Inspection on 05/02/09 for Sunnybrook

This inspection was carried out on 5th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunnybrook 17/12/09

Sunnybrook 07/03/08

Sunnybrook 29/03/07

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

CARE HOME ADULTS 18-65 Sunnybrook 2a Beech Road Ashurst Southampton Hampshire SO40 7BE Lead Inspector Sue Kinch Unannounced Inspection 5 February 2009 10:20 th Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 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 Sunnybrook DS0000068312.V373849.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 Adults 18-65. 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. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnybrook Address 2a Beech Road Ashurst Southampton Hampshire SO40 7BE 02380 292300 02380 293970 sunnybrook@consensussupport.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) Corich Community Care Ltd Manager post vacant Care Home 9 Category(ies) of Learning disability (0) registration, with number of places Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD). The maximum number of service users to be accommodated is 9. Date of last inspection 7th March 2008 Brief Description of the Service: Sunny Brook began operating in November 2006 and Corich Community Care Limited is the Registered Provider. It is a care home that provides support and help for adults with learning difficulties and with complex needs and behaviours that challenge the service. The building is a detached two-storey house situated in its own grounds and it is close to local shops and services. All people living in the home are accommodated in single rooms with en-suite facilities. The garden is enclosed and includes a summerhouse in which activities take place. All people that move into the home are referred through local authority adult services departments or health care trusts. When consideration is being made to use the service on behalf of someone by such organisations they are provided with information about the home’s service and the facilities. A copy of a report of the most recent inspection of the home carried out by the Commission for Social Care Inspection is readily available in the home. The reported fee structure at the time of the site visit on 6th February 2009 2008 was £1600 -£3800 per week. Sunnybrook DS0000068312.V373849.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 the people who use this service experience adequate quality outcomes. This key unannounced inspection was carried out following an assessment of information held by CSCI about the home and of information received since our last visit. We received an Annual Quality Assurance Assessment document from the manager of the home. Although we sent surveys to 15 staff, all people living in the home and some professionals providing a current service to the home, we only received two surveys completed by staff. During our visit to the home we met the people living in the home and were assisted by staff in their communication. We spoke with several staff about the systems and procedures, training and support and the needs of people living in the home. We spoke with the manager, viewed a sample of documents relating to the care provided, staff and systems and saw some shared and individual areas of the home. The visit took 7.5 hours. We also spoke with a relative after our visit. What the service does well: Friendly and supportive staff provide care and much of this is on a one to one basis although one person has more support and another less. Some of the care is provided in group activities but individual support needs are still planned to be met. The service takes account of the needs of individuals and plans care and support taking their wishes in to account. These are documented in detailed care plans and systems are in place to record the meeting of needs including health needs. Activities are arranged regularly for people to take part in and these include individual activities such as going to church, shopping, rides in the car, swimming and horse riding. The feedback from a relative and a care manager confirmed that families are able to be involved and visit and are involved in the planning of care. A relative said that the home responds well to issues raised. The building is clean, maintained and well decorated. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: We note that the manager informed us that he had sent a completed application for registration to his company for forwarding to the Commission but that this has not yet been received meaning that the home has not had a registered manager since February 2008. A requirement has been made in respect of this. We made a requirement in the last report about recording the rationale for decisions made in the best interests or people living in the home to promote their rights and interests. In the samples discussed at the inspection we found that we had verbal feedback that, for example relatives are being involved but there is not yet enough recording .We have made a new requirement. People living in the home have their movement restricted by the use of many internal locked doors such as to bathrooms, the kitchen, the laundry and bedrooms. External doors are similarly locked. Risk assessments must be undertaken, to ensure that such restrictions or any other restraints are Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 7 minimised, applied on an individual basis and regularly reviewed. Written evidence is also needed to demonstrate that relevant professionals and others involved in their service are consulted and agree that these actions are necessary. Where restrictions in place do not apply to individuals how they are to be helped must be included in their care plans. A requirement has been made about this. The home must have records of recruitment in the home for people working in the home and we have a made a requirement about this. We have not made requirements about the following and the manager has agreed to taken action. We have commented in the report about work needed to tighten up procedure to ensure confidential information is held securely. We have commented in the report that the updating of the service user guide should include information about any restricted areas in the home and the reason for this. Medication is provided to people living in the home by trained staff but the procedures around taking medication out of the home on trips needs to be reviewed to ensure risks of mistakes are minimised. 