Inspection on 09/09/08 for Sundridge Court Nursing Home

This inspection was carried out on 9th September 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sundridge Court Nursing Home 13/09/07

Sundridge Court Nursing Home 17/10/06

Sundridge Court Nursing Home 12/01/06

Sundridge Court Nursing Home 17/08/05

Sundridge Court Nursing Home 04/03/05

Sundridge Court Nursing Home 05/10/04

Sundridge Court Nursing Home 04/11/03

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/11/2008.

CARE HOMES FOR OLDER PEOPLE Sundridge Court Nursing Home 19 Edward Road Bromley Kent BR1 3NG Lead Inspector David Lacey Key Unannounced Inspection 9th September 2008 09:50 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 Sundridge Court Nursing Home DS0000010144.V371055.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. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sundridge Court Nursing Home Address 19 Edward Road Bromley Kent BR1 3NG 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 8466 6553 020 8466 5180 office@sundridgecourt.fslife.co.uk Harley Healthcare Nursing Homes Limited Margaret Anne Candy Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (1) of places Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing Notice issued 18 December 1998 Date of last inspection 13th September 2007 Brief Description of the Service: Sundridge Court is situated in a quiet residential area of Bromley. It is a purpose-built home providing nursing care for up to thirty older people. The home has twenty-four single bedrooms and three shared bedrooms. All bedrooms have en-suite facilities. A passenger lift provides access to all floors. Communal space includes a lounge, large conservatory and a dining room. There is a laundry on-site. The home has a large back garden with patio seating and there is some off-street parking at the front of the building. A bus route and Sundridge Park rail station are within reasonable walking distance for those with full mobility. The fees for this home are £750 - £1100 per week (this information given to CSCI in September 2008). Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star, which means that people using the service receive an adequate service. This key inspection included an unannounced visit by two inspectors, who between them spent a total of seventeen hours in the care home. Inspectors spoke with some of the residents and relatives, and met with the registered manager and some members of the home’s staff. Documentation was sampled for inspection, such as care plans, medication records, staff recruitment files, and policies and procedures. A brief second visit was made by one inspector to look at additional documentation. To gain the views of more people living in the home, we surveyed a sample of ten residents and received nine responses. These responses have also been taken into account. Information from the home’s Annual Quality Assurance Assessment (AQAA) has also been used to inform the inspection process. What the service does well: Offering help, including written information and trial visits, to people choosing a care home. Providing residents with contracts/statements of terms and conditions. Making sure the meals provided are varied and nutritious, and that the kitchen facilities and catering arrangements are good. Providing residents with an efficient laundry service. The provider makes sure the home’s staff members can have access to the training they need for their work with residents. Consulting residents, their representatives and staff members about the quality of services provided and about the running of the home. Supporting residents to manage their expenditure on small items within and outside the home, where residents need this assistance. The manager makes sure she is readily available to residents or their representatives if they have any matters they wish to discuss. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: They need to improve their management of medicines. Although they had improved their handling of controlled drugs, as we had previously required them to do, we still found a number of issues that needed attention to make sure all residents benefit from safe and effective practice. They need to improve assessments and care plans to a consistent standard, which will make sure staff always have the written guidance they need to deliver the right care for each resident. Improving care records will strengthen the evidence that the care each person needs has been delivered as planned. They could also provide more evidence of the involvement of residents in planning and reviewing their care. They could fit locks to residents’ bedrooms and offer to provide them with keys, whenever possible. They could improve the arrangements for formal supervision to make sure all care staff members receive this regularly. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 7 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. Sundridge Court Nursing Home DS0000010144.V371055.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 Sundridge Court Nursing Home DS0000010144.V371055.