Inspection on 21/05/08 for Sunnymeade

This inspection was carried out on 21st May 2008.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sunnymeade 15/05/07

Sunnymeade 22/08/06

Sunnymeade 20/02/06

Sunnymeade 25/10/05

Sunnymeade 24/02/05

Sunnymeade 29/07/04

Sunnymeade 10/03/04

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 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Sunnymeade Helliers Close Chard Somerset TA20 1LJ Lead Inspector Sue Hale Unannounced Inspection 21st May 2008 09:00 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 Sunnymeade DS0000016081.V364419.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. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnymeade Address Helliers Close Chard Somerset TA20 1LJ 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) 01460 63563 01460 68217 nicky.passant@somersetcare.co.uk Somerset Care Limited Mrs Nicola Susan Passant Care Home 50 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (50) of places Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service users admitted in the category DE will be accommodated in the units named Kingfisher and Azalea. 15th May 2007 Date of last inspection Brief Description of the Service: Sunnymeade is operated by Somerset Care Ltd, a large provider of residential and domiciliary care in Somerset. Sunnymeade is a 50 bedded purpose built care home, situated in a residential area of Chard. It has five units of eight places all on the ground floor. It also has some first floor accommodation, which residents must be able to climb stairs to reach. It is set in mature gardens, which have been provided this year with greater disabled access provision. The service is well established and provides personal care for Older Persons. The Company has plans for a major alteration to one part of the home and bedrooms within that area in order to enhance and improve services. The current fees are £460.00 to £485 per week. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspection was to inspect relevant key standards under the Commission for Social Care Inspection Inspecting for better lives 2 framework. This focuses on outcomes for residents and measures the quality of the service under four headings, these are excellent, good, adequate and poor. The judgement descriptors for the seven sections are given in the report. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two inspectors undertook this inspection over the course of one day in May 2008.The inspectors toured the premises, spoke to some residents, some staff and the registered manager. We looked at selected care files, staff files and other records relevant to the running of the home. We surveyed residents, relatives and professionals involved with people living at the home. A good response was received and the results are incorporated into the report. (15 from care managers, 11 residents, 16 relatives and 14 staff). Twelve residents surveys were received, 8 defined themselves as Christian, with five saying they were British, 2 English and 6 described themselves as having a disability. A professional surveyed said that care seems to be individually based and diversity accepted. During the inspection one of the inspectors carried out a Short Observational Framework Inspection. This type of inspection looks at staff interactions with the residents to determine if needs are being met and informs inspectors as to the quality of these interactions. What the service does well: The home produces a colour brochure with photographs of the home. A service user guide and statement of purpose are also available. People are encouraged to visit the home and spend time there before making a decision on residency. The home has positive links and good communication with medical and healthcare professionals and residents have access to healthcare services as necessary. A professional commented that the home provided excellent personal care at all times. Comments from healthcare professionals were postive. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 6 A range of activities is available within the home and Sunnymeade has good links with the local community. Staff have access to internal and external training and the majority of staff have achieved NVQ level 2 qualifications with many going on to NVQ level 3 courses. Staff were observed being kind and caring. They demonstrated a good awareness of resident’s preferences and needs. Residents spoken with are generally very happy with the care and support they receive at the home. Health and safety is taken seriously to protect staff and residents. Regular meetings are held with the residents and staff. What has improved since the last inspection? What they could do better: The statement of purpose and service user guide should make clear that there are periods of each day that the residential units are not staffed, and that there are occasions that there is only one member of staff on duty in the dementia unit. Both documents should contain all the required and recommended information so that prospective residents and their families can make an informed decision about residency. Pre admission assessments must be more robust to make sure that the needs of people have been fully assessed, the prospective residents and their relatives have been involved with this and their needs can be met by the home prior to admission. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 7 The computerised records and paper records need to be consistent to reduce the risk that care could be comprised by conflicting information. Care plans need to be reflective of individuals needs and reviewed and updated as necessary. Subsequent to this inspection the Area Manager met with CSCI and it was acknowledged that the staff team needed to contiune to develop their knowledge of the new systems in place. Consideration needs to be given to making mealtimes a more positive experience for people. There should be sufficient staff to provide assistance when required, to ensure that peoples meals are hot and that that they are not waiting for long periods of time for staff to be available. The Safeguarding policy should reflect locally agreed safeguarding procedures and the whistle blowing policy should include details of external agencies in line with good practice. Consideration should be given to how Sunnymeade could be more homely; this should include storage provisions and the display of training certificates in the front hall and main corridor. Infection control practices at the home need to improve to reduce the risk of cross infection. Consultation should take place with people who live in the home in the unit used for day care to find out their views of how the unit is laid out. The home would benefit from redecoration and refurbishment, although the home has stated that there are plans to improve the environment, this has been on going for some time. The laundry area should be cleaned and chemicals must be stored safely to reduce the risk of injury or ingestion by residents. The water temperature on all outlets should be checked frequently to make sure that water is delivered at the right temperature for safety and comfort. A review of the staffing levels has been undertaken by the home and additional staffing hours have been agreed. This includes additional senior cover on the evening shift. It is not acceptable for units to be unstaffed as this potentially places residents at risk. All staff should receive formal supervision in line with NMS. 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. Sunnymeade DS0000016081.V364419.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 Sunnymeade DS0000016081.V364419.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): 1,3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a service user guide, statement of purpose and colour brochure to give prospective residents information about the home but these do contain all the required information for people to make an informed decision. Pre admission assessments, including those for the step down bed are basic and need to be more robust. EVIDENCE: We were given a copy of the homes service user guide (dated February 2008) and the statement of purpose (dated July 2006). Both documents contain photographs of the home. The home also produces a colour brochure with photographs of the home which is available in alternative accessible formats. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 10 The service user guide contains a description of the services offered, views of some residents, gives the details of where people can obtain a copy of the latest inspection report, the qualifications of the registered manager and information about the terms and conditions of residency. It contains general details of the accommodation. It did not contain a copy of the complaints procedure however a leaflet on “Seeking your Views” is included in the welome pack giving people the necessary information. The statement of purpose contained a list of activities, a sample menu, a seeking your views leaflets, the arrangement for reviews, it makes clear that residents families are encouraged to visit and maintain contact with their relatives, it says that two units accommodate people with mental frailty; but does not make clear the homes registration with the Commission for Social Care Inspection. It does not contain the name or address of the registered provider and manager, or their relevant qualifications, the number and qualifications of staff, the organisational structure of the home, the age range and sex of the people who can be accommodated, whether nursing is provided, the criteria for admission, the arrangements made for consultation with residents about their views of the home, the arrangement for residents to attend religious services should they wish to do so, the number and size of rooms in the home or the fire precautions. Prospective residents and their families are encouraged to visit the home and spend time there before they make a decision on residency. The home has a pre admission assessment form. It should be clear from the form where the assessment takes place and who is involved in it and there should be sufficient detail to make a decision on whether the home can meet individuals needs. On one record checked there was no evidence that the person had been involved in the care planning until the first review despite the service user guide that tells readers that the plan will be drawn up with you. The manager told us that a new resident in the step down bed had complex needs and there were concerns that they needed a higher level of care that the home was registered to provide. A discussion took place in relation to the criteria for the step down bed, i.e. as a way to support people to return to the community and that a person who on consideration looked likely to need nursing care did not fit this criteria. The home has acknowledged that they were having difficulty in meeting the residents needs and referred them for reassessment. None of the residents spoken to had seen a service user guide or a copy of any CSCI inspection reports. However, eleven residents surveyed said that they received enough information about the home before they moved in. Sunnymeade DS0000016081.V364419.