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. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that the needs of people considering living in the home are assessed and can be met but the information available about the home needs to be updated to maximise access to information and to ensure that how the home operates is clear. EVIDENCE: In the last inspection report it was noted that the home had systems and procedures to use before and during admission, to ensure that the home could meet needs. We noted and were told that no admissions had been made since that last inspection although one person was going to be considered following an initial visit from a relative of a prospective resident. The manager described the process he would use including pre admission assessment, visits to the person, visits from the person, consulting other professional needed and providing a support package before admission to demonstrate that needs could be met. The manager said that the service users guide and the statement of purpose for the home were still in need of updating. The need to ensure that these Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 10 documents reflected practices in the home such as where areas of access are restricted, why and how those not needing the restrictions are supported was also discussed with the manager. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home have had their needs assessed and are receiving a service based on them but this would be enhanced by more thorough individual risk assessments to demonstrate that all restrictions used are necessary and independence fully promoted. All private information in the home is not held securely and attention to this would enhance peoples privacy. EVIDENCE: Staff spoke of key worker system in the home and the manager said that more training about this role is planned. Staff are involved in care plans and reviews for people living in the home. We viewed some of the records held for two people and found that they include profiles, assessments, details of activities planned, religious needs, a register of support plans, support plans including expected outcomes and staff Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 12 guidance to achieve them. Some of these were in a lot of detail where support needs were higher. We found evidence of recording on a day-to-day basis, showing that people were doing some of things they want to do including religious practices, health action plans, medical recording and some risk assessments. We noted that the care plans should be monitored every two months although records did not show that this has been consistent. After May 2008 they were reviewed in December 2008 and were due again in February 2009 showing that the system was being re-established. In respect of recording, in the samples viewed, we noted that there are systems in the home for more detailed monitoring needed such as weight charts and use of a particular piece of equipment. A discussion was held with the manager about extending the detail of recording further to ensure that use of a planned physical intervention was monitored more closely. We asked the manager about reviews with care managers and were informed that for one person a review had recently taken place. The reviews for that person had been taking place every three months and that parents were involved. Minutes were not yet available. For the second person we case tracked a review was planned for March 2009. A parent for someone said that they were consulted about the care, support and decisions for their relative and were happy with the care provided. The manager has recently organised staff into teams in the home to promote more continuity, consistency and accountability. We saw that there is an overlap of staff shifts early in the afternoon to which staff and the manager said allow for handovers and outgoing staff some time to complete paperwork. Staff, in the two surveys returned said that the way information is passed between staff and with the manager usually works well. In the AQAA the manager said that there are plans to make client files more person centred and all staff will undertake communication training. People living in the home have staff allocated to work with them mostly on a one to one basis and some two to one. Most of the people living in the home rely on a lot of non-verbal communication and discussion with staff demonstrated that they had knowledge of what peoples preferences and choices were and what specific gestures meant. One person gave an example of showing someone options to aid decisions. One staff member was seen to encourage a person to become involved in hoovering, which the person eventually decided to do. Another staff member was seen to encourage a person to go to the dining room. One staff member spoke about one persons choice not to go out that morning. Staff were seen to observe peoples reaction to things and seeing how they respond. We found evidence that other people are involved in the decisions about peoples care. A care manager said that a specific issue about obtaining a car for someone had been discussed as part of a review and that the parents had Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 13 also been involved. Records of decisions made at a recent review for that person were not yet available. The manager and staff separately spoke