useful, they allow you to discuss wider issues about the home”. The home has an effective system for handling complaints. The registered manager explained that the she does not manage service users monies. Relatives or their relevant social service departments manage their finances. The home’s administrator explained that monies for service user are paid in to the individual’s bank accounts. Two signatures are necessary to authorise any expenditure. The home does not hold cash for service users payment is made by cheque. The inspector saw that records were made of this. Fire drills were taking place and the fire alarm was tested regularly. The fire alarm system had been regularly checked and any maintenance needed had been carried out. The inspector questioned staff on the fire safety procedures and found that they understood fire safety issues. All health and safety policies were available. Certificates for gas, legionella and electrical testing were in date. COSHS guidance was in place and chemical were stored safely. Records showed that staff had received training on health and safety topics that ensure that they followed safe working practices. The inspector discussed health safety issues with staff and they demonstrated their understanding. The home has an effective system for monitoring accidents and this highlights any recurrent issues. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 20 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X x 3 Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 21 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 Standard OP7 Regulation 15(1) Requirement The registered persons must ensure that new service users care plans highlight how all the needs identified in their initial assessment will be met. The registered persons must ensure that all medicines administered to service users are recorded. The registered persons must ensure that fresh fruit is available for service users. The registered persons must ensure that a programme for the redecoration of the hallways if implemented. The registered persons must ensure that the carpet in bedroom 24 is cleaned. The registered persons must ensure that all en-suite showers have showerheads fitted. The registered persons must ensure that the en-suite showers are assessed by an occupational therapist to establish how they can be improved to meet the needs of service users. The registered persons must
DS0000010682.V301100.R01.S.doc Timescale for action 01/10/06 2 OP9 13(2) 01/09/06 3 4 OP15 OP19 16(2)(i) 23(2)(d) 01/09/06 01/01/07 5 6 7 OP19 OP19 OP19 23(2)(d) 23 23(2)(a) 01/09/06 01/10/06 01/12/06 8 OP28 18(1) 01/12/06
Page 22 Sunbridge Care Centre Version 5.2 9 OP30 18(1) ensure that 50 of staff achieves National Vocational Qualification in care at level. 2. The registered persons must ensure that training is provided on equalities and diversity issues. 01/11/06 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 OP30 Good Practice Recommendations The registered persons should ensure that training is provided on person centre care. Sunbridge Care Centre DS0000010682.V301100.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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