CARE HOMES FOR OLDER PEOPLE
Sunningdale Lodge Dene Road Hexham Northumberland NE46 1HW Lead Inspector
Janine Smith Key Unannounced Inspection 11th November 2008 10:00 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 Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sunningdale Lodge 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 603357 01434 608865 sunningdalelodge@schealthcare.co.uk www.southerncrosshealthcare.co.uk Southern Cross Home Properties Limited No current registered manager Care Home 50 Category(ies) of Dementia - over 65 years of age (50) registration, with number of places Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. One named resident is known to be under pensionable age. No further under pensionable age admissions are to take place without the prior agreement of the CSCI. 7th November 2007 Date of last inspection Brief Description of the Service: Sunningdale Lodge is a 50-bedded care home, which provides care including nursing for elderly people with dementia. The home is located on the outskirts of Hexham, next to another residential care home, also owned by the Southern Cross Group. The home is purpose-built with accommodation on three floors. Rooms are single, some with en -suite. The lower ground level provides catering and laundry facilities. There is a large attractively landscaped rear garden, with seating. Fees range from £383 to £400.78 (council) and £478 private. Information about the home is available including inspection reports. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means that the people who use this service experience adequate outcomes.
How the inspection was carried out Before the visit: We looked at: • Information we have received since the last visit on 20th November 2007. • How the service dealt with any complaints & concerns since the last visit. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service & their relatives, staff & other professionals. The Visit: An unannounced visit was made on 11th November 2008 and further announced visits on 12th and 18th November 2008. During the visits we: • • • • • • Talked with people who use the service, relatives, staff, the manager & visitors. Looked at information about the people who use the service & how well their needs are met, Looked at other records which must be kept, Checked that staff had the knowledge, skills & training to meet the needs of the people they care for, Looked around parts of the building to make sure it was clean, safe & comfortable, Checked what improvements had been made since the last visit. We told the manager what we found. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations – but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. Since the last inspection there have been some changes of management in the home. The manager, Mrs Elin Winter, was previously registered with the commission to manage this home but resigned her post earlier this year to take up another job. A new manager was employed but left her post within a
Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 6 couple of weeks. Mrs Winter subsequently re-applied for the manager’s post and has returned to work at Sunningdale Lodge. What the service does well:
The home makes its Service Users Guide easily available, which helps people to know about the service they can expect. Detailed assessments are carried out to ensure that the home can meet the needs of any potential residents. The health of residents is carefully monitored, which helps ensure that they receive routine check-ups as well as medical help when they are unwell. In addition, the staff seek specialist advice when this is called for, for example, they had sought advice from the Challenging Behaviour Team about a resident whose behaviour was causing concern. Many staff, but not all, demonstrate a good understanding of person centred care meaning that residents are treated as individuals. Care staff had used their knowledge of individuals to provide sensitive individualised care. Mostly residents’ personal care needs are met well, but there can be lapses. Staff make efforts to provide one-to-one support as well as social activities that interest residents, which helps to occupy and relax them. Staff demonstrated good initiative in providing activities, such as football and golf games for individual residents, because they knew they enjoyed these activities in the past. Most of the relatives spoken to who expressed views about the food, thought it was good. The cook prepares a selection of finger foods, which can be easier for people with dementia to eat if they cannot manage cutlery. This is good practice. Relatives and friends are welcomed into the home and encouraged to spend as much time with their relatives and to help with their care if they wish. The manager encourages good communication between the home and relatives. Many parts of the home have been redecorated. The heating system has also been replaced. As the home is redecorated, signage is being fitted to doors along with post boxes, to help residents identify what the rooms are used for. The staff work hard to keep the home clean and smelling fresh. The staff team are motivated and enjoy their work. One said she loved working here and felt supported and guided in her work. Another said in a survey, ‘I enjoy my job as a care assistant. Management and nurses are very supportive. Training very good.’ Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 7 Most of the care staff team have achieved a National Vocational Qualification in care. The company’s training programme covers a lot of relevant subjects. What has improved since the last inspection? What they could do better:
