Inspection on 03/03/08 for Sunhill Court

This inspection was carried out on 3rd March 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sunhill Court 10/09/08

Sunhill Court 02/10/07

Sunhill Court 29/11/06

Sunhill Court 22/11/05

Sunhill Court 04/08/05

Sunhill Court 21/10/04

Sunhill Court 07/08/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Sunhill Court Mill Lane High Salvington Worthing West Sussex BN13 3DF Lead Inspector Val Sevier Unannounced Inspection 09:40 3 March 2008 rd 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 Sunhill Court DS0000024220.V360480.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. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunhill Court Address Mill Lane High Salvington Worthing West Sussex BN13 3DF 01903 261563 01903 261563 sunhillcourt@btinternet.com 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) Woodean Limited Mrs Linda Kilgarriff Care Home 40 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (40), of places Physical disability (3), Physical disability over 65 years of age (3) Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of service users accommodated at one time should not exceed 40. To include up to thirteen (13) persons in the category Dementia Elderly (DE)(E) can be accommodated. 2nd October 2007 Date of last inspection Brief Description of the Service: Sunhill Court is a care home able to provide nursing care to forty older people. Thirteen people living at the home may have dementia and other related mental disorders and it is also registered to accommodate three service users in the category physical disability between the ages of fifty-five and sixty-five. The home is located in a very quiet residential area in the north of Worthing. The access to the main road is via a partly unmade road, which does not have street lighting. The home has thirty-two single rooms and four doubles. There are three levels all accessible by a vertical lift. The home has a sunroom built on the ground level and commands views over the Findon Valley. The current scale of fees being charged at the home is from £499 to £700 per week. Sunhill Court DS0000024220.V360480.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 0 stars. This means the people that use this service experience poor quality outcomes. The purpose of the inspection was to assess how well the home is doing in meeting the key National Minimum Standards and Regulations. The findings of this report are based on several different sources of evidence. These included: previous reports of visits to the home, the Annual Quality Assurance Assessment (AQAA) completed by the home, and an unannounced visit to the home, which was carried out on the 3rd March 2008. During the visit we looked around the inside and outside of the home, which included a sample of bedrooms and bathrooms. Staff and care records were sampled and in addition to speaking with staff, people who live at the home, relatives and nurses, their day-to-day interaction was observed. All regulatory activity since the last inspection was reviewed and taken into account including notifications sent to the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? Several requirements for action were made as a result of the last visit to the home in October 2007. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 6 It was seen on this visit that: Training has taken place with staff watching a training video on safeguarding adults and three hours with a trainer. It was seen that 18 staff have received an introduction to dementia. One staff member has joined the home since the last visit, and the staff record was seen to be current and contained all of the required documentation including evidence of a current Criminal Bureau Check. The manager stated that all staff receive supervision now although this was difficult to see for all staff as the records are kept on individual files. 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. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People that use the service can feel assured that their needs will be assessed and that the home has an understanding of their needs using the assessment process. EVIDENCE: We looked at previous reports and the AQAA for the home, which stated: “We carry out an individual needs assessment prior to clients moving to the home. A thorough assessment form is used to obtain as much information as possible from clients, family, representatives, social workers and hospital staff”. This was supported by evidence in the records of two care plans that we saw for individuals that had moved to the home since the last visit in October 2007. The assessment includes the following areas: personal hygiene and dressing; safe environment; eating and drinking and swallowing; working and leisure; Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 9 sleeping and aids to ability. It was also noted that there was information gathered from others who are involved in caring and supporting the individual, including the family and other health professionals. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 9 &10 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people using the service would benefit from staff having more information in the care plans on how they could support individual needs. There is concern that the people using the service are developing pressure areas and may not be receiving the care needed to resolve them. The current practice for administering medication places the people who use the service at risk. Some staff working practice helped to ensure that the privacy and dignity of people who use the service is promoted. EVIDENCE: On the day of the visit there were 29 people living at the home. We looked at four care plans two of which were for people that had come to the home since the last inspection visit. The care plans were one sheet of paper with headings on both sides for example eating and drinking, with instructions for staff about the support the Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 11 individual needed: “She can eat and drink herself with minimal supervision”. Another individual had two entries on their care plan the second one was not dated: • “Can feed herself she eats a normal diet she has good appetite”. • “She is now on pureed diet need plate guard”. Other areas included: toileting and personal care, mobilising, social psychological and communication, sleeping, safe environment, social interests and contact. There was an agreement for when bed rails are in use. On the care plans seen there was one signature of a person using the service about the plan of care, this was not noted for the other three care plans. Following the visit on 2nd October 2007 a requirement was made that the care plans must have a record of the level the pressure relieving beds must be set at and how often care and nutrition is provided to people who are being cared for in bed. It was seen that there were forms related to the individual’s pressure reliving equipment, however there was no information in the care plans related to how often care should be provided for those individuals being cared for in bed. The requirement has not been met fully and a new requirement is made for the care plans, which must reflect what care is provided to people being cared for in bed or in their rooms. There were moving and handling assessments with information on the equipment needed and the number of staff. There were risk assessments for falls and three of the plans indicated that the individual was a high risk however there were no plans of care to indicate how the risk could be lessened. It was seen that a tool was being used to monitor skin care and pressure area care called the Waterlow. For one individual in December 2007 their skin was intact and healthy in January 2008 dressings were being done regularly for a small skin breakdown on 20th February 2008, the record said ‘nothing special’. However the pressure area dressing information in the daily handover file had information that this individual had developed a sore, which was noted on the 21st February at 1.5 cm and on 24th February, was 2cm. One individual’s care plan for safe environment stated that: “risk of falls, she needs bed rails and supervision at times, also needs to take care when moving and handling to prevent bruise, skin tears”. Last reviewed 18/12/07. The Waterlow was reviewed August 2007 to November 2007 the last score had dropped with a statement that “she needs feeding most of the time and also needs to be hoisted by sling hoist”. It was seen in the dressing file that this Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 12 individual was noted to have a sore on their left shin on 1/3/08. In addition to these two individuals there were six other people with sores, which required dressings: 1) First person had sore on bottom, which had been reviewed January 2008 and February 2008 and this is only done ‘ as required’. 2) Second person has sores on side of left foot since 18/01/08, right heel blister since 17/01/08, bottom sore since 15/2/08, left buttock since 27/2/08 size 1.5cm, right buttock two sores since 27/2 1.5cm. They have a sore on their right thigh since 4/01/08 following a burn from tea when it was 4cm x 3cm and it was last reviewed 12/02/08 when it was 3cm. It was seen on the care plan for this individual that the GP has been involved who prescribed antibiotics, and a call was made to a wound advisor who would visit on 17/1/08 there was no record of this visit with the next notes dated 9/2/08. This person’s Waterlow was last reviewed February 2008 with a score of 14 with no recognition of the burns or other sore areas and a score of ‘0’ – healthy skin. 3) A third person has a sore on their right foot and has had this since 05/11/07 when it was 1.5cm at the last review on 29/02/08 it was 1cm, there is also a sore on the other foot from 21/10/07 when it was 1cm on the 29/02/08 it was 1.5cm. 4) A fourth individual has a sore on their right leg and has had this since 24/09/07 when it was 1.5cm the last review was 27/02/07 when it was 3cm, they also have a sore on their left leg which they have had since 07/08/07 when it was 3cmx2cm the last review on 27/02/08 it was 3cmx3cm. 5) The fifth person has a sore on their right leg first noted 20/02/08 at 1cm last review 03/03/08 it was 1.5cm. 6) The sixth person has a sore on their left leg first noted on 29/01/07 when it was 2cm, at the last review on 29/02/08 it was 4cm. They also have a sore on the inside of their right arm noted on the 25/02/08 as 2.5cm the review date for this was 01/03/08 there was no evidence that this had been carried out. This individual has a falls risk assessment, which indicates a high risk. The Waterlow was done in November 2007 it was 22 on 08/02/08 it was 29; there was no indication on the care plan of any extra support or action to lessen the risks for the individual. For several of these individuals there was an assessment of severe pain at the site of the wound when we looked at the medication administration records there was no evidence that they had received pain relief for the month of February 2008 to the date of the visit. This was noted at the visit on 16th January 2008 to the home when this was bought to the attention of the nurse on duty who stated that a meeting was planned for one individual about treatment options. This individuals care plan was seen on this visit and there was no indication that a plan had been made. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 13 We asked the manager when they would seek support from another professional for advice on pressure area care, she said they have a wound advisor who is also the representative for the company where they buy their dressings. It was seen that the products being used to treat the sores were all the same with no evidence that advice was sought from a doctor or tissue viability nurse. It was seen that diabetics have their bloods tested weekly, one individual had had this carried out, and another record indicated that an individual last had the test on 19/02/08. The home has introduced new record keeping for daily notes and baths for example, there is also another record system being kept. When we looked at the two we found that some individuals had not received a bath or shower since December 2007, January 2008 or the beginning of February. Several individuals were being strip washed. There was no indication in the care plans for the individuals of why they were not having a shower or bath, or whether they had been offered a choice and expressed in their own way not to have a bath or shower. There were requirements made from the last visit on 2nd October 2007 regarding medication, there was also a visit made to the home by a pharmacy inspector on January 16th 2008 when additional requirements were made. On this occasion we looked at the records and the stock for medication. There are polices and procedure in place regarding medication management and only trained nurses administer medication in the home. Medication is suitably stored in a locked cabinet that is clean and well organised. We found that Sudacrem is used for most of the individuals at the home with 21 pots in stock. One individual is prescribed Paracetamol ‘as required’; we found 160, which had come in November 2007, and a further 100 from January 2008. We looked at the Medication Administration Records (MAR). We found: One individual was prescribed Micralax ‘as required’ and it was seen that this was given on two occasions in February there was no indication as to reason decision was made to give it or outcome. Another individual is prescribed Haloperidol twice a day with no record of it being given, and Procyclidine to counter the effects of this medication is being given twice a day. We spoke with the manager who said that the community psychiatric nurse had advised that the Haloperidol should be ‘as required’ and that she would ask the GP when they visited the day after our visit to change the record. Another individual is prescribed a Nebuliser to assist with their breathing ‘as required’, it was seen that that they had been given this in February six times with no indication of the reason or outcome. At the pharmacy inspection in January it was noted that one handwritten MAR Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 14 had no record of date started or receipt of medicines and did not include who had written or checked it. We found five MAR records where they were handwritten with no date of the receipt of medicines and they did not include who had written or checked it. Records were not kept of applying prescribed creams, or that this task had been delegated to carers. When we spoke to the manager she said that this information was recorded in the care plan, the care plans were not clear when creams were applied by staff. One individual is prescribed Fersamil syrup there were two bottles in the stock cupboard of 200mls one dated January 2008 the other November 2007. The MAR indicates that the individual has been receiving this medication however the instructions on the box say to discard after 16 weeks and there was no date of when the medication had been started. One individual prescribed Paracetamol 1 or 2 4-6 hourly ‘as required’, had been given it regularly in February however there was no indication on what dosage had been given. This had been noted in January by the pharmacy inspector who stated that:” There were no care plans to tell staff, when to give ‘when required’ medicines or how to select from a prescribed variable dose; so that medication is administered in a consistent way for the benefit of service users”. A requirement had been made for a risk assessment to enable people to selfadminister medication, it was seen that one person continues to do this following a risk assessment. The management of medication was also a Requirement at the last three visits and has not been fully met. The home has put in place risk assessment for individuals who wish to self medicate, they have addressed the issues of multi use of creams. New requirements have been made as medication is not administered as prescribed, records are not maintained for ‘as required’ medication, and pain relief for individuals highlighted at the visit on 16th January 2008 has not been addressed by staff. One individual living at the home commented that staff were kind and gentle, there were no complaints about the food and there were books to read, however for them there was not enough to do. Another individual spoken with said that it was usual for two staff to get them up in the morning with a hoist however that morning one staff member had been called away and the member of staff who was new moved them herself. Sunhill Court DS0000024220.V360480.