Inspection on 17/04/08 for Sunnymead Manor

This inspection was carried out on 17th April 2008.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sunnymead Manor 01/12/08

Sunnymead Manor 20/11/08

Sunnymead Manor 04/06/07

Sunnymead Manor 08/05/06

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Sunnymead Manor 575-579 Southmead Road Southmead Bristol BS10 5NL Lead Inspector Vanessa Carter Unannounced Inspection 17th and 18th April 2008 09:10 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 DS0000066340.V362817.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. DS0000066340.V362817.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnymead Manor Address 575-579 Southmead Road Southmead Bristol BS10 5NL 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) 0117 979 1212 0117 979 2680 None Mimosa Healthcare (No4) Limited Mrs Susan Maria Horsewell Care Home 76 Category(ies) of Dementia (5), Dementia - over 65 years of age registration, with number (42), Old age, not falling within any other of places category (34) DS0000066340.V362817.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. May accommodate 34 persons in the OP category on the ground floor only - The Hollies Unit May accommodate up to 42 DE (E) persons on the Dementia Care Unit, of whom 5 may be aged between 55-65 years (DE) - The Poplars Unit The Registered Manager must be a RN1 or RNA on the NMC register A named person, who is either an RN1 or RNA with additional Dementia Care training, or a Level 1 Registered Nurse Mental Health (RN3 or RNMH) must be responsible for the running of the first floor (the Poplars Unit) May accommodate 2 named people aged over 50 years 5. Date of last inspection 4th June 2007 Brief Description of the Service: Sunnymead Manor is a 76-bedded care home, situated in the Southmead area of Bristol, close to the South Gloucestershire borders. It is operated by Mimosa Healthcare Limited. Mimosa has three other care homes in the Bristol area Bedminster (Honeymead Care Home), Bishopsworth (Bishopsmead Manor) and Shirehampton (Kingsmead Lodge). Mimosa also own homes in the Midlands and the North of England. The home is located near to Southmead Hospital and only a short distance from the centre of Bristol. There is a regular bus service into the centre of town that passes the front of the home. Sunnymead is a purpose built care home with accommodation provided over two floors. The home is run as two units. The first floor, Poplars unit, accommodates 42 persons requiring specialist dementia care nursing. The ground floor, the Hollies unit, offers 34 beds for general nursing placements. Both floors have communal and bathing facilities, and there is lift access, making the home fully accessible. The majority of the bedrooms are for single occupancy and have en-suite toilet facilities. The cost of placement is between £498- £560, dependent upon assessed need. Additional charges are made for a number of services - these are listed in the homes brochure. Prospective residents can be provided with information about the home and this will detail the services and facilities available at the home. DS0000066340.V362817.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 2 stars. This means the people who use this service experience good quality outcomes. This key inspection was unannounced and took place over two days. A total of 14 hours were spent in the home. Evidence to form the report has also been gathered from a number of other sources: • Information provided by the Home Manager in the Annual Quality Assurance Assessment (AQAA) • Information supplied by relatives of people who live in the home in CSCI survey forms • Information that has been received by CSCI since the last inspection, from Adult Community Care Services and Healthcare professionals. • Talking with the Home Manager • Talking with some of the registered nurses, care staff and ancillary staff • Observations of staff practices and their interaction with the residents • A tour of the home • Case Tracking the care of a number of people who live in the home • Talking with a number of the people who live in the home • Talking with a number of visitors to the home • Telephone conversations with relatives who had asked to speak to the Inspector • Looking at some of the homes records There have been significant improvements in this service since the last key inspection, but the manager is fully aware of where there is still work to be done. What the service does well: The information available about this home and the pre-admission assessment processes ensure that placement is only offered to those people whose needs can be met. Improvements in the homes care planning processes have meant that people receive the personal and healthcare support that they need. However, care planning does need to be more person centred in the dementia care unit. Medication practices are safe. Improvements have been made in the range of activities made available for people to take part in, thereby enhancing the quality of life for those who can participate. Visitors are able to visit the home at any reasonable time. People DS0000066340.V362817.R01.S.doc Version 5.2 Page 6 are offered a choice in what to eat and are provided with a varied and well balanced diet. The people who live here and their relatives can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. Sunnymead Manor is a safe, comfortable and well maintained home that is equipped to meet the needs of the people who live there. There is a planned programme of improvements to make the home more