Inspection on 19/01/07 for Sunnymede Nursing Home

This inspection was carried out on 19th January 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Sunnymede Nursing Home 25/07/07

Sunnymede Nursing Home 08/06/06

Sunnymede Nursing Home 15/10/05

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 Sunnymede Nursing Home 4 Vandyke Avenue Keynsham Bath & N E Somerset BS31 2UH Lead Inspector Wendy Kirby Key Unannounced Inspection 09:30 19 , 23 , 26 January and 21st February 2007 th rd th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sunnymede Nursing Home DS0000060331.V325151.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. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnymede Nursing Home Address 4 Vandyke Avenue Keynsham Bath & N E Somerset BS31 2UH 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 9863157 0117 9862232 Charlton Care Homes Ltd Bernice Currey Care Home 41 Category(ies) of Old age, not falling within any other category registration, with number (41) of places Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Staffing Notice dated 8th April 2002 applies. Manager must be a RN on parts 1 or 12 of the NMC register. Date of last inspection 8th June 2006 Brief Description of the Service: Sunnymede is registered to provide nursing care for up to 41 older people. The home is a converted older property partially extended and set in wellmaintained gardens with a pleasant location. The home offers accommodation over 3 floors, access being provided by stair and lift access. The home is situated within ¼ mile of the centre of Keynsham and many local amenities. Local venues are best accessed by car because of the gradient of local roads. The cost per week to reside at Sunnymede Nursing Home ranges between £486.00 and £580.00. Fees are reviewed annually and if care needs increase. This weekly fee does not include provision for items such as hairdressing, chiropody, dental, ophthalmic, or audiology services. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection conducted as part of the annual inspection process and included a three day visit to the home on the 19th, 23rd, 26th of January. Following this a service of concern meeting was held at the CSCI Aztec West office. The Company Director, Mr Andrew Cohen, Operations Manager Mrs M O’Conner, Area Manager Mrs L Hudson and Registered Manager Mrs B Currey attended the meeting. Details about the meeting are detailed in the report under the section entitled “What they could do better”. During the visits to the home the inspector spent time in discussions with the area manager and the registered manager. A number of records and files relating to the day-to-day running and management of the home were examined. Four residents care plans and care files were examined. The inspector spoke with the residents and observed them going about their daily routines. An extensive tour of the premises was undertaken, accompanied by the area manager and registered manager and an environmental audit was conducted. Members of staff were observed on duty and eight were consulted individually. The inspector sent questionnaires “Have your say” to residents in the home prior to the inspection and nine were completed and returned. Relatives and visitors “Comment Cards” were also sent and nineteen of these was completed and returned. Seven comment cards were completed and returned from visiting health care professionals. All of the information received is detailed throughout the report. Information from these has been collated and are detailed throughout the report. Feedback was given following each day of the inspection to the area manager and the registered manager on the outcomes. It was clear from this inspection that staff are committed to providing good personal care to residents. However the quality of the service is seriously compromised by the very poor state of the environment, which is in many instances unsafe and detrimental to health. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The service of concern meeting as mentioned above was arranged to discuss CSCI’s concerns and the points raised and discussed were as follows: Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 7 CSCI have served the organisation with 5 Statutory Enforcement Notices (Regulation 43’s) relating to: 1. Poor cleanliness in the home 2. Compromised privacy and dignity of service users 3. Potential risks to service users due to unsafe hot water temperatures and unprotected surfaces to radiators. 4. Unacceptable refurbishments throughout the home 5. Risks of cross infection due to inadequate sluicing facilities. An improvement plan has been submitted by the provider detailing all the work to proceed with set timescales in order to meet the set requirements. Further requirements made as a result of this inspection are as follows: 1. Suitable provision must be made for residents to receive their visitors in private accommodation, which is separate from their bedrooms. 2. Provide suitable dining room seating and table facilities so that residents can enjoy their meal times comfortably and in a congenial setting. 3. Dilapidated vanity units and old, cracked, stained sinks must be replaced. 4. Replace all lounge/recliner chairs identified during the environmental audit to ensure that they are of good quality, comfortable and able to meet the purpose for their intended use. 5. Provision must be made to ensure staffing levels continue to reflect the assessed needs and dependency levels of the residents at all times. 