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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments are inconsistent and not reflective of residents needs. Residents have access to appropriate medical and healthcare related services. Medication practices are not robust and need to improve to make sure residents are protected. Staff respect residents privacy and people are treated with dignity. EVIDENCE: We looked at selected care plans. On one file it was recorded that the person should be weighed weekly but there was no evidence that this had occurred. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 12 Records showed that the person had lost 6.7kgs from January 2008 to 14th May 2008 but no evidence that any action was taken, The person had seen their G.P. on ten occasions during this period but there was no evidence that staff had raised any concerns about the persons weight loss. The care plan had not been updated to reflect the persons weight loss to include any instructions for staff to provide specific care to meet this need. It was also noted on another residents care plan that there was a difference in recording in relation to how often the person should be weighed with one document saying weekly and another routinely. The person had not been weighed weekly. On some care plans checked there were differences in information between the paper record and the computerised record, which could compromise the care given. On one plan the resident had had a stroke but the care plans and risk assessments had not been updated to reflect this and there was no indication from records how the stroke had affected that person and whether their care needs had changed. A full review has since taken place by the company’s Quality Assurance Manager and actioned appropriately with regards to record keeping. On one care plan checked the initial assessment of need reflected information given by the funding authority but the homes assessment was basic and did not develop themes such as identified risks in sufficient detail and did not make clear whether or not the person needs were being met. One of the inspectors undertook a formal short obsevational exerise (SOFI) after lunch. This showed that the interaction between the staff and people living at the home could be improved upon. Eight members of staff surveyed said that they were usually given enough information about the people they look after; three said they sometimes were and three said that they always had enough information. However, one member of staff surveyed said that staff don’t get much information about new people coming into the home. Seven residents surveyed said that they always received the care and support they need and four people said that they usually did. The risk assessments state that by having policies and procedures in place, that in itself reduces risks to people, but this generic statement does not take into account resident individual needs, their specific circumstances or their own environment. The home provides appropriate pressure relieving equipment determined by individual need following a risk assessment. However, the pressure risk assessment tool showed to us was incomplete. It did not give any guidance for staff on what the scores mean and what if any action is needed when a risk is Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 13 identified. Information supplied by the home showed that the guidance was available to staff. Residents have access to a range of healthcare professionals including GP, District Nurse, Social Worker, Chiropodist and Optician. Residents spoken with confirmed that the GP is always available, if required. Nine people surveyed said that they always got the medical support they need with four people saying they usually did. One person surveyed said that in relation to medical support, they spot things before I do and put it right. Ten professionals surveyed said that they felt that individuals health needs were always monitored and five said that they usually were. One professional surveyed said that they were very pleased with the care residents get, another commented that Sunnymeade was an excellent care home. On one file it was noted that it had took 2 carers 35 minutes to get someone washed and dressed this morning. The person concerned is on a single staffed unit so meant that a member of staff from another unit had been present during this time with the second unit potentially unstaffed for this period. The home’s medication is stored securely. The inspector viewed the Medication Administration Record Sheets (MAR) for each person. It was observed that creams and ointments did not all have opening and expiry dates on them. One resident told us that prescribed creams were not always available, sometimes for a few days. They also said that it was not applied as prescribed and staff were so busy that the resident often told them to miss me out to save staff time. On one residents computer records it was evident that prescribed creams had not been available for several days, we looked in the persons room and the creams had been delivered 20.5.08. A healthcare professional surveyed had raised concerns about the delays in delivering prescriptions by the organisations new supplier. Risk assessments were in place for people who self medicate. The home had not recorded the reason for administration of several ‘as required’ medicines. The home should record the reason for administering ‘as required’ medication to ensure that the resident has a consistent delivery of care. Some gaps in medication records were seen. Eleven professionals surveyed said that they thought medication was always managed correctly and four said that they thought it usually was. One professional commented that staff were always quick to notice changes in residents health. Professionals commented on the good and effective communication with staff. However, one professional surveyed said that they thought that sometimes people were admitted to the home whose needs were too complex and that the home was reluctant to transfer onwards. The home had a sample list of signatures of all staff responsible for administering medicines. Photographs of residents and details of any allergies Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 14 were kept with the medication records. The medication policy was dated 2005 and needs updating. Staff were observed treating staff with respect .Six professionals surveyed said that the home always respected peoples privacy and dignity, there said the home usually did and one said that they sometimes did. One professional surveyed said that the home treats people with respect. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 15 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. People who live at the home are seen as individuals. A range of activities are available, consultation should take place with residents to see if they feel that all of these are age appropriate. Visitors to the home are encouraged and made welcome. Staffing levels and deployment of staff are such that many residents do not have a positive experience at mealtimes. Residents were happy with the quality and variety of food available. EVIDENCE: We spoke to some residents who told us that they were able to get up and go to bed at times to suit themselves. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 16 There is a notice board in the entrance hallway, which contained details of the days menu, an Easter newsletter and the activity programme. There are books for residents also kept in the entrance hallway. A professional commented that the home supported one resident to attend the church of their choice. A member of staff also commented that residents were able to continue their religious practice if they wanted to. During the SOFI (please refer to previous section) a member of staff walked into a lounge and put the TV on. They then asked the resident if they wanted the TV, one person said no but the member of staff did not respond and the TV was left on. The home produces a regular newsletter that is available for people living in the home and their families. The spring newsletter included an interesting life story of a resident. Some professionals surveyed said that they felt staff treated residents as individuals and were very good at encouraging /welcoming family and friends to visit. Some professionals commented on the positive links that the home had with the local community. Many residents were still having breakfast at 10am, with people being able to have cereal, toast and a cooked breakfast. The milk was semi skimmed, no whole milk was available. It was noted that some of the tablecloths were frayed and worn. One resident commented that they didnt like having to wait for so long for their meal. During mealtimes staff were particularly busy serving food to people sat at the main tables and those who chose to eat in their rooms. One person was heard to say several times I cant see whats on my plate, but the member of staff was so busy they did not respond. The meal was white chicken on a white pale and people with a visual impairment would have had difficulty in eating this meal independently. The person concerned was also unable to use a knife effectively and could not cut up their food, this was not cut up by staff and the person put large pieces into their mouth and then bit it off, letting the remainder fall to the plate. The person ate very little food but the plate was taken away without any question or any prompts to see if the person could be persuaded to eat more. On one unit the food arrived at 12.30pm and the last meal was served to a resident at 12.54. Two people were seen to have problems in cutting up the Yorkshire pudding and dealt with this by picking it up. On another unit staff told us that the meal trolley had arrived at 12.30pm, the demands on staff time were such that a service users were still eat their main meal at 1.15pm. For residents that needed assistance and prompting for eating the food was cold due to the lack of prompt assistance when the meal was served. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 17 Six residents surveyed said that they always liked the meal and six said that they usually did. One resident said that the meals were very good indeed, a nice variety. One person The kitchen was clean and tidy and there were sufficient quantities of fresh, fired, tinned and fresh food. The home provides special diets as needed and details of individuals likes and dislikes were known by catering staff. Two people spoken to said that the activities provided were inappropriate and were for children so only the very confused enjoyed them. Games that seem to be available were ludo, kerplunk, connect 4, battleships, scrabble, cards and crayons. Four people surveyed said that there were always activities available, four said there usually was, three that there sometimes was and one said that there were never activities available they could take part in. One resident surveyed said that they were left alone too long and felt that the day could be boring. Some members of staff felt that the home worked hard to provide activities including BBQs and garden fetes while another commented that the people would benefit from more outings but the funding comes from our amenities fund which is used in other activities. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 18 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. The adult protection policy did not reflect current locally agreed good practice. The whistle blowing policy should include details of external agencies. Recruitment procedures help to keep residents safe from the risk of abuse. EVIDENCE: The complaints policy was not displayed in the entrance hall but was seen in another area of the home. The seeking your views leaflets does not make clear to readers that people are able to contact us at any stage of a complaint. The information about complaint in the complaints log book for staff referred to the NCSC (National Care Standards Commission) so did not contain the current contact details for CSCI or make clear that complainants are able to contact the CSCI at any stage of a complaint. Nine people surveyed said that they knew how to make a complaint; six always knew who to speak to if they were unhappy, four people usually knew who to speak to and one person sometimes knew who to speak to. Seven professionals surveyed said that the home always responded correctly if Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 19 concerns were raised, three said the home usually did, with four responses blank. The adult protection policy stated that the home would investigate any allegations received. This is not in line with Somerset locally agreed safeguarding adults policy and would potentially comprise any investigation should an allegation be received. The home has a whistle blowing policy but it does not include details of any external agencies or the contact details of the Commission for Social Care Inspection. All members of staff surveyed knew how to raise any concerns that may occur. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 20 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): 19,24,25 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was generally clean and tidy although some areas had an unpleasant odour and the laundry needed cleaning. The home shows evidence of wear and tear and needs investment to update the facilities. Infection control practices need to improve to reduce the risk of cross infection. EVIDENCE: The home was generally clean and tidy on the day of the inspection, although there were some unpleasant odours particularly in the dementia units and some communal toilets. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 21 Each of the units (with the exception of one) has its own dining and kitchen areas. The kitchen areas were re-fitted in 2007. The home also has a main lounge and dining area. The communal bathrooms and toilet appeared clean and tidy although some as stated had an unpleasant odour. The bins were not foot operated and were open topped which could present a risk of cross infection. Not all bins had liners in. Hand wash and paper towels were available in most but not all bathrooms and toilets. Some hand wash dispensers were empty. Gloves and protective clothing was readily available to staff. There were no clinical waste bins in communal bathrooms or toilets, the manager told us that staff bag clinical waste and dispose of it immediately. Six residents surveyed said that the home was always fresh and clean; five residents said that this was usually the case. One resident said that the cleaners try very hard to keep it sparkling clean, while another commented that floors dont always get mopped and are sticky, while another person commented that more en suite facilities should be provided. This was also raised by a healthcare professional who stated that the physical environment of Sunnymeade could be improved particularly the size of rooms and the availability of ensuite rooms. In the dining room some light bulbs were not working and one bulb had been removed leaving the fitting exposed. We spoke to two people in the dining room who live in the home, they told us that they only had four chairs at the end of the dining room in which to sit other than their room and the main lounge in that area was used by people attending for day care. Some clocks in the home were not working. The home requires updating and refurbishment due to wear and tear, some furniture is worn, paintwork is worn, and many window frames are corroded and need painting. One relative surveyed said that the home would be improved greatly with double glazed windows. The paint is flaking on the kitchen ceiling; this could potentially fall into food. Wheelchairs, hoists and sit on scales are kept in the corridors due to lack of storage space. The laundry was not locked and contained chemicals that could be ingested or case injury to residents. There was a lockable cupboard inside the laundry, with a lock on but this was open. The sink area was dirty and the sink contained debris. One resident surveyed said that when washing goes missing they dont seem to care if they find it, but people spoken to on the day of the inspection said that there had been problems with the laundry due to short staff but that this had improved lately. One radiator has been guarded since the last inspection. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 22 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): 27,28,29,30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels do not meet the needs of people living at the home in a person centred way. Staff have access to internal and external training. The majority of staff have achieved N.V.Q level 2 qualifications. Staff recruitment procedures are robust and protect residents. EVIDENCE: A staff rota was seen that recorded the designation of all staff. There are occasions when the residential units are not staffed for periods of time; this is not made clear in the statement of purpose or service user guide which says that the home is staffed 24 hours a day. Although it does make clear that staffing levels vary at different times of the day it does not state that there are periods of each day when some units are not staffed. The Ms Passant told us that the organisation has agreed to increased staffing levels and that posts would be advertised this included carers and a shift leader. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 23 The units are staffed by one person, who has to leave the unit to complete paperwork on the computer and to assist staff in other single staffed units with residents who need assistance from two people with personal care or mobilising. A member of staff told us that residents had a neck pendant that they could use to call for attention and that staff told residents when they were leaving the unit. However, not all the residents on units that were classed as safe for residents to be left alone for times had neck pendants. Several staff raised concerns about the staff level in surveys, comments included, could do better More staff, make sure all the units are covered by care staff at all times not just part of the day, Often short staffed, a supervisor and a shift leader on every shift especially in the mornings will be useful. and we are often short staffed we have no extra carers; seniors and managers never help on the floor when short, all these comments were made by different individuals. Some staff told us that they had left the unit unstaffed on several occasions on the day of the inspection to answer buzzers from other units. Six residents surveyed said that there was always enough staff available with 5 people saying there usually was and one person saying that there sometimes was. The responses of residents surveyed varied. One resident surveyed said that they were left not wearing hearing aid alone in the lounge with no staff from 1.30pm onwards, with no alarm (round their neck). However, one person said that staff available and very prompt. Staff were observed throughout the day to be hard working and under pressure. However, staff were seen to be kindly and professional towards residents. Professionals surveyed described staff as helpful and well trained. Six staff surveyed said that there was usually enough staff available, four said sometimes, two said there was never enough staff available and only one person surveyed said they felt there was always enough staff on duty to meet individual residents needs. Recruitment systems in the home were found to be robust. The inspector viewed three staff files. These contained all of the required documentation listed in Schedule 2 of the Care Homes Regulations 2001. The home employs 36 care staff, 75 of which are qualified to NVQ level 2 or above. A further 2 staff are currently registered on NVQ level 2 courses. The home has a comprehensive staff training programme. This includes training in dementia awareness, activities, nutrition, first aid, signs and symptoms, food hygiene, health & safety, fire safety, and moving & handling. The manager confirmed that all staff have received the required mandatory Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 24 training. Fourteen staff responded to our survey, the majority of whom said that they had access to up to date, relevant training. Five staff said that the induction covered all aspects of the job very well and nine people said that it mostly covered the relevant areas. However, ten staff surveyed said that they usually felt that they had the right skills and experience; two felt that they only sometimes did with only two staff saying that there were always confident about their skills and knowledge. Some staff surveyed were doing NVQ training course and felt that this was really useful and helped them in their work. Numerous staff training certificates were displayed in the entrance hallway /corridor, some of which appeared to be out of date. This does not contribute to a homely atmosphere for people living at Sunnymeade. (As described in the service user guide page 3). Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 25 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 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a range of quality assurance measures in place. Residents’ monies are safeguarded. Supervision of staff is inconsistent and needs to follow national guidelines. Health and safety is taken seriously. EVIDENCE: Mrs Nicola Passant is the registered manager. She has many years experience in the care industry. Mrs Passant has completed an NVQ 4 in Management. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 26 Four professionals surveyed said that the manager and staff always have the right skills; nine said that they usually did with one saying that they sometimes did. The responses from the staff surveyed were mixed. Some staff said that they did not receive feedback or support from the management. However one staff member felt they could go to the Manager with issues. Some staff surveyed felt that there was a lack of understanding of the pressures staff were working under. The home’s quality assurance systems include a self audit against the National Minimum Standards. This is followed up with an action plan. The audit is undertaken at intervals at the request of Somerset Care head office. Suggestion forms are provided in the entrance to the home. The manager advised that surveys are sent out to residents and families. We were told that there had been one residents meeting in July 2007,minutes were taken and this showed that residents were able to make suggestions about activities and events and two residents volunteered to be part of the interviewing process for new staff. There had been had also been a meeting in April 2008 with 7 residents attending, Minutes were taken and these detailed the events planned, the change to Pharmacy Plus and discussion about the fire procedures. The home