Inspection on 16/11/06 for Sunnyside Care Home Ltd

This inspection was carried out on 16th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunnyside Care Home Ltd 01/11/07

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 Key Unannounced Inspection 16th November to 8th December 2006 14:00 DS0000050134.V321054.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 DS0000050134.V321054.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. DS0000050134.V321054.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 8911 9445 020 8911 9423 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 DS0000050134.V321054.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 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 DS0000050134.V321054.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. It is anticipated that service users now have to bear the costs of holidays under the new ownership. DS0000050134.V321054.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and a key inspection of the service for the inspection year 2006/2007. This meant that all key standards were covered as well as any other standard for which a requirement was made at the last inspection. The visit was done over two days beginning at 14.00 p.m. on the 16/11/06 and ended on the 8/12/06, which was the last day of the inspection. It was spread over this period to ensure meeting with as much of the staff, service users and relatives, where possible. At the time of the visit there were five services users in the home. Previous plans to redesign the home and reduce the number of beds were aborted. The service was going through a transitional stage from the previous owner, Mr. Gurdeep Singh to the new providers, CARETECH Community Services. The registered manager informed that the new providers were also planning to refurbish and redesign the home, but to date this has not been formally notified to the Commission. The inspection found that the service was generally managed with service users at the heart of its operations. Both management and staff were coming to terms with the changes introduced by the new providers, which reportedly caused some anxieties. However, as a team, they were committed to providing good client care. As part of the inspection two service users’ files were assessed. The inspector interviewed three members of staff and a relative of a service user. Detailed discussions were also held with the manager and, other staff members. Service users were also closely observed during their interactions with staff as they all had limited verbal communication skills. In this respect, their levels of satisfaction with the service were gauged from their non -verbal responses during the course of the visit. Written feedback from staff was also considered and although survey forms and questionnaires were sent out to service users and professionals, none had been returned at the time of writing the report. Several staff and service users’ records were also assessed and the inspection concluded with a detailed tour of the environment. What the service does well: Service users benefit from having a dedicated management and staff team that works towards meeting their varying needs. In so doing they ensure that service users are stimulated, given effective support: to maintain a healthy lifestyle and remain safe whilst living at Sunnyside. As part of ensuring consistency, the registered persons continue to provide staff with the opportunities for development and do their utmost to ensure that permanent staff are on duty to provide the twenty-four hour care and support DS0000050134.V321054.R01.S.doc Version 5.2 Page 7 to the service user group. The registered manager also monitors the staffing levels to ensure that service users’ needs are met. The healthcare needs of service users are particularly well provided for. This is due to both the awareness and prompt actions taken by the management and staff at the home. In aiming to provide high standards of care to service users the registered manager ensures, that staff undertake training to enhance their skills and expertise. This is positive as an outcome for service users. What has improved since the last inspection? What they could do better: Ensure that service users and their relatives have access to updated information about the service in formats suitable to them. In doing this, it is important to take into consideration the type of service i.e. learning disabilities – provided at Sunnyside. Service user plans could be developed in formats more suitable for the service user group. There needs to be clearer evidence as to how decisions are made by service users in for example areas of food. In this respect the meal arrangements need to be reviewed to also take into consideration variety, and safer food handling in the home. Consideration should also be given to the merit/s of staff having meals with service users. It is of great importance that risk assessments are kept updated and in place for all service users. Appropriate steps need to be taken to demonstrate that service users’ independence is promoted by; carrying out an occupational therapist assessment on the home, ensuring that all service users have appropriate clothing and, that they have a choice in the times they wake up and go to bed. DS0000050134.V321054.R01.S.doc Version 5.2 Page 8 More effort could be put into keeping various aspects of the environment in a good decorative state. Having a planned programme of maintenance and renewal is crucial to achieving this. Quality assurance in the home needs to improve by; having an annual development plan for the home, taking into consideration the views and/or experiences of service users and, carrying out regular monthly provider monitoring visits as required under Regulation 26 of the Care Homes Regulations 2001. A business and financial plan is required for the home as well as a valid insurance certificate for the business. It is also important that the registered manager is given support through regular supervision and appraisals. 