Inspection on 23/04/09 for Sunningdale

This inspection was carried out on 23rd April 2009.

CQC found this care home to be providing an Good service.

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunningdale 02/05/08

Sunningdale 03/05/06

Sunningdale 06/12/05

Sunningdale 31/05/05

Sunningdale 14/10/04

Sunningdale 19/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2010.

Key inspection report Care homes for older people Name: Address: Sunningdale 5 North Park Road Manningham Bradford West Yorkshire BD9 4NB     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sughra Nazir     Date: 2 3 0 4 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 24 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 24 Information about the care home Name of care home: Address: Sunningdale 5 North Park Road Manningham Bradford West Yorkshire BD9 4NB 01274545859 01274543265 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Crabtree Care Homes care home 40 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia Additional conditions: The maximum number of service users who can be accommodated is: 40 The registered person may provide the following category of service only: Care home only - Code PC, to service users of the following gender: Either, whose primary care needs on admission to the home are within the following category: Dementia - Code DE Date of last inspection Brief description of the care home Sunningdale is a 40 bedded home for people with dementia, some of whom may be under 65. The home is situated in the Manningham area of Bradford overlooking the park. A main bus route is close by. The home is operated by Crabtree Care Homes, which is a family run business. The building, a large Victorian house has been extended to provide additional single en suite bedrooms. Accommodation is on two floors with passenger lift access. Some of the very large rooms in the older part of the house are shared between two people. Care Homes for Older People Page 4 of 24 Over 65 0 40 Brief description of the care home The walled garden surrounding the property has a parking area and has been pleasantly landscaped to provide secure outdoor walking and sitting areas. This allows people the freedom of walking around and out of the house without restriction. Access to the property is through electric gates controlled with the help of CCTV cameras by staff from inside the house. Details of current fees can be obtained from the home. The following services are not included in the fees, Hairdressing, Chiropody private , personal clothing and toiletries and outings. A charge may be made to cover additional staff time needed for hospital escort duties. Care Homes for Older People Page 5 of 24 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an annual quality assurance assessment and sent surveys to staff and people living in the home. On an unannounced visit to the home we talked to people, their relatives, staff and the manager. We also checked some of the records, policies and procedures the home has to keep. We concentrated on the key standards and what the outcomes are for people living in the home, as well as issues which were raised at the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is Care Homes for Older People Page 6 of 24 considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Care Homes for Older People Page 7 of 24 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 8 of 24 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 24 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. By carrying out a thorough assessment the home makes sure that staff will be able to meet peoples needs. Evidence: The files we looked at showed detailed assessments of peoples needs are carried out before people move in. This helps the home make sure that they will be able to provide care to meet those needs. People or their relatives are always involved in the assessment process. The manager told us that people are encouraged to visit before making a decision about moving in although in many cases it is relatives who visit on behalf of the person needing care. The admission process includes a trial period to help the person decide if the home will suit their needs. Care Homes for Older People Page 10 of 24 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care planning should improve as planned to make sure peoples needs are not overlooked. The processes for recording and storing controlled drugs need improving to ensure drug safety and compliance with the law. Evidence: Care plans are in place for everyone at the home. The home has ordered a new care planning format to help staff keep better records of peoples care needs. The files we saw varied in their content. Some contained a lot of information. Most of the files contained basic information telling staff about peoples care needs, mobility, diet, oral health and footcare, mental health and challenging behaviour. There were however some gaps such as not detailing specific information on sizes for aids used to support continence and on one file there was no moving and handling risk assessment. We saw that one persons preadmission information showed that they had epilepsy and they were on medicaton for this condition. There was no care plan in place to tell staff what to do to respond to any needs arising from this condition. Care Homes for Older People Page 11 of 24 Evidence: The home is in process of changing its care plan format. The manager must ensure that the revised care plans contain all the information staff need to deliver a personalised service and that care needs are not overlooked. From the records we looked at we saw that at least fourteen people appeared not to have had a bath for more than three weeks. Staff explained that the records may not be uptodate and that they were encouraged to write down where people had refused or were given a strip wash instead. Practice and recording must be reviewed so that the home can be sure that peoples needs are being met. A healthcare professional we spoke to confirmed that staff seek advice appropriately and that they act on advice given. Staff awareness of nutritional needs has improved however the recording of weights is not consistently maintained. Medication records were seen and we found that records for medication prescribed on a when needed basis were not complete. Where medicines, including those prescribed as needed are not given the appropriate code or explanation should be documented on the Medication administration records. If the chart is blank the home cannot confirm if the medication was refused or actually not administered by the staff. If paracetamol is prescribed to be given regularly then this has to be followed. If it prescribed as needed (PRN) then there should be some guidance for the staff so that they know when and why paracetamol is to be offered to that person. This guidance should be attached to the medication record for each person. We discussed the recording of the application of creams on a MAR chart so that the home has an accurate record to show that people are getting the healthcare they need. We looked at the controlled drugs record book and found that the running total for medication held at the home did not include the next supply which was in the box. The assistant manager told us that they keep a running balance only for the box in use. This is unsafe practice as there is a risk of controlled drugs being unaccounted for. Both medication trolleys are now secured to the wall. When we visited we did not see a controlled drugs cupboard, however since the inspection the provider has told us that a controlled drugs cupboard was in place but staff were not aware. We saw that controlled drugs were being stored in the medicine trolley. Arrangements must be put in place so that controlled