of consultation with a parent about dental treatment for another person although this was not recorded. Another parent said that they had guardianship for their relative at the home and feels that decisions are made in the persons best interests. Providing more written evidence of consultation about decisions was discussed with the manager. In the two files sampled we noted that there are some risk assessments, which were written in October 2008, and there were list of those in place for each person. They covered issues such as infection control, bathing, showering, wheelchair use and risks of harm. However, we noted that there are several areas of the home and garden that have restricted access for all people, such as the kitchen, bathrooms, laundry, and bedrooms. Restricted access to the bathroom was discussed with a member of staff who was not entirely sure why it was locked but said that it always had been. Risk assessments were not in place demonstrating the need or agreement with relevant parties about such restrictions, which, if not necessary for some peoples safety is restricting their movement, decisions and independence. The manager agreed to address and a requirement has been made in this report. Care plans and risk assessments and other records are held in two locked offices used by the staff and management. Details about care for one person were noted to be on the wall outside and inside the ground floor bathroom. A door to a third office was left open with no one in the room and contained files with peoples names on indicating that they held personal records. The manager agreed to address this. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are increasingly able to do the things they like doing through effective communication and consideration of their wishes and needs. People enjoy the food provided based on individual preferences and choice. EVIDENCE: At the beginning of the inspection all but one of the people living in the home were leaving on a trip to Portsdown in the homes minibus. Later a member of staff said that one person had been driven separately in their own car. The person who did not go had chosen to get up later and then helped with household chores after having help with personal care and was then supported to go to a local shop. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 15 From conversations with staff, observations of records, discussions with a parent and observing activity we found evidence of people being involved in a range of activities based on what they are perceived to enjoy. An example was religious needs being met by two people being separately supported each week to go to a church of their denomination. Another member of staff described the activities that another person likes doing including horse riding and swimming twice a week and a parent referred to the same activities. Activity plans are in place and staff said they encourage people to take part. What people like doing and have done is recorded so that it can be monitored. A sensory room is available but was cold and a staff member said that it is not fully in use yet. The manager said that there is family contact for all people. One relative said that communication with the home is good and there is lots of it. The person visits regularly. A staff member was sitting with one of the people in the home just before lunch and writing letters to relatives. The person was drawing on the same paper, smiling and said that the person would be supported to walk to the post box and this occurred regularly. Individual needs are considered in day-to-day activities but as referred to in the section on individual needs and choices they do not have free access to all areas of the home despite having mostly one to one staff and the reason why is not documented. A new fence has been erected in the rear garden. In the AQAA the manager said that this is to allow outside activities to take place but the door to the garden from the lounge was locked. Records of food provided are recorded for each person and these were sampled for one person and had mostly been completed showing that the person had three meals a day and snacks in between them. There were very detailed support plans about food and eating for that person including what was to be achieved and how to reach the outcome. Aspects of it checked were in place. For example how the food should be served was recorded and we noted that this had been carried out. Likes and dislikes were recorded. The frequency of weight checks needed was recorded and we noted that this had been carried out too. We also saw records of recent involvement of a dietician. A regular visitor to the home considered the food to be good. At the mealtime people were encouraged to eat, the attractively presented meal at the same time but staff were noted to be flexible in meeting peoples needs. One person had a break in the middle of the meal and was encouraged back. Another did not want to eat and staff said that the food would be kept for them. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 16 Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home are assisted to access the range of services needed to meet their health and personal care needs and are helped to follow through the advice received. Medication is provided to people living in the home by trained staff but the procedures around taking medication out of the home on trips needs to be reviewed to ensure risks of mistakes are minimised. EVIDENCE: In the care plans viewed we noted that these included outcomes sought and ways to achieve them in personal care. In discussion about equality and diversity the manager also referred to a plan agreed for the company to provide an ensuite facility for one of the people living in the home. A member of staff described the process of supporting someone with personal care and talked about trying to get people to do things for themselves and to help