Inspection on 08/06/06 for Sunnymede Nursing Home

This inspection was carried out on 8th June 2006.

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 19/01/07

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 8th June 2006 09:30 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.V299116.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.V299116.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.V299116.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Staffing Notice dated 8th April 2002 applies. Manager must be a RN on parts 1 or 12 of the NMC register. To accommodate one named gentleman of 63 years of age. Date of last inspection 31st January 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.V299116.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. The inspection lasted one day. Following the previous inspection several requirements were made concerning the environment and issues related to the health and safety of residents, staff and visitors in the home. The Commission for Social Care of Inspection (CSCI) requested an assessment to be conducted by the Bath and North East Somerset Fire Safety Officer. Subsequently enforcement action was taken. A meeting was held on May 24th 2006 with the provider to discuss these concerns and an improvement plan with set timescales was requested by CSCI. An improvement plan has been received from the provider detailing all the work to proceed in order to meet the set requirements. During this inspection the inspector concentrated on any provisions already addressed by the home and these are detailed in the report. The inspector spent time throughout the day in discussions with the manager and a number of records and files relating to the day-to-day running and management of the home were examined. Four residents were case tracked. Their care plans and care files were examined. The inspector had discussions with the residents and observed them going about their daily routines. The inspector took a tour of the premises and the gardens. Time was spent observing residents in the home throughout the course of the visit and six were spoken with at length and three visitors. Members of staff were observed on duty and eight were consulted individually. The inspector sent questionnaires “Have your say” to forty residents in the home prior to the inspection and fourteen were completed and returned. Relatives and visitors “Comment Cards” were also sent; ten of these were completed and returned. Information from these has been collated and are detailed throughout the report. Feedback was given to the manager on the outcome of the inspection. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? The information gathered pre-admission provides a sound benchmark of the resident’s ability and state of health prior to admission. Care plans accurately reflect the residents’ needs and how they will be met. Residents and their families are now involved in this process wherever possible. Systems are in place to help ensure that there is consistency in assessing, planning, implementing and evaluating the resident’s care at the required times. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 7 The manager and her staff are continuing to 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. Menus have been developed and provide a varied, well-balanced choice of traditional home cooked meals. The menu includes alternative choices for residents who are diabetics or those requiring a pureed diet. There are good arrangements in place for staff training and awareness of protection of vulnerable adults. The following maintenance and improvement work has been carried out: • • • • • • • • • • • All broken cords on the residents call bells have been replaced. Suitable bins have been provided to ensure safe handling of clinical waste. Trailing wires and cables have been secured. Locks have been provided on all toilets and bathrooms. Signs have been put on the doors to indicate if they are in use. All beds have been risk assessed and beds requiring replacement have been obtained. Ongoing redecoration of rooms identified at the previous inspection and ongoing replacement of bedroom furniture. Replacement of flooring in specified corridors and some carpets in residents’ bedrooms. Outside communal areas have been cleared and fire escapes are no longer obstructed. Garden areas are now more pleasant to sit in. New equipment and tools for maintenance purposes has been provided. New garden furniture and parasols has been provided. All complaints or concerns are now documented and outcomes recorded. Additional housekeeping and laundry hours have been provided. The manager is now supernumerary. A new post has been created for a carer to assist with putting residents to bed between the hours of 7-10pm. A robust recruitment policy and procedure is now in place. Unannounced monthly visits take place by the registered provider (Regulation 26). Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 8 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 9 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.V299116.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 Quality in this outcome area is good. Prospective residents or their families have all relevant information to make a decision about the nature of the home. Prospective residents needs are assessed prior to admission to determine the suitability of placement to ensure that their needs can be met. Trial visits give prospective residents an opportunity to assess the nature of the home. EVIDENCE: A statement of purpose and a home guide is made available at the initial stage of enquiry to prospective residents/families. This provides useful information of the services available and includes the terms and conditions. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 11 All the residents’ surveys returned stated that they had received adequate information to help them decide if Sunnymede was somewhere they would like to live. They also confirmed that they had received a contract on admission to the home. Visits to the home are encouraged either for the day or perhaps for lunch dependent on their wishes. The home operates a robust admission procedure for residents’ to ensure the smooth running of this first initial period within their new home. Following a requirement from the previous inspection the pre-admission assessments have been reviewed. 