comfortable. Improvements with the staff team and the training arrangements, benefit the people who live in the home as they will be looked after by staff who are able to meet their needs. Management processes in the home have improved meaning that the best interests of the people who live there are kept at the heart of all decisionmaking. What has improved since the last inspection? What they could do better: The care plan reviewing process is satisfactory in the nursing unit however needs to be more effective in the dementia care unit. Reviews must be meaningful and where the care plan is not effective, the plan of care should be revised. The risk assessments for those people with dementia who like to wander, must be meaningful. Control measures must be about enabling people to wander DS0000066340.V362817.R01.S.doc Version 5.2 Page 7 and not be about preventing them to do so. The staff team need to think about how this can be achieved safely. The personal care records kept in the dementia care unit nurses station must be secure and not able to be seen by those who should not be doing so. There are no measures in place to prevent this happening at the current time. 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. DS0000066340.V362817.R01.S.doc Version 5.2 Page 8 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 DS0000066340.V362817.R01.S.doc Version 5.2 Page 9 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, 3, 4 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information available about this home and the pre-admission assessment processes ensure that placement is only offered to those people whose needs can be met. EVIDENCE: The homes Statement of Purpose provides a true reflection of the current service provision, and contains all the necessary information to enable any prospective person or their relative to make an informed decision about moving into the home. Five CSCI relative survey forms were returned to us and only one person said they had not been given enough information about the home. One person spoken to said, “my son made all the arrangements, I was in hospital at the time”. A Service Users Guide or a Welcome Pack is prepared for all new people with a personalised letter of welcome, and a copy of the residency agreement. A “Residents Questionnaire” is included and invites people to have a say about how they would like to be looked after. Copies of the guide are also kept in the reception area of the home. DS0000066340.V362817.R01.S.doc Version 5.2 Page 10 A pre-admission assessment in completed in all cases, to ensure that the service has the appropriate facilities to be able to meet the person’s needs, and that the care team are able to deliver the care that is required. The home manager usually undertakes this assessment, but it is hoped that other qualified nurses will also undertake this role in the future. The documentation completed for three people who have been recently admitted was examined. The assessment tool is a comprehensive document and provides a clear picture of the person’s specific needs. Where appropriate, assessments and care plans from the local authority and/or primary care trust are obtained, as part of the information gathering process. This assessment forms the basis of the care planning process. The home is able to cater for older people aged 65 years and over who require general, or specialist dementia nursing care. They are able to offer up to five places to people between the ages of 55-65 years in the dementia care unit, and can be authorised to provide accommodation on the general nursing floor for people younger than 65 years, if they can demonstrate they can meet the persons needs. The majority of people are admitted from the local hospital, and family members will usually have contacted the home, had a look around and found out what the home has to offer, beforehand. All new admissions will be reviewed after a ‘trial period’ usually of about four weeks, but sometimes this settling in period may need to be longer. DS0000066340.V362817.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, 10 and 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements in the homes care planning processes have meant that people receive the personal and healthcare support that they need. However, care planning does need to be more person centred in the dementia care unit. Medication practices are safe. EVIDENCE: Six care plans were looked at, three from each of the units. They were randomly selected, but chosen to check out specific information. The plans set out the individual care needs of each person and state how these needs were to be met. There has been an overall improvement in the quality of the care plans but this was more noticeable in the nursing unit. The plans for those people in the dementia care unit must be prepared with a more person centred approach to the delivery of care. The home manager acknowledged this as being an area where more improvement is needed. There were some good examples of individualised care planning, for example, where a person’s specific daily routine is incorporated into the care plan, what they will and won’t eat and specific communication methods. The day-to-day care for each person is recorded on a daily log sheet – the difference between what is DS0000066340.V362817.R01.S.doc Version 5.2 Page 12 recorded in the nursing unit and the dementia care unit was noted. “All care given” is not an adequate record of the care that has been delivered that day. Care plans are routinely reviewed on a