respectfully. Another member of staff thought from observation, that dignity and privacy is promoted in the home and gave an example of how another Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 18 member of staff had considered this when being shadowed in a personal care activity. In the AQAA the manager said that doctors on a yearly basis carries out health assessments and the home aims to have heath action plans for each client in the home. One was viewed but we also noted that the sample of health issues discussed with staff relating to dental treatment and dietary needs were documented in the care plans. Files viewed had sections for recording appointments and consultations with health professionals. Other areas were also covered in support plans such as skin care and mobility. A relative also confirmed that they had been involved in a recent consultation with a doctor. Medication is securely held in the home. We viewed a sample of administration records and these had been signed. More recently a witness had also signed them when given. A staff member said that they had been reminded of this. We observed two staff involved in providing medication in the afternoon together. Medication was taken from a container into which the tablet had been pre-dispensed and was given to the person before the record was signed. The container was labelled with a different medication which it also contained for as required purposes. The staff said that the second medication had been put in there because they had originally thought the person would be out when the medication was needed. The pre-dispensing was not recorded. This was discussed with the manager who agreed to check the Royal Pharmaceutical Society Guidance and was reminded that pre dispensing should be minimised and if used correct procedures should be followed. He agreed to address this. In a recent monitoring visit by the responsible person under regulation 26 it was noted that staff had been trained in medication and that assessments of competence were needed. The manager said that this had now been completed. Two staff agreed that they were trained and assessed as competent and that only they could carry out medication procedures. Another said that they had been trained in one specific procedure. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 19 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems in the home are developing to ensure that people are able to raise issues and have their concerns responded to so that they understand that action has been taken. The home needs to increase the recording of decisions made on behalf of people living in the home to ensure that their interests are fully promoted. EVIDENCE: Comments were made in the last report about there not being a prominent complaints procedure in the home. The manager said that one was displayed in the office and copies are in peoples files. However, he agreed to display one in the home and to review accessibility of information for people living in the home. As noted in previous sections of the report staff were noted to be actively listening and watching peoples communication to guide their actions while supporting them. Two staff in the survey said that they know what to do if people, relatives or service users have concerns about the home. The manager said that there had not been any formal complaints. A relative said that they felt able to address any issues with the home and that the home responds well and deals with matters. They said they had a good dialogue with the home. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 20 The record of training (excluding one existing and all new staff not yet on the record) showed that staff are trained in safeguarding. Records showed that staff had received training in this in 2007 and 2008. One established member of staff said that they had done an abuse awareness training course and also had completed a course through e-learning. That person was able to give examples of how they would deal with a particular situation should it occur and would report it. Another new member of staff had received training since starting and this had included prevention and protection, whistle blowing and reporting. The manager had recently reported a safeguarding issue under the safeguarding procedures although he said it was not then considered necessary to fully investigate through safeguarding. The manager said that he had liaised with social services concerning the issues and had subsequently taken action to review an element of care practices. We saw evidence of this. At the last inspection the need to ensure that the home could evidence that staff are given accredited training was raised as the home deals with challenging behaviour sometimes requiring a physical intervention. We were told that the staff are trained by such an agency and the training matrix provided indicated that all staff (excluding new staff) had received the training in 2008. The manager confirmed the organisation providing the training and that it is accredited. A discussion was held about ensuring that only staff who have received the training should be involved in the interventions. In a subsequent phone call the manager said that he had reviewed rotas to ensure this. At the last inspection it was noted that the money held for people living in the home was difficult to reconcile as money had been taken out for an activity. During this visit we checked two sets of records and the records matched the money held. We also noted that a receipting system was in use with receipts held for items purchased where sampled. A requirement was made in the last inspection report about decisions made on behalf of a person living in the home who lacks capacity. The rationale for the decision, who was involved and how it is in the best interest of the individual, was not recorded. This was to ensure that the rights and interests of the person are properly protected. At this