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Inspection on 27/06/06 for Sunningdale House, Perranporth

Also see our care home review for Sunningdale House, Perranporth for more information

This inspection was carried out on 27th June 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home provides comfortable, well-maintained accommodation, which meets the needs of the residents. The premises are clean and hygienic. Visitors report that they are made welcome. The manager carries out assessments of prospective service users to determine if the home can meet their needs. These provide staff with the directions and information that they require to met the needs of service users. Residents report that they are well cared for and feel that they have control over their daily lives. They have confidence in the staff, who are kind, skilled and respect their privacy and dignity. The service monitors the health care needs of service users and ensures access to appropriate services. Residents reported that they were satisfied with how their healthcare needs were met. The arrangements for the management of medicines were satisfactory. The home provides a variety of activities and distributes information about planned activities. Staffing levels met the required level. Recruitment practices protect residents by securing all required information and documents before new staff are employed. There is a structured staff training programme, which covers induction, required statutory training and NVQ at levels 2 and 3. Staff report that they are well supported and supervised. Systems for the safekeeping of service users` spending money were satisfactory.

What has improved since the last inspection?

The additional sun lounge is almost completed and ready for use as a communal area for residents. The manager is drawing up new care plans for existing residents. The provider has continued to review the policy and procedure and systems for managing medicines in order to protect residents. Moving and handling assessments have been completed for service users in order to ensure that residents receive safe assistance and support. Staff have received training in moving and handling. The training programme for staff has continued to provide staff with additional knowledge and skills so they can meet the personal care needs of residents. Action has been taken to reduce odours. The provider has carried a quality assurance survey. The questionnaire format covers key areas of life at the home and provides open questions which allow people to express their views.

What the care home could do better:

Care plans need to direct care staff in more detail in order to ensure that the residents` needs are identified and met. Regular reviews with residents and their representatives should be recorded satisfactorily. Risk assessments need to be broadened to identify fully the risks and protect individual residents. Daily records often lack detail about residents` activities, visitors, events and aspects of the individual`s care plan. The adult protection policy and procedure requires some amendments to accord with the local multi-agency guidance and to safeguard residents. Staff need guidance in completing accident records to support the manager in following up accidents and risk assessment. All staff must participate regularly in fire training and drills. The provider should ensure that photographs are retained of all staff and residents. The manager stated that she has been unable to provide formal supervision to staff. This is seen as an area for improvement.

CARE HOMES FOR OLDER PEOPLE Sunningdale House Boscawen Road Perranporth Cornwall TR6 0EP Lead Inspector Richard Coates Key Unannounced Inspection 27th June 2006 09:15 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 DS0000008907.V292523.R01.S.doc Version 5.1 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 DS0000008907.V292523.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sunningdale House Address Boscawen Road Perranporth Cornwall TR6 0EP 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) 01872 571151 01872 572633 Welling Ltd Alison Watson Care Home 36 Category(ies) of Dementia - over 65 years of age (6), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (36) Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: The registered provider for Sunningdale House is Welling Ltd; the responsible individual is Mr Alan Beale. Sunningdale House provides care for up to 36 older people. This includes registration for six people with dementia and six people with a mental disorder. The Registered Manager is Alison Watson. The home is situated near the centre of Perranporth with easy access to shops and other local community facilities. The home has a pleasant front garden overlooking the boating lake. The car park is steeply sloping and there is ramped access from this to the main entrance. There is a stair lift to the bedrooms on the first floor. The majority of bedrooms in the home are en suite. The home has spacious communal areas and the registered provider is currently completing an additional sun lounge. The home provides some day and respite care. The current scale of charges at May 2006 is given as £382 to £487 weekly. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a planned key inspection carried out at short notice so that the manager could be present. The purpose of the inspection was to follow up the provider’s compliance with the requirements and recommendations set in the last inspection report dated 8 February 2006, and to focus on the key national minimum standards as identified by the commission. Two inspectors were on the premises for two days. The methods used were discussion with the manager, staff, residents, and their relatives and visitors, inspection of records and documents, observation of the daily life of the home and inspection of the premises. The Registered Manager completed a pre-inspection questionnaire. The inspectors are grateful to the providers, staff and residents for their assistance in completing the inspection. What the service does well: The home provides comfortable, well-maintained accommodation, which meets the needs of the residents. The premises are clean and hygienic. Visitors report that they are made welcome. The manager carries out assessments of prospective service users to determine if