holds monies for some residents; monies were stored securely and robust systems in place to safeguard residents finances. Records checked were found to be correct. The homes registration and insurance certificate were displayed in the entrance hallway. There was no copy of the homes last inspection report. None of the residents spoken to had seen a copy of the last report. Selected residents finances were checked and found to be correct. Record keeping was good and procedures robust to safeguard individuals monies. Records were seen that evidenced that the home maintained and serviced the necessary equipment except the hoists, which were due to be serviced during May, and these had not yet been done. No evidence was available that water outlets were regularly checked to make sure that water was delivered at a temperature that was comfortable and safe. Fire safety equipment had been tested and a fire risk assessment was in place. There was evidence on the staff files looked at that yearly appraisal took place for most staff and that some staff had received formal supervision although this was not as frequently as recommended in the national minimum standards. Four staff surveyed said that the manager regularly had discussion with them; four said this happened often, four said this occurred sometimes Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 27 and one said never. One member of staff said that they have not had a threemonth appraisal/feedback on my job. Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 28 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 2 X 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X 2 2 2 STAFFING Standard No Score 27 1 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 2 X 3 Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation Schedule 1 (1-8) (10-12) (14)(16) 15(2)(b)(c ) 13(4)(c) Requirement The statement of purpose must contain all the information required by the Care Home Regulations. The registered person shall keep the service user’s plan under review; where appropriate and, unless it is impracticable to carry out such consultation, after consultation with the service user or a representative of his, revise the service user’s plan. Care plans must be reviewed, updated and actioned to ensure that the resident’s current needs are being met appropriately. The registered person shall ensure that unnecessary risks to the health or safety of service users are identified and so far as possible eliminated. The home must ensure that risk assessments are accurate when they are updated to reflect resident’s changing needs and to minimise the risk to the resident and staff. (Previous timescale of 15/07/07 Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 30 Timescale for action 30/08/08 2. OP7 30/08/08 not met). 3 OP9 13(2) The registered person shall make 30/07/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. (Previous timescale of 22/05/07 not met). 4 OP19 OP22 16(2) (k) All areas of the home including residents rooms and communal toilets must be free from unpleasant odour. The kitchen ceiling must be free of flaking paint. The home must ensure that staff are employed in sufficient numbers to meet the needs of service users. All chemicals must be stored securely. The laundry door must be locked. 30/07/08 5 6 OP19 OP27 13(4)(c) 23 (2)(b) 18(1)(a) 30/07/08 30/07/08 7 OP38 OP26 13(4)(a) (c) 30/07/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP1 Good Practice Recommendations The statement of purpose and service user guide should make clear that the residential units are unstaffed for periods of each day. The service user guide should include details of the staffs qualifications, the complaints policy and the current fee. Consideration should be given to providing more details about the individual accommodation available. DS0000016081.V364419.R01.S.doc Version 5.2 Page 31 Sunnymeade 3. OP3 The home should ensure that prospective service user’s needs are assessed accurately to ensure that the home can meet their needs appropriately. The home should record the reason for administering ‘as required’ medication. Outstanding since the last inspection. 4 OP9 5 6 7 OP9 OP16 OP15 The medication policy should be updated to reflect current good practice guidelines for care homes. Information about complaints should be consistent. Serious consideration should be given to providing whole milk and obtaining up to date information on the dietary needs of older people. The adult protection policy should be updated to reflect locally agreed safeguarding adult protocols. The whistle blowing policy should include the contact details of external agencies including Public Concern at work. Consultation should take place with people who live in the home in relation to the use of the main lounge by people who attend for day care. All clocks should work and be at the correct time. All residents should be offered a bedside light. All bins in toilets and bathrooms should be foot operated and lidded. All bins should be lined. The laundry area should be thoroughly cleaned. Consideration should be given to the display of staff training certificates in the residents home. Staff should receive formal supervision at least 6 times per year. The supervision should cover the topics detailed in nms 36.3. The water temperature on all outlets should be checked more frequently. 8 9 10 OP18 OP18 OP19 11 12 13 14 15 16 OP19 OP24 OP26 OP26 OP30 OP36 17 OP38 Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 32 Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 33 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 Sunnymeade DS0000016081.V364419.R01.S.doc Version 5.2 Page 34 - 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!