Some difficulties can be encountered where residents, because of dementia, can behave in ways, which can harm other people or themselves. Not all staff deal with some situations appropriately. The manager is making arrangements to ensure that staff are fully trained and that training is repeated where necessary and that staff receive appropriate supervision and support. Some relatives have justified concerns that their relatives may be harmed. This is because there are not staff present in communal areas at all times to help prevent incidents between residents, when it is known that there is a strong likelihood that incidents will occur. More care needs to be taken to ensure that residents wear their own clothing and preferred style of clothing, as this helps preserve their dignity and sense of identity. Medication was generally looked after safely, but some improvements are needed to ensure that the medication administration records are fully accurate. This helps reduce the potential for errors being made. Most people seem satisfied with the food provided and the support provided by staff, though it can be difficult for staff to provide uninterrupted one-to-one support to residents who need this at mealtimes due to the demands upon the staff team. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 8 When staff offer meal choices to residents, it would be helpful to show them the plated up meals, which will give them a better visual clue about what is being offered. Not all staff fully understand what the whistle blowing policy is about. Further training and/or guidance must be provided to ensure that staff understand the company’s whistle blowing policy and that legislation is in place to protect staff who report any concerns about abusive practices in good faith. Care staff often have to deal with very difficult situations in the home, as some people with dementia can become distressed and angry when they do not understand some of the situations they are faced with. Advice has been sought from the Challenging Behaviour team about how to care for specific individuals but there is an absence of evidence in staff training records to show how they are trained to deal with aggressive behaviour and what they should do if they need to protect someone from being harmed. In-depth training must be provided so that staff know how to support people in difficult situations, in ways to reduce the likelihood of harm occurring to residents and/or staff. Staffing levels are reasonable but may not always be enough when individual residents require a lot of one-to-one care and support to ensure that they and other residents are kept safe. Staffing must be kept under review to ensure that residents can receive the care they need, to avoid incidents where residents may harm other residents if they become distressed or upset because of dementia. The company have an established formal staff supervision system, which requires that staff have one-to-one meetings with a senior member of staff to discuss their work and support and training needs every two months. Some staff do not have a clear understanding of these processes. Work needs to be done to ensure staff understand the purpose of supervision and how and when it will happen. This will help ensure that staff fully understand that supervision is a formal, regular two-way discussion, which is there to support and develop the worker’s role and skills. Some bathrooms lack natural lighting, can appear gloomy and the light switches are located on the outside wall. These factors may make it more difficult for people with dementia to find the toilet independently. Consideration should be given to ways of making the toilets more visible to residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 9 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 Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive assessments are carried out before and after admission to ensure that people’s needs can be planned for and properly met. EVIDENCE: The care record of someone recently admitted into the home showed that a detailed assessment was carried out before they were admitted. The Service Users Guide was readily available in the lobby and the manager stated it was also available on audiotape. Two people stated in a survey, that they received a contract and received enough information about this home before they moved in. One said they ‘always’ receive the care and support they need, the other said they ‘usually’ do. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most people receive good, sensitive, individualised health and personal care from the staff team, when they need it. However, there are occasions, when residents’ safety and wellbeing can be compromised, due to staff not having the time or support they need to provide the very best care for individuals. EVIDENCE: The information from the pre-admission assessment is used to draw up a plan of care for each resident. These are reviewed regularly to ensure that it remains appropriate or whether or any changes are needed. The care plans read included a variety of physical and social assessments that are carried out. These included assessments of nutrition and dietary needs, moving and handling requirements (which tell staff how well the person is able to walk and move and how much help they need). There are also assessments
Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 12 of skin health and whether the person is at risk of developing pressure sores (sometimes known as bed sores). These are evaluated regularly. Pressure relieving cushions were being used for some residents. Since the last inspection, efforts have been made to find out what people would like to happen in the event of their death. Their wishes have been recorded in their care records, which helps ensure that staff are aware of this important information. A carer who completed a survey said they were always given up to date information about the needs of people they support ‘through report/care plan system and handovers during each duty’. Staff spoken to during the inspection, were well aware of the needs of the residents discussed. One regular visitor thought that communication could be improved between staff, as sometimes the visitor’s requests did not get passed onto other members of the staff team. Two other regular visitors said they were kept well informed about the welfare of their relatives. The care plans contained a section where discussions/concerns of relatives were recorded, which is good practice. Discussion with staff, visitors and information from surveys showed that people’s healthcare needs are being met by the home. The care plans showed that contact was made with GPs or community nurses when residents were unwell and that residents received regular check-ups from opticians, dentists and chiropodists. Their weight was being checked and recorded. Two surveys were received, which two residents’ relatives had helped to complete. Both said their relatives always received the medical support they need. One added, ‘minor