monthly basis, but again in the dementia care unit this needs to be more meaningful. One specific example was discussed with the manager in the feedback session at the end of the inspection. The review was just a repeat of what the plan said, but the plan was not effective in achieving the goals that were set – this particular plan needs to be re-visited. The manager audits a number of care plans each week, and has agreed that for now her efforts need to be concentrated in the dementia care unit. These measures will ensure that care planning processes are effective and people get the care they need. Two people had wound care-planning documentation, and it was evident how the home were monitoring the wounds and managing the dressings. Monitoring was supported by photography and an evaluation of the wound each time it was attended to. The care plans are supported by a number of risk assessments. These include the risks of developing pressure sores, moving and handling tasks, nutrition and the risk of falls. There were ‘generic’ risk assessments in place for two people who liked to wander, but one of the control measures was “ encourage them to sit down”. The staff need to think about how they can enable people to wander who want to, but also monitor their safety. Good procedures have been put in place to monitor falls. Falls logs are maintained and risk assessments are completed for all those who are at risk. A checklist has been introduced to aid in identifying any trends. The home does not have the services of a retained GP and anyone moving to the home who does not have a local doctor, will be allocated a GP by the PCT. This means that four different GP practice’s now visit the home. It was noted that there is now an improved relationship between the GP’s, other visiting healthcare professionals, and the home staff. Communication methods have been agreed and there is better organisation in arranging GP’s visits. The home will contact the intermediate care team where appropriate to prevent hospital admissions and have again demonstrated better working relationships with the team. Concerns have been raised in the past by the intermediate care team but the issues raised at this time have brought about a raised standard of awareness and action by the staff team. There was evidence in one persons file that a specialist nurse is consulted for advice and visits the home on a regular basis. A foot care professional visits the home on a weekly basis. A number of people are nursed in specialist nursing beds or with alternating air mattresses, in order to aid their comfort. The management of medications is safe. There are procedures in place for the ordering, receipt, storage, administration and disposal of medicines. The levels of stock are minimal and this is good practice. Oxygen signage would be DS0000066340.V362817.R01.S.doc Version 5.2 Page 13 displayed when this is appropriate, but no one was in need of oxygen therapy at the time of the inspection. A new medication storage room has been created on the ground floor and this provides better storage facilities. The nurses are monitoring the temperature of this room to ensure that the correct storage temperatures are maintained. Those people spoken with during the inspection, who were able to respond appropriately had the following comments to make regarding how they were looked after. “Yes I am well looked after”, “Everyone is very kind but I would prefer to be in my own home” and “they give me the help I need but sometimes they are a long time coming back to help”. Relatives who completed CSCI survey forms had both positive and negative comments to make “the regular staff are very good at understanding my mothers needs”, “the majority of staff are extremely kind and helpful” and “the residents are encouraged to do as much as possible for themselves”. Staff were observed going about their duties in a friendly and courteous manner but at times there were noted to be a lack of interaction between staff and the people who were around them. Staff who are asked to ‘supervise’ the people who are sat in the lounges could be interacting with them rather than just doing paperwork with their heads down, and when a person is continually calling out, some response from a staff member may halt repetitive behaviours. These two examples were noted in the dementia care unit and discussed with the manager at the end of the inspection. There has been an improvement in how the staff team approach the care for those people who have ‘end of life’ care needs. A “Thinking Ahead” form enables staff to collect information from relatives about the person’s specific wishes, when their illness has progressed. The staff will liaise with the GP’s so that decisions can be reached beforehand with all relevant parties. This means that the staff will be able to ensure that the right care and support is delivered at the appropriate time. DS0000066340.V362817.