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. Where possible the manager had obtained assessments and care plans from other professionals involved for example, social workers and hospital staff. A month’s trial period on both sides is usually undertaken to ensure that everyone is happy with the arrangements and to ensure that the placement is suitable. The home operates a robust admission procedure for residents, in the form a checklist to ensure the smooth running of this first initial period within their new home. Residents are referred to the Primary Care Trust for assessment of funding under the Registered Nurse Contribution (RNC) or Continuing Health Care (CHC). Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. The service had good systems for meeting and monitoring residents’ health and personal care needs in consultation with residents. There are safe systems of practice in receiving, storing, administering, and disposing of drugs. Staff have a good awareness of individuals’ needs and treat the residents in a warm and respectful manner, which means that they can expect to receive care and support in a sensitive way. 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. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 13 Following a requirement at the previous inspection the resident and their families are now involved in this process wherever possible. One relative confirmed to the inspector that a sister in charge had discussed and examined her mothers care plans and how they would meet her mothers’ needs. The manager is currently developing a new system in the home whereby a care review meeting will be arranged every six months for each resident, involving their family members and key worker. This meeting will be used to discuss and evaluate the residents’ care plans and will give the opportunity to raise any issues or concerns. 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. Intermittent care plans were available when short-term needs had been identified, for example one resident had had a recent bereavement. The plan clearly identified how this was affecting the resident and how the staff would support the resident through this difficult time. This is good practice. 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. The Inspector was informed that each resident was referred to a GP on admission to the home and an initial first visit was then set up. 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. 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. The staff in the home said the residents’ profiles enable them to recognise the person as an individual and gives them a better understanding of that person. It also creates topics of conversation, encouraging life review and reminiscence, which will have meaning to that individual resident. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 14 There has been a significant increase in staffing levels as a result of requirements made at the last inspection, which are detailed later in the report. These changes have enabled care staff more time to read residents’ care files in order to remain updated. In general the residents surveys evidenced that they receive the care and support they need and one resident stated, “I have good girls here looking after me”. One visitor on the day of the inspection said “my dad feels he is classed as a human being by staff in the home”. Comments from received “Comment Cards” were very satisfactory and complimentary of the staff and the care they provided. Relatives and friends stated, “Sunnymede provides home from home care”, “I cannot fault the care at all”, and “Excellent care provided, first class” Policies and procedures for receiving, storing, administering and disposing of medications were examined and correct. There were photographs of each resident on their medication charts to help ensure that medication was dispensed to the correct person. The administration charts were legible and continuity of administration was shown with a signature from the person dispensing. The manager and her staff are continuing to 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 one resident had replied, “I do not want to be admitted to hospital”. The home is currently enrolled in a pilot scheme (The Liverpool Integrated Care Pathway) using a comprehensive assessment tool for people who require palliative care. A care pathway is intended as a guide to treatment and an aid to documenting residents’ progress. The inspector looks forward to following the development of this new initiative at the next inspection. Sunnymede Nursing Home DS0000060331.V299116.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. Residents benefit from a varied activities programme, which is both enjoyable, stimulating and meets individual preferences and expectations. Residents maintain family contact and staff encourage family and friends to join in with activities and any outings. Residents receive a varied and wholesome diet that they are able to influence. 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 of the planned activities. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 16 On the day of the inspection staff were busy preparing for the summer fete, which was to be held the following day. This is one of the annual fund raising events that Sunnymede organise and all proceeds go to the residents’ funds. Several activities had been arranged for the special event including an entertainer, cream teas, and a toy, bottle and cake stall. The maintenance man had worked hard in preparing the garden the flower boarders were very pretty and well stocked and the lawns had been cut. During the inspection it was noted that the last finishing touches were being put in place, with plenty of seating and parasols for shade plus a gazebo. The inspector spoke with several residents and visitors who were all looking forward to the day. Posters were seen around the home to ensure that residents and visitors were aware of the forthcoming event. 