injuries are dealt with promptly. Relatives are always kept informed’. Several regular visitors were spoken to during and after the inspection. One, whose relative lived on the ground floor, said the care was ‘wonderful’. She said that staff spend time talking with residents and that they meet their individual needs. Relatives of two other service users expressed concern that their relatives had been injured by another one, usually when staff were not present in the lounge. One had been injured several times. The records and discussions with staff confirmed that this had happened because the resident concerned needs almost constant one-to-one attention and when this is not available from staff, she will approach other residents and can grab or bite them. This is not done maliciously but can cause injury. The staff confirmed that they do spend a lot of time with this resident, but can’t do this all of the time and there are times when there are no staff about in the lounge. This resident was observed shouting out and then removing her lower clothing in the lounge. It was
Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 13 several minutes before a carer came to assist, by which time the inspector had tried to help her. The carer seemed unsure about what to do. One carer was, on another occasion, seen to act inappropriately with this resident, by moving her too quickly across the lounge whilst shouting at her. (This incident was subsequently reported and dealt with through the Local Authority Safeguarding procedures and the home’s disciplinary procedures). On another occasion, one member of staff was observing sitting quietly with this lady talking to her and reassuring her. The resident was very relaxed by this, putting her head on the carer’s shoulder and holding her hand. The records also showed that staff had encouraged this resident to carry out tasks, such as dusting and pushing the laundry trolley, which she was said to have enjoyed and provided occupation for her. Staff also spoke of how they had used knowledge of her previous hobby to good effect. Most staff spoken to were clear about what they do to try to prevent any behaviours which might harm the resident or any others. Staff had rightly sought specialist advice about the behaviours she was presenting and a psychiatrist and the Challenging Behaviour Team were providing treatment and advice. The manager said she had brought in extra staff, so that more staff could attend sessions with the Challenging Behaviour adviser. The company provides training for staff about dementia, called Yesterday, Today and Tomorrow although not all staff have had this training yet. Residents were seen to be clean and well dressed. One regular visitor said that their relative was always kept clean, usually wore skirts rather than dresses as staff found this easier but despite having plenty of clothing was frequently dressed in other people’s clothing. Two other regular visitors were satisfied with the personal care provided to their relatives. One said their relative was incontinent but got the help they needed to be kept clean and comfortable. The medication system was looked at, including a sample of records, and discussed with a member of staff. Regular audits are carried out. The medication was generally looked after well, though it was found that an error had been in made in recording the quantity of one medication received. The details of one medication were duplicated on a medication administration record, which could lead to confusion or error. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff make efforts to provide person centred care and social activities that interest residents, which helps to occupy and relax them. Most people seem satisfied with the food provided and the support provided by staff, though it can be difficult for staff to provide uninterrupted one-to-one support to residents at mealtimes due to the demands upon them. EVIDENCE: An activities organiser is employed. Staff described some of the social activities and events provided, such as bingo, dominoes, cards and weekly art sessions. Staff also use a beanbag game, a net on a hoop to engage residents. Residents also get their nails painted. Entertainers visit occasionally and staff said they organise karaoke events. Events for friends and families are also arranged, which also help raise funds for activities. A minibus is available to the home one day in every twelve weeks. One of the staff said a Christmas lunch was being arranged at the Milecastle restaurant
Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 15 but there was a limit to how many residents would be able to attend, as staff voluntarily provided the support necessary in their own time. Staff spoken to said that they regularly spend time talking one-to-one with residents, although one said they felt guilty they may be seen as not working when they did this. A carer said some residents were occasionally taken out for a walk or drink. Some residents were recently taken out to see a firework display. A monthly church service is carried out and members of the Roman Catholic Church visit monthly. The staff were preparing one room which was to be called a ‘café’ and had been fitted out with a bar and an old-fashioned telephone and radio, for residents to use. A carer was seen asking residents if they wanted to play with a ball. Music was playing at times in some lounges. Some residents watched the remembrance services on the television in one lounge and this visibly moved one. Staff were caring in response. Three regular visitors said they did not see many activities taking place on the first floor, although one had once seen a toy golf game being played with one resident, which had helped occupy the person. Another visitor, whose relative lived on the ground floor, said that staff spent time talking with residents and she had seen dominoes and music played. She also said that staff became aware that a resident had enjoyed playing football in the past and they had kicked a ball back and forth to him, which he and other residents watching, seemed to enjoy. She also said that residents enjoyed singing at karaoke events. Training is provided to staff about using people’s life history, which can help them to provide more sensitive and individualised care. Two visitors said they were welcomed into the home and could visit