Inspection on 04/06/07 for Sunnymead Manor

This inspection was carried out on 4th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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 17/04/08

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 4th and 5th June 2007 09:15 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.V337443.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.V337443.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.V337443.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 8th May 2006 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 have 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 £471- £600, 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.V337443.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was unannounced and took place over two days. A total of 15 hours were spent in the home. Evidence to form the report has been gathered from a number of sources:• Information provided by the Home Manager in the Annual Quality Assurance Assessment (AQAA) • Talking with the Home Manager and deputy 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 residents • Talking with a number of the residents • Talking with a number of visitors to the home • Telephone conversations with a number of relatives who had asked to speak to the Inspector • Looking at some of the homes records • Information supplied by residents and relatives in CSCI survey forms • Information supplied by healthcare professionals • Information that has been received by CSCI since the last inspection, from Adult Community Care Services and Healthcare professionals. The overall analysis is that the home has made many improvements since the last inspection but needs to concentrate on raising its image with stakeholders, ensure that they always provide the best possible care by means of robust quality audits and establishing a collective responsibility by all qualified nurses and senior staff in monitoring what happens in the home. What the service does well: Information given to prospective residents and their families, and the assessment processes prior to being offered placement, ensure that placement is only offered to those whose needs the home can meet. Visitors are able to visit the home at any reasonable time and report being welcomed when they visit. Residents are offered a choice in what to eat and are provided with a varied and well balanced diet. Residents live in a home that is safe, comfortable and maintained well. Some minor improvements would further improve the access for all disabled residents to the home. DS0000066340.V337443.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. DS0000066340.V337443.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000066340.V337443.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. 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. Information given to prospective residents and their families, and the assessment processes prior to being offered placement, ensure that placement is only offered to those whose needs the home can meet. EVIDENCE: The homes Statement of Purpose accurately reflects the current service provision, and contains all the necessary information to enable any prospective resident to make an informed decision about moving to the home. Of the six CSCI resident survey forms returned, only half said they had been given enough information about the home, but one made the comment “my daughter made all the arrangements”. The Service Users Guide (Welcome Pack) is provided for all new residents, along with a residency agreement. Copies of the guide can also be found in the reception area of the home. DS0000066340.V337443.R01.S.doc Version 5.2 Page 9 One relative commented that they were in consultation with the care home because of differences between the residents agreement signed with the previous owners and the terms and conditions for Mimosa homes. The previous owner invoiced on a monthly basis whilst Mimosa do so on a four weekly basis. Pre-admission assessment processes have been improved since the last inspection. The manager or the deputy usually carries out assessments. The documentation completed for two recently admitted residents was examined. The assessment tool is a comprehensive document and provides a clear picture of the resident’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. After admission, the staff complete a ‘Physical and Social Care Assessment’ however this is only a tick-box assessment and does not serve any purpose. There is no space for staff to record and additional or specific information. Since the last inspection the manager has introduced a “Residents Questionnaire”. Prospective residents are asked to say what they would like life to be like once they move to the home – for example, what time they like to have their meals, how often they like to be bathed, and what pastimes they like to do. The home offers placement to 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 residents are admitted from the local hospital, and family members will have previously visited the home, had a look around, found out what the home has to offer and will have had a conversation with the manager. All new admissions will be reviewed after a ‘trial period’ usually of about four weeks. One relative spoken to confirmed that a review meeting had been held along with the social worker. DS0000066340.V337443.R01.S.doc Version 5.2 Page 10 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents may not always get the healthcare support they need despite there being improvements in the homes care planning processes. Medication practices are safe. EVIDENCE: Six care plans were looked at, three from both the general nursing unit and the dementia care