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. One resident expressed a wish to varnish a garden bench and one lady wanted to go out and buy herself a new pair of slippers both of these requests were met. A 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 and places of interest to visit. One residents survey stated “there is always something going on at Sunnymede”. There have been several additional activities arranged since the previous inspection including a gentleman who visits the home and plays old 78rpm records on a gramophone; residents have enjoyed his visits and singing along to their old favourites songs. A music therapist now visits the home every month. The session is tailored for all residents to participate in but has been particularly engaging for residents with dementia. Residents are given musical instruments to play with to music. After the session they perform a mini concert for staff and any residents who chose not to participate. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 17 Residents continue to enjoy trips to the local Brass Mill for lunch and volunteers from the Salvation Army visit to take residents out shopping in the local high street. A trip has been arranged for eight residents to attend a “wartime street party” organised by Fry’s Chocolate Factory. One resident and his wife were seen sitting in the gazebo together enjoying a drink in the sunshine. In discussions they told the inspector how happy they were and that there was always plenty of activity within the home to keep residents occupied. Comments were also made on the excellent job the new maintenance man was achieving and that already the gardens were looking beautiful and pleasant to sit in. 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 resident told the inspector “I always enjoy the service and the different hymns we sing”. The home operates an open door policy for visitors. Residents were able to see visitors in the privacy of their rooms and there are several semi-private seating areas in the garden. Visitors stated in comment cards “I can pop in anytime and I am made to feel welcome” and “ this is an open house day or night, I always get offered a cup of tea when I visit”. Several visitors explained that the level of privacy in the residents lounge when visiting residents was restricted due to the television and general activity within it. Previously a “quiet” room had been allocated to ensure that residents could receive guests without having to go to their bedrooms. Unfortunately this room is presently being used for storage purposes, however following a requirement from the previous inspection storage facilities are being addressed and it is hoped that the provision for residents receiving guests will be resolved in the near future. Following discussions at the previous inspection the home has now devised three weekly menu rotas. The menus consist of a varied, well-balanced 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. The cooks or the assistant are now visiting 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. This is very good practise and the staff involved should be commended for their new initiatives. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 18 Residents’ surveys expressed that “The food is always very good” and “we have plenty of choice”. One visitor said, “ My friend receives freshly cooked vegetables daily”. The inspector had a tour of the kitchen and store area and spent time with the cook and her assistant. They were able to demonstrate an awareness of individual requirements and needs of the residents, including special dietary requirements and personal preferences. They talked about themed events that they arrange for residents and that on St Georges Day the food was prepared concentrating on a “red and white” theme, for example red jelly and white ice cream. This was imaginative and fun for residents, staff and visitors. The kitchen was very clean and organised. On the day of inspection the temperature outside was over 28 degrees and kitchen staff were working in extreme levels of heat. Consultation is in progress with regards to providing equipment to alleviate the levels of heat in the kitchen. It was also noted that the overhead shelving for pots and pans was directly above the cooker and gas hob, which is a potential health and safety risk for kitchen staff. The manager explained to the inspector that the provision for more adequate ventilation in the kitchen will result in a revamp of the kitchen and that subsequently safer storage facilities for pots and pans will be addressed. In addition to the extreme level of heat the cook and her assistant were wearing white overalls with long sleeves. Uniforms are currently under review in order to meet with health and safety regulations and to be more conducive to working practise when it is very hot. Stores exhibited a wide range of foods. Food hygiene training was not up to date for all staff, however evidence was seen that future-training dates had been arranged. Documentation was provided to show that required temperature checks were being carried out on fridges and freezers and that food was also being probed after being cooked before serving. Risk assessments were in place and up to date. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 19 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. There are robust and comprehensive policies in place to manage complaints and residents can be confident that their concerns will be listened to and acted upon. There are good arrangements in place for staff training and awareness of protection of vulnerable adults. EVIDENCE: At the previous inspection it was discussed with the manager about recording and keeping a log of any concerns bought to her attention by the residents and visitors to the home. It was suggested that a ‘comments’ book be made available and kept by the visitors’ book to enable visitors to make positive comments as well as record their concerns. This has now been instigated and the book is available for residents and visitors in the reception foyer. 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 complaint. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 20 The complaints policy and procedure is detailed and contains all the required information. There have been no complaints received since the last inspection. Residents’ surveys stated that they knew how to make a complaint and who to talk to if they were not happy. Residents also said they would speak to their key workers with whom they had built relationships with and would also rely on their family members to discuss any concerns they may have. One visitors comment card sated “If my dad is unhappy I know I can always talk to Bernice the manager and it will be sorted out”. The home has written procedures for adult protection, whistle blowing, management of aggression, abuse, bullying and management of money/valuables. The ‘No Secrets’ document was also available. The inspector did not view all of these policies during the inspection. The inspector was informed by the manager that the organisation actively promotes staff training and education in these areas, all staff are encouraged to 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.V299116.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is poor. Residents do not live in a safe and well-maintained environment and are at risk in some areas of the environment. The hygiene and cleanliness of the home should improve following deployment of extra ancillary staff. EVIDENCE: At the previous inspection a number of requirements and recommendations regarding the environment and the safety and wellbeing of the residents were made. Enforcement action was also taken over issues of safety following an assessment from the Fire Safety Officer. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 22 General maintenance of the home had lapsed and the home was in the process of recruitment for a new maintenance man. One visitors comment card stated that,” Tidiness and maintenance does not appear to be a strong point”. Due to staffing levels the domestics were unable to fulfil their duties in maintaining adequate cleanliness in the home. The homes overall appearance and size of the home suggested that two domestics were not sufficient to cover all areas of the home effectively and did not allow for a regular ‘blitzing rota’. It was evident from observation that the domestics were concentrating on trying to keep priority areas clean such as residents’ bedrooms, toilets, bathrooms, lounge and dining room to the best of their ability. Other areas such as the sluices were not clean. A requirement was subsequently made to review the domestic staffing levels. As a result of this a meeting with the Registered Provider, Area Manager and the Registered Manager at Sunnymede was undertaken with the Commission. An improvement plan with timescales has now been devised to address these areas of serious concern. These will be closely monitored over the coming months until resolved. The focus of this inspection was to identify any improvements made in the interim since the previous inspection. The inspector had discussions with the newly appointed maintenance man who confirmed to the inspector that he had been fully informed of the impending action plan and of the work involved. The manager and the maintenance man have regular meetings throughout the week to keep updated on the progress that is being made. During the inspection evidence was seen of several provisions that had already been achieved. These included ongoing redecoration of rooms identified at the previous inspection and ongoing replacement of bedroom furniture, including profiling beds. Replacement of flooring in specified corridors and some carpets in residents’ bedrooms. Outside communal areas had been cleared making fire escapes safer and garden areas are now pleasant to sit in. The home is in the process of appointing a housekeeper and additional hours for domestic duties has been deployed over a seven-day period. The additional hours deployed in the laundry in the afternoons and over the weekends has relieved care staff from these duties enabling them to spend more time with the residents and fulfil their roles and responsibilities. Two care staff spoken with confirmed that they were enjoying spending more time with the residents on the afternoon shifts rather than having to do the laundry. It was enabling them opportunity to have time allocated to look at residents care files and keeping them updated with current needs. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 23 The manager and the new housekeeper will be developing a programme of rota cleaning in the home to maintain higher standards of cleanliness and ensure continuity of cleaning throughout all areas of the home. The programme will involve a “blitzing rota” and attention will be made to ensure that curtains are cleaned on a regular basis. One “visitors comment” card stated that “The home could do with a good cleaner, the home sometimes looks very dirty and dusty”. Residents’ surveys in general felt that the home was usually fresh and clean. One resident told the inspector “Sunnymede is a pleasant place to live in and my bedroom is always very clean”. The inspector is confident that the recruitment of additional staff will address the shortfalls in maintaining the cleanliness of the home and this will be monitored through additional visits. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 24 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. Adequate staffing levels help to ensure that resident’s needs are met. Residents are supported and protected by the homes recruitment policy. The residents are cared for by skilled staff that are trained and supported by management. EVIDENCE: Staffing levels have been reviewed following requirements from the previous inspection. Additional trained nurse hours are being deployed to allow the manager to work supernumerary enabling her to carry out her duties effectively. This is a new initiative and will be looked at in more detail at the next inspection. At the last inspection it was evident that night staff were unable to manage effectively when putting residents to bed. A new post has been appointed for a carer to work from 7pm-10pm to alleviate this problem. Staff spoken with 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.V299116.R01.S.doc Version 5.2 Page 25 The staffing levels are well supported by the manager and are indicative of the needs and levels of care required by the residents. If levels of dependence were to increase, then staffing levels would need to be increased. 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 makes good use of agency staff. This is good practice and provides a consistent care service to the residents. One agency nurse who works regularly at the home spoke with the inspector and said, “ I’m very happy and love coming here the staff are friendly and supportive”. 