any time. Staff described day-to-day routines in the home and said that residents chose when to get up and go to bed. Some residents were seen moving about the floor they lived on as they wished. Observations were made of the lunchtime meal in one of the dining areas on the first floor. Residents were offered a choice of potato bake or chicken casserole. Carers took time to explain the choices available to residents but did not offer any visual clues, such as a plated up meal, which may help residents state their preference. A plate guard was seen to be in use to help a resident eat their meal. Two carers helped serve the meals, then one was left to assist a resident who needed help to eat and drink. The carer sat next to her to provide this help and chatted to her, but had to frequently interrupt this process to assist other residents, for example, when one dropped cutlery and Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 16 to intervene when another resident got into a dispute with another resident, who became aggressive in response. A visitor said that staff did not routinely offer choices of meals to residents. Three residents are helped by their relatives to eat their meals, which they do most days. All said they did this because they wished to help their relatives as much as possible, rather than any concern that they might not receive the help they needed, although one added that they felt reassured that their relative had had one good meal as they has observed other residents not eating much. Another visitor, whose relative lives on the ground floor, was confident staff give their relative the support needed at other times. Two service users were helped to complete a survey, in which they said they always liked the meals provided. A relative commented on one survey, ‘the meals look appetising and (my relative) obviously enjoys them’. Mixed views were received from other regular visitors spoken to about the food provided. One said the food looked good with lots of vegetables and their relative had a good appetite, eating everything. Another said, said that their relative’s food had to be softened but was always nicely presented, with meat and vegetables prepared separately. Another said that their relative got good meals. Another said that residents were given small portions of food, which was not always of good quality. For example, mashed potato and vegetables made too watery when mashed, and the kitchen staff did not always seem aware of how many meals would be needed. It was noted in one resident’s record that another relative had raised concerns that their relative had not been given enough food for her evening meal. A member of staff said that hot and cold evening meals are provided on alternate evenings. Vegetarian dishes are also available. A selection of finger foods, such as fish fingers, sausage rolls, jacket wedges, are provided which older people with dementia can find easier to eat independently, when they cannot manage cutlery. Where people are not eating well, their food would be boosted with evaporated milk, custard, full cream yoghurts and butter. Biscuits, fruit, chocolate and home made biscuits, tea loaf, were examples of the type of between meal snacks provided. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has an open culture, which encourages people to raise concerns, however not all relatives feel confident about the safety of people living in the home. Safeguarding concerns are acted on promptly, but staff are not adequately trained to deal with physical and verbal aggression to enable them to protect and safeguard the residents in their care. EVIDENCE: The home had received one complaint since the last key inspection, which had been investigated but not upheld. Two surveys were received from service users, who were helped by relatives to complete them. They said that they would speak to the manager or nurse in charge if they had concerns. Four relatives spoken said they would readily complain if they had any concerns. Two of them said that the manager always listened, tried to allay any concerns and took action when necessary. One said improvements had been made when they had raised concerns, but sometimes things slipped back. One survey was received from a member of staff, who was clear about what to do if a resident or relative was unhappy about something. A member of staff spoken to was also clear about this.
Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 18 The care records contained a section recording monthly contacts with relatives to ensure that any matters of concern could be discussed and sorted out. This is good practice. The manager is fully aware of the procedures to follow when concerns are brought to her attention and takes appropriate action. The manager stated that all staff would shortly receive ‘alerter’ training to ensure that they knew what concerns they should report and how to do this. Two of three staff spoken to said they had had training about protecting vulnerable people. Two were not sure about the meaning of the term ‘whistle blowing’ but could describe the action they would take if they had concerns and could give examples showing they understood how people could be abused in a care home. They had confidence that the manager would take seriously any concerns if they had them. Since the last key inspection in November 2007, there have been five safeguarding concerns, which were investigated through the Company and Local Authority’s safeguarding procedures. Three concerned allegations of carers’ treatment of residents, one of which was witnessed by the inspector during this inspection, and each resulted in disciplinary action being implemented where necessary and further training, supervision and mentoring being provided to some staff. One concerned an injury to a visitor, and a plan of action was put in place to prevent any further recurrence. The other came about following concerns being received that staffing levels through the night were inadequate. Representatives of the Local Authority visited the home to look into this but identified no concerns. Care staff often have to deal with very difficult situations in the home, as some people with dementia can become distressed and angry when they do not understand some of the situations they are faced with. Advice has been sought from the Challenging Behaviour team about how to care for specific individuals but there is an absence of evidence in staff training records to show how they are given in-depth training to deal with aggressive behaviour and what they should do if they need to protect someone from being harmed. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and layout of the home enables residents to live in a safe and well-maintained environment. EVIDENCE: Parts of the home were being redecorated following replacement of the heating system, which had been unreliable. Whilst this work was carried out extra heating, additional staff and other measures were taken to ensure residents were kept warm. As the home is redecorated, signage is being fitted to doors along with post boxes, to help residents identify what the rooms are used for. All bathrooms, shower rooms and toilets have been redecorated in the past year. Toilet doors were closed. One seen had no natural lighting, which made
Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 20 it appear gloomy and difficult to see what was inside the room. The light switches are on the outside wall. These factors may make it difficult for residents with dementia to recognise the purpose of the room and use it safely. A small room used for meetings, has been fitted out with a bar area, an old radio and telephone. It has been labelled as a ‘café’ and it is intended to be used as a social area for residents to use. Safety audits are carried out, and records were kept of these. Two surveys were received from service users. One said the home is always fresh and clean, the other says it usually is. A frequent visitor said the home was always clean and smelled nice. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels are reasonable but may not always be enough when individual residents require a lot of one-to-one care and support to ensure that they and other residents are kept safe. Staff are given a varied range of training, but this could be widened further to ensure that all staff have the skills they need to meet the needs of people with challenging behaviour, and reduce the risk of harm occurring to people. EVIDENCE: The manager said that whilst occupancy in the home had dropped, the staffing levels had remained the same. There were 37 residents living in the home. Examination of the rotas and discussion with the manager and staff showed that the number of care staff is as follows:Ground floor Ground floor 1st floor 1st floor
Sunningdale Lodge 8 am to 8 pm 1 senior carer and 2 carers 8 pm to 8 am 1 senior carer and 1 carer 8 am to 8 pm 1 trained nurse and 4 carers 8 pm to 8 am 1 trained nurse and 2 carers
DS0000040471.V373086.R01.S.doc Version 5.2 Page 22 The manager’s hours are not included in the above nor staff employed for other tasks, such as food preparation, cleaning or laundry. The home has a bank of staff it can call on to cover absences. One survey was received from a member of staff who said there are usually enough staff to meet the individual needs of people. Two surveys were received from service users, who were helped by relatives to complete the survey. They both said that staff were usually available when needed. A relative added, ‘I am very satisfied with the level of care.’ One carer said during the inspection that it would be nice to have more staff so that carers had more time to spend with residents who need a lot of one-toone care. Another said it would be safer to have another carer working on the ground floor, as if a resident needs the help of two carers, only one is left to look after the remaining residents. Another thought the staffing levels were satisfactory, given that the home was not full. Two carers, who have worked nights, said that staffing levels were satisfactory through the night. A visitor to the home said that some of the staff ‘bend over backwards’ to help her relative, but that communication between the staff team could be improved. Another regular visitor said that the staff did a very good job, but that there needed to be more of them. They felt that their relative could be given more time to do things for herself, such as walking rather than being pushed in a wheelchair, if staff had more time. A visitor was concerned that another resident may have injured their relative at a time when no staff were present. The visitor was concerned that there were frequent occasions when staff were not present in the shared areas, when this resident, who needs a lot of help from staff, was distressed. As stated earlier, there have been instances when a resident has been injured by another. The manager said that staff would be instructed to ensure that a carer was always available to reduce the likelihood of such instances. Another visitor also thought there should be more staff to help residents. Another visitor, whose relative lives on the ground floor, said the home could usefully have more staff but staff were well trained and sensitive to people’s needs. Twelve of the care staff (85 ) have achieved an National Vocational Qualification (NVQ) at level 2 or 3. Some staff confirmed that they were doing or had achieved an NVQ. Staff receive regular training including a rolling programme of statutory training, as well as other training in other areas such as safe use of bed rails, malnutrition and assisted eating, diabetes, tissue viability, parkinson’s disease, person centred care, role of senior carers and key workers, and more. One carer said they had just completed some training about reminiscence. Another had just attended ‘life story’ training, which helps carers to use the information
Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 23 gathered about residents’ past lives, so they can provide more individualised care and training about the care records kept. The company runs a training course known as ‘Yesterday, Today and Tomorrow’ (YTT), which aims to provide staff with skills for working with people with dementia. Some staff confirmed that they had had this training, whilst another said they had not received any specific training about dementia yet, but was learning on the job. There was a lack of evidence that care staff had received training in dealing with physical and verbal aggression. A member of staff stated in a survey that their induction training had covered everything they needed to know ‘very well’ and that they had had relevant training and were looking forward to YTT and NVQ training. The files of three staff recruited in the past year showed that two written references had been obtained, though one was not on headed paper from the company concerned. Checks had also been made with the Criminal Records Bureau and each person had been asked to make a declaration about any criminal offences, though one person had not answered this question on the application form. Records were available showing the induction training the new staff had been given and the staff confirmed this training when spoken to. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 24 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is generally run in the best interests of residents, but ensuring that staff fully understand the concept of ‘supervision’, so that they can ensure that they obtain all the support they need to do their work effectively could strengthen this further. EVIDENCE: The manager, Mrs Elin Winter, was previously registered with the commission to manage this home but resigned her post earlier this year to take up another job. A new manager was employed but left her post within a couple of weeks. Mrs Winter subsequently re-applied for the manager’s post and returned to
Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 25 work at Sunningdale Lodge. She said she would be submitting her application for registration to the commission shortly. A carer said the manager had ‘a difficult job but ran the home very well’ and that she and the staff were very supportive. Southern Cross Healthcare has its own systems of quality monitoring in place in the form of regular audits of the systems in place in the home. Some audits are carried out by the manager and staff and some by other people employed by the company. The system for the handling and storing of money held on behalf of service users was looked at and found to be appropriate. A sample of records were looked at. Money belonging to residents is held in a bank account, which pays them interest. There is a system in place, when they want access to their money. The company have an established formal staff supervision system, which requires that staff have one-to-one meetings with a senior member of staff to discuss their work and support and training needs every two months. A sample of records were looked at, which showed that staff had received supervision but there were some gaps earlier in the year, which was no doubt due to the changes in management of the home. Two carers were asked about supervision and the concept explained to them. One said they did not receive this, another said it was not a formal process, but support was available if they requested it. There is a rolling programme of staff training covering essential health and safety issues. Carers confirmed the training they had had and a sample of records were also looked at. Health and safety checks are carried out on a regular basis, including fire safety systems, hot water, bed rails and window opening restrictors. A fire alarm occurred during the inspection. Most residents were left where they were, safeguarded by closed fire doors, as required by the fire procedure. The visiting inspector was not given any advice by staff to confirm whether they should leave the building, the route they should take or where to assemble. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X 3 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 3 3 X 3 2 X 2 Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Timescale for action Care must be taken to record the 31/01/09 correct quantity of medications received. This will ensure that there is an audit trail of medication and it can all be accounted for. Care must be taken to ensure that the medication administration records provided by the pharmacist are accurate and any duplicate entries are crossed through. This will help avoid confusion and reduce the likelihood of mistakes occurring. Service users must be given the support they need to wear their own clothing and preferred style of clothing. This will preserve their dignity and sense of personal identity. Training and/or guidance must be provided to ensure that all staff understand the concept of whistle blowing and understand the company’s whistle blowing policy and procedures. This helps ensure that staff understand the protection available to them if they raise
DS0000040471.V373086.R01.S.doc Requirement 2. OP10 12(4)(a) 31/01/09 3. OP18 13(6) 28/02/09 Sunningdale Lodge Version 5.2 Page 28 4. OP18 13(6) 5. OP27 18(1)(a) concerns about possible abusive practice in good faith and helps to protect service users. In-depth training must be 30/06/09 provided to care staff so that they know how to sensitively and appropriately support residents who may be verbally or physically aggressive because of dementia. Good training will help reduce the number of incidents requiring a safeguarding investigation. Staffing levels must continue to 28/02/09 be kept under review to ensure that there are sufficient trained staff deployed in the home to provide person-centred care to help avoid situations where residents may be harmed by other residents. 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 OP12 OP15 Good Practice Recommendations Ensure that all staff understand that time spent talking with residents is an important part of their role. Show residents plated up meals when offering choices, as this will help them decide what they would prefer to eat. Where people need help to eat their meals, they should be able to received uninterrupted one-to-one support from a carer. The meals service and staff support should be reviewed to find the best way of making sure this happens. Look at ways of making the toilets more visible/recognizable to residents with dementia as this will help them maintain their independence and dignity. Ensure that staff fully understand the purpose of supervision as a formal, regular two-way discussion, which
DS0000040471.V373086.R01.S.doc Version 5.2 Page 29 3. 4. OP19 OP36 Sunningdale Lodge 5. OP38 is there to support and develop the worker’s role and skills. Staff must be trained to give prompt advice to visitors about what to do, where to go and the assembly point, when a fire alarm occurs. Sunningdale Lodge DS0000040471.V373086.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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