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. DS0000050134.V321054.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 DS0000050134.V321054.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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are assured that thorough assessments would be carried out with respect to their needs. This helps to determine their suitability in living at Sunnyside. However, they should also have the benefit of having updated information in relation to the home. EVIDENCE: A statement of purpose and service user’s guide was in place for the benefit of individuals living in the home. It was noted that these documents were not updated in line with the recent changes to the service. As stated in the summary there has been a change in the registered providers, however this information was not available in these documents. Service users and their relatives need this information to be clear about exactly what is to be provided and by whom. The registered persons need to work towards providing these documents in a format that enables service users to relate to them. In case tracking the most recently admitted service user, detailed assessments were carried out by the registered manager with the input of senior staff in the home. The individual was assessed in several environments in which he was previously placed to include a day centre and a respite centre. His assessed needs were detailed including his special needs. There was also a ‘summary of needs’ that came as part of the referral information and this gave the home a DS0000050134.V321054.R01.S.doc Version 5.2 Page 11 broad picture of what his individual requirements were. A number of actions were devised e.g. one to one support at night, and put in place for meeting most of the needs identified and they were in his service user plan. Given the nature of his needs, actions were also developed through a risk assessment, as restrictions were necessary to promote the individuals safety. The home’s admissions procedure therefore remained thorough and in line with the national minimum standards. DS0000050134.V321054.R01.S.doc Version 5.2 Page 12 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) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. At Sunnyside service users needs are reflected in their individual plans. Whilst they are supported to make some decisions, more evidence of the support provided is required to demonstrate how other key decisions are made. Service users are supported to take risks, but ensuring that updated risk assessments are in place for each individual would enhance their safety and in some respects their independence. EVIDENCE: From the case tracking of two service users, there was evidence that their needs were detailed in their individual plans, which were reviewed. In both cases there was evidence in which their changing needs were accurately reflected in this document. Both service users were unable to provide direct input into setting their goals, but they had input from their relatives. In one of the cases the relatives were quite heavily involved, as they had cared for the individual for a very long time. It must be said that this experience and involvement worked in the service user’s best interests of the individual concerned, as there were significant deficits in relation to hearing, sight and speech for this person. Given the level of need, a night service user plan was in place to ensure consistency in DS0000050134.V321054.R01.S.doc Version 5.2 Page 13 providing care and support to the individual. The service user plan could improve by introducing user-friendlier formats e.g. visuals, graphics and/or the deaf/blind manual. A key-worker system is in place and staff are provided with various forms of training in communicating with individuals e.g. ‘guiding the blind’ (July 2006). It was noted that a new format was introduced using a tickbox style of care planning. This caused some anxiety amongst the team and one could not be certain whether this would improve the quality of service provided. In this respect the previous recommendation to develop friendlier service user plans would be retained. There was some evidence that service users are given support to make decisions about their lives. This starts from initial assessments and in the case of the most recently admitted individual, his plan had detailed the preferences of care and support that he required. Much of this information was gathered from his relatives and to some extent, other professionals that had worked previously with the service user. He was therefore able to enjoy a fairly comfortable and safe quality of life in the home. In another case there was evidence that a referral for advocacy input was made to the Daffodils Advocacy Project, but without much success. It was reported that the project was out of funding. In this same case action was taken by the registered manager and staff to get the GP review the individual’s medication in relation to the recent change in their health. The action taken was critical to the individual’s welfare and as such, a more appropriate approach to identifying and treating the change in the service