6. A system to be put in place so that residents and their advocates have the opportunity to discuss any issues, views and level of satisfaction about the service they are receiving. 7. Until safe provision has been made with regards to hot water temperatures and unregulated temperatures of radiators, risk assessments must be completed by the manager to ensure the safety of residents’ visitors and staff. A copy of this must be sent to CSCI CSCI will continue to monitor the home closely and carry out further timely inspections to ensure that requirements detailed in the improvement plan are resolved and that progress is being made. This will ensure the home complies with both the Care Home Regulations and National Minimum Standards. 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. Sunnymede Nursing Home DS0000060331.V325151.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 Sunnymede Nursing Home DS0000060331.V325151.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents needs are assessed prior to admission to determine the suitability of placement. They can be confident that staff will have the resources and skills to meet their assessed needs. EVIDENCE: The Inspector looked at the pre-admission assessments, which were comprehensive covering activities of daily living, a full health screen and personal history background. The information gathered pre-admission provides a sound benchmark of the resident’s ability and state of health prior to admission. The prospective resident, family and carers are involved in the pre-assessment and all information is used to determine the suitability of the placement. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 10 Where possible the manager had obtained assessments and care plans from other professionals involved for example, social workers and hospital staff. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Because they are consulted about their health and personal care needs residents can be sure their views and expectations will be considered. End of life plans ensure that residents last wishes will be acknowledged and respected Safe systems help to protect residents from the risk of medication errors. Residents’ privacy and dignity is at times compromised within the service provided. EVIDENCE: From the pre admission assessments the manager and the registered nurses are able to develop a set of care plans based on identified needs. During the first months trial period the residents’ plans are reviewed weekly and developed accordingly, the resident and their families are involved in this process wherever possible. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 12 A new system has been developed in the home whereby a care review meeting is arranged every six months for residents, involving their family members and key worker. This meeting is used to discuss and evaluate the residents’ care plans and also gives the opportunity to raise any issues or concerns. All relative/visitors comment cards agreed that they were kept informed of important matters affecting their relative/friend and were consulted about their care. Four residents records were looked at in detail, including pre-admission assessments, care plans personal history profiles and risk assessments. All records evidenced consistency in assessing, planning, implementing and evaluating the resident’s care. Random care files are audited monthly by the registered manager and the area manager during her monthly unannounced visits to the home (Regulation 26 visits). Residents had signed that the care plans had been discussed and that they agreed with the information and the aims and objectives contained in them. The care plans were very person centred and included detailed information including preferred choice of clothes to wear, what times to get up in the morning and preferred choice to have lunch. Personal history profiles on the residents were very useful and usually completed with the resident and the activities coordinator; information obtained included details of the residents’ childhood, adolescence and adulthood memories. Risk assessments were in place with detailed information to ensure safe procedures for example, manual handling, the correct use of bed rails and how to reduce the risk of falls. Health Care needs were well evidenced in the Care Files and included continence, nutritional and pain assessments. Records of the General Practitioner (GP) visits with residents and the outcomes were also documented. Specialist referrals and visits from other professionals including Chiropractors, Dentists and Opticians were also seen. All residents’ surveys confirmed that they felt they received the medical support they needed. Each resident is referred to a GP on admission to the home and an initial first visit is then arranged. Although the GP does not conduct weekly visits to the home, good working relationships with the GP have been formed and the GP will visit on request. Visiting health and social professionals comment cards stated, “I always feel that the staff at Sunnymede are very efficient and caring”, “Staff are always helpful and communicate well with us” and “I cannot fault the care given by staff to residents and their families”. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 13 Policies and procedures for receiving, storing, administering and disposing of medications were examined and discussed with the manager; all systems in place are effective and well managed. The home operates a monitored dosage system for the administration of medication, which is supplied at regular intervals by the local pharmacist. The GP’s conduct a medication review for all residents every six months. The home also keeps an accurate stock check of medicines given on an as required basis. Fridge temperatures are recorded daily. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. Staff were seen knocking on residents doors before entering confirming respect for the residents individual privacy and dignity. However there are other issues in the home that have been identified at previous inspections where the residents right to privacy and dignity is compromised. Previous requirements have been made following inspections carried out in the home from January 2006 to June 2006 with regards to refurbishment of residents’ bedrooms. During these inspections environmental audits that were conducted which highlighted that many residents rooms were not provided with suitable screening, for example net curtains or blinds. Existing curtains in many rooms were missing curtain hooks and in some cases did not fit the window size. When drawn the curtains would not meet or hang adequately. As mentioned in the summary of this report a further extensive audit of the residents’ bedrooms was conducted and although a small minority of bedrooms had been provided with adequate screening the majority had not. Consequently enforcement action is being taken following the serious failure of the service to comply with the requirements made. In addition to this, residents, relatives and visitors have often commented on the lack of private accommodation available to spend quality time without having to use residents’ individual bedrooms. Several visitors explained that the level of privacy in the residents lounge when visiting was restricted due to the television and the general activity within the lounge. Provisional arrangements were made due to a vacant bedroom becoming available, which was temporarily allocated as a “quiet” room whereby residents could receive guests without having to use their own bedrooms. Subsequently a recommendation was made that a permanent solution should be sought for residents to receive guests. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 14 During this inspection it was disappointing to see that this room is now being used for storage purposes and that staff were also seen having lunch in this room. A requirement will be made as a result of this inspection to provide private suitable facilities for residents to meet with visitors in private, which is separate from their own bedrooms. The manager and staff make every effort to establish resident’s wishes concerning palliative care and any provision residents and their families would wish for by developing end of life care plans. The manager explained that the plans are sensitively completed with residents and their families/significant others. Some families had chosen to take private time together to discuss their wishes and then pass the information on to the home so that a care plan could be devised. Plans were personalised and signed by the residents and a member of staff. The information sought was well thought out and should help ensure that residents’ choices are respected. One question asks, “What would you not like to happen in the event of ill health” and comments included, “I do not want to be admitted to hospital” and “I want to be pain free”. Sunnymede Nursing Home DS0000060331.V325151.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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Encouragement from staff enables residents to maintain good contact with family and friends. Residents receive a varied and wholesome diet that they are able to influence; however their comfort is compromised in the dining room setting. EVIDENCE: In conjunction with the residents the activities coordinator develops a monthly timetable of activities and forthcoming events. A copy of this is placed in communal areas throughout the home, to ensure that all residents and visitors are aware. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 16 The activities coordinator continues to provide a varied programme of activities for the residents. She is a well-established member of staff who is knowledgeable of the residents’ needs and aspirations. The coordinator is responsible for documenting a record of any activities the residents have taken part in. The inspector examined four residents’ files, which evidenced that this is being done. The information was detailed and provided a very useful reference guide. It was apparent that individual needs and aspirations were catered for. The photographic display of memorable days and events continues to be very popular with residents, visitors and staff and is on display in the corridor. The board is regularly updated and provides memories and topics of conversation for residents where they are able to reminisce. The home continues to explore new activities for residents, visiting entertainment and places of interest to visit. The music therapist visits the home every month to conduct a session tailored for all residents to participate in but it is particularly engaging for residents with dementia. Residents are given musical instruments to play with to music and after the session they perform a mini concert for staff and any residents who chose not to participate. On the second day of the inspection a mobile animal zoo was visiting the home, which was a great success, residents were able to hold and touch the animals and ask lots of questions. Residents are supported to satisfy their religious preferences. Several denominations visit the home for individual residents and every six weeks an interdenominational