CARE HOMES FOR OLDER PEOPLE
Sundial Lodge Sundial Lodge Park Hill Road Torquay Devon TQ1 2EA Lead Inspector
Judy Hill Unannounced Inspection 15th November 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 Sundial Lodge DS0000018438.V320605.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. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sundial Lodge Address Sundial Lodge Park Hill Road Torquay Devon TQ1 2EA 01803 292889 01803 291483 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) Sundial Lodge Ltd Mrs Sonja Ruth Brotherton Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 26th February 2006 Brief Description of the Service: Sundial Lodge is registered to provide accommodation and care for a maximum of 48 people in the registration category of ‘Old Age’. The Home is situated in a residential area of Torquay and is less than a mile from the town centre. The Home has private transport facilities and is also on a public bus route. Information about the service is available from the service provider in the form of a Statement of Purpose and a Service Users’ Guide. Copies of inspection reports are kept in the communal lounge and in the office and will be made available on request. Copies of reports can also be obtained from the CSCI Website. At the time of the inspection the fees ranged from £360 to £480 a week. Additional charges are made for providing meals and/or overnight accommodation for resident’s guests, professional manicures, pedicures and hairdressing, private telephone lines, magazines and newspapers and other items of a personal nature. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and was carried out on the 15th and 16th November 2006. The information contained in this report was gained in conversation with the residents, the registered service provider, the registered manager, care and ancillary staff and a visiting professional. Additional information was gained from a pre-inspection questionnaire that had been completed by the registered manager, questionnaires completed by the care staff and other recorded information including the Homes Statement of Purpose, Service Users Guide and previous inspection reports. Further information was gained from a partial inspection of the premises and an inspection of records, including service users needs and risk assessments, care plans and reviews and staff recruitment and training records. What the service does well:
The Statement of Purpose and Service Users’ Guide are well written and informative. The individual needs assessments are clearly written and kept accessible to the staff. Initial individual care planning is good and the resident’s health care needs are monitored on a daily basis. Timely referrals and the provision of transport facilities ensure that the service users can access primary and secondary health care services as and when needed. Personal care is provided in a way that respects the service users right to privacy and dignity. If it is safe for them to do so the residents will be encouraged to administer their own medicines if they want to. Medicines administered by the staff are handled safely and conscientiously. The service users are offered a range of activities. These include regular shopping trips, group outings in the summer, speakers, musical entertainment, armchair exercises and bingo. Transport facilities are available to enable the residents to attend clubs and church services outside the home and/or to visit friends. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 6 The residents may invite visitors at any time and arrangements can be made to provide them with a meal or overnight accommodation at a nominal charge in the guest suite. The residents are offer a choice of meals at lunchtime and at least one starter and main course offered are suitable for vegetarians. Subject to a satisfactory risk assessment, the residents are provided with en-suite kitchen facilities and groceries to enable them to prepare their own breakfast, tea and supper if they wish to do so. The complaints procedure is accessible and complaints are dealt with appropriately. Policies, procedures and staff training are provided to safeguard the residents from the threat of abuse. Sundial Lodge is a very beautiful listed Georgian mansion. The house and gardens are well maintained and the standard of cleanliness is very good. The residents have private apartments within the home, which have en-suite bath/shower and kitchenette facilities. This enables them to maintain their sense of independence. A large and attractive communal lounge is provided for the residents use. Safe staff recruitment practices are being to ensure that unsuitable people will not be employed to work at the home or with the residents. Induction and ongoing training is provided for the staff and over half the staff gained or are working towards gaining a National Vocational Qualification in Care. An appropriate number of staff are employed to provide night care and to carry out domestic, maintenance and catering duties. The registered manager is well qualified and very experienced at managing a care service. The registered service provider is also at the home on a daily basis and oversees the management of his business. A quality assurance/quality monitoring system is in place to gain feedback on the quality of the service provided from the residents and their representatives. Additional feedback from the service users is received through residents meetings. Residents are encouraged to handle their own financial affairs or to seek assistance from their families or a legal representative. The home is safely maintained and safe working practices are used. What has improved since the last inspection?
No requirements were made in the last inspection report.
Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 8 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 Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users are given the information they need to make an informed choice about whether the service will meet their needs. The residents individual needs assessments are good, but could be improved by providing more information about the social needs of people with dementia. EVIDENCE: Copies of the Homes Statement of Purpose and Service Users’ Guide were seen in the communal lounge and in the office. Both documents were reviewed as part of the inspection and found to well written and to contain comprehensive information about the home and the service provided. Written needs assessments were seen for a sample of service users. These were found to be clearly compiled and accessible to staff. Most of the
Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 10 assessments seen provided ample information about the needs of the service users. However, some improvements could be made to the process of assessing the needs of residents with dementia to ensure that their social interests, hobbies, religious and cultural needs are recorded. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The initial care plans are good but more attention needs to be given to the monthly reviews to ensure that the service users changing needs are recorded. The residents are actively encouraged to maintain their independence but can be confident that they will receive any help they need to maintain their personal hygiene, administer their medicines safely and attend appointments with the primary and secondary health care services. EVIDENCE: Each of the service users has a plan of care and a representative sample of care plans were inspected. Although the initial care plans were good and evidence was seen to demonstrate that regular monthly reviews are being carried out, the reviews lacked detail and it was observed that some deterioration to the health of some of the service users had not been recorded.
Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 12 Examples of this, which were identified in conversation with residents and discussed with the registered manager, include a deterioration in a residents hearing and another service users deteriorating short-term memory. Although the recorded reviews of care plans could be improved, evidence was provided to demonstrate that the service users primary and secondary health care needs are being monitored by the care staff on a daily basis and that timely referrals are being made to the professional health care services as and when necessary. Transport is available to enable the residents to keep appointments if necessary. The service users are actively encouraged to maintain their independence with regard to maintaining their personal hygiene and this is assisted by the provision of en-suite bath or shower rooms for all residents. Where help is needed this is provided and feedback from several of the residents spoken with confirmed that they are receiving the level help they need. The inspection coincided with annual inspection by the NHS Community Pharmacist and the outcome of this inspection was discussed with her. The outcome of the inspection had been very positive and her report showed that only one recommendation, which had been dealt with immediately had been made. Some of the residents manage their own medication and are encouraged to do so for as long as they are able. Lockable facilities are provided to enable them to store their medicines. The privacy and dignity of the service users is upheld very well. The Home provides the residents with their own apartments with private en-suite bath/shower rooms and kitchenettes. Most of the apartments have fixed screens separating their sleeping area from their sitting area. The staff were observed to knock at residents doors before entering their apartments. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The service enables the residents to maintain an independent lifestyle, within the safety of a residential home. EVIDENCE: It is the stated philosophy of Sundial Lodge to provide the residents with a home within a home. The service users have private apartments and are encouraged to determine their own routines for daily living. A programme of social activities arranged by the Home is given to each of the service users and includes three regular weekly shopping trips, one to the town centre, one to The Willows and one to St Marychurch. Other trips out are arranged in the summer months. Guest speakers are invited into the home to provide talks on a variety of topics and musical entertainers regularly visit the home. In addition to this bingo and armchair exercise sessions and coffee mornings are arranged. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 14 Holy communion is carried out at the home monthly and residents will be transported to Churches of their choice if required. The home has library facilities and a tuck/essentials shop. The residents may invite their guests into the home at any time and, with prior notice and for a small charge, arrangements can be made for them to share a meal or to stay overnight in the guest suite. Transport is provided to enable the residents to attend local clubs and/or to visit friends in the community if they wish to do so. Residents who can and want to prepare their own breakfasts, afternoon tea and supper are provided with the groceries they need to do so and have their own kitchen facilities within their apartments. If service users cannot use these facilities safely they are disconnected and all meals will be provided. If residents do not wish to prepare their own light meals they will be provided for them. Lunch is the main meal of the day. This is a three-course meal and the residents are given a weekly menu plan to complete and return to the kitchen with their choices of starter, main course and dessert. Vegetarian options are always available. Records of residents meetings showed that the residents have an input into menu planning. Most of the residents eat their meals in their apartments, although some of the more dependent residents use the communal rooms. Although this arrangement appears to suit most of the residents, consideration could be given to giving residents the choice of eating alone or within a social group setting if they prefer. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure is accessible to the residents and their representatives and complaints will be dealt with appropriately. The residents can be confident that policies and procedures and staff training is provided to protect them from the threat of abuse. EVIDENCE: A copy of the complaints procedure is included in the homes Statement of Purpose and Service Users’ Guide, copies of which are kept in the lounge. Some of the residents spoken with were asked if they would know how to make a complaint about the service provided and if they would feel comfortable doing so. The responses indicated that the residents did feel that they could make a complaint to the staff, the manager or the owner and that their complaint would be dealt with appropriately. The responses from questionnaires completed by the care staff indicated that they were aware of adult protection procedures. Policies and procedures relating to adult protection and abuse were reviewed in April 2006 and copies are kept in the staff room. Records were seen to show that staff training in the Protection of Vulnerable Adults is being provided.
Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 23 & 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The individual apartments, with private bath/shower room and kitchenette facilities, enable the residents to maintain their independence within this well maintained home. EVIDENCE: Sundial Lodge is a listed Georgian mansion set in a large landscaped garden. Any renovations carried out on the building have been done sympathetically and the building retains much of its original charm. The service users private accommodation is made up of apartments and each apartment contains a bed-sitting room or a sitting room with a separate sleeping area, an en-suite bath/shower room and a kitchenette. Most of the
Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 17 apartments are single but a small number of double apartments are available to accommodate couples. There is a very spacious communal lounge, which is ideal for large social events and small social meetings. Although the service users have their own private bath/shower facilities there is a communal bathroom and this has been fitted out to provide safe bathing facilities for people with physical disabilities. The bathroom, which is opposite the lounge, contains the only shared toilet. It was suggested by a resident that an additional shared toilet could be provided close to the lounge, as the current facility could not be used when a resident was using the bath. A team of five housekeepers and two maintenance/gardeners/decorators are employed to keep the residents apartments, communal areas and office accommodation clean and in a good state of repair. A partial inspection of the premises showed that they are carrying out their duties efficiently and conscientiously as all parts of the home that were seen and the gardens were very clean and well maintained. The laundry facilities are located away from areas where food is stored and prepared and feedback from service users indicates that their laundry is done quickly and efficiently. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents can be confident that the staff are well trained and trustworthy. The day care staffing levels need to be reviewed, but other staffing provision is adequate to meet the needs of the service. EVIDENCE: A team of five housekeepers are employed to keep the house clean and do the residents laundry. A partial inspection of the home indicated that they carry out their duties efficiently and conscientiously and this was confirmed in conversation with some of the residents. Two maintenance/gardeners/decorators/drivers are employed and again a partial inspection of the home and grounds indicates that this is sufficient for the needs of the home. A cook and a kitchen assistant are employed to prepare lunch for the residents. Feedback from service users indicates that the food is well prepared. The care staff carry out some day to day domestic duties for the residents and prepare drinks and light meals in addition to providing care.
Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 19 It was observed from the staff rotas that the day care staffing levels are very low for a home with up to forty-eight residents. The usually pattern is to have the deputy manager and one senior care assistant (or two senior care assistants) and one or two care assistants on duty during the day (8am to 8pm) and two waking staff on duty at night. The deputy manager and day care staff are also working twelve hour shifts and although it is acknowledged that this may be their preferred shift patterns, primary consideration needs to be given to ensuring that the staff rotas are drawn up to meet the assessed needs of the residents. The above was discussed with the care staff, the registered manager and registered owner and although it is acknowledged that most of the current service users are fairly independent, the number of service users with medium or high needs is increasing. The care staffing levels need to be reviewed to ensure that there are enough day care staff on duty to enable the deputy manager and care staff to meet the needs of the residents and to enable the deputy manager and senior staff to carry out reviews of residents needs and care plans. Several of the residents who were spoken with said that they felt that the night staff provided a good service and that they appreciated their evening and morning visits to check that they were alright and had everything they needed. Some residents however also commented on the shortage of care staff during the day. The pre-inspection questionnaire completed by the registered manager identified that 41 of the care staff had completed NVQ in Care at Levels 2 or 3 and that a further three care workers were working towards gaining a qualification. Responses from staff questionnaires and an inspection of staff recruitment practices indicates that safe recruitment practices are being used to ensure that unsuitable staff are not employed to work at the home. Responses from staff questionnaires, and inspection of staff training records and conversations with the registered manager and staff indicates that the provision of staff training is good. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users can be confident that their home is well managed and safely maintained. EVIDENCE: The registered manager is Sonja Brotherton, she has over eighteen years experience of managing a care service, is a Registered General Nurse and has completed her Registered Managers Award. She is also a qualified National Vocational Qualification Assessor. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 21 The registered provider is Steven Vans-Colina, he works at the home on a daily basis attends the business side of running the home, including finances. The Home has a quality assurance/quality monitoring system, using questionnaires to gain feedback from the service users, their friends and families. The information received had been analyses and areas for improvement had been identified. There is also a residents association and records of meetings with the management were seen. These very clearly showed that the service users views, as expressed through their representatives, are listened to and acted upon. Most of the residents are able to handle their own financial affairs or to gain the help they need from their families or a legal representative. The registered owner is appointee for one service user and evidence was seen that the service user receives and signs for his personal allowance. The pre-inspection questionnaire completed by the registered manager identified that all of the required and recommended policies and procedures are kept and are regularly reviewed. Copies are kept in the staff room to enable the staff to access them. The premises are very well maintained and recommendations from the most recent inspection by the Fire Safety Service had been dealt with quickly and efficiently. Records of staff training were seen to demonstrate that staff training is provided in health and safety related areas. Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 3 X 4 X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? N/A 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 14, 15, 17, 24 Requirement The registered persons must ensure that detailed reviews of the services users needs and care plans are carried out and recorded. The registered persons must review the day care staffing levels to ensure that sufficient staff are employed to provide care for the residents and to keep the residents needs assessments and care plans up to date. Timescale for action 15/02/07 2 OP27 18 15/01/07 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 2 Refer to Standard OP3 OP21 Good Practice Recommendations The needs assessments for people with dementia could provide more information about their social needs and personal background. Consideration could be given to providing an additional communal toilet facility close to the lounge.
DS0000018438.V320605.R01.S.doc Version 5.2 Page 24 Sundial Lodge Sundial Lodge DS0000018438.V320605.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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