user’s health. Most of the staff were quite familiar with the actions of service users when they are either pleased or dissatisfied with staffing interventions. However, it was not always clear in some cases how service users for example made decisions around the food they would like on a particular day, as picture menus were not used in the home. In one case there would have been a need to develop opportunities for an individual, to smell and/or taste the samples of food to ensure that he could contribute to decision-making – this had not been in place and needs to improve (Also See Standard 17). None of the service users were able to manage their own finances independently. However, adequate arrangements were in place to support them in this area. Risk assessments are carried out for each service user as part of their overall assessment, during their admission to the home. They were individually undertaken and took into consideration the aspirations, skills and abilities of each service user This is useful in guiding staff to promote service user’s independence within a risk management framework. Service user safety is balanced with the need for them to take risks. In three of the five cases, risk assessments were in place and updated. However, others were not completed as they were to be carried out by the key workers. This meant that for those individuals they were unable to maximise DS0000050134.V321054.R01.S.doc Version 5.2 Page 14 their independence in a safe manner. This needs to improve and as such, risk assessments must be in place for all service users. DS0000050134.V321054.R01.S.doc Version 5.2 Page 15 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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy opportunities for personal development by taking part in activities - suited to their needs. They are encouraged to use some community facilities and where possible, are supported to maintain positive relationships with their family. Although arrangements are in place to promote their rights and nutritional needs, improvements are required in both these areas to ensure an enhanced lifestyle. EVIDENCE: There was evidence that the most recently admitted service user continued attending a day centre, which he attended, prior to moving into the home. Staff worked well in ensuring that there was continuity in his programme and from observing the individual, he looked comfortable with his attendance to the facility. It must be noted that his continued attendance, was in line with the wishes of his relatives, as they were actively involved in his care. Given the level of disability, most of the service users were not actively involved in academic or employment training. However, staff spent time helping service users develop personal skills, safety awareness and confidence. DS0000050134.V321054.R01.S.doc Version 5.2 Page 16 One example of this is where a service user previously avoided the use of escalators and with staff support has started using them. For another service user, he is taken to eat out in a less busy restaurant initially, until he becomes more confident to use one that is much busier. These examples though simple are important to making a difference to service user’s lives. The task for staff begins in the home where support and guidance is given to individuals for them to participate in activities – based on their capabilities. It was noted that they each had a social diary with a small, but reasonably frequent range of activities that they did externally. Service users are appropriately supported with their personal finances, either through their next-of- kin or an appointee. Service users were observed getting out and about in the community and for most shopping was one of the key things they enjoyed. They get the opportunity to do this fortnightly and for one individual, he enjoys riding the bus. He also goes out shopping for his toiletries, which is therapeutic – where he uses his sense of smell in making choices. Another individual goes out walking for half hour regularly and this keeps her in touch with her external environs. Pictures were seen of service users shopping in Lakeside - enjoying themselves. There was a list of dates for planned activities over the recently concluded festive season, and this included a staff and service users’ Christmas lunch out. Staff worked flexibly to ensure that service users were able to integrate into the community. It was observed that varying levels of support was provided and this was based on individual needs. During the course of the inspection, the relative of a service user took the opportunity to give feedback on the care and support that his son was receiving from the home. He stated that; ‘my son is well–cared for and I feel welcome here’. The relative has a close relationship with his son and staff at the home, and what was important – is the value to both parties of the visits. There were at least two other good examples where, relatives were involved in the care and support of service users. In so doing the management and staff maintained cordial and professional relationships with various parties. A good case on point could be drawn from the fact that the information gained from the parents of a service user was used to carefully provide for the specialist needs of one individual. Given the level of service user disability, the role of the next-of-kin was critical to ensuring that the best interests of service users were put first. This is a strong area of the home’s operations. Two members of staff were interviewed and were aware of the General Social Care Council’s