drugs are safe, secure and kept in legally compliant storage. Care Homes for Older People Page 12 of 24 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples dietary needs are met and their access to social activities is improving. Evidence: Peoples access to leisure activities has improved since the last inspection. The home now has access to a minibus and people go on trips such as visiting stately homes, art galleries, museums, picnics etc. One person told us they really enjoyed visiting local canal and seeing the barges and locks. People are supported to use local facilities such as the park. Staff need to ensure that they offer more activities and opportunities for social interaction for people who are not able, or choose not to participate in trips. Staff told us that people and their families are encouraged to participate in fayres and fund raising events. We saw that meals are served in a friendly homely atmosphere. People had a choice of meals.one vegetarian and one meat choice. They can also have sandwiches if they Care Homes for Older People Page 13 of 24 Evidence: prefer. We saw that the menu is displayed. People told us that they enjoyed their meals and that preferences such as curries are accommodated. One person told us meals are marvellous Care Homes for Older People Page 14 of 24 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 can be confident that their views will be listened to. Actions taken in response to concerns are improving. Evidence: Two complaints have been referred by the Commission to the home since the last inspection. Responses to complaints are prompt and show that the home has investigated peoples concerns. The manager needs to develop a record that shows all complaints are recorded and respnded to in a professional manner, also allowing the service to identify and respind to any trends. All staff have some training on keeping people safe from abuse as part of their induction programme. The clear display of protocol and procedures for reporting abuse will help staff more confidently respond to any concerns. Care Homes for Older People Page 15 of 24 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this 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 live in a safe clean environment. Evidence: All bedrooms are comfortably furnished and the majority are light and spacious. People are encouraged to bring personal possessions into the home which makes each room look individual and homely. Communal bathrooms and toilets are located throughout the home and the general standard of fixture and fittings was found to be good. Externally the grounds are safe, secure and very well maintained. There are electronic gates to the main entrance to the home which means that people living there are able to use the garden area unescorted. Care Homes for Older People Page 16 of 24 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this 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 are cared for by staff recruited using safe recruitment procedures. Evidence: Recruitment and selection procedures are in place that include checking the Protection Of Vulnerable Adult POVA register and obtaining at least two written references and a Criminal Record Bureau CRB report before new staff are permanently employed. This helps the home make sure that staff they employ are safe to work with vulnerable people. The manager confirmed that all new staff receive induction training using the Skills for Care Common Induction standards. These are nationally agreed induction standards designed to help new staff get the skills and knowledge they need to care for people. Following induction training there is an expectation that staff will study for a National Vocational Qualification NVQ at either level two or three depending on the post they hold. There is a staff training matrix and training development plan in place confirming that all staff have an individual training and development plan. Staff told us that their induction did not cover everything they needed to know. One person said they needed more information on healthcare and medication Staff require proper training according to the challenging care needs. Care Homes for Older People Page 17 of 24 Evidence: We saw that staff address people with courtesy and respect and are skilled in supporting people who can display behaviour that challenges others. Having formal training may give staff more confidence in dealing with such behaviour. Care Homes for Older People Page 18 of 24 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management and administration should continue to improve to ensure that record keeping is robust and improvements continue. Evidence: The self assessment we sent to the home was completed on time. It was clear but needed to include more information on how the home meets peoples needs. It did not tell us what the manager had done to meet outstanding requirements. We know that there has been a change of manager at the home. The manager should make application to the Commission for registration which will help assure people that she has the skills and experience to manage the home. There is a quality assurance system in place including sending out survey questionnaires to people living at the home their relatives and visiting health care professionals. The survey gives people the opportunity to express their views of the service and is an important part of the quality assurance monitoring process. Care Homes for Older People Page 19 of 24 Evidence: The home holds money in safekeeping for a number of people and transaction sheets are in place showing income, expenditure and a balance. Only senior staff deal with financial transactions and regular audits are carried out to make sure the records are accurate and in good order. Receipts are obtained for any items purchased by staff on behalf of people. Following the last inspection the home has revised procedures so that two staff now sign the transaction sheets. This helps to make sure that the home is handling peoples money more safely. Information provided in the self assessment form showed that all equipment in use at the home is serviced in line with the manufacturers guidelines. The self assessment also shows that policies and procedures are in place. Care Homes for Older People Page 20 of 24 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 21 of 24 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 The provider must make 30/09/2009 arrangements to ensure that controlled drugs are stored securely in accordance with the requirements of the Misuse of Drugs Act 1971, the Misuse of Drugs (Safe Custody) Regulations 1973 and in accordance with the guidelines from the Royal Pharmaceutical Society of Great Britain So that controlled drugs are kept safe as required by the law. 2 9 13 The controlled drugs register 30/09/2009 must include a record of all controlled drugs in the home including drugs received for the next administration period. So that the home has an accurate record of all drugs in the home. Care Homes for Older People Page 22 of 24 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 7 Care plans should be updated to make sure staff have all the information they need to deliver care in a consistent and personalised manner. The service should develop more activities and opportunities for social interaction for people who are not able, or choose not to participate in trips. This will ensure that everyones social needs are met. The manager should make application to be regsitered with the Commission. This will ensure that people are assured that she has the skills and experience to manage the home. 2 12 3 31 Care Homes for Older People Page 23 of 24 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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