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, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements have been made in the range of activities made available for people to take part in, thereby enhancing the quality of life for those who can participate. Visitors are able to visit the home at any reasonable time. People are offered a choice in what to eat and are provided with a varied and well balanced diet. EVIDENCE: Significant improvements have been made with how the social needs of people who live in the home are met. There are now two Activity Organisers, one who works full time and the other who covers 6 hours, three days a week. Activities are provided for both units, but people can pick and choose what they want to participate in. Previously the home have employed a ‘general assistant’ who helped out with the activities, this person has now left but a replacement has already been recruited who will start in the near future. There is a weekly plan of activities and examples of things that were happening in the home the week of the inspection include, shopping trips and walks outside weather permitting, bingo, arts and crafts and flower arranging and games involving minimal exercise. Each month a birthday party is arranged to celebrate those for that month and family and friends are invited to attend – the party for April was held on day one of the inspection and an DS0000066340.V362817.R01.S.doc Version 5.2 Page 15 outside entertainer visited. One person said “I enjoyed the singing, I always like to sing along”. There are plans that a section of the gardens to the rear of the building will be revamped with raised flowerbeds so that a “gardening club” can be arranged. One other person said “I am told what things are happening but I don’t always want to take part. I like watching TV or reading in my own room”. Despite this raised level of activity, a large proportion of people still spend most part of the day sitting in the lounges and watching TV– one relative wrote in a CSCI survey form “I would like my mother to do more but she just wants to sit and doze in front of the TV. She is quite frail now”. As referred to before in this report, care staff could look at interacting more with the people they are supervising. Since the last inspection a library service from St John’s Ambulance Service has been arranged and volunteers visit and speak with people. The ‘Good News Team visit on a monthly basis and organise a non-denominational church service. Representatives from some churches visit on an ad-hoc basis. All visitors are welcomed to come in to the home at any reasonable time. During office hours there is a receptionist/ administrator who is able to welcome them into the home and provide them with any assistance that is needed. One relative said “I visit most weeks – the home is much better these days and I enjoy going there now”. It is evident that people are encouraged to make decisions about how they are cared for. A Residents Questionnaire has been introduced and people are asked for their views regarding meal times, bathing or showering preferences and preferred activities. During the course of the inspection the staff team were observed offering people choices about where they spend their time and what they would like to drink. They are able to choose what they do and what time they want to get up and retire to bed, however many of the people who live in the home are unable to express their views and opinions, and staff plan their care and support based upon the knowledge they have of that persons needs. There is a choice available at all meal times. There are two main meals at lunchtime with selection about what they would like to eat the day before however there are plans to have a trial with choices being made prior to having the meal. Roast meals are served twice a week and fish is traditionally served on a Friday. On the first day of inspection, a mild chicken curry or cauliflower cheese were on the menu. The meals were well presented and those spoken to after lunch said that they had enjoyed their meal. The majority of people take their meals in the dining room, but can choose to be served in their rooms. There is a dining room on each floor; a copy of the day’s menu is displayed on each table. Staff provided assistance with feeding for a number of people and this was done sensitively and was unhurried. The cook likes to visit new people as soon as possible after admission to discuss any specific dietary requirements. DS0000066340.V362817.R01.S.doc Version 5.2 Page 16 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 good. This judgement has been made using available evidence including a visit to this service. The people who live here and their relatives can be assured that any complaints they have will be listened to and acted upon and that they will be safeguarded from harm. EVIDENCE: A copy of the complaints procedure is displayed in the main reception area and is also included in the welcome pack that is given to everyone and their families. It details the processes that will be followed if concerns are raised and says that any complainant will be informed of any actions taken and the outcome. All CSCI survey forms completed by relatives said they were aware of the homes Complaints Procedure. One relative said “any concerns I have had have been responded to very quickly” whilst another said “ some issues have recurred after they have been resolved and I have to complain again”. A number of complaints have been raised with CSCI and the home manager was asked to address the issues raised. A discussion during the inspection evidenced that only one of the issues was yet to be dealt with. Examination of the home’s complaints log showed that the home manager had dealt with four other matters since the beginning of the year. All but those most recently received has been handled according to the complaints procedure. The measures that are taken in dealing with complaints or concerns that are raised ensure that the appropriate action is taken. Since the last inspection in June 2007, there has been a significant reduction in the level of dissatisfaction reported to CSCI by