CARE HOMES FOR OLDER PEOPLE
Sunningdale House Dene Road Hexham Northumberland NE46 1HW Lead Inspector
Deborah Haugh Announced Inspection 4th January 2006 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.V259044.R01.S.doc Version 5.0 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.V259044.R01.S.doc Version 5.0 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@highfield-care.com Southern Cross Home Properties 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.V259044.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th August 2005 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 therefore access to landscaped gardens and patio areas can be obtained on each level.There are single rooms all, but two, with en-suite facilities and many rooms lead via French doors immediately into the garden area. There are lounges and dining rooms on each floor and other quiet sitting areas are available 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. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The announced inspection took place on 4/01/06 from 9.30 until 3.20 pm. The Registered Manager, Mrs Eileen Ferguson was on duty during the visit. There were 40 service users at the time of the visit. Staffing levels were checked. Time was spent looking around the home to check the cleanliness, maintenance and decoration during the visit. Prior to the inspection questionnaires were provided to service users and relatives. Service users completed thirteen questionnaires and they also shared their views during the inspection. Time was also spent observing the contact between the service users and staff. Two Relative/Visitor questionnaires were completed and views were sought from visitors during the day. Four care plans were examined. Arrangements for the administration and management of medication were checked. Recruitment, finances, training, catering, protection and quality assurance were also examined. What the service does well:
All of the service users spoken with and questionnaires said they liked living at Sunningdale House, they felt safe, liked the food and felt that staff treated them well. Comments included; - ‘Very happy here.’ - ‘Treated like a newborn baby.’ - ‘ Staff are very kind.’ - ‘I feel very lucky to live in this home. Activities are excellent. I have been on some very good trips and enjoy the entertainment.’ - ‘ Everything’s ok.’ - ‘ It’s a lovely home, very clean.’ - ‘You can take or leave the activities, you have the choice.’ - ‘ I prefer to spend time in my room, I like my music.’ Relatives and visitors made the following comments; - ‘ I have visited many care homes over many years. Sunningdale House is second to none.’ - ‘It’s always clean here.’
Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 6 - ‘Always made welcome when we visit.’ Staff spoke to service users with respect and were seen knocking on bedroom doors. The decoration and furnishings in the home are personal and homely. Some service users have brought their own possessions with them. The home has large landscaped gardens to the front and rear of the home and several of the bedrooms have patio doors, which lead out, onto small patio areas that then lead to the larger gardens. The garden areas are generally accessible to those with reduced mobility or those who require using a wheelchair. The home has a designated activities person who organises an impressive range of social leisure and cultural activities according to service users preferences and lifestyles. The activities exceed the minimum standards. The service users said that their lives are flexible and they can choose what to do on a daily basis. Recruitment arrangements are robust and therefore service users are protected. Staff are experienced and trained. The manager provides clear leadership and provides the home with stability and a commitment to continue to improve the quality of life of the service users. Staffing levels are appropriate to the needs of the service users. What has improved since the last inspection? What they could do better:
Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 7 Menus still need to provide more detail and catering staff would benefit from training on older people’s nutrition. Fortifying foods such as butter and full fat yoghurts should be available. One area of medication must improve. Care plans are in good detail and nutritional action has improved. However more detail is needed on the content of special diets. Information was provided to the home following the inspection. Financial care plans are not assessed or in place for service users who may require them. 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. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 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.V259044.