code of conduct in promoting the rights of service users. They were observed addressing service users by their preferred names, interacting with them and generally providing individualised care to service users. Some service users were more independent than others, and from observation staff worked well with individuals in promoting their privacy. However, some DS0000050134.V321054.R01.S.doc Version 5.2 Page 17 thought needs to be given to carrying out the handover in the presence of service users. This practice was observed during the inspection and adequate steps were not taken to protect the confidentiality of service users, as personal matters relating individuals were openly discussed. Staff were also observed describing the action they took in providing personal support to an individual in the presence of two service users. Although service users relied heavily on nonverbal communication, their right to confidentiality must be preserved, unless there are extremely good reason/s - not to so do. Improvement is required in this area. It was noted that in some cases, service users’ relatives advocate on their behalf and there was one case in which a service user had been referred to the Daffodils advocacy project. During the assessment of meals, it was observed that the nutritional needs of service users were taken into account. Low fat, low sugar diets were made available and the medical conditions of service users along with the implications were considered as part of meeting their nutritional needs. The service users currently at Sunnyside are a diverse group and it was clear that in some instances their cultural needs e.g. the provision of Halal meat, were met. The registered manager informed that she checks the kitchen to ensure that meals are prepared in line with service users’ plan and nutritional needs. However, staff were overwhelming in their feedback, that service users are not given a choice of food. Picture menus were not yet developed, neither was a system where service users could ‘taste and smell’ meals in enabling them to make a more informed choice. The feedback also informed that Halal meat is mostly purchased for two service users, but would also be given to a service user from Afro-Caribbean descent – which is not of the same cultural origin. In assessing the food that was provided over a period, there was evidence that at times rice, Soya milk, corn meal porridge, mash potato, green bananas and plantain were provided for the service user that enjoys her cultural food. It was clear that this could be provided more regularly. There were concerns that the desserts were mainly fruit and while this is healthy, service users reportedly preferred a bit of variety e.g. low sugar cakes. One service user did not like fruit, but would have cooking apple, with a bit of custard and this is not provided. While it is positive that a fresh supply of fruit and vegetables were available, service users could be provided with more variety in their meals. One of staffing suggestions was a weekly takeaway. Staff were concerned that they were now doing the catering seven days per week, as a caterer is no longer employed. This did not have a major impact on their care hours, although staff stated that they preferred spending more valuable time with service users. Staff were also concerned that they were not allowed to have meals with service users as part of making the occasion more relaxed. This is a valuable concern, which the registered persons should DS0000050134.V321054.R01.S.doc Version 5.2 Page 18 consider. During the course of the inspection, it was observed that a number of food items were improperly stored – in that they were left opened. The registered manager needs to review the arrangements for meals in the home. DS0000050134.V321054.R01.S.doc Version 5.2 Page 19 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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users generally enjoy personal support in accordance with their needs and wishes and the staff team is proactive in ensuring that both their physical and emotional needs are met. Medication practices in the home ensure the well-being and health safety of service users. However, more needs to be done in relation to promoting service users’ independence to enhance their welfare as a whole. EVIDENCE: Service users follow their individual plan and are encouraged to work with staff in providing personal support to them. This is important as the range of special needs of the service user group is quite varied and as such, would be best provided in line with the preferences of each individual. The staffing deployment takes full account of this and every effort is made while providing the support – to promote and maintain service user independence. The key working system in the home enhances this. One good example of this was where a plan was in place to improve a service user’s independence with regard to toileting. The initial results were promising in that the service user was actually engaging in the process, which could have positive long-term outcomes e.g. having to change less frequently and/or promoting greater personal comfort. DS0000050134.V321054.R01.S.doc Version 5.2 Page 20 In one case a service user with sensory loss affecting the eyes was observed being supported to the bedroom. Handrails were in place along the walls leading from the ground floor to the first floor and staff with appropriate training (e.g. guiding the blind), provided guidance to the individual. Whilst this was negotiated successfully and with some difficulty, it did not promote the service user’s