unit. The plans set out the specific care needs of each resident and state how these needs were to be met. There has been an improvement in the quality of the care plans and any minor changes or suggestions were discussed with the manager at the end of the inspection. A couple of the residents should have had a ‘communication plan’ was one improvement that should be made. There were some good examples of individualised care “likes to spend her time wandering about, carrying her handbag, but will collect other peoples belongings”, and “prefers to sleep with a dim light”. These improvements have meant that the day-to-day needs of each resident are recorded. The manager audits a number of care plans each week, and is monitoring the competency of some staff. This will ensure that care planning processes are effective and residents get the care they need. DS0000066340.V337443.R01.S.doc Version 5.2 Page 11 Two residents 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. This is improved practice from the last inspection. The care plans are supported by a number of risk assessments. They are completed about the risk of developing pressure sores, moving and handling tasks, nutrition and the risk of falls. The ‘core’ assessments in respects of falls do not take into account any specific factors that may affect that individual and cause falls. Falls risk assessments should be individually prepared and be based upon any identified trends or particular significant events. A number of other ‘core’ assessments have been placed in care files and these are not always relevant. Care plans are reviewed on a monthly basis however there was no evidence that the care plans had been reviewed with the resident or their representative. The records made about reviews were generally brief – “care plan remains effective and no changes made”. The home no longer has the services of a retained GP and the relationship with GP’s and other visiting healthcare professionals, has now become strained. New residents will be allocated a GP by the PCT, therefore a number of GP’s now visit the home. There is a lack of organisation about arranging GP’s visits and communication between some staff members and the GP services is poor. This has the potential to mean that residents will not get the care they need. Both parties will need to address this for the sake of the residents. In the meantime, the home must ensure that they always get healthcare advice when it is needed. One relative wrote in a CSCI survey form “I had to ask for two weeks before the home got the GP to visit my relative” and another resident was not seen by their GP for six days following a fall. There was evidence in one persons file that a specialist tissue viability nurse had been consulted for advice. A foot care professional visits the home on a weekly basis and reports that communications are now better with the nursing staff following any instructions she leaves for ongoing care – a record of all her visits are made in the care file. A number of residents are nursed in specialist nursing beds or with alternating air mattresses, in order to aid their comfort. Improvements have been made in the homes management of medications and there was evidence of safe procedures in respects of the ordering, receipt, storage, administration and disposal of medicines. Only a brief conversation took place with the deputy manager regarding medicine management. The levels of stock are minimal and this is good practice. Oxygen signage is displayed where this is appropriate DS0000066340.V337443.R01.S.doc Version 5.2 Page 12 Residents and relatives spoken with during the inspection had a mixed response regarding how they were treated. “Everyone is very kind”, “some of the girls are kind and caring” and “I visit weekly and I see a lot of real kindness. The staff are very patient”. Other comments included “the girls are alright, some are dippy” and “ no-one just ever sits and chats with me”. The majority of staff were seen going about their duties in a friendly and professional manner and responding to residents and visitors in a familiar style. However, a number of observations were made about staff practice where improvements to attitude are required. These examples were discussed with the manager There have been concerns expressed about how the home approach the care of residents who have ‘end of life’ needs, although on the day of inspection recently bereaved residents visited the home to thank the staff for the care that had been provided to their dying relative. This situation is something that must be resolved so that residents always receive the appropriate care. The home must ensure that appropriate advanced care plans are discussed with a resident and their relatives, and relevant healthcare professional, to ensure that their wishes are known, and therefore met. One of the managers in another Mimosa care home has devised a form “Thinking Ahead” that could record this planning process properly. DS0000066340.V337443.R01.S.doc Version 5.2 Page 13 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 adequate. This judgement has been made using available evidence including a visit to this service. Not all residents are able to participate in a range of activities therefore the quality of life for them is restricted. Visitors are able to visit the home at any reasonable time. Residents are offered a choice in what to eat and are provided with a varied and well balanced diet. EVIDENCE: The home has one Activities Organiser who works for 6 hours each day Monday to Friday and provides activities for both units. After lunch a general assistant helps with the activities as well. A large proportion of the residents spend the most part of