group visits the home to provide a service that represents various individual faiths. One residents survey stated, “I enjoy the church services provided”. Residents stated in their surveys that activities were provided in the home that they could take part in and comments included, “I enjoy all the activities and outings”, “I particularly enjoy the music therapy” and “Although I prefer to stay in my room and watch television I do like go on the outings arranged”. The home operates an open door policy for visitors and all comment cards received stated that staff welcome them to the home at any time. The home has three weekly menu rotas, which consist of a varied, wellbalanced choice of traditional home cooked meals. Each day residents have a choice of two meals and in addition to this omelette; fish or ham is also made available on a daily basis. The menu includes alternative choices for residents who are diabetics or those requiring a pureed diet. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 17 The cooks or the assistant visit each resident every morning to gain feedback on the food served the previous day and take requests from the menu plan for the day ahead. Residents’ surveys expressed that, “The food is always very good”, “Good choice of meals offered” and “ I had lovely scampi yesterday”. The inspector observed lunchtime on the third day of the inspection. The manager has utilised one of the lounge areas as a dining room since the previous inspection, because it is bigger and allows for more residents to enjoy the social advantages of dining together. Unfortunately it is not able to accommodate everyone. Staff had used their expertise and knowledge of the residents, personalities, preferences and ability to eat independently, when seating them for lunch. The dining room furniture was quite shabby in appearance and inappropriate for the needs of many residents. The tables accommodate up to four residents. Many of the residents require seating with adequate support for example arm rests. The dining room chairs are not suitable to provide this support to the residents and therefore have to remain in their wheelchairs. Because of the size of the wheelchairs and the restricted height of the tables, residents are unable to get up close to the table to eat their meal comfortably. There were no tablecloths and the placemats were worn, stained and cracked. During lunch the supply glasses had run out and residents were given plastic beakers with handles. The dining room ambience was not dissimilar to that of a café. Staff members supported residents that required assistance with eating their meals in a respectful, sensitive way. Staff sat at the same level as the resident and assisted them without rushing. They were also seen to be polite and helpful when serving the meals. It was noted that a large majority of residents require assistance with eating their meals, including feeding and regular prompting. Sunnymede Nursing Home DS0000060331.V325151.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): 16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are robust and comprehensive policies in place to ensure that complaints by residents or their families are taken seriously and acted upon. There are good arrangements in place for staff training and awareness of protection of vulnerable adults so that residents are protected from abuse. EVIDENCE: A ‘comments’ book is available and kept by the visitors’ book to enable visitors to make positive comments as well as record their concerns. A copy of the complaints procedure is on display, which means people, will know how to obtain the required information if they want to make a formal complaint. The complaints policy and procedure is detailed and contains all the required information. Residents’ surveys and relatives comment cards stated that they knew how to make a complaint and who to talk to if they were not happy. The home has written procedures for adult protection, whistle blowing, management of aggression, abuse, bullying and management of money/valuables. The ‘No Secrets’ document is also available. The inspector did not view all of these policies during the inspection. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 19 The manager informed the inspector that the organisation actively promotes staff training and education in these areas, all staff attend training in dealing with difficult behaviours and protection of vulnerable adults. Staff training records evidenced this commitment. A number of staff are undertaking the National Vocational Qualification in care award, and a component of the award addresses issues around the topic of the protection of vulnerable adults from abuse. Sunnymede Nursing Home DS0000060331.V325151.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): 19,20,21,23,24,26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents do not live in a safe and well-maintained environment and are at risk in some areas of the environment. Bathing and toilet facilities are inadequate. The hygiene and cleanliness of the home is poor. EVIDENCE: The Commission has made various requirements about the environment and the potential risks to the health, safety and welfare of residents, visitors and staff in the home. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 21 Some of these requirements have been ongoing since October 2005 and despite conducting a service of concern meeting with the registered provider in May 2006 and repeating statutory requirements that have been made following subsequent inspections, the majority of the requirements remain only partially met or outstanding. Consequently enforcement action is being taken following the serious failure of the service to comply with the requirements made under the National Minimum Standards and the Care Homes Regulations 2001. Due to the number of failures in terms of the environment, which are too numerous to mention in this report, the following, are just some examples of the outstanding requirements and what was identified during this inspection. Residents Bedrooms Although some provision had been made, many still require redecoration and refurbishment which includes replacing existing vanity units, and replacing old cracked sinks, provision of adequate storage facilities, new headboards, lampshades, flooring, lounge chairs, curtains and nets/blinds. Sluicing There have been ongoing concerns about the top floor sluice that contains facilities only suitable for “slopping out”. Staff confirmed that five out of the six residents on the top floor require the use of a commode and that they continue to take soiled bedpans through the top floor corridor down the stairwell to the sluice downstairs, which has adequate disinfecting facilities. This is poor practice with serious implications for potential cross infection. On the second day of the inspection it was noted that one of the sluice floors was in very poor state and in need of replacement and the sluice disinfector was leaking. By the third day of the inspection the maintenance operative had repaired the leak, replaced the flooring and the room had been deep cleaned making a vast improvement. Bathrooms and toilets Only one bathroom has been refurbished following previous requirements, and this has been completed poorly. In particular the tiles have not been laid well and look as if they may come off the wall and the existing bath hoist has already chipped enamel from the surface of the new bath when lowered into the water. This will be a potential risk for cross infection as the chip will get bigger and rust will occur. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 22 Two long nails were sticking up from the base of the toilet in this bathroom, where it had obviously been removed when fitting the new flooring. The radiator had no protective guard or thermostatic temperature control. Refurbishment of the other bathrooms and toilets had not been commenced. Communal Lounges The lounge at the back of the house was dirty, particularly around a crevice area under the conservatory windows. These crevices had collected large amounts of dust, flies, moths and food debris. Underneath these windows were radiators, which had all of the guards hanging off, and pipe work exposed. On the second day of the inspection these areas had been cleaned and the maintenance operative had replaced the radiator guards with new ones. The lounge at the back of the house smelt of urine. It was not sure where the source of the smell was coming from, however the carpet either needed a shampoo or replacement and the lounge chairs were grubby with worn threadbare fabric which was torn in places. Some new chairs had been purchased in an adjacent smaller lounge, however it was noted that at least six non-reclining chairs required replacement and nine reclining chairs. In the front lounge two radiator pipes were jutting up approximately twelve inches out of the floor where the radiator had been previously removed. An immediate requirement was made to make this safe. This problem was also identified in other parts of the home. Corridors, hallways and stairways have not been redecorated and remain in a bad state of repair. Hot water outlets Three repeated requirements had been previously made to ensure that hot water temperatures were not above the safe recommended levels of 43oC. Although some provision had been made in residents’ rooms by fitting thermostatic control valves, at least seventeen were identified at this inspection that had not had this done. Temperatures were checked for most of these by the inspector and they ranged from 45oC to 50oC. Radiators Various radiators throughout the home still require either protection guard’s fitted or temperature control valves to guarantee safe low temperature surfaces. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 23 Hygiene and cleanliness Previous requirements have been made over the cleanliness of the home and, although the home has deployed additional domestic hours, the cleanliness of the home remains poor. In some areas of the home it was difficult to assess the cleanliness due to the poor décor/paintwork, dilapidated furniture and worn, torn fabric on upholstery, old curtains and existing nets and carpets. Windows were also dirty and the paint on the frames and window seals was flaking. Much of the dirt in the home is ingrained. There was no evidence of recent systematic high-level cleaning particularly as mentioned previously in the communal areas. The wheelchairs were encrusted with talc, food debris and liquid spillages. Commodes were spot checked by the inspector and these too were dirty. Bedside tables and small tables used in the lounges for residents to eat at or place drinks on were also encrusted with food debris. Some of these tables had been replaced since the last inspection due to rust, split plastic covering to the frames and general wear and tear, however other such tables were identified during this inspection and require replacement. On the first day of the inspection the inspector noticed some rubbish in one bathroom on the floor behind a bin. Four days later on the second day of the inspection the rubbish was