independence. There was no evidence that an occupational therapist assessment had been requested or undertaken. This must be carried out in the service user’s interest. Evidence was available that other forms of specialist advice was taken, e.g. from the RNIB and the RNID, but this did not go far enough. The home also has specialist involvement from a consultant psychiatrist. Service users were generally well presented, groomed and wearing their individual clothes. Personal care was carried out in private and in a sensitive manner throughout the course of the inspection. However, staffing feedback received informed that service users were not given a choice particularly with regard to when they get up. They informed that service users were given that option mostly on weekends when the manager is not around. Staff indicated that they have challenged this, indicating that some service users would like a lie in, but are instructed to get them up. Whilst it is recognised that service users may require support to get up for their appointments – they should be allowed some element of choice in the matter. This needs to improve. It was also reported that some service users were in need of appropriate clothing and while the inspector did not examine the wardrobe of service users, action must be taken to ensure that all service users have access to appropriate clothing. All service users were registered with a GP and records were held on visits made to and by health professionals. This included the use of dentists, opticians and the chiropodist. Health appointments were appropriately recorded for all service users. Staff interviewed showed a good understanding of the needs of all service users, but were also quite knowledgeable about the needs of service users for whom they were key working. Staff also demonstrated the ability to identify when the health of service users deteriorate. There is also clear policy guidance for staff to follow when these situations arise. Emergency numbers were widely posted in the staff office to acquire further assistance as required. From assessing the files of service users, it became evident that staff knew what they were doing in supporting service users when they become unwell. There were good examples of the management and staff going all out to get the best possible healthcare for service users. This included investigative and diagnostic work for a couple of service users. One service user managed to have a blood test – for the first time in many years and this was instrumental in helping to come to a clearer diagnosis of the individual’s physical health. DS0000050134.V321054.R01.S.doc Version 5.2 Page 21 Given the complexity of the individual’s physical and special needs a multi – disciplinary meeting was called as appropriate. Evidence was provided to show the difficulties staff had to endure with external professionals in acquiring healthcare services for e.g. in King Georges Hospital, where staff were behaving indifferently as a result of the behaviours of a service user. It is a credit to the management and staff for sticking out for service users with disabilities to ensure that their healthcare needs to which they are entitled are adequately provided for. This is a strong area of the home’s operations. Medication practice was observed and an assessment of the drug storage and record – undertaken. The staff responsible for medication referred to the drug charts and discharged her responsibilities in a satisfactory manner. None of the service users were capable of self-medicating and so they rely upon the staff to carry out this responsibility in a safe manner, to ensure that their health and welfare is promoted and protected. A satisfactory medication policy and procedure was in place in the home and staff were aware of it. There are key members of staff that have the responsibility for administering drugs and they all have been provided with training in medication. It was noted that the home’s medication is assessed on average, every twomonths by the pharmacist. The manager along with two members of staff, are responsible for ordering medication. The manager has undertaken a practical and theoretical assessment on the handling of medication. Plans were in place to carry out similar assessments every six-months for all staff handling medication. This is a positive step. Along with the British National Formulary, staff have access to leaflets kept in the medication folder - as a form of guidance. The registered manager gave an example in which the GP was asked to consider the long-term effects of Risperidone on a service user, which brought about a positive outcome for the service user. Medication handling is a strong area of the home’s operations. DS0000050134.V321054.R01.S.doc Version 5.2 Page 22 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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints policy and procedure is available for the benefit of service users and their relatives. Adequate procedures were also in place at the home to ensure the protection of service users coming into contact with the service. EVIDENCE: The complaints record was assessed and over the last year two complaints were recorded. One was substantiated and the investigations were carried out within, the policy timescale. The complaints procedure was updated and remains available on the notice board. Most of the service users are unable to raise complaints independently and rely upon their relatives to assist them. From interviews held with staff, they viewed complaints, as a positive feature in promoting the rights of service