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, 2, 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are assessed to ensure the home can meet their needs, though the recording of these assessments needs improvement. They are given enough written information about the home and can visit before making a decision whether to move in. Residents have written contracts/statements of terms and conditions with the home. Sundridge Court does not offer intermediate care, thus standard 6 does not apply in this instance. EVIDENCE: The home provides a statement of purpose and a service user guide. These are made available to residents, their families or any other interested parties. The most recent CSCI inspection report was on display in the home’s reception area, together with copies of a leaflet ‘How to choose a nursing home – helpful information’ that people could take away. All but one of the residents Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 10 responding to our survey said they had received enough information about the home before moving in so they could decide if it was the right place for them. Residents have written contracts/statements of terms and conditions with the home. Contracts were seen on the files of three residents sampled at random. All but one of the residents responding to our survey confirmed they had received a contract. Residents and their families are advised there is a trial period at the start of their stay in the home. Family members visiting the home on the day of our inspection explained how they had chosen Sundridge Court for their relative after visiting the home. Their relative had not been well enough to make the choice without family help. They said they felt the admission process had been good and that they had received enough information about the care home to make a choice. They said the home’s manager had visited their relative in hospital to carry out an assessment. It seems that, in practice, families often choose the home on behalf of their relatives. For example, another resident said her family had chosen the home for her because she was in hospital at the time. Pre-admission assessments are carried out by senior staff from the home but, from sampling relevant documentation, it was evident improvements are needed to the recording of these assessments. For one resident, the preadmission assessment document had not been fully completed. The format of this document was from Caring Homes and had a pre-printed statement that all sections of this pre-admission assessment must be completed in full. However, the sections for baseline observations, allergies, other risks and elimination had been left blank, and the document had not been signed or dated. This meant that potentially important information about the resident’s needs had not been recorded and it was not possible to know when or by whom the assessment had been carried out. For another resident, a different document format had been used for the pre-admission assessment. This assessment had also not been fully completed or signed or dated. A third resident whose documentation was examined had a full pre-admission assessment on file but it had not been signed or dated (requirement 1). Sundridge Court Nursing Home DS0000010144.V371055.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents are generally satisfied with the care provided, and have access to local health care services when they need them. Care plans and risk assessments are drawn up when a person is admitted but there are gaps in some of them, which means residents cannot be confident there is always full written guidance for staff about meeting their needs. Records of care provided are usually but not always accurate. The home’s management of controlled drugs is now satisfactory but there are other aspects of medicine administration that need improvement to make sure residents always benefit from safe and effective practice. Residents are treated with respect and their privacy upheld. EVIDENCE: An inspector spoke to five residents who were all generally satisfied with the care provided. Comments made included, “we are very well looked after”. Six residents who returned completed questionnaires to the commission stated they always receive the care and support they need. Two stated they usually Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 12 receive the necessary care and support, and one that this is sometimes the case. Six residents stated they always receive the medical support they need, and one said this is sometimes the case. Comments included that there is less contact with doctors than in hospital and that “there is always a nurse on duty for me to talk to”. Two residents chose not to answer our question about medical support. From case-tracking and examination of documentation, it was evident the home had met our previous requirement that written care plans and risk assessments are drawn up for each resident as soon as they are admitted to the home. Care plans prepared showed how assessed needs were to be met and provided adequate guidance for staff. However, there were gaps in some care plans and risk assessments, which is an issue needing attention to make sure residents get the help and care they need. For example, two people casetracked had bedrails fitted but neither had risk assessments completed in relation to this. A resident had a catheter but a care plan had not been written as to how this should be managed and a continence assessment had not been completed (requirement 2). The home’s AQAA stated residents and families are encouraged to contribute to care plans but there was a lack of evidence in the care records sampled during the inspection visit that care plans had been discussed with the resident or their family (recommendation 1). An inspector viewed care records for two people, both of whom had been admitted to the home with wounds. The records showed that a GP and other relevant healthcare professionals, such as a physiotherapist and community liaison nurse, had seen these residents with regard to wound care. This supported the home’s AQAA statement that residents have the