CARE HOMES FOR OLDER PEOPLE
Sunningdale House Dene Road Hexham Northumberland NE46 1HW Lead Inspector
Jackie Burke Key Unannounced Inspection 28th November 2007 09:30 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 Sunningdale House DS0000040486.V346595.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. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sunningdale House Address Dene Road Hexham Northumberland NE46 1HW 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) 01434 606767 01434 607010 sunningdalehouse@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Care Homes No 2 Limited Mrs Eileen Ferguson Care Home 48 Category(ies) of Old age, not falling within any other category registration, with number (48) of places Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 20th February 2007 Brief Description of the Service: Sunningdale House is a purpose built three-storey building situated on the outskirts of Hexham. The home is built on a hill. There is access to landscaped gardens and patio areas on each level. There are two double rooms available for those who wish to share and all rooms have en-suite facilities. Many of the bedrooms in the home have doors, which give access to the garden area. There are lounges and dining rooms on each floor and other quiet sitting areas are located around the home. Local shops, cafes, transport and other amenities are within walking distance. Sunningdale House can accommodate frail elderly service users. The home does not provide nursing care. The cost of the service ranges from £415 to £520 per week dependant on financial assessment. Information is available for new and prospective service users, which outlines services provided in the home. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is a report of an unannounced key inspection, which took place on 21 November 2007. There are 42 rooms in Sunningdale House and on the day of inspection 39 were occupied. Three care plans were examined and this included assessments, daily records and medication records. Staff recruitment and training, safety and protection, catering and quality assurance were also examined. Staffing arrangements, policies and procedures, complaints records and care plans were looked at. Time was spent looking around the home to check on cleanliness, safety and maintenance. This provided opportunities to talk to six residents and the staff on duty. Time was spent observing contact between staff and residents. The manager of Sunningdale House is unwell and is on sick leave from her job at present. A great deal of work has been undertaken by the manager and the deputy manager since the last inspection and a manager has been seconded from another service within the Southern Cross Group to undertake managerial responsibility until the manager of the home returns. What the service does well:
The home provides a lifestyle that matches residents’ expectations and wishes and there are lots of things to do and join in with. Residents told the inspector ‘I am very happy here’ One person said “ I love it here, this is a home, well it’s my home” Another said, “I’ve never been in a place like this before but the staff are very good and my room is very comfy” One person told me she had “No complaints at all”. There is a full time activities coordinator employed at Sunningdale House and there is a varied range of activities and events taking place. The shared mini bus was available during the week of inspection and trips were planned for each day of the week. Residents are helped to enjoy their independence and make choices about what they do with their time. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 6 The staff are well trained in many areas and over half have achieved a qualification to a national level. The home is very pleasant and welcoming both inside and out. What has improved since the last inspection? What they could do better:
Further training in care planning and evaluation should be arranged to ensure that all staff are competent in the development and recording of care plans. There are insufficient bathrooms available for the number of service users within the home. Staff currently transport residents to the first floor, as there are no bathing facilities in use on the ground floor. A replacement bath has been ordered but the bathroom must be operational to allow for choice in bathing and personal hygiene. Plans are in place to improve bathrooms facilities on each floor and action should be taken to ensure that choice and decision-making in personal hygiene is not compromised. A training audit should be undertaken, and identified gaps in training should be addressed. More training in dementia awareness is required for all staff. Moving and handling training updates are required for some staff. Sunningdale House DS0000040486.V346595.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. Sunningdale House DS0000040486.V346595.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 Sunningdale House DS0000040486.V346595.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): Standard 3. Standard 6 is not applicable Quality in this outcome area is good The needs of residents are thoroughly assessed before they move into Sunningdale House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files were looked at during this inspection. The manager carries out most pre-admission assessments in addition to assessments undertaken by care managers for those assessed as requiring residential care by the local authority. People who are admitted to Sunningdale House as private clients have an assessment of need made by the manager. Clear and informative documentation about assessments was seen within care files. Sunningdale House DS0000040486.V346595.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 and 10 Quality in this outcome area is good Care plans, which are generally thorough, are in place and the needs of residents are met by staff. There is a clear medication policy, and procedures are in place to safeguard service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were looked at and records show that risk assessments are in place and that a great deal of work has taken place since the last inspection to improve the way that care plans are written. Care plans; risk and health assessments are reviewed monthly and are dated and signed. Some evaluation records are repetitive and state that “needs remain the same” or “follow stated care plan”. The manager audited care plans after the inspection and found similar entries. The manager agreed to arrange further training for staff to improve this area. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 11 Nutritional screening is in place and care plans to meet dietary needs are kept in care files. This information is shared with catering staff to improve nutritional planning for residents. Observations in the home show that staff are mindful of the rights of residents to dignity and respect. Staff were observed to address people politely, to knock on individuals doors and to provide personal care and support in privacy. Work has been done since the last inspection to improve awareness amongst staff about the medication procedures within the home and a clear written guide has been produced for staff. Checks were undertaken on records of controlled drugs during the inspection and found to be satisfactory. Senior staff take responsibility for administering medication and have been provided with training. Procedures are in place to support service users who wish to administer their own medication. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good All aspects of the daily life of the residents are assessed, and their needs and wishes are met as far as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents have detailed social care assessments and comprehensive care plans regarding their lifestyles and preferences. Residents said that they are able to make choices about how they spend their day and choose if they wish to participate in activities and events in the home. One person was knitting squares for blankets, others were engaged in a quiz and others chose to read and watch television in the round lounge on the top floor. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 13 There is a full time activities coordinator in post at Sunningdale House. Events and activities are displayed on notice boards throughout the home and a quarterly newsletter is produced for residents and relatives. The shared mini bus was in use during this inspection and a number of people were planning to take part in a trip to a teashop. One person was going out to the pub for lunch, and other outings were planned throughout the week to ensure that people were given the opportunity to participate. Visitors are made welcome and may choose to visit at times which suit residents. Meal planning has improved since the last inspection and Sunningdale House is involved in a corporate initiative of Nutmeg Menu Planning. This highlights nutritional standards and supports staff to plan a balanced menu for service users. The cook was available to discuss the benefits of menu planning and demonstrated records regarding the dietary needs of service users. The computerised audit tool indicates that there is an issue with high sodium content in the diet of residents. As a result he is looking at introducing low sodium foods and making changes in ordering procedures to minimise processed foods available in the menu. Fortified drinks and supplements are available for those who are assessed as having nutritional needs and records in the kitchen replicate assessment information in care files. Catering staff provide special diets including those with diabetic needs. A hot roast beef dinner was served at lunchtime with carrots, red cabbage, mashed potatoes and Yorkshire pudding. Homemade soup was prepared in the kitchen for teatime. Meals are spaced throughout the day with snacks and drinks. People spoken to said that the food was very good at Sunningdale House. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good Complaints are dealt with appropriately and service users are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a complaints policy within the home, which is displayed and included within the service users guide. Staff have received training in safeguarding adult’s procedures and showed that they were aware of their responsibilities to report poor practice. Written records of complaints made to the home were kept and showed that complaints had been investigated in a satisfactory manner and followed the policies and procedures within the home. The residents said that they knew problems were dealt with and who to speak to. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 15 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): Standards 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is good The standard of the environment within the home is good, although there are insufficient bathing facilities for the numbers of people who live in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has spacious lounges, dining rooms and other recreational spaces to enable various events and activities to take place. There are also “quiet “sitting areas throughout the home. The corridors are wide, with good access throughout the home and to the gardens and car park. The furnishings, fittings and lighting are domestic in style and of good quality. All areas of the home were attractively presented, clean and well maintained. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 16 A ground floor bathroom has been converted to a storage area and the bath removed to improve space and operational use. On the day of inspection, another bathroom was out of use as the height of the bath is too steep for residents to use safely. Plans are in place to improve bathing facilities on each floor. There are three bathrooms in use within the home. Staff are transporting residents between floors, as there are insufficient bathing facilities on the lower floor to meet the needs of service users. All of the bedrooms apart from two have en-suite facilities. Twenty-five rooms have French doors leading onto small patio areas, which then lead onto the landscaped gardens. Many are highly personalised by residents and two commented on the comfort and space within their rooms and the ability to furnish them as they wish. The laundry is situated on the ground floor and was tidy and appeared to be well organised. Regular monitoring and audits are competed by the Registered Manager and the Company auditor to ensure compliance with infection control policies. There are sluicing facilities in the home. The gardens are very pleasant and welcoming with lots of seasonal colour and interest. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 17 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): Standards 27,28,29 & 30 Quality in this outcome area is good Staff recruitment procedures are good, and there are sufficient staff on duty to meet the needs of the residents, but some staff need further training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a staff rota, which shows staff on duty throughout the twenty-four hour period. The manager of the home is currently unwell and absent from work. There is a manager seconded from another home within the organisation whose hours are supernumerary. The deputy manager is on maternity leave and an acting deputy has been appointed to cover maternity leave. Senior care assistants are allocated to each floor with appropriate care staff. This shows that systems are in place to ensure that the organisation and management of the service meet the needs of service users. The staffing requirement for seven care staff in the morning and afternoon, six care staff in the evening and four care staff at night was being met. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 18 It was apparent that staff receive a good amount of training and update in key areas such as safeguarding adults, first aid, medications and health conditions including diabetes care and podiatry. Some staff have attended training in dementia care entitled ‘yesterday, today and tomorrow’. Some staff are not always using safe moving and handling procedures in transferring residents from chair to wheelchair. There is a commitment to training within the home and 70 of staff have attained NVQ levels 2 or 3. Staff spoken to confirmed that they have access to training and are encouraged to participate. The manager keeps written individual training records. Four staff files were looked at. Criminal Record Bureau checks are undertaken and clearance certificates are held at head office. Records are available within the home to confirm that CRB checks are in place. Staff awaiting results of CRB checks work under supervision. Staff files show that staff have received induction training. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 19 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): Standards 31,33,35, 36 &38 Quality in this outcome area is good Residents live in a home, which is well run and managed in the best interests of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The seconded manager has relevant experience and qualifications to run the home efficiently and to meet the stated purpose, aims and objectives. A great deal of work has been done since the last inspection to address issues raised and to improve standards within the home. Monthly proprietor visits are undertaken and written reports are produced. Record keeping has been improved and records audited by the manager and deputy manager to comply with issues raised at the last inspection.
Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 20 Policies and procedures are well organised and easily accessed. The home’s maintenance person gives fire safety training and records were in place. Accident records were adequately detailed and kept in good order. Forty-one accidents were recorded over a three-month period. Accidents are analysed on a quarterly basis and audited via head office. Accident recording forms have been improved since the last inspection and include information on the number witnessed, and action taken. Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 3 3 Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 22 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 OP7 OP30 Regulation 15 (1) (2) b 18 (1) c i Requirement Further training in care planning and evaluation should be arranged to ensure that all staff are competent in the development and recording of care plans. Sufficient assisted bathing facilities should be provided to meet the needs of service users and to provide choices in personal care and hygiene. A training audit should be undertaken and gaps in training identified and met. More training in dementia awareness is required for all staff Moving and handling training updates are required for some staff. Timescale for action 31/01/08 2. OP21 23 (2) j 31/01/08 3 OP30 18 (1) c i 31/01/08 Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 23 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 Sunningdale House DS0000040486.V346595.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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