users. A satisfactory adult protection procedure remained in place at the home and this includes clear guidance on ‘whistle-blowing’. Most of the staff team had training on adult protection and from interviews held with a random samplethey understood their responsibility in protecting vulnerable adults. There were no adult protection issues in the home. DS0000050134.V321054.R01.S.doc Version 5.2 Page 23 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): (24,26,30) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Although service users have the benefit of a homely environment, the home was lacking in maintenance. Service user bedrooms generally met their needs and the home remained clean and hygienic. EVIDENCE: During the course of the inspection, the registered manager spoke of the organisation’s plan to refurbish and re-design the home. However, the Commission has had not received written proposal/s of any such changes even up to the time of writing this report. Although service users were generally safe, the home was in dire need of redecoration and repair. At the time of the visit, a planned programme for the maintenance and renewal for the fabric and decoration of the home was not available. There are arrangements in place to deal with issues of maintenance e.g. repairing the emergency lighting, and records were kept on works carried out. In touring the building a number of areas required improvements. They included: 1) damp to; the lounge in unit B, the kitchen in unit A near the cooker, the spare bedroom, and the staff office (ceiling), 2) Large cracks in the plastering behind the fridge in unit A and around the kitchen doorframe, DS0000050134.V321054.R01.S.doc Version 5.2 Page 24 vertical cracks in shower 12 and the spare bedroom, 3) redecoration of the whole of the lounge in unit B, 4) replacing the shower hose in bathroom 9 and 5) replacing or repairing the kitchen door lock in lounge B. The items identified were the key areas that stood out and given their level of disabilities, service users were unable to voice their concerns about their environment. In this respect the registered persons need to carry out their regulatory responsibility to ensure that service users live in a home that is maintained in a good decorative state. The communal areas were accessible to service users, had good lighting and ventilation and, some plants were added to give it a more homely feel. It was also warm and service users looked comfortable either viewing TV or listening to music. There is adequate space to provide for activities, some of which were slowly developed. Service users have some form of sensory stimulation, but a dedicated sensory room would be an asset to the service as a whole. Some bedrooms were assessed with the permission of the service users and they were in a better condition, when compared to the communal areas. They were personalised, some more so than others. In one case a service user had her picture engraved in a wooden background on her wall. It was clear when communicating with her about the picture that she was pleased with it. Furnishings and fittings were of a good standard and in one case appropriate steps were taken to ensure the safety of the service user e.g. using a padded mattress, instead of a headboard. Service users enjoyed privacy in their bedrooms, with staff having access within individually agreed plans. Despite the improvements that are required to the communal areas, the home was clean and ancillary staff is generally responsible for this. The laundry facilities were cited away from eating areas, generally adequate, and had the capacity to effectively clean soiled linen. This is important given the needs of the service user group and staff spoken to were generally satisfied with the laundry facilities. Appropriate arrangements were in place for washing hands, which are cited throughout the home e.g. toilets, baths and laundry areas. The laundry floor is impermeable and was kept in a clean condition. Policies and procedures for infection control were updated and available to all staff. DS0000050134.V321054.R01.S.doc Version 5.2 Page 25 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): (32,34,35,36) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. At Sunnyside service users receive care and support from a dedicated and effective staff team. Robust recruitment procedures ensure that service users are safe when engaging with staff. A focussed approach is in place to improve the skills and expertise of staff. Regular supervision now provides staff with sound direction. The process of carrying out staffing appraisals in the home has started and this would also have a positive impact on their contributions to the service. EVIDENCE: At the time of the inspection one hundred per cent of the staff team had achieved their NVQ level 2 in Care. A number of staff did start their NVQ level 3 in Care. Service users were therefore benefiting from being supported by staff that had a good understanding of basic care. What was promising was that a number of staff were keen to improve their skills and knowledge. The registered manager did her part in ensuring that staff were able to access further training as part of their development. From interviews held with two of the staff – they demonstrated a sound knowledge of the service users’ needs and the service aims. They were creative in communicating with service users and as such did so through the use of: objects of reference, some pictures and, the individual non-verbal gestures of service users. DS0000050134.V321054.R01.S.doc Version 5.2 Page 26 In one case a