opportunity to be seen regularly by various visiting healthcare professionals. Records in relation to wound management were generally satisfactory however, for one person, records did not support that the dressing frequency had been followed, as there was no record of the wound being dressed for a period of eight days (requirement 3). Both people had the appropriate pressure relief equipment provided and had been seen by the tissue viability nurse. Wound assessment records showed that the treatment was effective. It was understood that staff normally make sure residents are always able to call for help when they need it but this was not always the case during our visit. An inspector spoke with a resident who was sitting in her room. The resident needs help to move about and when questioned said she would call for help if she needed to go to the toilet. However, her call bell was a long way out of her reach, as was her water jug if she needed a drink. A nurse came in to give the resident her medication and, when pointed out by the inspector, agreed the resident needed the call bell and water jug within reach and moved them for her. On later inspection, the falls risk assessment on the resident’s care plan showed ‘high risk’ and that she needs help from two staff to mobilise. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 13 Thus, there was the potential for an accident if the resident had tried to get some water or her call bell without help. The manager agreed to remind staff to make sure call bells and any other items needed are always within reach for people who are not able to move about independently. From this inspection, issues about medication raised at our last visit had been addressed. However, it was also evident there still is room for improvement in some aspects of medicine management, to make sure residents always benefit from safe and effective practice. A medication policy and procedure was available, which had last been reviewed in July 2007. The document was viewed and included all aspects of medicine management. From discussion with nurses, it was apparent that staff had been assessed as competent to manage medicines. Records were kept for receipt and administration of medicines but not for the disposal of medicines. Records of disposal are an important part of the safe management of medicines (requirement 4). A contract was in place for the safe disposal of medicines and ‘doom kits’ provided to destroy controlled drugs. Medicines were supplied in blister packs and individual containers. Staff had added room numbers to the individual containers, which is considered unsafe practice. Should a resident change rooms there is a risk the wrong medicines could be administered (recommendation 2). Storage facilities were satisfactory and a cooling unit was fitted in the medicine storage room to maintain a safe temperature. Our previous recommendation about the temperature of this room had been addressed. A medicine fridge was provided and the temperature was being monitored daily. Records seen showed medicines were being stored at a safe temperature. Medicine administration charts were generally completed well, and residents’ identity was shown. Our previous recommendation about labelled and dated photographs accompanying each resident’s medicine chart had been met. A gap was seen on one administration chart and, when the stock for that particular medicine was checked, it was incorrect so the person may not have had the medicine as prescribed. It was difficult to complete an audit trail on individual medicines as staff did not carry forward medicines from the previous cycle and did not always include the number of doses supplied. The nurse on duty and later the manager assisted the inspector with checking the medicines and medicines stocks. Medicine supplies were checked for four people. One was correct and inaccuracies were noted in the remaining three. For all these three people, there were inaccuracies when the amount in stock was checked against the amount supplied and administered. For one resident, the stocks of six out of the nine medicines prescribed were incorrect (requirement 5). Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 14 The home’s manager had responded promptly to our previous requirement to improve the management of controlled drugs. At this inspection, it was evident that satisfactory arrangements were now in place to manage controlled medicines. The home provided a separate controlled drugs cupboard for use by local hospice staff, although no medicines were being stored in this cupboard at the time of this inspection. Three controlled drugs were checked and found to be correct. However, it was noted one medicine was difficult to check as the amount in stock had not been carried forward to the new administration chart, and the medicine was not included on the most recent administration chart even though the person was still prescribed the item. Our previous recommendation about medical review of the homely remedies protocol had been met. A homely remedy list was provided and had been reviewed and signed by the GP in October 2007. The list included one topical medicine. Not all medicines on the list were in stock. Three homely remedy medicines were in stock and were checked. One was correct but there were no records of receipt or administration for the other two (requirement 6). Neither medicine profiles nor protocols for ‘as required’ medicines were in place for residents. This is something the home should consider, as a significant number of medicines were written on the administration charts to be given ‘as directed’. We had required at the previous inspection that any information about a resident’s personal care that is put on display be done so discreetly. There was no evidence on this occasion that residents’ privacy and dignity were being compromised in this way, and we judged this requirement to be met. Staff spoke to residents in a polite and appropriate manner, and were seen to knock before entering a resident’s room. From discussions with staff, it was evident they knew about respecting residents’ privacy and dignity when giving personal care. Inspectors did not assess standard 11 on this occasion but noted from discussions with the manager and from the home’s AQAA that Sundridge Court will shortly begin working with a local hospice on the Gold Standards Framework for care homes, which focuses on palliative and end-of-life care. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices and have their preferences met wherever possible. Activities are available for residents to engage in as they choose. Residents are supported to maintain contact with their families and friends, provided this is their choice. Residents are generally satisfied with the food provided, and staff members try hard to make sure their dietary needs and preferences are met. EVIDENCE: The home employs an activities organiser, who coordinates a programme of planned activities, arranges trips out, and organises entertainers to visit the home. The home has an ‘arts and crafts’ group and a ‘gardening club’. During this summer, the home held a garden barbecue which was enjoyed by residents and their families. Of the residents who returned completed questionnaires to the commission, five stated the home always arranged activities they could take part in, two said there are usually such activities, and one stated this is sometimes the case. One resident commented there were activities but “I don’t always join in”, and another said she enjoyed the sing-aSundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 16 long sessions. A resident said she likes to spend time reading the newspaper or magazines in the lounge. Some visitors were concerned that their relative who had only just moved into the home might spend all day in the bedroom and not have enough social contact. They were reassured after speaking with the manager and knowing the home has an activities coordinator. They were enabled to take their relative into the gardens in a wheelchair, and to have their relative introduced to a few of the other residents and begin to get to know them. Visiting is encouraged at any reasonable time, and residents are supported to keep in touch with their families and friends, provided this is their choice. The AQAA states children’s activities packs are available for younger visitors, and that pets are also welcome to visit and a water bowl has been provided in the garden. Special arrangements can be made for private birthday parties. The home’s AQAA stated staff encourage families to take out their relatives, with support from staff as needed. A resident said the staff take residents out when the weather is nice, not only into the garden but sometimes into Bromley also, “it’s nice, you can do your own shopping”. A visitor said she had taken her relative away on holiday recently. Some residents were in the dining room for their lunch but, as there is not room for everyone in this room, some residents take their meals in the lounge or conservatory on individual tables. Some others were having their lunch brought to them in their rooms. Staff were wearing blue aprons while they were serving food. Sensitive, unhurried assistance with feeding was provided by staff as needed. The dining room has a water dispenser, and staff were also giving out fruit juice. One resident was having a glass of wine with his lunch. A resident who had earlier told an inspector she did not usually like the food said the fish was “quite good”. Another resident had asked for an alternative to the main menu options and this had been provided. We received mostly positive comments about the food provided. Four of the residents responding to our survey said they always like the meals at the home, four that they usually like them, and one that s/he sometimes likes the meals provided. One resident commented positively about the catering staff, “they always make sure you like things on the menu, if this does not suit your requirements they will find you something you like”. Five residents who spoke with an inspector during our visit were all generally satisfied with their meals. A resident suggested it would be good to have condiments always made available rather than having to ask for them. The menu is planned over a four-week period and is changed each week. Examination of the menus indicated a balanced and nutritious diet was being offered to residents, with choice of meals and the availability of alternatives if the main menu did not meet individual preferences. A relative who visits the home on most days said the food is very good and staff members give attention to people’s diets and food preferences. It was evident residents are Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 17 consulted about their food preferences, and that their views about menus are sought and taken into account. ‘Meet the chef’ meetings are held, to make sure that residents are happy with the choice, variety and quality of meals. The most recent meeting had been in August, the minutes of which were available for inspection. There had been recent written communication between manager, care staff and kitchen staff that identified residents with weight loss, so those people could be offered high calorie diets and have their weight recorded every two weeks. It was noted that supper is served about 5pm, which is not long after lunch and means there is a long time until the next set meal at breakfast. This may affect some residents’ oral intake and staff should monitor this (recommendation 3). The chef said that snacks and sandwiches are left out and staff have access to the kitchen at all times, so residents can ask for something to eat whenever they wish. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 18 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. If residents or their representatives raise concerns or complaints they will be taken seriously. The home has policies and procedures for complaints and for safeguarding adults. Staff receive training and know about protecting residents from abuse. EVIDENCE: The home has an appropriate complaints procedure. A copy is displayed prominently in the home and a copy is also provided in the guide given to each resident. There is a ‘suggestion box’ in the reception area where people can post their comments. The manager said she is available to residents or their relatives to discuss any matters. Of the residents who returned completed questionnaires to the commission, six stated they always knew who to speak to if they were not happy, one stated s/he usually knew this, and two that this was only sometimes the case. All of the residents stated they knew how to make a complaint. The AQAA states the home had received four complaints in the previous twelve months, and we had been made aware of a complaint since the last inspection. The home’s complaints file was seen during the inspection. For one complaint, the outcome letter to the complainant was on file but no other records relating to the matter were available. There were more complete records about another Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 19 complaint, for example there were both acknowledgement and outcome letters on file. We have recommended previously that the home strengthen how it evidences its handling of complaints, and would like to see this addressed with more rigour. During our visit, there were signs of wellbeing amongst residents, who appeared comfortable and relaxed when interacting with members of the staff team. An inspector spoke with five residents and all were generally satisfied. Comments made included, “I am very happy in the home and feel safe”. The AQAA stated that all staff members are required to attend training in the protection of vulnerable adults. The home also promotes whistle blowing and the protection of residents from abuse through its policies and procedures. The home needs to make sure there are effective outcomes from the training provided, and this could be in part achieved through regular supervision. Staff members know about raising any concerns they might have about residents’ safety and welfare. The home provides contact details of the local (Bromley) independent advocacy service, and the home reported in its AQAA that this advocacy service had held a talk at the home for residents, relatives and staff, to let them know about its work. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 20 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, 22, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is clean, comfortable and generally well maintained. The home has infection control procedures for its staff to follow to ensure effective hygiene. EVIDENCE: The home was clean and tidy but some of its décor was rather tired and dated. The manager said a refurbishment programme was about to start, with completion intended by the end of this year. A visitor said she was aware of this planned programme and was happy it was happening as some of the furnishings and carpets need replacing. Seven of the residents who returned completed questionnaires to the commission stated the home is always fresh and clean, and two stated this is usually the case. A relative commented that because the cleaners do such a good job, “it’s a delight to go into this home”. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 21 All the residents spoken with during the inspection were generally satisfied with their environment. Bedrooms seen were clean, and satisfactorily furnished and equipped. Personal clothing was neatly stored and discreetly labelled. Residents are encouraged and supported to make their bedrooms as personal as possible, by bringing some of their own items, family photographs and small pieces of furniture. Two bedrooms were assessed against the standards and found to comply, except that the rooms had no door locks so residents are not able to lock their rooms (recommendation 4). This was raised with the manager, who said it was a matter that she understood was being addressed by the company. A resident said she was satisfied with the facilities, that her room was always kept clean and that her bed and chair are comfortable. Another resident invited an inspector to look around her room. She was very pleased with her room, which had been made personal with family photographs and other items. A married couple were sharing one bedroom that was seen. Although both were incontinent, there was no screening provided between the beds. As this potentially compromised privacy and dignity, the inspector asked that it be made evident it was their choice not to have screening. The home has a passenger lift to access upper floors. Grab rails are fitted in all corridors and toilets. An emergency call system is installed in all areas of the home that are accessible to