relatives and other stakeholders, DS0000066340.V362817.R01.S.doc Version 5.2 Page 17 regarding the quality of the service provided in this home. Management of complaints training is being arranged for registered nurses so that they can take responsibility for dealing with concerns that are raised directly with them. The home has a policy on the Protection of Vulnerable Adults (POVA) and clear guidance is available for the staff to follow if abuse is suspected, alleged or witnessed. POVA training sessions are arranged for staff on a regular basis and all staff are expected to attend these sessions. Discussion with both registered nurses and care staff during the course of the inspection evidenced that they are aware of safeguarding issues, and that they would report any concerns that they had, but still that they would see the home manager as being the person who would report matters to the other agencies. At the beginning of May, the manager will be attending the Safeguarding Training put on by the local authority, and staff will be updated following this, on locally agreed protocols. DS0000066340.V362817.R01.S.doc Version 5.2 Page 18 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, 20, 21, 22, 23, 24, 25 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sunnymead Manor is a safe, comfortable and well maintained home that is equipped to meet the needs of the people who live there. There is a planned programme of improvements to make the home more comfortable. EVIDENCE: The home is a purpose built care home with accommodation arranged over two floors. Entry into the home is via a secured doorway, and during ‘office hours’ a receptionist is available to welcome and direct visitors to the home. There is one passenger lift in situ, meaning that the home is fully accessible for those with impaired mobility. Visitors to the Poplars dementia care unit (upper floor) can either use the lift or the staircase that is secured with a key padded system. This reception area is used by a number of people during the day, to sit in and watch the comings and goings of the home. One person said, “I always like to sit here, the staff stop and talk to me”. DS0000066340.V362817.R01.S.doc Version 5.2 Page 19 The area to the front of the property is laid out for car parking and is surrounded by established shrubbery. There is level access in to the home but a small wooden ramp has been placed by the front door because of a small lip in the doorframe. There are two main areas of garden, to the side and rear of the home. Access to the side garden is from the main ground floor lounge, where a wooden ramp enables people in a wheelchair to go outside. There is an area of patio with garden furniture that can be used by people and their visitors in the warmer weather. The gardens to the rear of the property are little used at present, but there are plans to develop one of the areas with raised flowerbeds. Communal spaces are available on each floor, consisting of two lounges and a dining room per floor. The dining rooms are to be refurbished with new tables and chairs and the furniture is already on order. The dining rooms are laid out with small tables, tablecloths and the menu for the day displayed. It was noted during the inspection visit that both dining rooms were promptly cleaned after each meal. Some new lounge furniture has already been provided but there are plans for additional seating to be provided and new carpeting to be laid. Blinds have been ordered for the conservatory to help keep the room cooler in the summer months. The corridors throughout the home are wide with grab rails either side. The home is well decorated throughout. The corridors in the dementia care unit are painted different colours with the purpose of helping residents orientate themselves. There are a sufficient number of bathrooms and shower rooms located around the home. A new ‘wet room’ has been created on the ground floor and there are plans to convert one of the upstairs showers in to the same. One of the bathrooms is to be refitted with a new hi/low bath. There are plenty of toilets located throughout the home and in near vicinity to the communal areas. The home has a plentiful supply of manual handling equipment on both floors – there are now three hoists and 1 stand aid on each floor. Toilets are fitted with grab rails and each bedroom has a call bell system so the residents can summons assistance. Call bell cords were present in all rooms at the time of inspection, and where appropriate these were placed within reach of the person in the room. The majority of bedrooms are for single occupation and all but two rooms have en-suite facilities of a toilet and wash hand basin. Those rooms without ensuites have a wash hand basin installed. Shared rooms have appropriate screening in place to ensure residents privacy. A number of bedrooms are still furnished with ordinary divan beds but five specialist nursing beds have already been purchased and there will be an ongoing programme of replacement with hospital type or profiling beds. The mattress on one unmade bed was noted to be old and marked. One relative spoken to prior to the inspection made a comment about the poor state of the mattress on their DS0000066340.V362817.R01.S.doc Version 5.2 Page 20 relative’s bed. This was discussed with the manager who arranged for both to be changed as 12 new mattresses have already been delivered to the home. A number of relatives commented again on CSCI survey forms that bedrooms are not always kept tidy. During a tour of the home, it