the day sitting in the lounge and sleeping – one relative wrote in a CSCI survey form “people sit around in a circle and sleep through boredom”. The manager is hoping, due to the numbers of residents and the specific needs of most of the people, that additional resources will be made available so that there is a worker for each unit. The role of the person would be enhanced if specific ‘activities for dementia care residents’ were to be arranged, an opinion that the activities organiser agreed with. DS0000066340.V337443.R01.S.doc Version 5.2 Page 14 The organiser has a basic weekly activities programme that includes flower arranging, hand and nail care, painting, music and film shows. One resident commented on a CSCI survey form “the music man was popular but no longer comes”. On the first day of the inspection the flower arranging session only involved two of the residents, and on day two a period of bingo playing took place. One resident said, “it’s not my cup of tea but I go along because it is something to do”. Another resident said that they liked to do painting so painting was then arranged for them and a number of other residents. Although the home completes a social history for each resident and finds out about their previous lifestyle and pastimes, this does not appear to influence the activities that are then arranged for them. Some residents chose to remain in their own rooms and not to participate in any of the homes activities – “I do not like mixing with the others, I have always kept myself to myself”. One resident said “I just watch the TV all the time, but I would love it if staff had time to come and have a chat with me”. Conclusions from watching staff interact with the residents evidenced that there is a wide range of difference between the practices of different staff members. Whilst some staff were very attentive and keen to provide a sense of well-being for the residents, others did not attempt to interact at all and were non-communicative. The attitude of one particular staff member was discussed with the manager who will need to address this shortfall Visitors to the home are encouraged and can visit at any reasonable time. One relative commented “I visit most days and the staff are always welcoming”. One visitor commented “I visit weekly. I see a lot of real kindness and the staff are very patient”. There is some evidence that residents can make decisions about how they are cared for. The home have introduced a Residents Questionnaire so that their views regarding meal times, bathing and preferred activities are sought prior to admission, and the activities organiser will complete satisfaction surveys with residents. This will be referred to again under standard 33. Residents who can, choose where they want to spend their time and what time they want to get up and retire to bed, but many of the residents are unable to express their views and opinions. Residents have a choice of breakfast and one resident said, “I love the cooked breakfasts”. There is a choice of two main meals at lunchtime and the choice will have been previously made with the help of the general assistant. On the first day of inspection, beef stew or sausages were served, along with vegetables. One visitor who was feeding their relative their meal said “this is a good sized meal today, sometimes the helpings can be small” but also added “my relative has a small appetite”. The meal was well presented and residents appeared to be enjoying the meal. The majority of residents take their meals in the dining room, but can choose to be served in their rooms. DS0000066340.V337443.R01.S.doc Version 5.2 Page 15 There is a dining room on each floor; a copy of the day’s menu is displayed on each table. Cold drinks were provided with the meal and residents were asked what they wanted to drink. It was noted that the staff only attended to one resident at a time and those that were assisted to feed at a later time, were not left to sit in front of their meal that was going cold. The staff sat down with the residents who they were helping to feed, and all but one maintained good eye contact with the resident and talked to them. This is much better practice than that that had been observed on previous inspections. DS0000066340.V337443.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 adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives concerns may not be listened to or acted upon as the homes complaints procedure is not always followed. Staff knowledge of adult protection issues has improved because of training that has been arranged, but the home must always ensure that residents do not come to any harm, and get the help they need. EVIDENCE: The homes complaints procedure is displayed in the main reception area and is included in the service users guide. 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 residents and relatives said they were aware of the homes Complaints Procedure. Examination of the home’s complaints log showed that three complaints have been dealt with since the beginning of the year. These complaints had been about loss of a resident’s personal belongings, and care needs not being properly addressed. Whilst the manager had responded to each complainant and informed them of the actions that would be taken, there was no evidence that the manager was looking at staff practices to make sure that a similar situation reoccurred. DS0000066340.V337443.R01.S.doc Version 5.2 Page 17 In addition to these three complaints, CSCI have been informed of four other complaints raised by healthcare and social care colleagues, there have been meetings with the home and action plans have been prepared. One relative wrote on a CSCI survey form “I have complained on five occasions about the ramp by the front door, and nothing gets done”. The fact that these examples were not recorded in the complaints log do not evidence that the home takes complaints seriously. The home must ensure that lessons are learnt from any complaints made about their service to ensure that the quality can then be improved upon. 