CARE HOMES FOR OLDER PEOPLE
Sunningdales 75 Southbourne Overcliff Drive Southbourne Bournemouth Dorset BH6 3NN Lead Inspector
Catherine Churches Unannounced Inspection 10:30 6 February 2006
th 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 DS0000003990.V282510.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. DS0000003990.V282510.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Sunningdales Address 75 Southbourne Overcliff Drive Southbourne Bournemouth Dorset BH6 3NN 01202 426745 01202 420944 sunningdales75@aol.com 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) Mrs Betty Mary Turner Care Home 10 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10) DS0000003990.V282510.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One named service user (as known to CSCI) in the category LD (Learning Disability) may be accommodated to receive care. One named service user under the age of 65 years (as known to CSCI) in the category DE (Dementia) may be accommodated to receive care. 23rd August 2005 Date of last inspection 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 for single occupancy and have a wash hand basin. 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. DS0000003990.V282510.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the morning of 6th February 2006. The inspection took place as part of the regular, programmed inspection schedule for the home. This report should be read in conjunction with that from the inspection in August 2005 as all key inspection standards are reported on in these two reports. The purpose of this visit was to check that the home continues to run in a satisfactory manner and that the people who are living in the home are properly cared for. The premises were inspected and a number of records examined. Time was also spent time observing routines within the home and talking with residents and staff. Mrs Turner was available throughout the inspection. What the service does well:
Sunningdales provides a homely, relaxed and comfortable environment with a welcoming and friendly atmosphere. The home is nicely presented and well maintained with a regular programme of refurbishment and improvement identified and acted upon. The home maintains good standards. Most areas inspected on this occasion were found to be satisfactory or had only minor shortfalls. The home is positively managed and well staffed. The staff group is stable and were observed to be respectful, helpful and caring. Due to its small size Mrs Turner clearly knows and understands the residents well and is keen to support them to make choices and encourage them to remain active and as independent as possible despite major cognitive impairments. This is achieved in particular through a good range of activities and personalised care and good knowledge of residents personal histories as well as good communication with relatives, representatives etc. Prior to the inspection comment cards were sent to residents, relatives, GP and others who have involvement with the home. Responses were received from 2 residents (completed for them by relatives), 2 relatives, 2 GP’s, a care manager and a chiropodist. Responses to all questions were positive and the following comments were also made: “Utter confidence in the owners and staff and retain a good harmonious relationship with them” “An excellent, small homely well managed home catering for individual needs” DS0000003990.V282510.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000003990.V282510.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 DS0000003990.V282510.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): None of these standards were assessed as only standard 3 is applicable and there have been no new admissions for a considerable period of time. EVIDENCE: DS0000003990.V282510.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): 9 Residents receive prescribed medicines at the correct times and in the correct amounts. Recording procedures for newly prescribed medications could be improved to provide an even higher level of risk management and further reduce the potential of harm to residents by the wrong administration of medication or accidental use of discontinued medicines. EVIDENCE: Medicines in the medication cupboard were examined together with administration records. Additional medications added to the Medication Administration Record (MAR) by hand were not being signed or counter signed to confirm that instructions and quantities were correct. Medication for a resident no longer at the home was found in the cupboard. DS0000003990.V282510.R01.S.doc Version 5.1 Page 10 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): 14 and 15 Residents have the opportunity to choose their own lifestyle within the home and this means that their individual preferences and routines are respected. Dietary needs of the residents are well catered for with a balanced and varied selection of food provided. EVIDENCE: It was noted from documentation and observation of rooms that residents are encouraged to bring their own personal items of furniture and to personalise rooms etc. Choices are also promoted with encouragement to make decisions regarding food, clothing, social activities etc. It should be noted to that due to the level of cognitive impairment experienced by residents it is often very difficult to promote choice but observation and discussion confirmed that staff do so whenever possible. Mrs Turner also explained how she tries to get to know her residents as well as possible so that she understands their likes and dislikes and often refers to residents family and friends as they have a much better understanding of the resident and may know what they would have chosen. Food records evidenced that a suitable and varied diet is provided in the home. Stocks were also inspected and it was found that there was a variety of different foods available with plenty of fresh, frozen and dried goods.
DS0000003990.V282510.R01.S.doc Version 5.1 Page 11 Residents are mainly unable to actively state their likes and dislikes. Mrs Turner stated that she observes their reactions to foods and notes if they clearly do not like something and also refers to relatives and representatives to get information on peoples likes and dislikes. DS0000003990.V282510.R01.S.doc Version 5.1 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 the following standard(s): 16 The home has a satisfactory system for making complaints. This means that residents and others involved in the home that may wish to make a complaint should feel confident that they would be taken seriously and that matters of concern will be acted upon. EVIDENCE: The complaints procedure was displayed in the main hallway of the home and included in the Service Users Guide that is given to all residents/representatives. No complaints have been made either to the home or to CSCI. DS0000003990.V282510.R01.S.doc Version 5.1 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 the following standard(s): Neither of the key standards were assessed on this occasion as both were assessed at the last inspection and found to be met. EVIDENCE: DS0000003990.V282510.R01.S.doc Version 5.1 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 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): 28 and 29 Residents are in safe hands. Staff are completing training courses to ensure that they have the required competencies. The staff team remains stable; this provides a good level of consistency and continuity for residents. EVIDENCE: The home employs eight care staff. One has completed NVQ level 2 and two are currently studying for this and nearing completion. Once they have successfully completed this training Mrs Turner will start other staff that are keen to train on the course. No new staff have been employed since the last inspection but it is known from previous inspections that the home has satisfactory procedures in place for staff recruitment. DS0000003990.V282510.R01.S.doc Version 5.1 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 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 38 The management arrangements for the home support good care practice for the residents. Quality monitoring systems need to be better defined and coordinated in order to demonstrate that the home is run in the best interests of the residents. 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 has developed various methods of gaining feedback both from residents and their relatives. However, procedures for analysing results and responding to any issues raised and publishing this information have not been developed. Fire records, staff training records and accident books were examined and found to be up to date and detailed.
DS0000003990.V282510.R01.S.doc Version 5.1 Page 16 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 3 15 3 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 X 28 2 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X X X 3 DS0000003990.V282510.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation 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 Regulations. This is an ongoing issue. It is recognised that the home cannot resolve this entirely themselves as other agencies also need to undertake work. Further information was left regarding advocacy services that may be able to assist in this matter. Timescale for action 1. OP35 20 30/08/06 DS0000003990.V282510.R01.S.doc Version 5.1 Page 18 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hand written entries on Medication Administration Records should be signed and a second person should check this and sign to confirm this. All discontinued medicines and those belonging to residents no longer living in the home must be returned to the Pharmacy and a record kept of this. A minimum of 50 of staff must be trained to NVQ level 2 or equivalent in care to ensure that staff are suitably qualified and competent. 1. OP30 2. OP28 DS0000003990.V282510.R01.S.doc Version 5.1 Page 19 Commission for Social Care Inspection Poole Office 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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