sensory board was developed for an individual. Staff were able determine whether a service user was pleased, unhappy or discomforted during their interaction with them. It was noted that a number of staff attended a creative communication course, which enabled them to interact positively with service users. An assessment of the service users records indicated that staff were capable of working with the multiple and individual needs of service users. They also worked well with external professionals in meeting the needs of service users. Satisfactory arrangements were in place for robustly screening staff wishing to work in the home. A random sample of four staffing recruitment files were examined and found to be in order i.e. containing all the detail required by regulation e.g. CRB checks, medical declarations, copies of passports and birth certificates and where applicable – the eligibility to work in the United kingdom. References were appropriately taken up and although in one case, the names given differed from the one given on the application form. This was followed through and a valid reason noted for this. Service users therefore have the assurance that staff working with them are fit to so do. This is confirmed only upon the satisfactory completion of a probationary period, which not only meets the minimum requirements, but also constitutes good recruitment practice. The registered persons continued to recruit a diverse team in terms of gender and ethnicity, which in the interest of the current service user group. All staff have a copy of the GSCC code of conduct and from observation most were able to put the principles into practice. There was evidence that a satisfactory training plan is in place for staff and this developed from undertaking a training needs analysis of the staff team. More importantly the training was planned right up until March 2007. All staff including those working bank shifts had a thorough induction that was in line with the national minimum standards. In looking at the file of one of the bank staff- they had undertaken training in moving and handling, health and safety, food hygiene, first aid, infection control and epilepsy awareness. Training was devised based on the needs of service users and this ensured that staff were skilled up to meet individual’s needs. One example could be drawn from the fact that training was specifically set up in areas such as; ‘guiding the blind’ and ‘stimulation and communication’ with an individual with significant sensory impairment. Other keys areas of training that would ensure service user’s safety included; adult protection, complaints handling for frontline staff and non-violent physical intervention. One area that has to be looked at is training in equality and diversity. This is a strong area of the homes operations. It was noted that staff were in receipt of regular supervision and this is positive. Staff interviewed found it useful and there was a general view that DS0000050134.V321054.R01.S.doc Version 5.2 Page 27 the relations between the management and staff had improved. The manager explained that supervision was streamlined and aimed at giving staff as much support as possible. The process of appraisals had started and staff were given information about it, as well as the relevant form to fill out. It is envisaged that they would be rolled out as early as January 2007. A staff team that is wellsupported and developed would offer a better service to individuals living at Sunnyside. This is positive. DS0000050134.V321054.R01.S.doc Version 5.2 Page 28 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) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A good management structure is in place at Sunnyside to promote welfare and best interests of service users. This includes the arrangements for health and safety. The overall quality of the service could be improved through better quality monitoring and ensuring that key management systems are in place to promote the welfare of service users. EVIDENCE: The registered manager has achieved her NVQ level 4 in Care and has started her NVQ level 5. She also confirmed that she was pursuing a ‘masters in health services management’. She actively participates in training related to the service and has responsibilities for; monitoring policies and procedures, internal budgets, monitoring standards and codes of practice and ensuring that service users rights and responsibilities are maintained. There was evidence that she maintains professional relationships with external agencies in the interests of service users and the service as a whole. DS0000050134.V321054.R01.S.doc Version 5.2 Page 29 It was noted that an annual development plan for the home was not in place, although a quality assurance audit had been carried out. This audit was around the documentation in the home in relation to CareTech’s policies and procedures. It was not possible to fully establish how the audit determined the quality of care for service users or their experiences. A service user survey had not been carried out. There was some evidence that monthly provider visits were carried out, but from the home’s records and that of the Commission, they were infrequent. Since the transition on May 18th 2006, there have been less than five reports produced by the organisation. This needs to improve, as it falls well below the minimum standards. There was good evidence that health and safety in the home was maintained at a good standard. All staff had appropriate training and during staffing interviews, they demonstrated a good understanding of their responsibilities