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. On day one of the inspection POVA training sessions had been arranged by the newly contracted Mimosa training provider. Approximately 30 staff attended. The staff spoken with after the training said they found it to have been an informative session that had greatly increased their awareness. The home must ensure that at all times their actions or omissions to act, do not place any resident at risk of harm. Concerns have been raised on three occasions by healthcare and social care colleagues that some residents had not been receiving the care they were assessed as needing, or had not been referred to the GP for advice as necessary. These shortfalls have meant that the home has been closely monitored. Whilst the home has made strives to improve practice, it will continue to be monitored for some time. DS0000066340.V337443.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. Residents live in a home that is safe, comfortable and maintained well. Some minor improvements would further improve this area. EVIDENCE: The home is a purpose built care home with accommodation arranged over two floors. There is lift in situ, meaning that the home is fully accessible to disabled persons. Visitors to the dementia care unit on the upper floor can either use the lift or the staircase that is secured with a key padded system. One disabled relative who completed a CSCI survey form said that they have asked the home on a number of occasions for the small wooden ‘temporary’ ramp at the front door to be replaced with a more robust one. The current ramp still leaves a ‘lip’ to be negotiated, and although this does not cause difficulties for other wheelchair users, it is something that the home should consider to enhance the environment. This would improve the accessibility of the home for those in a wheelchair. DS0000066340.V337443.R01.S.doc Version 5.2 Page 19 Communal spaces are available on each floor, consisting of two lounges and a dining room per floor. The dining rooms are pleasantly set out with small tables with the menu for the day displayed. New lounge furniture has been purchased and placed in the reception areas on both floors and provides additional places for residents to sit. One resident said “I like to sit here and watch all the comings and goings.” The corridors 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. To the front of the property, the area is laid to car parking surrounded by established shrubbery. There are two main areas of garden, to the side and rear of the home. Although the grass was well overdue to be mowed, the manager explained that the gardeners were due that week. Access to the side garden is from the main lounge – since the last inspection a wooden ramp has been installed therefore residents and relatives are able to sit outside in the warmer weather. The home has seven bathrooms and three shower rooms and some are equipped with bath seats or can be used with hoists. One of the bathrooms is currently out of use whilst urgent repairs to the floor are being made. 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. 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, but one relative said “I have had to raise concerns about a call bell not being available for my relative”. 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 large proportion of the bedrooms are furnished with divan beds but a number of specialist nursing beds have already been purchased and there is a rolling programme of replacement. Two relatives commented on CSCI survey forms that the resident’s bedrooms are not kept tidy. In particular, comments were made about the standard of bed making and the way in which the chest of drawers and wardrobes were left. A tour of the home found their concerns to be justified. Observations included beds made with ripped bedding, drawers being left partially opened with clothing spilling out and wardrobe doors being left open. This is very sloppy practice and does not give the impression that the staff have any ‘pride’ in their work. DS0000066340.V337443.R01.S.doc Version 5.2 Page 20 A number of the rooms were empty and had been prepared for new people. These were neatly prepared and should be the standard to which all resident’s bedrooms are kept. The standard of cleanliness in the home was generally good and all areas were clean tidy and free from any offensive odours. There is one allocated housekeeper per floor each day, plus a senior housekeeper who oversees their work. Of the six CSCI resident survey forms returned, all but one made positive comments about the standards of housekeeping whilst the negative comments were about the bed making, for example. There are now two members of staff working each day in the laundry room. Comments on both relative and resident CSCI survey forms said that clothes still go missing. Discussion with the senior housekeeper confirmed that this does happen, but it is getting better. All residents clothing must be clearly marked and sometimes this does not happen. On a regular basis any “lost property” is put out for residents to reclaim. DS0000066340.V337443.