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. The manager and her staff are conscientious in attending training relevant to the care needs of the residents. 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 any remaining staff. One staff member spoken with stated that the training she had received had increased her knowledge and confidence when delivering care. At the previous inspection it was evident that the efficiency in applying for Criminal Record Bureau (CRB) disclosures was not an effective process. The documentation for staff disclosures was dealt with through head office and was a lengthy procedure, whereby new recruits had to wait along time before they could commence employment. One staff member at the time had commenced her post without the CRB disclosure. Subsequently a requirement was made for the member of staff to be supervised at all times when delivering personal care until the CRB had been obtained. A robust recruitment policy and procedure is now place and the manager has applied to the CRB to become a counter signatory, enabling her to apply for staff CRB’s directly. The staff files inspected showed all the appropriate documents and checks were in evidence. CRB’s are being retained until the inspector has examined them. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 26 Residents’ surveys stated that, “the staff work hard to please everyone” and “I enjoy living here and in general everyone is helpful.” Visitors’ comments included, “The whole team are of a caring nature”, “Everyone at the home is great” and “Staff are friendly, approachable and respectful”. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 27 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38. Quality in this outcome area is good. Residents’ needs and best interests are central to the management approach in the home. Staff receive appropriate supervision. The homes record keeping policies for financial procedures safeguard residents. The health and safety of residents, staff, and visitors is promoted. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 28 EVIDENCE: Mrs Currey has been the manager at Sunnymede for four years. Mrs Currey has a dedicated team who work with her to ensure that the highest standards of care are achieved and maintained. Mrs Currey is a registered general nurse who was able to demonstrate an understanding of the needs of the individuals living in the home. Mrs Currey has made provision for various requirements made at the last inspection and continues to keep the inspector informed of all further developments. Working supernumerary, new staffing levels and the recruitment of new ancillary staff should assist the home to continue meeting outstanding requirements and the inspector looks forward to monitoring their progress. There was a high degree of satisfaction expressed by all of the residents spoken with. Based on the comments received from residents surveys and visitors comment cards and through the inspectors observation it is evident that residents feel the home is run in their best interests and to ensure their needs are being met. 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 and completed by residents and relatives. The comments from the surveys included “I feel that my views are always listened to” and “Everyone is very caring, this is home from home” One new initiative towards achieving effective quality assurance was to send surveys to community professionals who visit the home including, various GP’s and Chiropodists. The inspector examined the surveys. All were very complimentary of the service provided and included comments “care and knowledge of the individuals is second to none”, “There is an excellent awareness of the residents needs” and “ There is always a cheerful manner from all the staff”. GP’s had stated that the home was well run and that appropriate referrals were always made that required a GP visit. The policy and procedure for holding residents pocket 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. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 29 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. Four members of staff spoken with confirmed that they receive regular supervision and find them beneficial. Monthly equipment checks, including bed rails, wheelchairs, beds and commodes are being conducted and recorded; any repairs carried out are also documented. 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. Following a requirement from the previous inspection the appropriate monthly visits now take place by the registered provider (Regulation 26). These visits are unannounced and include interviews with staff and residents to review and assess the quality of care provided. Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 31 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 OP19 Regulation 23(2) 23(2) l,m Requirement The home must comply with the agreed improvement plan within the set timescales: 1. Refurbishment of remaining bathrooms and toilets. 2. Ongoing refurbishment of all remaining bedrooms. 3. Refurbishment of top floor sluice. 4. Storage facilities are to be provided for aids and equipment, including wheelchairs. 5. Make sufficient power points available for use. 6. All corridors and stairways must be redecorated. (These are repeated requirements) The home must comply with the agreed improvement plan following the issue of an Enforcement Notice from CSCI in relation to Fire Safety within the home. Timescale for action 06/07/06 2 OP19 23(2)(b) 24(4) 06/07/06 Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 32 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 Refer to Standard OP19 Good Practice Recommendations Provision for residents to receive guests without having to use their bedrooms or communal areas in the home would be more conducive to ensure quality private time is spent. Alternative saucepan storage away from the oven and gas hob would further protect the cooks and kitchen assistant from potential risks. 2 OP38 Sunnymede Nursing Home DS0000060331.V299116.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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.V299116.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. 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