in maintaining safe working environment and service user safety. Risk assessments regarding health and safety were reviewed and certificates for gas, electric and fire equipment were in date. Fire drills were carried out regularly and in addition to the signing in book, a fire register is maintained. It was also noted that there were no outstanding requirements from visits previously made by external agencies e.g. fire, environmental health. Risk assessments were in place and updated. A health and safety audit is carried out on the home monthly and this identifies issues that present a risk to service users and staff. Safety procedures were appropriately posted throughout the home and a record of accidents and incidents is maintained. At Sunnyside service users are assured that they are safe and all reasonable steps are taken to maintain their safety. Lines of accountability in the home were clear and staff and one relative spoken to, confirmed this. The registered manager confirmed that there were systems in place for financial control and monitoring. However, a business and financial plan was not available for inspection and the manager advised that she had not seen one. As a result it was difficult to determine the financial viability of the service. It is recognised that the service is owned and run by a large organisation, however it is unknown what is allocated to the home. One of the key concerns at the inspection was the fact that an insurance certificate was not available for the home. The last certificate expired on 4/4/06. This needs to be in place as soon as possible. Despite the fact that the service is fairly stable, this was threatened, as the registered manager did not feel supported in her role. This experience was supported by from the fact that she has had two formal supervisions from May 18th 2006. Given the organisation’s ambition’s to develop the service and bring it in line with their objectives, it is critical for the manager to have the support required to effect change/s, as required. DS0000050134.V321054.R01.S.doc Version 5.2 Page 30 The registered manager has the responsibility of leading staff team that provides a service to individuals with complex needs. It is therefore crucial that support via supervision and appraisal is regularly provided to the registered manager in line with the national minimum standard 43.3(iii)- for younger adults. DS0000050134.V321054.R01.S.doc Version 5.2 Page 31 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 2 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 X 26 3 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 4 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 4 4 x 3 X 2 X X 3 2 DS0000050134.V321054.R01.S.doc Version 5.2 Page 32 NO 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 YA1 Regulation 4,5 Requirement Timescale for action 28/02/07 2. YA9 3. YA9 4. YA16 YA7 5. YA18 The registered persons are required to update the statement of purpose and service user guide in a format that is best suited to the service user group. 13 The registered persons are required to have in place, updated risk assessments for all service users. 13 The registered persons are required to: 1) review the hand over arrangements to promote service user confidentiality and 2) take adequate steps to ensure that staff follow them. 12, 13, The registered persons are 15(2)(m) required to review the meal arrangements in the home to: 1) demonstrate how service users choose their meals, which must documented, 2) provide more varied diets (including desserts) for all service users, and 3) ensure that food is appropriately stored at all times. 12,13,23(m) The registered persons are required to: 1) carry out an occupational therapist DS0000050134.V321054.R01.S.doc 28/02/07 28/02/07 28/02/07 31/03/07 Version 5.2 Page 33 6. YA24 23 (2)(b)&(d) 7. YA39 24(1)(a)(b) 26(2)(4)(5) 8. YA43 25(2)(c) & 25(2)(e) 9. YA43 18(2)(a) assessment on the premises in relation to service users with physical and sensory disabilities, 2) ensure that all service users have appropriate clothing and, 3) demonstrate that service users have a choice in waking up and going to bed. The registered persons are required to: 1) carry out the works specified in Standard 24 of this report and, 2) have in place a planned programme of maintenance and renewal for the fabric and decoration of the home. The registered persons are required to; 1) have in place an annual development plan for the home, reflecting outcomes for service users and 2) Carry out monthly provider visits to the home – with reports available to the Commission. The registered persons are required to; 1) make available to the Commission -a business and financial plan for the home and 2) Provide evidence of a valid insurance certificate for the home. The registered provider is required to ensure that the registered manager is appropriately supervised. 31/03/07 28/02/07 28/02/07 28/02/07 DS0000050134.V321054.R01.S.doc Version 5.2 Page 34 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 YA6 YA17 Good Practice Recommendations The registered persons should develop service user plans in user- friendlier formats. The registered persons should review the practice of staff having meals with service users, to assess whether it adds value to service users’ mealtimes. DS0000050134.V321054.R01.S.doc Version 5.2 Page 35 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. Extracts may not be used or reproduced without the express permission of CSCI DS0000050134.V321054.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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