residents. The call system was working well during our visit although, as noted above under the health and personal care standards, staff need to make sure residents are always able to call for help when they need it. With regard to equipment to assist residents to mobilise, the AQAA confirmed there are enough hoists to meet residents’ needs. Further improvements have been made to the outdoor facilities since the previous inspection. These include a water feature, and herb and vegetable area. Some residents spoken with said they enjoyed being able to sit out during the warm weather and that, even when the weather is not good, they still like to look out over the garden. The home had appropriate infection control strategies in place, and disposable aprons and gloves were accessible to staff. Clinical waste is disposed of through an approved contractor. Alcohol gel dispensers are available, and staff and visitors are encouraged to use these. The home has two sluices, which are fitted with sluicing disinfectors. Many of the wheelchairs seen during our visit needed cleaning. This was raised with the manager who said this need had already been noted and would be attended to as soon as possible. The laundry has had the same assistant in post for some years, which has provided continuity of service. A resident said how pleased she was with the service from the laundry, as clothes come back promptly and are cleaned and pressed well. One of the two washing machines was in need of repair. The assistant said it was to be fixed the following day as it was under a Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 22 maintenance contract, and there was no resulting backlog of laundry. The other washing machine and the dryer were working well. Both washing machines had been installed since our last inspection. Each resident is allocated a laundry basket, and labelling of clothes is done by families or by senior carers from the inventory lists made on admission to the home. The assistant said she has regular infection control training updates, most recently about six months ago. Soiled laundry is washed using alginate bags. The laundry has a wash hand-basin, and there was liquid soap and paper towels in place. There is a cleaning schedule for the laundry. It was evident that cleaning behind the machines was needed, which the assistant said would be carried out. Cleaning fluids are kept for safety in an outside shed under lock and key. The kitchen was appropriately equipped, with a new cooker, boiler and chest freezer installed since our last inspection. A chef and assistant staff the kitchen each day, and food hygiene certificates for all catering staff were on display. The kitchen had received a recent food hygiene inspection from the local council, the outcome of which had been satisfactory. One item only had been raised for attention, and this had been attended to. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 23 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. Staffing levels are generally satisfactory, though it should be more evident they are kept under review in accordance with the dependency levels of residents. The recruitment procedures operated by the home are robust and contribute to the protection of residents. Staff members are provided with training that is relevant to their work in the home. EVIDENCE: On the day of our inspection, there were twenty-eight people in residence and one vacancy. Although Sundridge Court is registered to provide nursing care for up to thirty people, a single resident is occupying one of the home’s shared rooms. The manager was in charge, supported by a qualified nurse and five carers. One other carer had come in at the start of the shift but had been unwell and gone off-duty. Two of the carers were from an agency. Another qualified nurse was in the home for training but helped with the medicine inspection and with some of the nursing duties on the floor. The residents who returned completed questionnaires to the commission stated that staff listened and acted on what they [the residents] said, though two added this is only sometimes the case. Four of the residents stated that Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 24 staff members are always available when they needed them, with four stating this is usually the case, and one resident stating staff are sometimes available when needed. A resident who stated staff are usually available felt there was a need for “flexibility and understanding” by residents that staff may not always be able to be available immediately. An inspector spoke to five residents and all were generally satisfied with the care provided and the attitude of staff. Comments made included, “staff are very nice” and “the staff are always polite and caring”. A relative of a person who had not been in the home very long said the care from staff was very good and that her relative was happy in the home. Another visitor said staff are attentive and give good care but that it would be better to have more staff on duty. This visitor commented that staffing levels had dropped in recent times with the departure of some staff members though also thought the home was doing what it can to improve this situation. Discussions with staff showed they thought they worked well as a team but were concerned that staffing levels might be reduced. The covering of vacant shifts by agency staff was thought to work well if the agency staff member(s) were reasonably familiar with the home but, if not, then continuity of care for residents was made more difficult. Staff rotas sampled for inspection showed that the