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are encouraged to maintain links with family and friends; however there was no evidence that individuals receive stimulation or activities. Dietary needs are well catered for with a balance and varied selection of food available that meets individual dietary requirements and choices. EVIDENCE: Following the last visit to the home in October 2007 a requirement was made for the home to record attendance in activities or outings, to monitor that individuals receive opportunities of stimulation and maintain interests. We were unable to find this. We spoke with the manager who said that they had planned to have an individual with specific time dedicated to activities but this had not happened. She stated that staff are carrying out more one to one time with individuals, however there was no evidence of this in the care plans or the dally records. This requirement has not been met and will be addressed separately to this report with the provider. Relatives spoken with on the day said that they were able to visit and did not feel restricted. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 16 All residents spoken who with were able to pass comment were complimentary about the food provided. The meals seen looked nice and were presented in a way that looked appealing. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided with a selection of choices every day. In addition special diets and individual preferences and needs were catered for example: soft and pureed meals and diabetics. Food was seen being taken to individuals in their rooms, or other small areas in the home, they were not covered. There was no record of individual likes or support needed in the care plans seen. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 17 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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service are protected through the open complaints process. and the staff’s knowledge and understanding of safeguarding and protection issues. EVIDENCE: The home has a complaints procedure, a copy of which is displayed in the entrance hall; the manager was advised of the change of address for contacting the commission and she altered the complaints policy at the time of the visit. We saw the complaints book, which showed that the manager records and investigates complaints and concerns. People who live at the home who were able to comment and two visitors said that if they had a complaint they would feel confident about telling the manager or a member of staff. There have been no complaints made to the home or the commission since the visit in October 207. A requirement was made following the last inspection visit in October for staff to receive training in safeguarding adults. It was seen that in October staff had watched a training video and DVD and in November they had received three hours training from a trainer. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 18 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 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service live in a homely well-maintained environment. EVIDENCE: We looked around some of the home and were able to see communal areas such as the dining room, lounge, bedrooms and bathrooms. All of the bedrooms seen were brightly decorated and had evidence of individual personalities with pictures and photographs on the walls, and other personal effects. People who live at the home are encouraged to furnish the room with personal belongings such as furniture and pictures, to make it feel like home. Consideration is given to the support of needs with the use of equipment. Specialist beds are available at the home for those that are assessed as needing them. There is also specialist seating, a lift and adapted bathing facilities. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 19 It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working), alcohol gel sanitizers and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home’s laundry was appropriately sited and equipped and effective procedures were in place for the management of soiled laundry items. The home manages all the laundry with dedicated staff. There was no malodour in the home and it was seen to be clean and tidy. Comments from residents about the condition of the premises included: • “They are particular about keeping it clean, the windows ands so on, I think they also look after the building”. • “It is kept spotless and I like looking out of the window. The trees and plants change colours and I can see the birds”. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 20 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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the services do not have all have their needs met. Staff have received some training in how to support individual needs, it is not clear that staff have applied any knowledge from the training, and this places people who use the service at risk. People who use the services are protected by the recruitment procedure. EVIDENCE: The staffing structure provides a broad spread of experience and professionalism: manager, nurses, support workers, kitchen staff, laundry and housekeeping. It was seen that there is support from the community psychiatric team. Staff spoken with on the day of inspection said that they were aware of the needs of the residents who live at the home. The manager said that she has had to employ agency staff recently to ensure that there are sufficient staff to meet the needs of people using the service, she tries to have the same staff from one agency. She hopes to have new permanent staff begin work at the home soon. The home has policies and procedures in place regarding staff employment. A requirement was made from the last visit regarding recruitment. Since then only one new member of staff has come to work at the home and it contained Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 21 all of the necessary documents including a Criminal Bureau Check (CRB) number. Training certificates are held on individual staff files but there is no overall training plan in place to monitor when training is due, although this has been recommended to the manager on more than one occasion and they have not done this. A requirement had been made following the visit in October 2007, for staff to receive training in dementia care, it was seen from certificates that had recently arrived at the home, that during February 18 staff have received three hours on dementia awareness. Some staff have also attended a half day refresher in moving and handling, watched a training video and answered questions on food hygiene, and watched a caring for confusion training video. It was not possible to accurate number for staff training, as this would involve looking at all individual staff files. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 22 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 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Whilst there have been some improvements since the last visit, the care plans, healthcare and lack of support to reduce risks put people at risk. Sustained improvement would be helped by using monitoring systems and in depth training in meeting the needs of individuals at the home. EVIDENCE: The Registered Manager has four years management experience and as yet has not completed the Registered Manager’s Award. She is a registered nurse. Several requirements were made as a result from the visit to the home in October 2007 and by the pharmacy inspector in January 2008. The manager had sent us an action plan stating the action they would take or had taken to meet the requirements. We received this on 10/12/08, the pharmacy inspector Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 23 visited on 16th January 2008 and made two further requirements regarding medication as a result of that visit. The manager states that staff are receiving supervision now, records are kept on individual files. The recruitment of staff was only evidenced on this occasion by one file as only one new member of staff had started at the home since the last visit. Training has been given for safeguarding adults, and an introduction into the care of those individuals with dementia. The manager has sent Regulation 37 notices to us regarding incidents at the home, however it was difficult for her to find the home’s copies at this visit. There was no evidence to show that the manager has met these requirements: Medication is still of concern regarding the administration and recording of ‘as required’ medication. Action is still needed regarding the activity and stimulation available for individuals. Care plans and records to show how often support and care is provided to people who are being cared for in bed were not seen. In addition from this visit: the care plans did not have a record of action to lessen risks that had been assessed and the number of pressure sores that were being treated was of concern. The care plans also did not have a plan of care to reduce the risks identified in assessment tools for example falls and Waterlow. Resident’s monies & valuables can be locked in lockable drawers in the resident’s room. The home doe not look after anyone’s monies. The people who use the service and their relatives or representatives, are able to discus all aspects of the running of the home generally or on a personal level. This opportunity is offered in questionnaires, which are sent out annually. Following a fire at the home on December 23rd 2007 the fire officer for the area has written to the home complimenting them on their action. It was seen that there was a fire risk assessment for the premises; tests of equipment and regular risk assessments of the premises and working practices were undertaken regularly. Accidents and incidents in the home are recorded in an accident book. The records were not available during the visit but we were shown a monitoring log, which showed what falls accidents had occurred in December and January. Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 24 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 3 X 2 Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Sch 3 (1)(b) Requirement Timescale for action 03/05/08 2 OP8 13 (4) (b)(c) 3 OP8 13 (1)(b) 4 OP8 12(1)(3) People who use the service must have clear individual care plans describing the support that staff give to meet identified needs including how often care and nutrition is provided to people who are being cared for in bed and for individuals who are in wheelchairs in their rooms. Where it has been identified 03/05/08 through a risk assessment that people who use the service are at risk from falls, a care plan must be put in place to lessen those risks. Individuals who have been 03/05/08 identified with potential risks to their pressure areas or with actual skin breakdown must be reviewed by the GP and the care plan updated to include how the risks are to be reduced and specify how wound care needs are to be met. Where it has been assessed that 03/05/08 people are in pain through illness or pressure sores, pain relief must be given to alleviate the pain. A record must be kept and DS0000024220.V360480.R01.S.doc Version 5.2 Sunhill Court Page 26 5 OP9 13 (2) 6 OP9 13 (2) 7 OP30 18(c) individual needs reviewed regularly. Individuals records must state 03/05/08 the amount of medication given where there is a choice of dose for “as required medication” The records must also state the reason medication was given and any effect it had. Where there is a change in 03/05/08 medication from regular administration to ‘as required’, this must be prescribed as such and other medication taken into account at the same time. Staff must be trained in up to 03/05/08 date wound care practices and how to reduce the risks of pressure sores developing. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sunhill Court DS0000024220.V360480.R01.S.doc Version 5.2 Page 28 - 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!