the home can meet their needs. These provide staff with the directions and information that they require to met the needs of service users. Residents report that they are well cared for and feel that they have control over their daily lives. They have confidence in the staff, who are kind, skilled and respect their privacy and dignity. The service monitors the health care needs of service users and ensures access to appropriate services. Residents reported that they were satisfied with how their healthcare needs were met. The arrangements for the management of medicines were satisfactory. The home provides a variety of activities and distributes information about planned activities. Staffing levels met the required level. Recruitment practices protect residents by securing all required information and documents before new staff are employed. There is a structured staff training programme, which covers induction, required statutory training and NVQ at levels 2 and 3. Staff report that they are well supported and supervised. Systems for the safekeeping of service users’ spending money were satisfactory. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 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 Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, Sunningdale does not provide intermediate care (standard 6) Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The needs of service users are assessed so that they can be assured that the home can provide adequate care. Some assessments require more detailed recording of information. EVIDENCE: The records of residents case tracked included written assessments of need. The assessments completed recently were improved in comparison to earlier ones. The commissioning authority had provided satisfactory assessment information for some residents. However, for others the commissioning authority had provided poor care management assessment and care planning information. This did not support the provider in good care planning. The needs assessments for people with non-complex needs were satisfactory. The assessments for people with more complex needs were not recorded in sufficient detail to reflect the complexity and detail of their needs in the areas specified by standard 3.3. There was, for example, no evidence that the provider had sought information from the GP or specialist nurse about the Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 9 needs of a resident recently admitted with a specific form of disability. This would have been good practice and ensured that his needs were met. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 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): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Written care plans direct and inform staff about how to meet the residents’ health and personal care needs. The plans need to be more detailed and specific in the direction provided to ensure that each resident’s diverse needs are met. The healthcare needs of residents are monitored and addressed so that their needs are met. The arrangements for the management of medicines protect service users. EVIDENCE: All residents case tracked had written care plans. Recently drawn up care plans were much improved compared to older plans. Care plans are drawn up from an individual perspective that reflects personal choices and preferences. Care plans can lack specific directions for staff in respect of some needs. For one of the residents case tracked, there was a lack of clear direction for staff about a specific mobility issue and the use of an item of equipment. Similarly for another resident case tracked the care plan did not advise staff how they should deal with key issues related to her mental health. In other care plans, there were some good examples of clear directions and information for staff. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 11 A new format has been introduced for reviews. The reviews case tracked did not evaluate the care plan adequately or evidence the involvement of the resident and their representatives. A number of residents said that they had not seen their care plan in responses to an in house questionnaire. The changes recorded in one review appeared to require a new care plan to be drawn up but this had not been done. Risk assessment is not consistent. The provider is now recording risk assessments for moving and handling. Previous formats of risk assessments were general statements of all the potential risks associated with an activity even where there was no identified risk for the resident. These risk assessments did not assess accurately the individual risks to the individual resident. Risk assessments should be individual for each resident with specific directions for staff about controlling the identified risks. The risk assessment process needs to be broadened to include the risk of falls, environmental risks, for example in the resident’s bedroom, and risks arising from individual behaviours and disabilities. Daily notes are brief and focus on physical care, and provide limited information about diet, activities, visitors and occurrences. This results in records, which do not reflect an accurate picture of all that goes on in the home. The records of health care appointments and contacts indicate that the healthcare needs of residents are monitored and met. Residents stated that their healthcare needs were well met. The Registered Manager discussed the needs of one resident who currently receives visits from the district nurse. Service users were confident in the staff and reported a positive attitude from staff in all aspects of care and support. They felt that staff respected their privacy and dignity, and treated them with respect. Medicines are stored in a locked cupboard on the ground floor and in a locked medicine trolley on the first floor. The storage facilities are well ordered. Staff who administer medicines have received appropriate training. The home has recently introduced the Boots monitored dosage system. Inspection of the records showed that most were completed appropriately and identified some improvements that could be made. Medicines for disposal are stored in a separate section of the medicines cupboard. A disposal log is in place. There is a dedicated locked refrigerator for medicines. It is recommended that the temperature of this is recorded at least once daily. Staff were aware of good practice in relation to insulin storage and removal from the refrigerator 24 hours before first use is recorded on the administration record. The policy and procedure needs to be amended to include guidance on homely remedies as set out in the commission’s recent Professional Advice on the Administration of Medicines in Care Homes. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 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, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are supported to follow a lifestyle which accords as far as possible with their own choices and preferences. A varied programme of activities is provided. The diet provided is varied and nutritious. EVIDENCE: The provider sets out policies on autonomy and choice and on social activities. Information about activities is provided in information packs and on the notice board. Current activities include sessions with an activity worker for games and other recreation, keep fit sessions twice weekly, story telling, art and crafts, and film sessions. The inspectors noted an excellent keep fit session during the afternoon. The trainer kept a group of residents actively engaged throughout the session paying effective attention to each individual’s needs. It is particularly commendable that the provider engages a professional trainer for this session. The residents enjoy trips outside the home during the summer months. A hairdresser visits regularly and was in the home on both days of the inspection and residents were appreciating this service. Residents generally felt that there was enough for them to do. Exploring and recording the social care needs and preferred activities of residents in their assessments Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 13 and care plans, and maintaining more informative daily records for each resident would improve compliance with this standard. Residents felt that, in the main, the routines of daily living suited their expectations and preferences and they felt in control of their day-to-day lives. One recently admitted resident was pleased that she had been able to bring some items of furniture in to the home. Residents stated that the arrangements for visiting were satisfactory and suited their families and friends. A visitor reported that they were always made welcome and offered a hot drink. Residents made generally positive comments about the food and catering arrangements. Some residents responses to the quality assurance questionnaire showed that there were not fully satisfied with the meals, but they were not specific as to the improvements required. This was reflected in some conversations with residents. The provider should review this matter in detail with residents as a follow up to the survey. Residents reported that they received their preferred breakfast. The menu for lunch is a four-week cycle of meals with a variety of vegetables and puddings. A range of choices is available on request in addition to the main dish. The evening meal is a choice of soups, salads, savouries, sandwiches and a pudding. Staff discuss the choice of meals for the day with residents and retain records of the meals eaten. Fresh fruit is available. Dietary needs and preferences are recorded in the assessment and care plan. The cook reported that specific diets are provided for a number of residents with diet-controlled diabetes. The Registered Manager stated that the menu for residents with diabetes had been reviewed and improved. Four residents have food cut up and use appropriate eating equipment, and two currently have liquefied meals. No residents require assistance with eating. There are records of food allergies. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 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): 16 and 18 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. There are arrangements to protect service users from abuse; the policy and procedure needs further development. EVIDENCE: The Registered Manager reported that no formal complaints have been recorded since the last inspection. The Commission has also received no complaints or concerns. Responses to the homes quality assurance survey questionnaire indicated that residents knew who to go to if they had concerns. The home’s complaints procedure complies with the standard and regulation. The home has a written adult protection procedure. This would be improved by including information about the varied forms that adult abuse can take, so that staff are able to recognise when abuse is occurring. The paragraph about the action to be taken where the resident is not willing to consent to the abuse being reported should be revised. It should state clearly that the Registered Manager or senior person in charge, must report all concerns and allegations to Cornwall Department of Adult Social Care without delay and must explain the reasons for this to the resident. The Registered Manager was informed about the revised local multi-agency adult protection guidance. Six staff from the home are attending the multi-agency alerter’s training during the summer. Other staff have completed in-house training in the protection of vulnerable adults. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 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 and 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is well maintained and provides a generally safe environment. The premises are clean and hygienic providing a pleasant environment and reducing risks to residents. EVIDENCE: Sunningdale House is located in a pleasant residential area near the centre of Perranporth, with the local facilities and services nearby. The building is spacious, attractive and well-maintained. The car park at the front is quite steeply sloping. There is a ramp from here for people using wheelchairs, or with poor mobility, to the main entrance which is essentially level, but has a small step. Many of the ground floor rooms have doors, which open, onto paved patio areas. The home is close to the boating lake and residents are supported to go for walks around the lake. The provider keeps records of routine maintenance, redecoration, re-carpeting and carpet cleaning which Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 16 evidences a programme of continuous refurbishment and renewal. The