nursing unit has one qualified nurse on duty for each shift over the 24-hour period. Normally, six carers work in the morning, five in the afternoon/evening and two at night. There had been a few occasions, according to the worked rotas when the staffing had fallen below these levels. As on the day of our inspection, there had been use of agency staff to cover vacant shifts. The manager confirmed the home has reduced its care staffing levels when the number of residents has fallen below 25. This may well have been appropriate but it is important that the home is staffed according to the dependency needs of its residents, rather than simply by how many residents there are (recommendation 5). Even though the number of people living in the home may fall, if the dependency of residents is high then more staff may be needed. Staffing levels and skill mix are important matters the home needs to keep under review. Dependency needs may increase, given the home is about to work collaboratively with a local hospice. Staff members I spoke with outlined the recruitment and selection process they had undergone before taking up their posts. They said this had included an interview, references and Criminal Records Bureau (CRB) checks. Three staff files were sampled for inspection, all of which contained the necessary recruitment information. Evidence of equal opportunities monitoring was seen on recruitment files. Staff members undertake statutory training and carers are supported to undertake NVQ awards. Staff spoken with during the inspection outlined the training they had completed, including induction training, and how they tried to apply their learning in their work in the home. One of the company’s training officers was in the home on the day of our visit. She explained that the Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 25 company has an in-house training service, with training provided about issues such as moving and handling, safeguarding, fire safety, customer care, dementia and record keeping. Experiential training methods are used for topics such as moving and handling, including the use of hoists. Some training such as health & safety and food hygiene is delivered through e-learning. External trainers are employed to provide training on medicine management, continence care, tissue viability and nutrition. The trainer said the home can request training for staff and should be monitoring the effectiveness of staff training through supervision and appraisal. Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 26 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, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home now has a manager who is registered with the CSCI. The home assures the quality of its services, taking the views of residents into account. Residents’ financial interests are safeguarded. Arrangements for the supervision of staff should be improved. Health and safety matters are monitored, and the home has made sure relevant checks are up to date. EVIDENCE: Since the previous inspection, the commission has registered Maggie Candy as the manager of Sundridge Court, following assessment of her application to us. She is an experienced nurse and has previously been the registered manager Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 27 of a care home. The home’s AQAA confirmed the company has a regional manager who is contactable by the home manager at all times to discuss any issues. A deputy manager post has been created for the home since the last inspection, and the post-holder had recently taken up her appointment. The manager walks around the home each day to meet with residents and makes herself available without appointment at ‘weekly surgeries’ to meet with relatives or other representatives to discuss any matters they wish to raise. A resident responding to our survey commented, “Maggie the manager, you can always speak to her and she has time for you”. The self-assessment (AQAA) provided to us by the home’s manager was clear and contained relevant information. The AQAA told us about changes made and also where the home still needs to make improvements. The home has strategies to assure the quality of its services, in which the views of residents and their representatives are taken into account. A residents committee has been recently set up and had its first meeting in August, for which the minutes were available. Seven residents had attended and various aspects of service provision had been discussed. An “Annual Service User Questionnaire Feedback” for August 2008 gave a summary of responses to questionnaires sent by the home to residents. Individual returned questionnaires were also available for inspection. The questionnaire covers aspects such as: health, choice and security; care delivery; social and daily aspects of life; environment; meals; complaints and protection. The home’s AQAA identifies changes that have been made, for example, to menus and to activities provision as a result of feedback. The AQAA states that communication was highlighted as an issue by relatives, therefore all staff have been made aware to contact families directly should there be any concerns. The manager distributes a quarterly newsletter, and copies of the most recent edition (September 2008) were available in the reception area. This edition of the newsletter offered helpful information to residents and their families, for example, about the forthcoming refurbishment programme. The home had also obtained feedback from an “Annual Staff Questionnaire”, sent out in August 2008. The responses are made centrally to the company and remain