Inspection on 01/11/07 for Sunnyside Care Home Ltd

This inspection was carried out on 1st November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunnyside Care Home Ltd 16/11/06

Sunnyside Care Home Ltd 30/01/06

Sunnyside Care Home Ltd 29/09/05

Sunnyside Care Home Ltd 16/03/05

Sunnyside Care Home Ltd 28/10/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Sunnyside Care Home Ltd 13-15 Sunnyside Road Ilford Essex IG1 1HU Lead Inspector Stanley Phipps Unannounced Inspection 1st to the 7 November 2007 14:30 th Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 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 Sunnyside Care Home Ltd DS0000050134.V354134.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 Adults 18-65. 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. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunnyside Care Home Ltd Address 13-15 Sunnyside Road Ilford Essex IG1 1HU 020 8553 4230 020 8514 3098 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) www.caretech-uk.com Sunnyside Care Home Ltd Mrs. Deeba Kazim Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th November 2006 Brief Description of the Service: Sunnyside Care Home is a care home providing personal care and accommodation for up to fifteen people aged 18 - 65 with a diagnosis of mild to moderate learning disability, who need support in order to live in the community. Care and support is provided on a twenty-four basis. The home has changed owners in that as of 18th May 2006, the service has been acquired by a large private organisation under the provider name of CARETECH - Community Services Limited. The home is located in Ilford approximately half of a mile away from the Ilford Town Centre. It is situated on a good bus route and service users have easy access to a full range of local facilities, which they are encouraged to use. The service was opened in January 2004 and is a large detached house that is set in its own grounds. All bedrooms are single and contain en-suite facilities. The building is an amalgamation of two houses and there are plans to have an A and B unit. There are bedrooms on both the ground and upper floors and access is via stairs on either side of the building. There are extensive grounds to the rear of the building that allow service users the opportunity to pursue external activities. There are staff on hand night and day to provide care and support to the service users. A statement of purpose is made available to all service users in the home and is kept in the main Office. Given the level of disabilities service users are likely to have, this document is also made available to relatives and stakeholders. A service user guide is also given to each service user upon admission to the home. Fees for the services provided range from £1300 to £2,500 per week. Service Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 5 users pay additional for Toiletries-£20-£50 per month; Hairdressing-£10-£15 per session; Chiropody-£15; with Transport, Activities and Membership services-all variably priced. Service users also have to bear the costs of their holidays. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out between the 1/11/07 and the 07/11/07. It was unannounced and a key inspection of the service, which meant that all the key minimum standards for ‘Younger Adults’ were assessed. The assessment also considered information provided in the Annual Quality Assurance Assessment (AQAA) by the registered persons. An assessment of policies and procedures, medication practice, activities, menus, all records required by regulation, service user plans and the environment was undertaken. Over the course of the inspection discussions were held with several staff, two service users, senior staff members and the registered manager. The inspection also considered comment cards completed by staff and/or service users alongside verbal feedback that was provided by external professionals. The inspection found that service users living at Sunnyside were generally receiving a satisfactory standard of service. On the first day of the site visit an immediate requirement notice was served in relation to; the physical state of a service user’s bedroom and the promotion of safety within the identified area. A forty-eight hour timescale was given and the registered persons complied with what was required of them. While the care and support element of the service was in the main – good, it was clear that the environment was below acceptable standards – despite evidence of regular monthly provider monitoring visits. Most of the previously made requirements particularly in relation to the environment were not acted upon. This is notwithstanding the fact that the last inspection had been carried out approximately one year ago. This situation was considered serious enough for the Commission to invite the registered persons to attend a meeting at one of the Commission’s local offices to set out the concerns referred to above. This meeting took place on the 15/11/07 and was attended by the responsible individual and one of the directors. In summary, the agreed outcomes included; appropriate action to be taken to address all outstanding requirements within the most expedient timescales, and providing evidence in writing to the Commission by the 30/11/07 regarding all actions current and future with timescales in remedying the concerns. The Commission made it clear that failing to do this would result in a management review of the service being conducted, which could result in enforcement action being taken to achieve the relevant improvements. The Commission also reserved the right to at any time in the future carry out a random visit to monitor the compliance with the outstanding issues raised in the last inspection report. Most of the information required was provided within the timescale given. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 7 What the service does well: What has improved since the last inspection? What they could do better: Ensure that all requirements including those related to the environment – are carried out in a timely manner and in line with the timescales stated by the Commission. Any changes to the timescales set, must be agreed with the Commission. Take positive action to ensure that the respect and dignity of service users is preserved at all times. Carry out all the environmental repairs within the timescales set in this report. Keep staffing levels under review, particularly at peak periods. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 8 Produce an annual development plan and carry out an internal audit of the service. Carry out all the health and safety improvements detailed in the requirements section of this report. Develop strategies to increase service user involvement in the home, particularly around staffing recruitment. Make training provisions for the registered manager. 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. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (1,2) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users now have updated information, which they could rely on in making a decision to live at Sunnyside. Their needs are assessed in detail prior to admission to determine the suitability of the home in meeting them. EVIDENCE: There was evidence of improvement in this area as the statement of purpose and service user has been reviewed. They are now merged into one document, which is in a more user-friendly format with pictures enshrined throughout and alongside the text. In discussion with the most recently admitted service user, it became clear that the individual was aware of the document, which was described as, informative. The content of statement and service user guide was in line with the national minimum standards for younger adults. The assessment details of the most recently admitted service user was examined and were quite detailed. The process involves a senior manager along with the registered manager. The pre-admission documents were found in order and service user plans have been developed from the assessments that were carried out. The home’s current admissions’ process ensures that service users participate in choosing whether to live at Sunnyside, part of which involves them having a trial stay at the home. Service users have some assurances that their needs would be met, once they decide to live there. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (6,7,9) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users have the benefit of a comprehensive plan that is developed with their needs in mind. Staff continue to engage with service users to enable them to achieve their individual objectives. This involves taking risks within an improved risk management framework to ensure that their safety and independence is promoted. EVIDENCE: Service user plans were in place for each of the service user living at the home and from discussions with one individual, it was clear that she was aware and a part of the process. This document is used as a working tool by staff in the home and each service user is assisted by their key-worker in developing this document, which sets out their aims and aspirations. It must be stated that each of the plans was specific to the needs and goals of individual service users. The registered manager informed that plans were in place to introduce person centred planning, once staff have had the appropriate training. The plans viewed were reviewed internally at six-monthly intervals with an annual review involving external professionals. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 12 There was an improvement in this area of the homes operations as evidence was provided to demonstrate how service users were supported to make decisions about their lives. One example is where an individual has the benefit of advocacy input in acquiring day care services that are specific to the person. Another example is where clear guidelines and information is made available to an individual who enjoys being out independently. The methods used for involving service users in choosing their meals, were also much clearer. This is extremely important given the diverse communication needs of the group. Picture menus were used in some cases and plans were in place for using food smells to determine individual meal preferences. Risk assessments were in place for each service user and they were linked to their individual plans. They were updated, which represents an improvement, and reviewed annually. From the documentation seen it was also clear that expert input was also sought when determining the best possible outcome for service users. One of the service users interviewed showed an awareness of why a risk plan was in place for her. More importantly, she was party to its development and so, felt in control while being safer. On examining the risk assessments, clear actions were recorded to keep the risks to a minimum and this forms an important part of safeguarding adults. The risk management plan was aimed at promoting service users’ independence and as such was developed in the least restrictive way. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (12,13,15,16,17) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users are enabled to participate in their community as far as possible. They also enjoy a range of activities and, are able to maintain and develop social and personal networks of their choosing. They are supported to exercise their rights, which are respected and promoted by staff in the home. Service users also enjoy a variety of meals that meet their cultural and nutritional needs. EVIDENCE: There was evidence that each service user is supported to develop practical life skills within their individual capabilities. For most people, this experience is rewarding and a good example could be drawn from the case of one service user – being encouraged to do her own meals. In other cases service users were supported to develop skills in maintaining their personal health and to a lesser extent –helping to tidy their private spaces. One service user continues to attend a day centre regularly and from all reports - quite looks forward to it. Records indicated that service users had specialist inputs from; the speech and language therapist, a psychologist and a psychiatrist. Service users therefore have opportunities for personal development at Sunnyside. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 14 Service users access the local restaurants, banks, shops, parks, church, the dentist, and their local GP. Staff worked flexibly to enable this, despite the availability of community resources for service users with specialist needs. It was reported that service users also enjoy going out driving. One individual informed that she enjoys going out and were happy with the support given by staff in enabling this. At the time of the visit, one service user was going to do some shopping and she spoke positively of the staff regarding the support they provided to her enabling her to do as much as she could - independently. It was clear that service users were given opportunities to engage with their community and the outcomes are recorded in individual activity planners, although staff reported that at times, the opportunities are affected by the level of staffing in the home. From the staff feedback forms returned, forty per cent stated that sometimes the staffing levels were inadequate to meet the service users’ needs. The impact of this would be followed up separately under staffing. From looking at a sample of service users’ files, it was clear that every effort is made by the staff and management of the home to support service users to engage and maintain their families and friends network. There was evidence that relatives are kept informed about events and developments about service users. A visiting policy is in place to enable this invaluable contact to be made. One service user is supported to visit his father and another visits his relations particularly in relation to his cultural events. It was noted that in some cases new family contacts have been made and the registered manager reported that it has had a positive impact on service users’ welfare. In discussion with the most recently admitted service user, she described the staff as being respectful – allowing her to express herself and her point of view. She spoke positively about the staff interaction with her and described the feeling of being valued. From observation during the inspection, staff were observed in the main – treating service users with dignity and respect. However, there was one occasion where the interventions made by the staff concerned, compromised the dignity and respect of at least two individuals. It was noted that the occurrence was above the staffing ability and expertise, however, service users are entitled to have their dignity and respect preserved at all times. Meals were also observed and it was deduced that service users were quite pleased the meals provided at Sunnyside. Improvements were noted in their level of involvement in choosing meals e.g. picture menus being used and service users being encouraged to help out with the food shopping. This provides opportunities for them to pick what they prefer, once it is not contraindicated by a medical professional. There were varying levels of skills in this area, but opportunities for involvement were available to all. Supper was observed and this was relaxed with specialist support being provided to individuals in a sensitive manner. The menu was curry chicken and rice and Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 15 this added variety to the menu plan, while satisfying the individual preferences of service users. There was evidence that meals were freshly prepared and there was a fresh supply of fruits and vegetables. As part of health monitoring service users are weighed regularly and referrals are made to the dietician as and when necessary. Menu planning is done on a weekly basis, and one service user is supported to prepare her meals, which also includes doing her food shopping and budgeting. This is positive. While the management of food was generally good, the storage of food needed improving. This is covered in standard fortytwo of this report. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (18,19,20) People who use the service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users continue to benefit from receiving personal support in line with their needs. The management and staff work well to ensure that their physical and emotional needs are met. The support provided with medication ensures that service users health and welfare is promoted. EVIDENCE: There was good evidence from the support plans seen, to confirm that service users’ preferences are identified and recorded. More importantly most of the staff demonstrated a clear understanding of how service users are managed on an individual basis. It is true to say that the ethos in the home is one in which the service user plan is used as a working tool. There were clearer arrangements in place for individual service users in relation to getting up and going to bed and staff were observed working closely within the guidelines agreed – in most cases. Service users were observed wearing appropriate clothing in relation to their culture and