CARE HOMES FOR OLDER PEOPLE
Sunningdale House Boscawen Road Perranporth Cornwall TR6 0EP Lead Inspector
Richard Coates Announced Inspection 8th February 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.V270824.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.V270824.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 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.V270824.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 29th April 2005 Brief Description of the Service: The registered provider for Sunningdale House is Welling Ltd and the responsible individual is Mr Alan Beale. Sunningdale House provides care for up to 36 elderly people. This includes registration for six people with dementia and six people with mental disorder. The Commission for Social Care Inspection is currently determining an application for the registered managers post. 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 sloping access from this to the main entrance. 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 for service users. The home provides some day and respite care. Sunningdale House DS0000008907.V270824.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 announced inspection to review compliance with key standards in the areas of care planning, healthcare and staffing. The last inspection carried out on 29 April 2005 was unannounced and covered a significant number of the standards identified as key standards by the commission. A follow up visit took place in August 2005; the provider had complied with the requirements and recommendations set at the April inspection. The commission investigated a complaint made during April 2005 about a range of issues including inappropriate care practices, the management of medication, staffing levels and systems of care. A number of these concerns were upheld; other elements of the complaint were not upheld or were unresolved. The provider has taken action to address these matters. The manager submitted a detailed pre-inspection questionnaire and supplementary information. Two inspectors spent over six hours at the home. They spent time with the manager, staff and residents, inspected documents and records, and toured the premises. The inspectors wish to thank the manager, 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. The manager has recently carried out detailed assessments of prospective service users to determine if the home can meet their needs. The manager is also in the process of drawing up new care plans. 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. They have confidence in the staff, who are kind, skilled and respect their privacy and dignity. The service monitors the healthcare 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 Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 6 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? 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.V270824.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.V270824.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 The needs of service users are assessed so that they can be assured that the home can provide adequate care. EVIDENCE: Case tracking the records for residents showed that more recent assessments were completed comprehensively and covered the issues specified in the standard. Basic information is initially recorded on a pre-admission record and this is transferred to a detailed assessment format. There was clear evidence that the resident’s care needs had been assessed adequately to establish that the home could meet these needs. Older assessments were not adequately detailed or proportionate to the complexity of the resident’s need and were not consistently signed. The provision of assessment and care planning information from the local commissioning authority appeared inconsistent. Standard 5 was not inspected in detail, but records did not record trial visits by prospective service users or introductory contacts with their families and representatives.
Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 9 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 Detailed written care plans direct and inform staff about how to meet the residents’ health, personal care needs. They need further development to include service user’s social and activity needs. The healthcare needs of residents are effectively monitored and addressed. The arrangements for the management of medicines protect service users. EVIDENCE: The manager is currently re-writing the care plans for all service users. The care plans inspected were easily understood, set out clearly the abilities of the service user and directed care staff about the interventions required to meet their assessed needs. There was evidence of reviews. The manager stated that she would be setting up review systems to follow the introduction of the improved care plans. Care plans lacked evidence of the involvement of the service users or their representative, for example a signature, and did not cover the service users’ social and activity needs. The inspectors accept, however, that the new manager has made it a priority to draw up sound baseline care plans and these will be developed and refined further. The manager will be training staff in drawing up care plans in order that this task can be effectively shared.
Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 10 The records contained detailed moving and handling risk assessments with clear directions for staff. Where a hoist and sling is in use, the action plan should specify the size and type of sling to be used for the service user. Risk assessments had been completed for service users for, for example, bathing, medicines, eating, and locks on bedroom doors. The intention here is commendable, but the risk assessments did not assess accurately the individual risks to the resident, but provided generic risk management advice about each area, including where there was no identified risk for the resident. Risk assessment should be individual for each resident with specific directions for staff about managing identified risks. Daily notes are brief and focus on physical care, and provide no information about activities, visitors and occurrences. This results in records, which do not reflect an accurate picture of all that goes on in the home. Residents reported that staff were kind and sensitive while assisting with personal care and respected their privacy and dignity. All residents are registered with local GP practices. The files contain detailed records of contacts with GPs and other health professionals. Tissue viability assessments are recorded. The local community nursing service provides pressure-relieving equipment when there is an assessed need. The manager reported that the community nurses visit the home on most days and staff consult them about the changing needs of residents. One resident who was case tracked was sitting on a pressure-relieving cushion as indicated by her assessment. Care plans include directions and guidance on the management of continence. Residents stated that the staff monitored their healthcare needs and accessed appropriate services when this was necessary. A chiropodist visits the home regularly. The arrangements for the management of medicines were satisfactory. The policy and procedure complies with current good practice guidance. The receipt of medicines is checked and signed for on the medicine administration record. Storage arrangements are secure. Records of administration were accurate and in good order. The stocks held of a sample of medicines were checked against the record and these were accurate. A record is maintained of medicines returned to the pharmacy. Eye drops and insulin not in current use were appropriately stored in the refrigerator, and the date of opening of the eye drops was recorded. A small amount of controlled drugs were in use and records were satisfactory. Staff who administer medicines receive suitable training. Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 11 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 Residents are supported in a lifestyle, which generally meets their expectations and preferences. EVIDENCE: The provider sets out policies on autonomy and choice and on social activities. Information about activities is provided in monthly information packs, which are distributed around the home. Current activities include three sessions weekly with an activity worker for games and other recreation, keep fit sessions twice weekly, fortnightly story telling, art and crafts on Thursday, and film sessions on Saturday. Trips outside the home are planned for the summer months. A hairdresser visits regularly and was in the home on the day of the inspection. Some residents stated that there was sufficient activities provided; others felt that they would appreciate more. Compliance with this standard would be strengthened by including the social care needs and preferred activities of residents in their care plans and by maintaining more informative daily records for each resident. Residents felt that, in the main, the routines of daily living suited their expectations and preferences. A small number felt that they were asked to get up rather early and the manager undertook to investigate this. She stated
Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 12 clearly that no one should be getting up at a time that did not suit him or her. Residents made positive comments about the food and catering arrangements. Residents with diabetes felt that the provision of cakes, puddings and biscuits suitable for diabetics could be improved. The manager undertook to respond to this. Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 13 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 The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. EVIDENCE: The provider’s complaints procedure complies with the standard and regulation. A record of all complaints and concerns is kept in a complaints register. The register included records of recent complaints and concerns and how they had been responded to and resolved. Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: These standards were not inspected in detail, as they were included in the last unannounced inspection. Residents reported that the communal areas and their individual rooms were kept clean and hygienic. All bathrooms, toilets and basins inspected were clean and hygienic on the day of the inspection. On a cold winter day, the home was warm and comfortable. No obvious health and safety risks were noted during the inspection. However, the fluorescent lighting in the kitchen lacks suitable covers over the tubes. Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 15 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 The staffing and training arrangements ensure that the needs of residents are met. Recruitment procedures protect the well being of service users. EVIDENCE: The manager provided a copy of the four-week staff roster. The provider uses a computer programme based on the Residential Forum model, which calculates staffing levels on the basis of residents’ care needs. The staffing detailed on the roster comfortably met the level set by the Residential Forum model for the 25 residents in residence. Staff reported that they felt that staffing was adequate. The manager stated that as occupancy increased towards the capacity of 36, staffing levels would be increased in line with the model. The roster details adequate domestic staff and a cook is rostered daily. There is a handyperson. The manager should ensure that the hours she works are recorded in order to evidence at least 30 hours of active and informed management time each week. The current level of qualification of staff at NQV level 2 is 52 . The deputy is undertaking an NVQ at level 4; three staff are undertaking NVQ level 3, and three staff undertaking NVQ level 2. The roster and records indicated that there is always a qualified first aider on duty. None of the current night staff have an NVQ level 2. A qualified team leader sleeps on the premises and is on call. This goes some way in addressing the issue, but is not a long-term solution. A recommendation is made in this report that the provider needs to review the qualifications of night staff.
Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 16 The provider has a standard application form. It was recommended that the form would benefit from a section for the applicant to state why they feel that they are suited to the job that they are applying for. The provider may also wish to review whether the reference request format provides sufficient space for a response where the reference giver has more detailed comments to make. Records for recent recruitments showed that all required information and documents, for example Criminal Records Bureau disclosures, photographs and written references had been obtained before the workers had begun their employment. Staff receive a statement of terms and conditions of employment. Staff training files contained detailed records of induction training. Staff felt that they had received a very positive welcome to the home and a good induction. The inspectors provided information to the manager about the revised Skills for Care induction specification, which is effective 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 current training needs of staff within a reasonable time scale. Food hygiene is being booked locally for those staff who have not completed this or who require updating. Seven staff have yet to complete training in infection control. The manager is a qualified trainer in moving and handling. Training in adult protection is currently provided in-house, and the manager is planning for staff to attend the local multi-disciplinary alerters’ training. Staff were positive about the supervision and support that they received to do their jobs. They expressed no concerns and had no specific suggestions for improvements. Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 17 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): 33 and 35 The provider has not completed a recent quality assurance survey which consults residents, their representatives and other stakeholders. The systems for managing personal money safeguard the financial interests of service users. EVIDENCE: The manager is developing a suitable format of questionnaire for seeking the views of residents and their families and representatives. This will be undertaken later in the year, and a summary produced of the responses. The responsible individual makes regular visits to the home and submits copies of the reports for these visits to the commission. There is a corporate procedure for the review and revision of policies.
Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 18 The poster for the inspection was displayed in the entrance hall of the home. The manager reported that the provider does not act formally for any service user in the management of their financial affairs. The home does provide a facility for the safe keeping on behalf of service users of small sums of spending money. There is a simple guide for staff for the deposit and withdrawal of money. All transactions are recorded and signed by two people. A sample of the cash held was checked against the records and found to be accurate. It would be good practice for the responsible individual to check a sample of the records and sign them off as part of his regular visits. Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 19 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 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X X X X X X X X X 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 X X 2 X 3 X X X Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 20 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. 2. Standard OP7 OP7 Regulation 15 13 Requirement Care plans must include the social and activity needs of service users. Risk assessments must cover the individual needs and circumstances of each service user. The registered person must seek the views of service users and their representatives as part of a formal quality control system. Timescale for action 31/08/06 31/08/06 3. OP33 24 31/12/06 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 OP12 OP19 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 registered person should review the variety of the diet available to service users with diabetes. The fluorescent lighting tubes in the kitchen should be
DS0000008907.V270824.R01.S.doc Version 5.1 Page 21 Sunningdale House 5 OP27 fitted with suitable covers. The registered person should review the lack of qualifications in the night staff and produce an action plan. Sunningdale House DS0000008907.V270824.R01.S.doc Version 5.1 Page 22 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
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