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A stable staff team and improvements in the induction process for new staff and ongoing training, will benefit residents by ensuring they are looked after by better trained staff. However, the whole team must take responsibility for the quality of the service provided. EVIDENCE: The staff rotas showed that for each shift, on each unit, there are a mix of registered nurses and care assistants - there appears to be sufficient levels of staff but the manager must always ensure that staffing levels are allocated according to the dependency levels of each resident. Examples where extra staff have been allocated to deal with certain situations were discussed. The home still does not have a lead nurse ‘in charge’ of the dementia care unit; therefore the deputy manager has been moved upstairs to undertake this role for now. This unit has been without a lead nurse for a long time and needs a strong leader who will provide direction for the staff team. The manager must ensure that this is provided with these current arrangements. In addition to the care staff there are catering, maintenance, housekeeping and laundry personnel. An increase in the number of ancillary staff has had a positive effect in the home. Staff spoken to during the course of the inspection, were helpful and friendly, but some staff did not demonstrate that they were skilled or competent, or knowledgeable about the resident’s needs. DS0000066340.V337443.R01.S.doc Version 5.2 Page 22 One relative who completed a CSCI survey form said, “I ask questions of staff and they can’t answer, they just shrug their shoulders”. Another relative said, “I have difficultly understanding the speech of some overseas staff, and in making myself understood”. This was not evident during the inspection: however, some of the overseas staff were very difficult to engage in conversation. The home currently have no care staff who are qualified to NVQ Level; however, some of the care staff from abroad have higher qualifications in care (nursing) and are employed as senior care assistants. The manager explained that ten care staff are on NVQ training at the moment. This will improve the quality and competency of the staff and ensure that residents are cared for by staff who are able to meet their needs. A sample of staff recruitment records was examined. There was evidence of good recruitment practices meaning that unsuitable staff are not employed at the home and residents are safeguarded from being cared for by unsuitable workers. The induction-training programme for new staff members has been tightened up and is now provided for all new employees. One staff member said that they had been allocated a mentor who they had then worked with at the beginning and that they had a workbook to complete. A copy of the workbook was shown – this covers health & safety, infection control, fire procedures and manual handling to name a few. Since the last inspection the Mimosa have contracted a new training provider and a training plan has been formulated for the home. For a five month period the following courses have been arranged – fire safety, manual handling, skills for care, infection control, dementia awareness, POVA and food hygiene. During the course of the inspection the manager arranged additional training for eight staff on risk assessment and management, this following some concerns that had been raised. This example does evidence that the home will take appropriate action to resolve their shortfalls. 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.V337443.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, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of the home must ensure that it keeps the best interests of the residents at the heart of decision-making processes. 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 just completed an NVQ Level 4 in management and is therefore suitably qualified in managing the service. DS0000066340.V337443.R01.S.doc Version 5.2 Page 24 The home has a deputy manager, who has recently been moved from the nursing unit to the dementia care unit. This unit has been without a lead nurse for a long time, and has been without clear leadership and direction. The manager must ensure that the residents on the dementia care unit receive a consistent service, and that the unit is developed in line with current good practice. From knowledge of the manager’s demeanour in recent multi-disciplinary meetings, examination of records made of in-house meetings, and from discussions with staff, the style of management does not encourage a two way exchange of views. The registered nurses are not encouraged to be involved in the decision making processes and therefore do not see that they have any responsibility in the running of the home, or the care of the residents. There is an over-riding feeling that all decisions are made by either the manager or the deputy. Resident’s views can be sought when ‘customer satisfaction surveys’ are completed with the activities organiser, however the information gained is not used to make any changes. The home complete a number of quality audits in respects of catering, finance, housekeeping, health & safety, care planning documentation and infection control to name a few. The Annual Quality Assurance form completed for CSCI prior to this inspection made no reference to how the home was monitoring the quality of the service, ensuring that the resident remains at the heart of any decision making process. Mimosa Healthcare have completed an annual “quality monitoring system” audit but this only involved checking administrative functions and paperwork. There are currently no procedures in place to capture views about the day-to-day service provided. At the last inspection CSCI were advised that Mimosa planned to do their first full quality assurance exercise, encapsulating all stakeholder views and opinions. This has not happened, does not evidence that they want to address the “poor image” of the home, and is disappointing. Opinions from the residents, relatives and other visitors to the home, healthcare and social care professionals must be sought and an annual development plan be devised, reflecting the aims and outcomes for residents. The home has procedures in place to manage any monies they hold on behalf of the residents. A number of the accounts were checked against the records held and they tallied. 