CARE HOMES FOR OLDER PEOPLE
Sunningdales 75 Southbourne Overcliff Drive Southbourne Bournemouth BH6 3NN Lead Inspector
Catherine Churches Unannounced 23 August 2005 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 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. Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Sunningdales Address 75 Southbourne Overcliff Drive, Southbourne, Bournemouth, Dorset, BH6 3NN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01202 426745 01202 420944 Mrs Betty Mary Turner PC Care Home only 10 Category(ies) of DE(E) - 10 registration, with number MD(E) - 10 of places Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: One named service user (as known to the NCSC) in the category LD (Learning Disability) may be accommodated. Date of last inspection 08 March 2005 Brief Description of the Service: Sunningdales is a care home providing personal care and accommodation for 10 older people who have dementia or a mental disorder. It is owned by Mrs Betty Turner who is also in day-to-day charge of the home. The home is located in the Southbourne area of Bournemouth and is close to the sea, shops and other local amenities. Accommodation is arranged on the ground and first floor levels. There is no passenger or chair lift access to the first floor. All rooms are centrally heated, carpeted and furnished. The home has one double room that has an ensuite facility the other eight rooms are fro single occupancy and have a wash hand basin in the room with access to communal lavatories and bathrooms. There is a communal lounge/diner and conservatory on the ground floor. There is also a very attractive secure garden at the rear of the property. Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 23rd August 2005, the inspection process took two and a quarter hours. The purpose of this inspection was to review the requirements and recommendations that had previously been made and to check that the 10 people who were living there were safe and well cared for. The premises were inspected and records were examined. Time was spent with Mrs Turner, the registered owner and residents were observed and spoken with as a group in the ground floor lounge. The Inspector met all except one of the residents: the remaining resident was out for the day at a local day centre. What the service does well:
On this occasion 12 standards were assessed. Of these 7 standards were fully met and 2 were exceeded. The home offers a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home is positively managed and well staffed with a staff group who were observed to be respectful, helpful and caring. The home undertakes a detailed assessment of needs prior to a resident’s admission to the home thereby ensuring that they are well aware of the residents needs and prepared to meet them. Once admitted, the home has a good system for documenting needs, how they are met and responding to changes as well as ensuring that residents receive the required support from other professionals such as Doctors, district nurses, CPN’s etc. Whilst there is no formal activities programme, Mrs Turner has taken a great deal of time in getting to know residents and their families as well as their likes and dislikes and tailors interaction and 1-2-1 activities accordingly. The home is commended for the detailed life history that has been compiled for each person living in the home and which is particularly useful for those with memory impairment. Sunningdales provides a good standard of accommodation and is nicely decorated and furnished. The home was clean and tidy throughout and also free of offensive odours despite high levels of incontinence. The home is commended for this. Sunningdales is well staffed with a commitment to regular training for staff thereby encouraging motivation and improving competency.
Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 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. Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 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 standard(s) 3, standard 6 is not applicable to this home. Assessments of residents and their needs, prior to their admission, were satisfactory. This means that residents and their representatives should feel confident that the home is aware of all the needs of the person and is able to meet them. EVIDENCE: The majority of residents have lived at Sunningdales for some time. The preadmission assessment for the most recently admitted resident was examined. The information in this record was detailed and informative and meets the requirements of the National Minimum Standards. The resident concerned had a cognitive impairment and so the inspector was unable to hold a meaningful conversation with them. Analysis of the information recorded showed that the content was of a high standard and very detailed. The home is commended for the “life history” pack that has been developed in order to gather pertinent information about a person’s past life, experiences, family and friends. Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 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 standard(s) 7, 8 and 10 Care plans for residents who live at Sunningdales are detailed and informative. This means that staff have sufficient information to provide a good level of care and the home can also demonstrate the care that has been provided. The home ensures that resident’s healthcare needs are met through seeking appropriate input from GP’s and other healthcare professionals. The ethos in the home is one of respect for the people living there. This means that residents are settled and comfortable and their privacy is respected and promoted by the staff in the home. EVIDENCE: Care plans and related documentation regarding 3 residents were examined. Files were well laid out and regular risk assessments had been undertaken. Reviews were being undertaken on a monthly basis or more frequently if changes dictated this. Records also demonstrated that residents are assisted appropriately to seek help from healthcare professionals such as Doctors, District nurses, chiropodists and opticians.
Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 10 It was observed that staff knock on doors before entering and that residents preferred form of address is recorded and used. Interaction between residents and staff was also observed and noted to be respectful and appropriate. Requirements made at the previous inspection regarding medication were monitored and found to be satisfactory. Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 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 standard(s) 12 and 13 Sunningdales provides a homely and flexible environment that is able to respond to individual preferences and abilities with regard to daily life and social activities. Open visiting arrangements are in place enabling residents to retain contact with families and friends. EVIDENCE: Due to the dementia and other mental disorders of the resident group, Mrs Turner reported that she has found that the residents have very poor concentration levels and often do not enjoy group activities. Evidence from records and discussion with Mrs Turner showed that she has undertaken a large amount of research into resident’s previous lives etc so that she and the staff are able to converse with them about things they have done and know what residents may enjoy on a one-to-one basis. The home has 2 birds and 2 cats that are clearly popular with the residents. The Inspector spent time chatting with those residents that were in the lounge. They were all relaxed and happy to chat about the cats and their visitors. Families are also very much encouraged to visit whenever they can and also to take people out for walks etc
Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 12 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 standard(s) 18 Arrangements for protecting service users from abuse were satisfactory: staff had a good knowledge and understanding of Adult Protection issues. This means that Sunningdales is a safe environment that will protect residents from abuse. EVIDENCE: Staff have received training, since the last inspection, in recognising and preventing abuse as well as the action to take should they believe abuse has taken place. Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19 and 26 The home is well presented. Residents live in a safe, well-maintained environment that was clean, hygienic and free from offensive odours. Residents had been assisted in personalising their rooms. Having their own possessions has helped some people to orientate themselves within the home. EVIDENCE: A tour of the premises confirmed that the home is well decorated, furnished and equipped. Dorset Fire and Rescue Service has visited the home and confirmed that it complies with their requirements. The laundry area is well organised and equipped: there is a washing machine with a sluice programme, and one tumble drier. The walls and floors were easily cleanable and separate hand washing facilities were available. Staff had a good understanding of infection control procedures, having recently undertaken training, and the relevant protective clothing was available. The home was also completely free of offensive odours despite the high levels of incontinence amongst residents.
Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 14 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The home is well staffed ensuring that residents receive the care and attention they need in an unrushed manner. There was a positive atmosphere in the home and residents had a happy, relaxed relationship with the owner and staff. There is an ongoing staff training programme and a commitment to NVQ training. Such training means that there is an increased level of understanding and competency amongst the staff. EVIDENCE: Examination of the staff rota and observation throughout the inspection demonstrated there was a sufficient number and skill mix of staff to meet the needs of residents. Staff training is provided on a regular basis. Mrs Turner advised the Inspector that, since the last inspection, staff have undertaken training in the Protection of Vulnerable Adults, Infection control, medication administration and Dementia Awareness. The Inspector recommended that Mrs Turner develop a matrix style record to demonstrate that staff have undertaken regular training and updates. Requirements made at the previous inspection regarding staff recruitment were monitored and found to be satisfactory. Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 15 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 and 38 Management practices, with regard to the financial interests of one resident, do not sufficiently demonstrate that appropriate safeguards are in place. However, the Inspector does believe that Mrs Turner does more than merely protect the interests of this person and that there is often a negative balance with regard to this persons finances. The health, safety and welfare of residents and staff is protected by the systems that the home has in place for staff training, maintenance and risk assessment. EVIDENCE: Mrs Turner advised that the home does not handle residents money or hold valuables except for a long standing arrangement relating to 1 resident (known to the person’s social worker). It was noted at a previous inspection that the arrangements in place for the management of this money do not comply with the restrictions under Regulation 20 of the Care Homes Regulations 2001. Mrs
Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 16 Turner clearly understands this to be the case but is unable to make changes without the support of the residents Social Worker and this has not, to date, been forthcoming. The Inspector agreed to follow this up with the social worker concerned. Fire records, accident books and risk assessments were examined and were found to be up to date and detailed. The recording in the accident book did not comply with the requirements of the Data Protection Act 1998. Information on how to obtain the appropriate format was provided by the inspector. Certificates were available to demonstrate that staff had received training in mandatory areas such as health and safety, fire prevention and moving and handling. The manager was also aware of staff that required updated training, in areas such as first aid, but there was no record to demonstrate this. It was recommended by the Inspector that a matrix form of record be kept to clearly show what training has been undertaken and the timescales for necessary updates. Requirements made at the previous inspection regarding notifications and fire doors were monitored and found to be satisfactory. Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 17 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 x 15 x
COMPLAINTS AND PROTECTION 3 x x x x x x 4 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x 1 x x 2 Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 18 NO Are there any outstanding requirements from the last inspection? 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 35 Regulation 20 Requirement It is required that the arrangements for receiving the benefits of the resident (name known to CSCI) are reviewed to ensure the compliance with Care Homes Regualtions. 23/8/05 This requirement is repeated as this issue must be resolved. It is recognised that the home cannotreslove tis entirely themselves as agencies also need to undertake work. Timescale for action 28/02/06 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. Refer to Standard 30 Good Practice Recommendations It is recommended that a recording system is developed to clealry demonstrate that all staff have received mandatory training and that this trainnig meets the minimum requirement of 3 paid days training per year. All accidents must be recorded in a format compliant with the Data Protection Act 1998. An approporiate book must be obtained and used for both residents, staff and anyone else who may sustain an injury on the premises.
D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 19 2. 38 Sunningdales Sunningdales D55 S3990 Sunningdales V236407 230805 Stage 4.doc Version 1.40 Page 20 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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