inspection making such decisions was discussed with the manager who was not able to provide such records. He agreed to address this. He gave an example of other decisions made including parents or in reviews but clear records were not available. Examples of how others are involved in decisions are recorded in the section on individual needs and choices. Another requirement has been made. A requirement was made after the last inspection about staff training in making decisions for people who lack capacity. We were informed in the improvement plan sent to us that that this would be organised for the senior Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 21 staff. During this visit the manager checked with the organisation and found that this had not been carried out. He said that he would follow this up. By the end of the inspection he informed us that that it had been organised for all staff within three weeks. He was advised to then ensure that it is followed up in supervision. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment is comfortable safe, and well maintained for the benefit of the people living in it but assessments are needed to ensure that restricted access to areas is minimised. EVIDENCE: Several shared areas of the home were viewed including a bathroom, lounge, dining room, kitchen, corridors, stairwell and offices. The home was noted to be clean and suitably decorated with no obvious hazards. The two single bedrooms viewed were similar with evidence of personal effects. We discussed, with the manager, the suitability of the environment in respect of equality and diversity and he said that there were plans for an ensuite facility planned for one person, which the company was to provide. The manager, in the AQAA, had said that the communication between the staff and the maintenance people had improved and problems were being dealt with more quickly. Staff said that they have a book to use to report maintenance Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 23 issues in and that work is completed at least twice a week and more often if needed or if something is urgent. The last inspection report referred to restricted movement about the home as there was restricted access to bedrooms, bathrooms, personal ensuite facilities and that reasons for this were not documented. A requirement had been made about this in the last report of the home in September 2007 before this company took over. At this visit we noted that access was either by a sensor key fob or use of a code pad. We also noted other areas of the home with restricted access as referred to in the individual need section and the lifestyle section. In absence of records in respect of this a requirement has been made. The manager said that there is a plan in place for the prevention and control of infection and that 15 staff are trained. We noted from the matrix of staff training that staff are provided with infection control training. We spoke with one staff member about this who confirmed that they had received the training. It was also noted that one care plan referring to infection control was in place for one of the people we case tracked. A staff member said there are regular special collections of waste. There is a laundress working for 30 hours a week in the home. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The recruitment of staff needs to be more robust to ensure the safety of people in the home is properly promoted. People living in the home are benefiting from increasing levels of permanent staff and revised organisation of them but increased training and development will ensure their needs are met. EVIDENCE: There has continued to be a turnover of staff at the home since the last inspection with six new staff recently recruited and five more planned to start work. Records, observations and conversations revealed that there are mostly six staff on a day shift, sometimes including the deputy. At times there are more. The home continued to use two to three agency staff on a shift although the manager said that these generally are regular to the home. The rotas supported this. However, this meant that most people for most of the daytime have one to one care. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 25 In the last inspection report comments were made about the need to improve the recruitment practices in the home as there had been reliance, in the records sampled, on personal references. At this inspection we asked to see records for three people recruited to the home. We found evidence of a Criminal Record Bureau (CRB) checks for one person but no other record. No references for another person and records for a third person. This was brought to the managers attention. A discussion was held with a new member of staff who confirmed that a CRB had been carried out before working in the home and the two staff responding had also confirmed this in their surveys. A requirement has been made. Systems to support staff are developing. There are staff meetings. The manager said that the new shift system provides an overlap after lunch, which allows for recording and meetings such as supervision. From observation of records and verbal feedback from staff there is evidence of supervision improving. It has been identified in a recent regulation 26 visit that supervision was not up to date. The manager said that senior staff were about to have training in it. Training was discussed with the manager. We were provided with a matrix of the training received by the staff excluding the last six new staff. This indicated that staff have been receiving training over the last year in key areas such as, food hygiene, fire safety, moving and handling, first aid, infection control, conflict management, and medication. Some staff still needed the training and training needed overall was identified. But, there are many new staff to induct and in January 2009 only 36 were assessed in NVQ levels. The training matrix provided indicated that the training needs of the staff team in autism, communication and equality and diversity had yet to be assessed. (See section on protection regarding plans for Mental Capacity training.) Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living in the home would benefit from the manager being registered and quality assurance improved further to ensure that the service meets peoples needs. Good systems are in place to promote the health and safety of people living in the home. EVIDENCE: The home has not had a registered manager since February 2008. Since the last inspection when a temporary manager was in place, a new manager has been recruited and started work in May 2008. We wrote to the organisation Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 27 again in November 2008 to ask the company to ensure that an application for registration was submitted. Although the manager said that he had completed his application and had sent it to his head office by the date of this inspection we had still not received it and therefore a requirement has been made in this report. Comments from a relative and a member of staff were positive about the manager being approachable. He was reported to be keen to make things work. A care manager said that they were very positive about the way the home was managed. The AQAA was discussed with the manager. This had given some information about developments in the home but not enough about the progress in relation to requirements and actions in the last report. A requirement was made in the last report about quality systems for monitoring needing to include obtaining the views of people living in the home and other interested parties. The manager said that consultation was being addressed through the new care plans, that families are involved and care managers are involved in the review process. He has not carried out a general survey. During our inspection we collected information from staff, a relative and a care manager who gave examples of other people influencing the service including through the review process. These examples are referred to in previous sections of the report. The requirement has not been repeated. We noted that there are regular regulation 26 visits to the home by a representative of the company and records are held in the home. The manager said that in order to improve the quality of the service he had made some changes to arrangements of the staff shift so that they were now working in set teams led by seniors who will work on consistency and this has increased accountability. Each team has a checklist to work with. A relative spoke positively about the team changes she said that there is more consistency for the people living in the home as well as the parents. They said that, for example, the staff leading the shifts are sharing their knowledge of the people with other staff. We found that improvements are needed in some management and staff practices commented on in other areas of this report such as staff recruitment, risk assessment regarding restricted areas and recording of decisions made on behalf of people. Out of date policies and procedures were noted to be in the home at the last inspection. These were not viewed on this occasion but the manager said that a new file of procedures was delivered late summer last year and that these were being added to as new ones arrive. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 28 The generic household risk assessments were discussed with the manager and a member of staff. They had previously been identified in a regulation 26 visit as being mixed up with individual ones. We noted that few were in the risk assessment folder but the manager and staff member said that a further 30 were ready to be printed. The manager said that the home has a fire marshal responsible for completing fire checks. We sampled some of the fire records and noted that these were well maintained and that regular checks of the fire system were taking place. These included specialist checks. We noted from the fire training matrix, which the manager said was up to date apart from the new staff who were about to be added. We sampled some aspects of this. It indicated that there is a commitment to training staff in health and safety and all staff on the list were recorded as trained in 2008 except two. All were reported to have been fire trained on or since May 2007. Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 2 2 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 2 x x 3 x Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 30 Yes 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 YA9 Regulation 13(7) Requirement Risk assessments must be carried out to demonstrate the reasons for limiting access to any areas of the home and to show that appropriate consultation has taken place. This is to ensure that independence is promoted and only necessary restrictions on freedom of movement based on health and safety are used. Timescale for action 05/04/09 2. YA23 12(3) Records in the home must include reasons for decisions made on peoples behalf, who was involved and how it will meet needs. This is to ensure that the rights and interests of the person are properly protected. Records of employment checks must be completed and held at the home before a member of staff commences work in order to maximise protection of people living there. DS0000068312.V373849.R01.S.doc 05/04/09 3. YA34 19 05/04/09 Sunnybrook Version 5.2 Page 31 4. YA37 8 The registered person must ensure an application is submitted to the Commission for the registration of the appointed manager. 05/04/09 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 Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 © 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 Sunnybrook DS0000068312.V373849.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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