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 3 was assessed met at the last inspection (NMS 6 is not applicable) EVIDENCE: Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Care plans are in place and staff have the information to meet service users needs. But nutrition and financial needs must be recorded/in more detail The health needs of service users are met and multi disciplinary working is taking place. The arrangements for the administration of medication are satisfactory but one area must improve to protect service users. EVIDENCE: Four care plans were sampled and they are detailed and positive and include the preferences of service users. Nutritional screening is in place and good care plans for meeting special dietary needs have improved but these are not in specific detail regarding supplements and snacks required for special dietary needs. Care plans must be shared with the cook. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 11 Financial care plans are not assessed or in place for service users who may require them. Comprehensive risk assessments are in place, including ones aimed at preventing falls, pressure sore management and lifestyle choices. The care plans, risk assessments and reviews had been reviewed at least monthly and were dated and signed. A daily record is maintained and this was found to contain detailed information regarding the daily life of service users. Comprehensive social care plans are in place. (See NMS 12) An audit of the arrangements for management of medication was undertaken. Arrangements are satisfactory but creams when opened must be dated. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,12,14 & 15 Activities, community contact and relationships with family and friends are excellent. Service users are able to choose from a wide range of occupations. Service users have control over their lives. Dietary needs of service users are well catered for but improvements must be made. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 13 EVIDENCE: Activities within the home include crafts, gardening, woodwork, board games, coffee mornings, tea dances and in house entertainment. The service users enjoy a ‘Luncheon Club’, Women and Men’s group weekly were they can enjoy a meal in a local pub or restaurant or go on trips. Recent outings include visits to Harrogate, Whitby, Hartlepool, Shildon Railway, Ostrich World, Cragside House, Wallington Hall, Light Water Valley, Metro Centre by Limousine and the Millennium Bridge. Service users spoke of their holidays to Blackpool, Paris and Berlin. Service users have detailed social care assessments and comprehensive care plans regarding their lifestyles and preferences. There is a hairdressing salon and the hairdresser visits weekly on a Monday. The library visits every month and books are available in the lounge. The home produces a quarterly newsletter, which records events in the home and also includes relatives and service user information, quizzes, poems, welcomes and congratulations of service users and staff. Service users said that they are able to choose if they wish to participate in activities and events in the home. People have their own telephones if wished. Visitors are made welcome and can visit when they wish. The catering in the home is very good with good choices available at all times. Menus are in more detail and care plans improved. However snacks, suppers, fruit and drinks must also be on menus. Care plans must also identify the preventative action to be taken ie Milky drinks, fortified snacks and food. Preventative action is also in place to fortify food such as evaporated milk, full fat milk and cream but butter and full fat yoghurt must also be provided.for assessed malnourished service users. The assistant cook was not clear about the nutritonal needs of older people. The catering team, where required must receive appropriate training regarding the nutritional needs of older people. Copies of nutritonal care plans must be shared with the catering team so that they can put them into action. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 (NMS 16 was assessed and met at the last inspection) Systems are in place to protect service users from abuse EVIDENCE: Staff have received training in the policy and procedure for the Protection of Vulnerable Adults (POVA). Staff are clear about their responsibilities to report poor practice. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 & 26 The standard of the environment within this home is good providing residents with an attractive, safe, clean and homely place to live. EVIDENCE: The home has spacious lounges, dining rooms and other recreational space to enable various events and activities to take place. There are also “quiet “sitting areas throughout the home. A separate smoking area has been created in the lounge on the ground floor. The corridors are wide, access throughout the home and to gardens and car park is accessible to service users with reduced mobility or those using wheelchairs. A passenger lift services all areas of the home. The furnishings fittings and lighting are domestic in style and of good quality. All areas of the home were attractively presented and decorated. New curtains have been provided in the lounges.
Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 16 There are sufficient baths and toilets that are close to lounges, bedrooms and dining rooms. The majority of the bedrooms have an en-suite facility. Appropriate aids and adaptations are available in toilets and bathrooms. All areas were clean and well maintained. A new corridor carpet and heavy duty carpet on the middle floor next to the kitchen has been provided. Two bathrooms are not assisted and service users would benefit from two walk-in showers in these areas. 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. The bedrooms inspected were clean, fresh nicely decorated and highly personalised by service users. Although nursing care is not provided adjustable beds are available. Service users have lockable facility for storage of medicines and personal items and service users are provided with keys. The laundry is situated on the ground floor away from the kitchen areas. The laundry areas were clean 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. One recommendation was made to improve infection control and this was to provide plastic covered pull cords to be used in communal bathrooms and toilets for ease of cleaning. The garden fence and overgrown shrubs have been cut back and repaired. A gardener has been employed. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Staffing numbers are appropriate to the assessed needs of the service users, size, layout and purpose of the home. The Registered Provider ensures that service users are cared for by staff that are trained but some training must still be provided. Robust staff vetting protects Service users. EVIDENCE: The home maintains a rota showing, which staff are on duty throughout the twenty-four hour period. The Registered Manager is supernumery and the home employs a deputy and senior care assistants are allocated to each floor with appropriate care staff. The home operates a “key worker system. The staffing requirement is: 7 care staff in the morning and afternoon: 6 care staff in the evening: 4 care staff at night: Sufficient domestic and ancillary staff are employed. Staff receive appropriate training in food hygiene, fire safety, moving and handling, health and safety, Five a day nutrition, customer service, palliative
Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 18 care, first aid, dementia and sensory impairment. Protection of Vulnerable Adults is provided to staff. The catering team must receive appropriate training regarding the nutritional needs of older people. The home has exceeded National Minimum Standards for NVQ Level 2 training at 52 by end of 2005. (Required level is 50 ). Care Staff have the following; NVQ Level 2 – 7 And 6 staff have commenced NVQ Level 3 – 5 And 4 staff are completing NVQ Level 4 – 1 And 4 staff are completing and 2 staff are completing One of the Cooks has NVQ Level 2 in Catering One of the Domestics has NVQ Level 1 in House keeping Recruitment arrangements were examined. Suitable systems and checks were found. Two references, police and Protection of Vulnerable Adults checks and staff identity are in place. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 The Manager is suitably qualified and experienced and provides clear leadership. The Manager is supported by the senior staff in providing clear leadership throughout the home, with all staff demonstrating an awareness of their roles and responsibilities. Southern Cross is developing quality assurance systems. Arrangements for the management of service users own personal money protects service users. Service users are protected from robust health and safety arrangements. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 20 EVIDENCE: The Registered Manager has vast experience and qualifications to ensure the home is run to meet the stated purpose, aims and objectives. Southern Cross Care Homes Ltd acquired Highfield Care Homes and are developing quality assurance arrangements. The current quality assurance system is ISO9001/ Health Mark Certification. Service users money, which is looked after by the home, is securely stored. Only the Registered Manager, Deputy and Administrator have access. Care plans must be put in place where service users require assistance with finances. Advice has been sought from the Fire Safety Officer regarding door chocks and door self-closers. No fire doors were chocked open on the day of the visit. Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 3 3 X 3 X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 2 X 3 X X 3 Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 22 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 2 Standard OP9 OP30OP15 OP8OP7 Regulation 13(2) 15, 16(2), 18(1) Requirement Medication arrangements must improve; 1. Date creams when opened. The arrangements for service users finances must be assessed i.e. personal monies, ability, risks, and representative’s support. Care plans must be put in place where appropriate. Menus must be in more detail so that judgements can be made as to their suitablility and nutritional value. (Fruit, snacks, supper, drinks) Preventative action must be taken to fortify meals for special diets and assessed malnourished service users ie the use of butter, full fat yoghurts. Care plans must identify the preventative action to be taken ie Milky drinks, fortified snacks and food. (OUTSTANDING 31/10/05) The catering team must receive appropriate training regarding
Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 23 Timescale for action 04/01/06 31/03/06 the nutritional needs of older people. Nutritonal care plans must be shared with the catering team. (Copies in the kitchen.) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP26 OP21 Good Practice Recommendations Consider providing plastic covered pull cords to be used in bathrooms and toilets for ease of cleaning. Two bathrooms are not assisted and service users would benefit from two walk in showers in these rooms (1st & 3rd floor). Sunningdale House DS0000040486.V259044.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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