still there. The inspector picked up the rubbish and found latex gloves, a china handle from a cup, plastic tabs from incontinence pads and a piece of faeces. The home has appointed a full time housekeeper to work as a domestic and coordinate ancillary workloads within the home. There is an additional full time domestic staff member and a vacancy exists for a weekend position. During discussions with the area manager it was suggested that the home has at least one hundred domestic hours per week. This does sound like an adequate staff provision for a home of this size, however on the third day of the inspection it was evident that the one hundred hours previously stipulated also includes a full time post for laundry services. Without the weekend domestic hours covered it would be difficult for the weekday cleaners to catch up and keep on top of their normal duties. Due to the current vacancy for a cook the housekeeper has been covering some of these shifts rather than cleaning. All of the factors mentioned above may have some bearing on why the cleanliness of the home is so poor. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 24 Health and safety Besides the factors mentioned above several other potential areas at risk were: an overloaded wardrobe not secured to the wall, two cracked wall plug sockets which were in use and a fully opened bottom drawer in a bedside cabinet which wouldn’t stay shut. Subsequently immediate requirements were made to eliminate the potential risks associated with these factors to help ensure residents, visitors and staff safety. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The staffing levels are not adequate to help ensure that resident’s needs are fully met. Residents are supported and protected by the homes recruitment policy. Staff are trained so residents should receive a service from a confident and competent team. EVIDENCE: Staffing levels have been monitored and reviewed following previous requirements. Additional trained nurse hours are now deployed to allow the manager to work supernumerary. Following a service of concern meeting with the registered provider in May 2006 it was agreed that an additional carer would work a twilight shift from 6.30pm-9.30pm to assist the night staff to manage more effectively when putting residents to bed. Staff spoken with at the inspection in June 2006 confirmed that this had been a positive move and that residents were able to go to bed at a time of their choice and that staff felt they had sufficient time to do this without feeling hurried. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 26 During this inspection the inspector enquired about the continued effectiveness of this additional staffing provision she was informed “it works really well when it happens”. The part time position had not been filled on a permanent basis and the manager was relying on existing staff to pick up the extra occasional shift when they were able to so. Consequently the twilight shift remains uncovered and the residents’ choice to go to bed when they want to and at a reasonable time is now compromised. One relatives comment card stated, “The twilight shift has its problems but the idea of it is very good”. This is completely unacceptable practise and contradicts the homes philosophy of care in that staffing levels will increase when the dependency levels of the residents changes. It also undermines and shows the homes complete disregard for the requirements made under Regulation 18 (1) (a). An immediate requirement was made for the shift to be covered indefinitely at all times until the high dependency levels of the residents’ changes. Through further discussions with the residents, manager and staff it was evident that there were major shortfalls providing personal care in the mornings and that fluid and nutritional needs were also compromised. On the third day of the inspection the inspector noted than many residents were being brought down for lunch after 12.30pm and looked like they had just woken up. Staff admitted that very often due to the dependency levels of the residents some could be got up as late as 12.30pm. When asked about the provision of mid morning drinks for those residents some replied that they take it up to their allocated residents and give it to them in bed and others admitted that sometimes they are just too busy to give them a drink particularly those residents who require assistance. Many staff felt that they rushed the residents when delivering personal care and that they had to cut corners in order to get all the work done. Other staff felt that it was better to take your time and not rush the residents but this meant that some residents were often offered lunch having only just got out of bed. The inspector examined some of the dependency levels of residents compared to the levels determined at the previous inspection. The number of residents with dementia had increased by four to twenty-six, residents requiring help with dressing and undressing had increased by one to twenty-nine, residents who require supervision with eating and drinking had increased by four to twenty-one. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 27 Residents’ surveys ask “Are staff available when you need them?” and “Do you receive the care and support you need?” comments included, “ The staff are very good but I have to wait if they are seeing to someone else”, “Not all the time”, “Sometimes they are very busy” and “They do their best”. The inspector examined staffing rotas. Some staff were on leave and replacement staff names had been inserted to keep the required levels. The manager uses her own staff group to cover any staff absences and on occasions has used agency. However staff confirmed that not all shifts are covered on every occasion and they have had to work with reduced staffing levels. One relative stated, “Although there is always someone to contact I feel that sometimes staff are under pressure, especially when residents request the toilet facilities”. At the time of the inspection thirty out of thirty-one residents require an amount of assistance with meeting toileting needs. An immediate requirement was made to deploy additional care staff hours in the morning to help ensure that residents receive personal care in an unhurried manner, at a time of their choosing and that all residents are offered a mid morning drink. Staff morale did seem low at times during the inspection, when staff were asked, “Do you think the residents are well cared for at Sunnymede?” they replied, “We do give them a lot of love”, “It would be nice not to rush so much in the mornings” and “Sometimes you can go home feeling frustrated”. Comment cards received from relatives and visitors to the home stated, “Myself and my family appreciate all of the staffs efforts and good work and the brilliant care they give our relative”, “Staff are always welcoming and do their best to make my relative happy” and “Generally I feel the home is well run with obliging staff who are friendly and helpful”. A visiting health care professional to the home stated, “I find the staff caring even to the extent of giving up personal time in the interests of the residents. The staff are familiar with the clients backgrounds and needs and deliver good care under not always ideal conditions”. The recruitment process was examined and all staff records examined showed that the home follows correct recruitment procedure and policies. Records contained application forms, references, and a CRB (Criminal Records Bureau) disclosure. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 28 As mentioned in the last report the induction programme is a fairly comprehensive document based on the Skills for Care standards. The document acts as a prompt for the trainer to discuss issues, systems and policies with new staff, who then sign to say the information has been given. After completion of the induction training staff go on to commence foundation training this again was a fairly comprehensive document based on the Skills for Care standards. The home continues to support their staff with NVQ training and the enrolling programme continues. A training matrix has been developed and the inspector was able to see that all mandatory training was undertaken and course dates had been organised for staff up to December 2007. The manager and staff are conscientious in attending training relevant to the care needs of the residents. This year the team are focusing on training in “Caring for people with Parkinson’s disease”, “Dementia awareness” and “Understanding visual impairment”. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 29 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): 31,33,35,36,38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are some areas of management that have major weaknesses, which compromise running the home in the best interests of the residents. Staff receive supervision, however the sessions are not up to date. The homes record keeping policies for financial procedures safeguard residents so that residents can be sure their finances will be managed correctly. The health and safety of residents, staff, and visitors will be further protected when risk assessments are in place. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 30 EVIDENCE: Mrs Currey has been the manager at Sunnymede for four years. She has a dedicated team who work with her to try and ensure that the highest standards of care are achieved and maintained. Mrs Currey is a registered general nurse consistently demonstrates a sound knowledge and understanding of the needs of the individuals living in the home. The manager and staff team work relentlessly to try and ensure that the residents receive as much care, empathy, love and attention as they possibly can. Although there are some good systems in place to help ensure that the home is run in the best interests of the residents, questions must be asked as to why some of the services provided give great cause for concern particularly around staffing levels, the environment and the health, safety and wellbeing of the residents and why these continue to be inadequately managed by the whole of the management team. Serious concerns are raised when the service continually fails to comply with the repeated statutory requirements that have been made following each inspection. The inspector asked how the management team intended to address this. The inspector was informed that the Area Manager intends to work closely with Mrs Currey and make regular visits to the home. She will now be conducting thorough monthly visits to the home (Regulation 26 visits) and will be sending copies of these to CSCI. These visits must be unannounced and include interviews with staff and residents and an audit of the premises to ascertain the quality of care provided. This should enable the management team to be able to make a judgement of the standard of care provided in the home and address any evident issues that have been identified. Some areas of quality assurance systems within the home are good. Residents meetings are held 6-8 weekly and are well attended. Minutes are taken and circulated to residents and their families on the notice boards throughout the home. Staff will ask residents prior to the meeting if they have any issues they would like to discuss and any information they would like to share with the group. The manager conducts an annual audit to assess the satisfaction of residents with regards to the service that the home provides. This information is obtained through questionnaires. The results are collated and an action plan is developed to address any issues that may have arisen. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 31 This year’s audit has yet to commence however the inspector did examine last years audit at the previous inspection and the effectiveness of the outcomes and the results from the surveys were good. At present there are no systems in place for meeting with relatives and visitors to the home. This is currently under review and will be looked at during the next inspection. The policy and procedure for holding residents personal money was examined and three individual accounts were looked at. It was evident that good accounting methods are adopted which account for all transactions documented and receipts for sundries were available to see. There is an annual appraisal process, which ties in with the supervision arrangements. The manager has established a formal recorded supervision procedure for all staff. A plan is devised for discussion relating to the residents, work issues, staff issues, personal development and training. The recorded outcomes of the supervision evidenced the effectiveness of the sessions. Supervision with staff are currently not up to date. Monthly equipment checks, including bed rails, wheelchairs, beds and commodes are being conducted and recorded; any repairs carried out are also documented. However these are clearly not adequate to maintain the home to an acceptable standard. The inspector saw that all relevant checks were maintained correctly and at the required intervals including all fire alarms, equipment and emergency lighting. The homes records showed that all necessary service contracts were up to date including, gas and electrical services, manual handling equipment and lift servicing. Fire safety training for staff is given on induction and then at the recommended given intervals, as recommended by the Fire Prevention Officer. All night staff undertake this on a three-monthly basis, and day staff sixmonthly. Due to the potential risks of scalds and burns to residents, staff and visitors from the uncovered radiators and excessive temperatures of the hot water in residents’ rooms, the manager must develop risk assessments in the interim until safe provision has been made. Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 1 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 1 1 X 1 1 X 1 STAFFING Standard No Score 27 1 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 2 X 3 2 X 1 Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 33 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 OP10 Regulation 23 (2) (i) Requirement Suitable provision must be made for residents to receive their visitors in private accommodation, which is separate from their bedrooms. Provide suitable window dressing e.g. Net curtains or blinds to ensure residents privacy at all times. Repeated requirement. Provide suitable dining room seating and table facilities. The home must comply with the agreed set timescales as set in the statutory enforcement notices: 1. Refurbishment of remaining bathrooms and toilets. Fourth repeated requirement 2. Ongoing refurbishment of all remaining bedrooms. Third repeated requirement 3. Refurbishment of top floor sluice. Third repeated requirement 4. All corridors and stairways must be redecorated. Third repeated requirement DS0000060331.V325151.R01.S.doc Timescale for action 05/06/07 2. OP10 16(2) (c) 31/03/07 3. 4. OP15 OP19 16(2) (c) 23(2) (b) (c) (d)(i) (k) 05/06/07 05/06/07 Sunnymede Nursing Home Version 5.2 Page 34 5. Dilapidated vanity units and old, cracked, stained sinks must be replaced. 5. OP20 16 (2) (c) Replace all lounge chairs identified at the environmental audit as specified in the report. 1. Provision must be made to guard radiators or guarantee low temperature surfaces. Twice repeated requirement. 2. Provision must be made to ensure that hot water temperatures are at save levels. Third repeated requirement 1. Urgent provision must be made to deep clean all areas of the home. 2. Develop a cleaning rota to ensure that hygiene standards are maintained and send a copy of the rota to CSCI. Third repeated requirement Provision must be made to ensure staffing levels continue to reflect the assessed needs and dependency levels of the residents. A system to be put in place so that residents and their advocates have the opportunity to discuss any issues, views and level of satisfaction about the service they are receiving. Risks assessments must be completed by the manager with regards to excessive hot water temperatures and unguarded radiators to ensure residents, visitors and staff safety and a copy should be sent to CSCI 05/06/07 6. OP25 13 (4) (a) (c) 31/03/07 7. OP26 23 (2)(d) 21/02/07 8. OP27 18 (1) (a) 13/03/07 9. OP33 24(1) 10/04/07 10. OP38 13 (4) (c) 10/04/07 Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 35 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 36 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 Sunnymede Nursing Home DS0000060331.V325151.R01.S.doc Version 5.2 Page 37 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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