Inspection on 14/04/05 for Sunbridge Care Centre

This inspection was carried out on 14th April 2005.

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

Sunbridge Care Centre 11/07/06

Sunbridge Care Centre 25/10/05

Sunbridge Care Centre 20/01/05

Sunbridge Care Centre 14/05/04

Sunbridge Care Centre 25/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE SUNBRIDGE CARE CENTRE 108 Hickory Close Edmonton London N9 7PZ Lead Inspector Tony Brennan unannounced 14 April 2005 @ 10.00am 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 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 Version 1.10 Page 3 SERVICE INFORMATION Name of service Sunbridge Care Centre Address 108 Hickory Close, Edmonton, London N9 7PZ Telephone number Fax number Email 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 Robin Comerford for Ashbourne Healthcare Ltd Tracey Wilson PC Care Home only 43 Category(ies) of OP Old Age registration, with number of places SUNBRIDGE CARE CENTRE Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 Four specified service users who have dementia may remain accommodated in the home. 2 The home must advise the regulating authority at such times as any of the specified service users vacate the home. Date of last inspection 20 January 2005 Brief Description of the Service: Sunbridge Care Centre is a modern purpose built care home registered to care for 43 older people. The home is owned and operated by Ashbourne Healthcare, a private company. 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. SUNBRIDGE CARE CENTRE Version 1.10 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 process. The inspector also sort to confirm that the nine areas for improvement found at the last inspection were addressed. On the day of the inspection the homes manager was not in the home. Senior staff and the home’s administrator assisted the inspector. The inspection took place over one day. The inspector spoke with eight service users, three relatives and seven staff. The inspector spoke with the District Nurses and had written feedback from other professional. The inspector toured the building and examined a range of records relating to the care and management of the home. What the service does well: What has improved since the last inspection? What they could do better: There are twenty-six areas were the home needs to make improvement that were highlighted at this inspection. People living at Sunbridge Care Centre commented that they had not been told how their needs would be met. Information on care needs was found to be incomplete and had not been checked regularly to ensure that it was up to date. The information on what people living at the home needed help with was not sufficiently detailed. Medical needs were not being met, particularly of those who were at risk of developing pressure sores. The records of medicines being given were not SUNBRIDGE CARE CENTRE Version 1.10 Page 6 always complete. Not all the needs of people living at Sunbridge are not being meet. People living at the home said that they did not have varied activities and that trips had not been provided. The record of medicines administered to those living at the home were not complete. The home needs to ensure that there is enough staff to care for those living at the home. The staffing level needs to be reviewed to determining that are enough staff to support people living at the home Staff had a number of unmet training needs. For example, in dementia care and the recording of information and care planning. Staff were found not to be getting the help and guidance from management they needed. A number of records were incomplete and the home had not checked that the gas supply was safe. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. SUNBRIDGE CARE CENTRE Version 1.10 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 Standards Statutory Requirements Identified During the Inspection SUNBRIDGE CARE CENTRE Version 1.10 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 standard(s) 1, 3, 4 Services users and prospective service users are provided with comprehensive information about the service. Recently admitted service users assessed needs were not identified in care plans. The home does not meet all of the assessed needs of service users. EVIDENCE: Service users spoken to said that they had information on the service provided at Sunbridge Care Centre. The statement of purpose was found to contain all the required information. Since the last inspection an updated service users guide has been put in place. All service users have a copy of the service user guide in their bedrooms. A recently admitted service user said that staff generally understood her needs. The files of two recently admitted service users were found to contain detailed initial assessment of their needs. There were also assessments from social workers. The inspector found that two of the service users who had recently been admitted did not have care plans prepared. Staff with whom the needs of these service users were discussed had differing opinions as to the care they required. SUNBRIDGE CARE CENTRE Version 1.10 Page 9 Service users spoken to were generally happy with the care they received. The district nurses informed the inspector that they are concerned about the care of wounds and the way issues had not been followed up. An example of this was a service user who had been found to have a cut on their leg and staff could not explain how this had occurred. From talking to staff and looking at care records the inspector found that there were issues in meeting the needs of service users consistently. Two service users who had been admitted in March 2005 had no care plans and staff had differing views of their care needs. SUNBRIDGE CARE CENTRE Version 1.10 Page 10 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 standard(s) 7, 8,9 Service users needs had not been planned for. Services users medical needs were not fully identified. The administration of medicines was not recorded, putting service users safety at risk. EVIDENCE: Service users spoken to expressed the opinion that they were well cared for. Care plans still needed to include more information on how the needs of service users would be met. Also there was still no evidence that service users or their representatives had been consulted about the contents of their care plans. Care plans had not been reviewed monthly. There is a falls risk assessment in place. The falls assessment required that a detailed assessment be carried out if three or more of the questions were answered ‘yes’. The inspector found that this had not been done for two of the service users who were at