areas of the grounds accessible by residents are tidy and safe. Residents reported that they were spending time outside in the summer weather. The home was clean and hygienic on the day of the inspection. All bathrooms and toilets were clean and hygienic and there were no unpleasant odours. Liquid hand wash and disposable towels were located throughout the home. The vertical blind in the first floor bath and shower room is in poor condition. In bedrooms, there were some cobwebs on light shades and dust on the tops of wardrobes. There was also a pile of frames, cushions and other equipment at the end of the ground floor corridor by the staff room. This did not block any essential fire access, but marred the overall good impression of the inside of the building. The main lounges and dining rooms are spacious, well presented and comfortable. Residents were satisfied with the cleanliness of their rooms and the communal areas. Residents stated that they found their rooms comfortable. The rooms of residents case tracked were personalised and met the required standard. The laundry is situated away from the kitchen. The floor is impermeable. There are two washing machines and a tumbler drier, all of industrial standard. A sluicing sink provides a disinfectant wash for soiled articles. Each resident has an individual laundry basket. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The staffing and training arrangements ensure that the needs of residents are met. Recruitment procedures support and protect the service users. EVIDENCE: The provider’s uses a computer programme to calculate the weekly care staffing hours required for the number of residents and their levels of need. This is based on the Residential Forum model for calculating staffing levels. The Registered Manager provided recent print outs for this which showed staffing levels above the level set by the model. Staff generally felt that staffing levels were satisfactory. The Registered Manager should ensure that she records the hours that she is on duty. The levels of domestic staff and cooks are temporarily reduced by the absence of some individual staff. The Registered Manager had covered this by the flexible use of staff and an additional appointment. This situation must be kept under review. The recruitment records for recently appointed staff contained required documents – application forms, Criminal Records Bureau disclosures, two references and evidence of identity. Not all staff records contained photographs as required in Schedule 2 to the regulations. Staff receive a statement of terms and conditions of employment. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 18 The level of qualification of staff at NVQ 2 exceeds the 50 set by the standard. The records of recent inductions for new staff evidenced a satisfactory level of training. A recently appointed care worker was very positive about her induction and training. However, the records of earlier inductions did not substantiate an induction that met the Skills for Care specification. The Registered Manager is aware of the revised Skills for Care induction standards which are operational from September 2006. The manager has a clear view of the training needs of the staff team. The provider has a training programme which should meet the training needs of staff within a reasonable time scale. Staff were booked on a range of training courses including dementia awareness and adult protection alerter’s training. Staff were positive about the informal supervision and support that they received to do their jobs. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 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, 36, 37(partially) and 38 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The home has an experienced registered manager who is determined to ensure that it meets its stated purpose and objectives. Staff do not receive formal supervision. The health and safety of residents and staff are generally promoted and protected, but some issues require addressing. EVIDENCE: The Registered Manager is Alison Watson. She exceeds the experience requirement for a Registered Manager, and is working on her Registered Manager award. She has completed training in the last year in food hygiene, adult protection and as a moving and handling trainer. There are clear lines of accountability in the home, through the team leaders to the Registered Manager who reports to the Responsible Individual. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 20 The provider has carried out a quality assurance survey and obtained responses from residents. The Registered Manager reported that attempts to consult with professionals, GPs and care managers, had met a poor response. It would be useful to record this as part of the survey outcomes. It may be possible to obtain the views of professionals by including a brief ‘quality’ element in all review meetings where community nurses, social workers and case coordinators attend. Residents have clearly felt able to give their views in the latest survey, and the responses from residents are encouraging for the provider and manager. Specific comments from the residents’ responses are referred to in the appropriate sections of this report. The provider has not yet produced a summary of the responses for residents and their representatives as required by regulation 24(2). There are regular residents’ meetings, which are recorded. The Responsible Individual had recently attended a residents’ meeting. The provider does not act as an appointee for any residents for their benefits or manage any savings accounts for residents. The home does provide a safe keeping service for residents’ spending money. The records detail amounts paid in, for example by family members with power of attorney, amounts paid out, for example for hairdressing, and a running balance. Two staff sign all entries. Cash is held as individual amounts. A sample of these individual amounts were checked against the records and found to be accurate. The supervision of staff continues to be informal. Staff are not receiving formal recorded supervision at least six times a year as specified in standard 36. In addition to a confidential one-to-one session, supervision takes many forms which include a supervisor working with staff in delivering care and recording feedback on