the weather, which was positive. A key worker system is in place, which provides good support to enable service users to achieve their personal goals. This is enhanced by the specialist support e.g. psychology, speech and language and psychiatry. The registered manager informed that a deaf and Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 17 blind assessment was carried out in relation to the environment to determine the suitability of the home in meeting the specialist needs of a service user. Although it was difficult to acquire feedback from most of the service users living at Sunnyside, it is true to say that their privacy was promoted. This outcome was determined primarily through observation over the two days of the inspection. Where verbal communication was possible, the outcome was confirmed as - that their privacy was promoted, when supported with personal care. The staffing mix is adequate to offer same-gender care, should this be required. Both written and verbal feedback from service users informed that they could do what they want in the home on a daily basis, which is positive. All service users are registered with a GP and records assessed indicated that are in place for them to see other health professionals such as the dentist, community nurses, chiropodist and the opticians. There was evidence that professionals such as the physiotherapist and a psychologist has been involved Sound records were maintained where service users attended health related and professional appointments e.g. GP or a psychiatrist. The manager and her staff have a very good understanding of the health care needs of all service users in the home. Records demonstrated that timely interventions were made to enable service users to maintain a healthy lifestyle and sound arrangements were in place for service users to see professionals privately. This is a strong area of the homes operations. Medication practice and protocols were examined, and it was clear that there is an effective and established system for the administration of drugs in the home. One of the systems in place for example is guidance for staff when using ‘as required medication’. All staff responsible for handling medication is provided with training including refresher training. At the time of the inspection, one service user was supported to manage her medication independently and this monitored in a sensitive manner. Medication records were thoroughly assessed and they were well maintained. Medication storage was in line with the national minimum standards and related guidance. The manager randomly and regularly monitors drug administration in the home and through her knowledge and expertise, is able to positively influence the outcomes for service users in relation to their medical management. Service users are therefore assured that they would receive excellent support with medication in managing their healthcare. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (22,23) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users and their relatives are assured that when complaints are raised – that they would be acted upon. Sound procedures are in place to promote the protection of service users living at Sunnyside. EVIDENCE: A complaints procedure is in place and available to service users, relatives, staff and external professionals. In discussion with one individual, she demonstrated a sound awareness of this procedure. One of her responses was: “If I am unhappy I would complain to Deeba (manager) – she would sought it”. The complaints record was examined and there was one complaint that was made by a relative since the last inspection. The handling of the complaint was satisfactorily recorded with a clear audit trail from start to finish. Staff spoken to showed an awareness of the importance in supporting service users to complain – should they be unhappy with any aspect of the home. This is positive. There was one adult protection matter since the last inspection and the registered manager cooperated and acted in line with the local authority’s safeguarding protocols. The outcome of this matter was – ‘ No Further Action’, as evidence was provided to demonstrate that the management and staff were providing the best quality of health care support to the individual concerned. Good systems remain in place to safeguard service users from abuse, which included a clear and accessible protocol on abuse and specific training in relation to safeguarding service users. From observing practice in the home, speaking with the management and staff team – it was clear that every effort is taken to protect service users from abuse. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (24,25,30) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The quality of the environment at Sunnyside has deteriorated to the extent that it has become less homely, although it was generally clean and hygienic. This is true for both the external and internal aspects of the environment and at least one bedroom. Action has been proposed by the registered persons to remedy the defects, which would not only meet the national minimum standards, but provide greater comfort for all service users. EVIDENCE: The home remains accessible to local amenities and facilities and is generally safe. However, it was in need of repairs and re-decoration. The registered persons failed to carry out a number of improvements to the environment as identified at the last inspection report. This failure gave the Commission great cause for concern and so they were invited in for a meeting with officials from the Commission. The main outcomes were that key information relating to compliance with the environmental and all outstanding requirements, be submitted in writing to the Commission by the 30/11/07 and this was complied with. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 20 The other main outcome was for an action plan to be provided with fairly short timelines for the completion of all outstanding works that were previously made. During the course of the inspection, it was noted that the carpets on the ground floor corridor was stained and raised near the first exit door (2) and the kitchen window was dirty and unsightly. There were also a number of missing tiles from the laundry walls. The external grounds looked neglected and the designated smoking area, which is externally cited, did not consider a basic service user need i.e. the need to keep warm. The registered persons need to improve the conditions of the facility that has been designated for smoking. The inspector looked at some bedrooms, including the one on which an immediate notice requirement was made. The service user concerned is unable to advocate for himself by virtue of his disability and though the leaking roof had repaired, the room was in a poor decorative state – with holes in the ceiling and significant levels of damp patches around the internal aspect of his bay window. This must be addressed as a matter of priority, as the service user is unable to see the state of the room he is placed in. This failing by the registered persons calls into question their strategies for promoting equality and diversity across its services. The premises were clean and hygienic during the course of the inspection. Good facilities remain in place for staff to clean their hands and policies and procedures for infection control were updated and available to staff. Staff spoken to showed a good understanding of their responsibility under health and safety. The laundry floor is impermeable, which ensures that it could be hygienically clean and the home complies with the Water Supplies Regulations 1999. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (32, 33,34,35) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Service users benefit from a staff team that is committed, trained, and adequately supported in providing care to them. Staffing levels need to appropriately reflect the needs of service users, particularly at peak times. Recruitment practices ensure that service users remain in safe hands, while living at Sunnyside. EVIDENCE: Staff were observed on the day of the inspection going about their duties in a diligent manner, apart from the one occasion referred to earlier in this report. It should be noted that most of the staff team have achieved an NVQ Level 2 in Care and so have a good basic understanding of the principles underpinning the delivery of good quality care. This is reinforced at induction, where staff have an opportunity to go through the common induction standards outlined by Skills for Care. In discussions with staff, they were able to demonstrate a good understanding of the service users’ individual needs. In discussion wit a service user she remarked ’my key worker helps me with my goals and meets with me for talk-time – which I am pleased with’. Service users therefore receive a service that generally meets their needs. There was evidence that the staffing levels are considered alongside the needs and aspirations of service users, although there are questions around the Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 22 consistency of its application. On the day of the visit the dignity and respect of two service users was compromised in what was a combination of; not having the right staffing levels at a peak moment (lunch time), the staff on duty dealing with the issue not having the expertise to manage a somewhat complex situation, and the staffing failure to recognise and apply de-escalating strategies in managing the situation. The key however rests with the staffing levels and feedback received from an external professional confirmed this view. Fifty per cent of the written staff feedback informed that staffing levels ‘sometimes’ – adequately met the needs of service users and so the registered persons need to review this. The risk of compromised quality care is exacerbated by the fact that there has been a heavy use of agency staff (from rosters viewed) in the home over the last couple of months for various reasons. While the registered manager has good systems in place to ensure that agency staff are given an induction along with formal supervision to carry out their roles – this could conflict with levels of commitment and consistency displayed by them. One example is where an agency staff had left the premises without the manager being aware, notwithstanding the fact that the registered manager wanted her to stay on for another hour. In discussion with this individual, she confirmed that the ‘bank staff’ pool had deteriorated, which resulted in her having to use more agency staff. Two of the most recently recruited staff files were examined and he recruitment practices were found to be satisfactory. Two references were in place for both staff and criminal bureau reference checks were in place and appropriately carried out. In discussion with staff, they were aware of the General Social Care Council’s code of conduct and the importance of this, in relation to their practice. It was not evident how service users were involved in the recruitment processes and the registered persons should look at this. There is a good training and development plan in place for staff at Sunnyside, which is primarily based on the needs of service users. Staff are encouraged to take up training and most of them respond positively to this. Eighty-seven per cent of the staff felt that they were given training that was related to their roles, while keeping them updated with new ways of working. Seventy-five percent of the staff reported that they are given training to meet the diverse needs of the service user group. Most staff expressed the view that the training was more person centred and this is positive. It was reported that a training programme for the manager was not in place and the responsible individual for the service should address this shortcoming with some urgency. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (37,39,42,43) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Management systems are in place to provide a quality service at Sunnyside. Some improvement in quality assurance monitoring enabled better outcomes for service users, however more work is required in this area. Although there was evidence of sound insurance and financial arrangements for the homes operations, health and safety practices need to improve to make Sunnyside a safer place to live. EVIDENCE: The registered manager is suitably qualified and experienced in running the service at Sunnyside. She has been doing so for over three years and has made a positive impact on improving outcomes for service users. She has completed her NVQ Level 4 in Care and has been on training to update her skills and knowledge in areas such as; Emergency First Aid, Epilepsy Awareness and The Mental Capacity Act. She has booked to attend an Advanced Dementia and Learning Disability Course and is keen to keep abreast of developments in her field. Most of the staff feel ably supported by the Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 24 registered manager and service users are quite responsive to her. More importantly she knows and understands the needs of each service user currently living in the home. While there have been some improvements in the quality monitoring of the service, an annual development plan and an internal audit had not been carried out on the home. Monthly provider visits with reports are now regularly carried out and so this provides a good opportunity for strengths and weaknesses of the service to be identified and acted upon for the benefit of service users. An extended timescale of the 31/12/07 has been given for the completion of the annual development plan and a separate timescale would be set for the registered persons to provide evidence of undertaking an internal audit of the service. There was evidence that some aspects of health and safety had been carried out to promote a safer environment at Sunnyside. However, there was evidence to confirm that service users’ safety is compromised, as there were several incidences of unsatisfactory food storage at Sunnyside. They were discussed in detail with the management and some senior staff in the home. There was also a failing by the registered persons to address issues of safety such as a request to replace a fire safety door in kitchen (2) and no action has been taken to ensure that the security lights to the front and rear of the building are maintained in working order. Staff have expressed concern about the lack of responsiveness on critical safety issues in the home. This could be summed up from one of their quotes: “ Sunnyside feels like the forgotten home”. In discussion with the registered manager, she confirmed that she has been having regular supervision and feels a lot better supported by her current line manager. It should also be noted that a valid certificate of insurance has been made available for inspection along with the financial details of the organisation. In this respect it could be concluded that service users are assured that the service provision at Sunnyside is on a stable financial footing. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 4 4 X 3 x 2 x x 2 3 Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 26 YES Are there any outstanding requirements from the last inspection? 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 YA16 Regulation 12,13 Requirement The registered persons are required take appropriate steps to ensure that the respect and dignity of service users is promoted at all times. The registered persons are required to:1) Complete all areas of work as identified in the action plan submitted(4/11/07) to the Commission) Make appropriate arrangements for window cleaning and the maintenance the external grounds, 3) Clean or replace and make safe the carpets in the corridor (2), and 4) Take appropriate steps to provide more comfortable arrangements for smoking in the home. The registered persons are required to review the staffing levels DS0000050134.V354134.R01.S.doc Timescale for action 07/07/08 2. YA24 23 (2)(b)&(d) 31/12/07 3. YA33 18(1)(a) 07/01/08 Sunnyside Care Home Ltd Version 5.2 Page 27 4. YA39 24(1)(a)(b) 5. YA42 12, 13, 15(2)(m) particularly at peak times of the day. The registered persons are required to:1) ensure that the annual development plan is sent to the Commission by the 31/12/07 and 2) an internal audit is carried out on the home. The registered persons are required to promote health and safety in the home by: 1) by ensuring that food is appropriately stored at all times, 2) Action is taken to replace the kitchen fire door in unit 2 and 3) taking steps to ensure that security lights in the front and rear of the building are in working order. Item 1 of this requirement was previously made with a timescale of 28/02/07. 31/01/08 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA34 YA35 Good Practice Recommendations The registered persons should devise strategies to enable service user involvement in the home, particularly in relation to recruitment. The registered persons should ensure that a training programme is in place for the registered manager. Sunnyside Care Home Ltd DS0000050134.V354134.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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. 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