risk from falls. Diary notes were not detailed and did not show how the needs identified in care plans are being met. Two new service users admitted in March 2005 had no care plans. Staff spoken to were not clear about how to care for these two service users. The inspector spoke with the district nurses who were visiting the home on the day of the inspection. They commented that staff do not provide information on the wounds that have occurred and these had not been recorded in daily SUNBRIDGE CARE CENTRE Version 1.10 Page 11 records. The inspector checked the records for one service user who had been found with a graze and found this had not been recorded. The inspector examined the turning records for two service users and found that these had been completed as recommended by the District Nurses. District Nurses went on to explain that this was the minimum recommended for both service users. The records for both service users showed that the treatment and severity of their pressure sores were different. The home did have a body chart to record any tissue viability issues on initial assessment. This was not followed up after admission and there was no risk assessment in place to alert the homes staff to the increased risk of developing pressure sores. The inspector discussed this with the homes senior staff and explained that this would need to be addressed. The equipment for the prevention of pressure sores was in place. Records showed that all service users were registered with a GP and had had other medical assessment and treatment. Since the last inspection, the home has added a section on covert administration of medicines to the medication policy. The inspector examined the medication records and found that the records of medicines received and returned were complete. The record of medicines administered on the second floor had gaps where medicines had been administered and this had not been recorded. Medicines that had been prescribed to be given had not been recorded or a reason given for none administration. The inspector saw that the medicines administration record showed that medication had been consistently refused. Records showed that the GP had been consulted. Given the service user was on medication which required to be monitored and to be taken regularly the home needs to risk assess and hold a review of the service users needs to ensure the service users safety. The inspector was able to confirm that staff had recently received training on medicines administration. SUNBRIDGE CARE CENTRE Version 1.10 Page 12 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 standard(s) 12, 15 Service users were not provided with sufficient and varied social and cultural activities. Service users are provided with varied and balanced meals. EVIDENCE: The service users spoken to commented that there could be more activities provided. On the morning of inspection there was a bingo session. Not all service users spoken to were interested in this. The activity programme showed this was the only activity provided on the day of the inspection. The activities programme showed that only one activity was provided each day. The activity organiser explained that the time she had allocated daily was only four hours as her time was split between providing activities and training. Service users also commented that there had not been trips out for sometime. The inspector spoke with two service users who felt that they had not had a chance to practice their religion. The activity organiser explained that only the Catholic church visit the home. Service users commented that the food was good and choices were provided. The menu showed that varied and balanced meals were offered. Service users said they were consulted daily about the choices being offered. The inspector saw that meals were well presented and they were provided in a relaxed environment. SUNBRIDGE CARE CENTRE Version 1.10 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 standard(s) 16, 18 Service users are confident that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: Service users said that they felt confident in making their concerns known to staff. 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. Service users said that they felt safe and could approach staff if they had any concerns regarding how they were 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. Training on Adult protection had been provided. SUNBRIDGE CARE CENTRE Version 1.10 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 standard(s) 19, 24, 26 The home provides a safe and well-maintained environment for service users. Service users bedrooms are comfortable and they have their personal possessions with them. The home was not free of offensive odours. EVIDENCE: The home has a programme in place for the renewal of the furnishing and decoration of the home. The home is adapted to the needs of service users and is located near to shops and public transport facilities. Service users bedrooms were appropriately decorated, furnished and carpeted. The bedrooms seen were personalised. The inspector found on walking round the building that their was an offensive odour in the corridor on the first floor. The laundry facilities were appropriate. SUNBRIDGE CARE CENTRE Version 1.10 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 There are not sufficient staff to meet the needs of service users. Staff do not have the skills to meet all the needs of service users. Service users are not safeguarded by the home’s recruitment procedures. EVIDENCE: Service users spoken to said they felt generally well cared for, but said that at times there were not enough staff available. Service users also felt that staff changed from one day to the next, which they found unsettling. The inspector saw that the rota showed that there were two staff on each floor throughout the day. Staff spoken to explained that they moved from one floor to another. The inspector saw from care records that the needs of service users were complex and varied between the floors. The inspector explained that the staff level must be reviewed to ensure that there are sufficient staff to meet the needs of service users. The practice of moving staff from one floor to another must be reviewed to ensure that the service users are effectively supported. The rota showed that some staff were working sixty hours a week. The senior staff explained that there are currently the equivalent of three full time posts vacant. The home needs to ensure that these are filled so that the hours worked by staff is decreased. The inspector examined five staff files and found that they did not contain all the necessary