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 not carried out on a regular basis for all staff, particularly so with the care staff. Care staff confirmed that arrangements are sporadic and that they “get called in” for a session and there is no planning for them to discuss what they want to. DS0000066340.V337443.R01.S.doc Version 5.2 Page 25 The homes records are much improved since the last inspection. The standard of recording is improved and the records are kept secure. The arrangements for storage are better, with nurses offices set up on both floors. 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. Works were currently underway in one of the ground floor bathrooms but measures to protect the resident’s safety were in place. Manual handling assessments are completed for each resident and result in a safe system of work being devised for each person. The plan is kept with all care planning documentation, but a copy is also displayed in each resident’s bedroom. Staff spoken with during the inspection made reference to the location of the guidelines. The home must ensure that these guidelines remain up to date – for one resident their ‘safe system of work’ had not been amended to reflect a recent review of their mobility care plan. Only safe manual handling procedures were witnessed during the inspection however one relative who completed a CSCI survey form said “the staff lift under arm. I have asked them not to do this”. This comment was discussed with the manager who advised that this would be a disciplinary offence if it were to be witnessed. Manual handling training has been arranged with the new training provider and several staff said they had already attended a session. The home needs to monitor any falls and accidents more closely to ensure that any trends are identified. For those residents who have falls, a log of each event should be maintained. This will then mean that staff can put strategies in place to eliminate or at least reduce the risk of further recurrences. The home must ensure that all falls are appropriately recorded, reported and acted upon, as there have been times when this has not happened. Risk assessment processes must be improved to ensure that any possible risks are identified and so far as is possible eliminated. This is particularly important when any new items of furniture are introduced. This will ensure that residents are not placed at risk of injury. DS0000066340.V337443.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 3 8 2 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 1 1 X 3 2 3 2 DS0000066340.V337443.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 OP8 Regulation 13(1)b Requirement The home must ensure that residents receive the treatment, advice or other services from any healthcare professional as necessary. The home must ensure where end of life care needs are identified, appropriate plans are made after consultation with all parties and records are kept. (The timescale for this has been extended to allow for proper consultation with GP’s). Timescale for action 05/07/07 2. OP8 OP11 15(2)c 31/08/07 3. OP12 16(2)n The home must provide a programme of activities that has regard for the needs of the residents and meets their expectations The home must ensure that all complaints made are dealt with as per their complaints procedure and records are kept of any action taken. 05/09/07 4. OP16 22 05/07/07 DS0000066340.V337443.R01.S.doc Version 5.2 Page 28 5. OP18 12(1)b The home must ensure that 05/07/07 proper provision is made for each resident to receive the care that they have been assessed as needing, and also any new needs that have developed. This is so that the health and welfare of each resident is safeguarded. The home must ensure that each registered nurse is suitably qualified, competent and is knowledgeable about the residents who are in their care. The home must establish and maintain a system for reviewing the quality of its service, ensuring that the views of all stakeholders are considered. A copy of the results from any survey should be forwarded to the Commission along with the homes development plan. 05/07/07 6. OP30 18(1)a 18(3) 7. OP33 24 05/12/07 8. OP38 13(4)c The home must identify any 05/07/07 unnecessary risks to the health & safety of residents and take the appropriate actions to eliminate them. • A record of all falls should be maintained where necessary, so that trends can be identified. • Risk assessments must be completed to ensure that unnecessary risks are identified and so far as is possible eliminated. DS0000066340.V337443.R01.S.doc Version 5.2 Page 29 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP24 OP28 OP36 Good Practice Recommendations Care plan reviews must show who is involved in the process Residents bedrooms should always be neatly maintained and respect shown towards residents’ belongings. The homes commitment to NVQ training should be increased to ensure that care staff are suitably trained. All staff should be formally supervised at least six times a year DS0000066340.V337443.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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.V337443.R01.S.doc Version 5.2 Page 31 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!