was noted that in comparison to the last inspection visit, the appearance of rooms was improved, but by no means perfect. Part of the reason is due to the standard of furniture and bedding. Some rooms have already been refurnished with new wardrobes, chest of drawers and bedside cabinets, and new bedding and curtains. These rooms looked much nicer. The manager has already made arrangements for the purchase of six new sets of bedding per month. A number of the rooms were empty and had been prepared for new people. The standard of cleanliness in the home was generally good and all areas, bar one, were clean tidy and free from any offensive odours. Several relatives who completed CSCI survey forms commented that the home does not always smell very nice when the home is entered. On both days of the inspection, there was no bad smells apart from the one specific room (the nurses office) in the dementia care unit. Arrangements were made to sanitise this room immediately but people who live in the room should ideally not be entering in to this room when staff are not present. There is one allocated housekeeper per floor each day, plus a senior housekeeper who oversees their work. Staff work each day in the laundry room – on occasions clothes do get temporarily mislaid. To try and rectify this problem, the manager has organised so that name labels can be purchased and sewn on. DS0000066340.V362817.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 good. This judgement has been made using available evidence including a visit to this service. Improvements with the staff team and the training opportunities available benefit the people who live in the home as they will be looked after by staff who are able to meet their needs. EVIDENCE: Staffing levels are allocated according to the dependency levels of all the people who live in the home and each shift is covered with a mix of registered nurses, senior care assistants and care assistants. Although the home currently has a number of vacant rooms there appears to be sufficient levels of staff. There are currently no lead nurses for either of the units and the deputy manager has left to take up a manager position in another of the Mimosa care homes. The dementia care unit has been without a lead nurse for a long time and needs a strong leader who will provide direction for the staff team. This is a vital area of improvement as the few shortfalls that have been highlighted in this inspection have been in respect of this unit. The manager is already actively addressing this situation. One new registered nurse is due to start at the home soon and there are currently just two care staff vacancies. Bank staff are used to cover any free shifts and there is very little use of agency staff. This means that the people who live here will be looked after by people are familiar with their needs. In addition to the care staff there are catering, maintenance, housekeeping and laundry personnel. Staff spoken to during the course of the inspection, were helpful and friendly and aware of the needs of the people they are looking after. DS0000066340.V362817.R01.S.doc Version 5.2 Page 22 One relative who returned a CSCI survey form said, “The majority of staff are extremely kind and helpful”. Another relative said, “There are now more regular staff on duty and this is better for my mum”. There are currently eight care assistants who are qualified to NVQ Level 2 or hold an equivalent qualification – this equates to a 25 ratio of trained members of staff. However, a further 15 staff are at various stages of the training programme and once these have completed the course, there will be a 75 ratio of trained staff members. This evidences that there is a real commitment to staff training and that the quality and competency of the staff team is viewed as important to ensure that people get the care they need. A sample of six staff recruitment files were looked at to determine the process the manager follows to ensure that the right staff are employed. The six people had all started working at the home since the last inspection. Each person had been recruited following written application, interview and assessment, references from previous employers, and POVA1st and CRB checks. This evidences good recruitment practices meaning that unsuitable staff will not be employed at the home and the people who live there will be safeguarded from being cared for by unsuitable workers. An induction-training programme is provided for all new employees, with the new recruit being allocated to a mentor who they will work with until they are confident in their role. They will also have a workbook to complete. A copy of the workbook was shown at the previous inspection and covers health & safety, infection control, fire procedures and manual handling, as well the principles of care and adult abuse issues. Mimosa has again contracted with a new training provider and a training plan is provided for the home on a monthly basis. Examples of training sessions that are planned for the next couple of weeks include COSHH, manual handling, food hygiene and fire awareness. A sample of staff training files evidenced a range of differing training. The manager has completed a matrix highlighting the dates when each member of staff last completed mandatory training. The introduction of the new training provider will benefit the home in providing a staff team that are better qualified to undertake their roles. DS0000066340.V362817.R01.S.doc Version 5.2 Page 23 