their work, a staff meeting, a small group training session and an annual appraisal. The Registered Manager submitted a list of required maintenance and servicing records with the pre-inspection questionnaire. A sample of these were checked against the original documents and found to be accurate. The general assistant carries out a range of regular health and safety checks. These include checks for Legionella, and on wheelchairs and call bells. The required hazard advice notice was not displayed in a room where the resident used oxygen. A temporary notice had been provided, and the Registered Manager was awaiting the correct format from the pharmacist. The hot water supply to wash basins is controlled by individual thermostatic valves to prevent scalding. The water emerging from some taps appeared rather hot initially, although it cools down after a period of running. The provider should check and re-adjust, if necessary, the thermostat settings. The environmental health officer had visited the home recently. The cook reported that this had been a positive visit with no requirements issued. The Registered Manager reported that the report was not at the home for Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 21 inspection and has been asked to send a copy to the commission in due course. The home records refrigerator and freezer temperatures daily. Some of the freezer temperatures have been slightly above the recommended limit. It is recommended that the provider review the freezers, thermometers and systems in place. As has been reported in the section on care planning, individual risk assessments for residents are not consistently adequate to ensure that potential risks are identified and controlled. Risk assessments do not always provide staff with clear directions and information about how they should manage and reduce specific risks to a resident. The accident record was inspected. Staff need training in the information to be recorded in an accident report to better support the Registered Manager in risk assessment and in auditing accidents. There is a fire risk assessment for the home which details assessments related to specific areas and issues. The fire risk assessment states that individual risk assessments are required in respect of each resident’s mobility and evacuation from the home. These risk assessments are not in place. However, the Registered Manager stated that in the event of a fire, the fire service would take responsibility for evacuating residents. Some bedrooms have narrow doors, and these should be included in the risk assessment. The current fire procedure summarises the arrangements in place. It does not detail the actions to be taken when an incident occurs. There should also be a record for staff to sign that they have read and understood the procedure. Records detail dates of fire drills and fire training but do not confirm adequately that all staff have participated regularly. Records also detail required checks on fire alarms, emergency lighting and fire fighting equipment. Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 22 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 2 X X X 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 1 2 2 Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Dates for action not arrived yet 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 Requirement Care plans must include the social and activity needs of service users. Timescale for action 31/08/06 2. OP7 13 Risk assessments must cover the 31/08/06 individual needs and circumstances of each service user. Care plans must direct and inform staff in detail on the actions required to meet all aspects of the service user’s personal, health and social needs. Care plans must be reviewed monthly. The adult protection policy must direct the person in control of the home to report all concerns about adult abuse promptly to Cornwall Department of Adult Social Care. The registered person must make arrangements for all staff to receive formal supervision. The registered person must retain a photograph of each DS0000008907.V292523.R01.S.doc 3. OP7 15 30/10/06 4. 5. OP7 OP18 15 13 30/10/06 30/10/06 6 7 OP36 OP37 18 17 and Schedule 30/10/06 30/10/06 Sunningdale House Version 5.1 Page 24 8 OP38 3 23 9 OP38 23 service user. The registered person must revise the fire procedure to give clear directions about the actions to be taken in the event of an incident. The registered person must provide training for all staff in fire prevention and the procedure to be followed in the event of a fire. 31/07/06 30/10/06 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 3 4 Refer to Standard OP7 OP7 OP3 OP9 Good Practice Recommendations Care plans should evidence where possible the involvement of the service user and their representative. Daily records should include more information about the delivery of care and the daily life of service users. The depth of the resident’s needs assessment should reflect the complexity of their care needs. The policy and procedure on medicines should include guidance on homely remedies as set out in the commission’s recent Professional Advice on the Administration of Medicines in Care Homes. The temperature of the medicines refrigerator should be checked once daily. The registered person should review the current menus and meal arrangements, and explore the views of service users. The registered person should obtain a copy of the new local multi-agency adult protection procedures. The registered person should produce a summary of the responses to the quality assurance survey and make this available to current and prospective service users and DS0000008907.V292523.R01.S.doc Version 5.1 Page 25 5 6 OP9 OP15 7 8 OP18 OP33 Sunningdale House 9 10 OP38 OP38 other interested parties. The registered person should check and re-set where necessary, the thermostatic controls on hot water taps. The registered person should review the operation of the freezers, the accuracy of the thermometers and the recording systems in place. All staff should receive training in how to complete an accident record. 11 OP38 Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 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 Sunningdale House DS0000008907.V292523.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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