documentation in relation to the recruitment of staff. References and CRB checks were missing. Training records showed that staff are doing the NVQ at level 2. The home does not have 50 of staff with this SUNBRIDGE CARE CENTRE Version 1.10 Page 16 qualification. Training records showed that staff still needed to receive training in dementia care and first aid. Since the last inspection, training was provided on manual handling. Given the issues already discussed regarding recording of service user information, staff need training on recording. Given the issues with care planning and tissue viability already discussed in this report training must be provided on these topics. SUNBRIDGE CARE CENTRE Version 1.10 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 36, 37, 38 The home does not have appropriate management cover. Staff are not appropriately supervised. Records are not maintained as is required. Service users and staff health and safety is not promoted at all times. EVIDENCE: On the day of the inspection the manager was sick and there was no deputy manager in post. The inspector spoke with the regional manager who explained that cover would be provided by herself and another senior manager. The inspector observed staff on the day of the inspection and saw that some decisions were not taken. The inspector found that the requirement to ensure that staff receive regular supervision had not been met as staff confirmed that they had not had supervision. Records of care and staff were found to be incomplete. The home has the necessary health and safety policies and procedure in place. Apart form the Gas Safety certificate all other certificates were available for inspection and in date. The records of fire prevention and the testing of fire equipment and drills were up to date. SUNBRIDGE CARE CENTRE Version 1.10 Page 18 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 3 x x x x 3 x 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 2 x x x x 1 2 2 SUNBRIDGE CARE CENTRE Version 1.10 Page 19 Yes 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. Standard 4 7 Regulation 14, 15 15(1) Requirement The registered persons must ensure that the needs of service users are met. The responsible person must ensure care plans have sufficient information to ensure that the needs of service users can be met. (This requirement is restated as the timescale of the 1st April 2005 was not met). The responsible person must ensure that care plans are signed by service users or their representatives to confirm that they had read and agreed the contents of the care. (This requirement is restated as the timescale of the 1st April 2005 was not met). Timescale for action 1st July 2005 1st July 2005 3. 7 15(1) 1st July 2005 4. 7 5. 6. 7, 8 7, 8 The responsible person must ensure that care plans are reviewed monthly.(This requirement is restated as the timescale of the 1st April 2005 was not met). 15 The registered persons must ensure that the risk assessment of falls is carried out. 14, 15, 17 The registered persons must Version 1.10 15 1st July 2005 1st July 2005 1st July Page 20 SUNBRIDGE CARE CENTRE 7. 8 13(1)(b), 14 13(1)(b) 15(1)(2) 8. 8 9. 10. 9 9 13(2) 13(2) 11. 8, 9 13(1)(b), 14 12. 13. 12 12 16(2)(n) 16(20(n)( m) 14. 15. 16. 12 26 27 16(3) 13(3) 18(1)(a) ensure that service users diary notes give full information on how their personal and medical needs are met in line with the needs identified in their care plans. The registered persons must ensure that service users tissue viability is assessed and reviewed. The registered persons must ensure that each service user with tissue viability needs has a care plan stating the action to meet them. The registered persons msut ensure that the administration of medicines is recorded. The registered person must ensure that the reason for the non-administration of required medicines is recorded. The registered persons must ensure that risks to service users from the non-compliance with medication is assessed. The needs of one service user consistently refusing medicines must be reviewed as part of a multi disciplinary review. The registered persons must ensure that a varied programme of activities is offered. The registered persons must ensure that service users have access to regular trips as aprt of participating in the life of the local community. The registered persons must ensure that service users are able to practice their religion. The registered persons must ensure that the home is free of offensive odours. The registered persons must ensure that the staffing level is reviewed using the staffing tool to ensure that there are sufficent Version 1.10 2005 1st July 2005 1st July 2005 1st July 2005 1st July 2005 1st July 2005 1st July 2005 1st July 2005 1st July 2005 1st July 2005 1st July 2005 SUNBRIDGE CARE CENTRE Page 21 17. 27 18(1)(a) 18. 19. 20. 27 28 29 18(1)(a) 18(1)(a) 19 21. 30 18(1)(a) 22. 23. 30 31 18(1)(a) 8 24. 36 18(2) 25. 26. 37 38 17 23© staff to meet the needs of service users. The registered persons must ensure that the practice of moving staff from one floor to another on a daily basis is reviewed. The registered persons must ensure that the three care worker vacancies are filled. Th registered persons must ensure that 50 of staff have achieved NVQ at level 2. The regsitered persons must ensure that all the required documentation relating to the recruitment of staff is available for inspection. The responsible person must ensure that training is provided on dementia care and first aid. (This requirement is restated as the timescale of the 1st April 2005 was not met). The registered persons must provide training on recording and care planning. The registered persons must ensure that effective management is in place at all times. The responsible persons must ensure that supervision occures six times a year and that this is recorded. (This requirement is restated as the timescale of the 1st April 2005 was not met). The registered persons must ensure that all records are complete. The registered persons must ensure that a current gas safety certificate is available for inspection 1st July 2005 1st August 2005 1st December 2005 1st July 2005 1st August 2005 1st August 2005 1st July 2005 1st August 2005 1st August 2005 1st July 2005 27. 28. 29. SUNBRIDGE CARE CENTRE Version 1.10 Page 22 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 Good Practice Recommendations SUNBRIDGE CARE CENTRE Version 1.10 Page 23 Commission for Social Care Inspection 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 © 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 SUNBRIDGE CARE CENTRE Version 1.10 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!