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, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management processes in the home have improved meaning that the best interests of the people who live there are kept at the heart of all decisionmaking. EVIDENCE: Mrs Susan Horsewell, the home manager has been in post since February 2006 and is registered with the Commission for Social Care Inspection. She is a registered nurse, has experience in dementia care and has had many years in a management role, within another care home setting. Mrs Horsewell has completed an NVQ Level 4 in management (Registered Managers Award) and is therefore suitably qualified in managing the service. DS0000066340.V362817.R01.S.doc Version 5.2 Page 24 A number of quality assurance audits are completed on a regular basis to monitor how the service is performing. These are done in respects of catering, finance, housekeeping, health & safety, care planning documentation and infection control. The home manager will complete a total of five care plan audits each month and will provide nurses with corrective action forms where improvements are required. The manager has acknowledged the fact that this process needs to be concentrated on the dementia care unit for now. Mimosa have undertaken an annual survey asking relatives for opinions upon the staff team, accommodation, complaints procedure and inclusion in the care planning process for their relative and the catering service. The main development plans for the home are around the environment and the refurbishment. The Annual Quality Assurance (AQAA) form completed for CSCI prior to this inspection evidenced that the service does know where they need to improve and how they are going to achieve this. The home has procedures in place to manage any monies they hold on behalf of the residents. The records were not checked on this inspection however the home has previously demonstrated that they have good administrative systems in place to log all transactions. The home has a cascade system of staff supervision in place, including an annual appraisal and work performance monitoring for some staff members. A look at the homes records showed that supervision is generally carried out on a regular basis for most of the staff team. Care staff confirmed that they have regular supervision and that they have the opportunity to make suggestions about things that affect people’s care The standard of record keeping is satisfactory although some improvements in the daily logs for people who live in the dementia care unit, would ensure that an accurate account of actual care delivered is maintained. The records kept in respects of each person must also be kept more securely in the dementia care unit. The office is left open at all times, and a number of people wander in an out moving items about and there is not always a staff member available to ensure that paperwork does not get removed. This has the potential to mean that peoples records may be read by those who should not be doing so. The manager was exploring the possibility of a key padded lock being installed. The home has a maintenance person who undertakes all environmental checks and organises or completes any repairs. Maintenance also complete regular audits of the fire alarm system, fire fighting equipment, emergency lighting and the water temperatures. An examination of the homes records evidenced that all necessary service contracts were up to date. No health and safety issues were noted during a tour of the property and the home looked clean tidy and well maintained. DS0000066340.V362817.R01.S.doc Version 5.2 Page 25 Manual handling assessments are completed for each resident and result in a safe system of work being devised for each person. The manager explained that regular audits of these forms and staff actions are undertaken to ensure that safe procedures are followed. These measures have been put in place following concerns having previously been raised about unsafe manual handling practices. Only safe manual handling procedures were witnessed during the inspection. Any incidences of falls and accidents are monitored closely to enable the staff team to be able to identify any trends and take preventative actions. A robust set of documentation is used to ensure that the staff use set guidelines. These measures have been put in place to ensure that accidents and falls are appropriately recorded, reported and acted upon. DS0000066340.V362817.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 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 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 X 3 X 3 3 2 3 DS0000066340.V362817.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 OP7 Regulation 15(2) Requirement Care plans in the dementia care unit must be meaningfully reviewed and revised as necessary to ensure they remain effective. For those people in the dementia care unit who like to wander, meaningful risk assessments must be carried out. This is to ensure that all measures are taken to ensure the activity is, as far as possible, free from any avoidable risks. Care records in the dementia care unit must be securely kept and not accessible to those who should not have access to them. Timescale for action 17/06/08 2. OP8 13(4)b 17/05/08 3. OP37 17(1)b 17/05/08 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 DS0000066340.V362817.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000066340.V362817.R01.S.doc Version 5.2 Page 29 - 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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