anonymous to the home. Regular staff meetings are held, with the most recent in July 2008 for which the minutes were available, and there is a weekly meeting of heads of department. The home’s regulation 26 file that was seen during the inspection showed that visits had been undertaken each month and reports produced. Views from residents and staff had been taken into account. The home makes sure residents’ financial interests are safeguarded. Money that residents have asked the home to look after for them is kept under lock and key in a room that is locked when unoccupied. There are regular internal audits to monitor the home’s management of residents’ money. Such money is Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 28 held to allow small day-to-day purchases within and outside of the home. Two senior staff members sign residents’ personal finance records, in accordance with policy, and records are retained and made available to relatives for viewing. The home’s administrator deals with any residents’ or relatives’ queries regarding finance. During our visit, an inspector checked records for three residents against monies held and all were satisfactory. It was not evident that staff members are receiving regular supervision. This was raised with the manager as an area that should be improved to enhance the support given to staff, which in turn should benefit the residents they are caring for (recommendation 6). As noted above under standard 30, supervision also offers an opportunity to monitor the outcomes from staff training. The manager and the maintenance technician had carried out an internal health and safety audit in August 2008, and sent the findings to the provider. The overall score for this internal audit showed the home was “maintaining a good standard” in this aspect of its provision. As far as could be determined during our inspection, most health and safety documentation was up to date and within the appropriate timeframes. The last Legionella risk assessment had been undertaken in February 2007, and information provided after the site visit confirmed a Legionella check was carried out in March 2008. Health and safety documentation was not filed well, which made it difficult to locate and inspect particular items. This was discussed with the manager, as there may be times when such information is needed and neither she nor the technician is available. There was evidence during the inspection that the home takes fire safety seriously. The fire alarm went off, caused by a hot trolley. The manager and her staff ensured fire safety procedures were followed immediately, and that the cause of the alarm was identified and dealt with. Sundridge Court Nursing Home DS0000010144.V371055.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 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 3 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X 2 X 3 STAFFING Standard No Score 27 3 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 2 X 3 Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement The registered person must ensure full records of each preadmission assessment are kept, including the person carrying out the assessment signing and dating it. The registered person must ensure care plans and risk assessments are fully completed for each resident, to make sure all residents get the help and care they need. The registered person must ensure the delivery of care is always recorded. Otherwise, it cannot be fully determined that the care that residents have been assessed as needing, such as wound care, has been delivered. The registered person must ensure records are kept of the disposal of medicines, as these are an important part of the safe management of medication. The registered person must ensure the amount of any medicine held in stock is correct when checked against the DS0000010144.V371055.R01.S.doc Timescale for action 31/10/08 2 OP7 15 31/10/08 3 OP8 17 31/10/08 4 OP9 13 31/10/08 5 OP9 13 31/10/08 Sundridge Court Nursing Home Version 5.2 Page 31 6 OP9 13 amount supplied and administered. The registered person must ensure homely remedy medicines kept in stock always have a record of receipt and administration. 31/10/08 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 OP7 OP9 Good Practice Recommendations The registered person should ensure it is always made evident that care plans have been discussed with residents and/or their representatives. The registered person should make sure staff do not add room numbers to individual medicine containers. Should a resident change rooms, there is a risk the wrong medicine could be administered. The registered person should ensure residents’ oral intake is monitored. This is because intake for some residents may be affected by supper being offered quite soon after lunch and then no set meal until breakfast. The registered person should ensure doors to residents’ bedrooms are fitted with locks suited to their capabilities and accessible to staff in emergencies. Residents should be provided with keys unless their risk assessments suggest otherwise. The registered person should ensure it is clearly evident that staffing levels are kept under review in accordance with the dependency levels of residents. The registered person should ensure care staff receive formal supervision at least six times each year. 3 OP15 4 OP24 5 6 OP27 OP36 Sundridge Court Nursing Home DS0000010144.V371055.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Sundridge Court Nursing Home DS0000010144.V371055.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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