Inspection on 26/01/06 for Sunnyside House

This inspection was carried out on 26th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Sunnyside House 05/07/07

Sunnyside House 04/01/07

Sunnyside House 04/07/06

Sunnyside House 28/09/05

Sunnyside House 04/03/05

Sunnyside House 20/09/04

Sunnyside House 18/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Sunnyside House Main Road Birdwood Glos GL19 3EA Lead Inspector Ms Tanya Harding Unannounced Inspection 26th January 2006 10:30 Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 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 House DS0000055006.V280208.R01.S.doc Version 5.1 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 House DS0000055006.V280208.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sunnyside House Address Main Road Birdwood Glos GL19 3EA 01452 750491 01452 750405 sunnyside@orchardendltd.co.uk www.orchardendltd.co.uk Orchard End Limited 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) To be Appointed Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd September 2005 Brief Description of the Service: Sunnyside provides accommodation and personal care to ten people who have learning disabilities and some who may also have additional challenging behaviours. The home is divided into two separate living areas; the main house which can accommodate six service users and the bungalow which can accommodate four service users. All service users have single rooms. In the main house there is a large dining room, lounge, main kitchen and laundry. Bathroom and toilet facilities are shared. In the bungalow there is a small kitchen, lounge and a dining room as well as communal bathroom and toilet facilities. There are spacious grounds around the home and a small lake. Some small animals and birds are kept. The home is set back from a busy main road in a rural village with some local amenities nearby. Service users are supported to use public transport and the home’s own transport to access a variety of community facilities in Gloucester and the Forest of Dean. The home is part of the group of homes known as Orchard End Limited, which is a subsidiary of C.H.O.I.C.E Limited. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over four hours and was supported by the home manager and one of the team leaders. The main purpose of this visit was to assess the progress made in meeting the requirements made in the last report. A number of records were inspected including staff files, support guidance, daily records and fire safety records. Three service users were out at college and one person returned to the home following a trip to the garden centre. Four service users were greeted and observed going about their daily routines. What the service does well: What has improved since the last inspection? Better guidance has been given to the staff team about responding the service users in a respectful and non-confrontational way to promote better relationships. The home has received input from the assistant psychologist and from the company’s physical intervention tutor to promote good approaches around managing challenging behaviours and to develop staff skills and confidence in this aspect of care. Further progress has been made in providing accessible and detailed support guidance for service users. Service users’ meetings have resumed and offer people an opportunity to chair meetings and contribute ideas and views about changes and improvements to the home. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 7 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 House DS0000055006.V280208.R01.S.doc Version 5.1 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: A new service user has moved into the home since the last inspection. The person said they have settled in well and liked the home. Staff spoken with confirmed that the service user was offered visits to the home and trial stays to enable the person to make an informed choice. The home manager has provided an update with regards to the requirement made in the last report to establish a crisis management plan to ensure that a specific service user receives the support from relevant professionals if their needs increase. The requirement has not been met at the time of this visit. The manager advised that a meeting took place with the person’s care manager on 12/01/06 to discuss the specialist needs the service user has. Following this the manager has written formally to the service users’ GP requesting a formal referral for further support. From discussions with care staff it was evident that the person’s needs are changing again and it is imperative that the specialist support can be accessed promptly to ensure the service user’s wellbeing. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Systems for recording and monitoring of service users’ expenditure appear robust and offer people protection from financial misuse. EVIDENCE: The home keeps records of all expenditure. There is an individual record for each service user of what allowances come in and what has been spent. Receipts are kept and tallied with the written record every week. The home manager showed evidence of his own regular monitoring. This is done as an additional check, again on weekly basis. Records of items purchased by service users over an agreed amount are kept as part of their inventory. There is an allocated activities budget, which is used for funding trips out to town and pubs. Staff expenses are also paid for from this budget. The revised support plans provide some information about how each service user is supported to manage their money. The manager said these will be further improved to provide greater detail with emphasis on service users having greater control over their finances. Minutes of the last service users’ meeting provided evidence of discussion about house rules and negotiations about use of TV in the communal lounge. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 and 17 Service users take part in fulfilling activities in line with their interests and wishes. There is a focus on promoting people’s independence and inclusion. Service users are provided with a wholesome and varied diet which accommodates their likes and dislikes. EVIDENCE: Three of the service users were attending college courses on the day of the visit. One person came back from a trip to the local garden centre. The service user said they enjoyed the outing and had refreshments out. Two of the residents had aromatherapy treatments on the day of the visit. One service user was supported to access a local spa on the afternoon of the visit. Records seen provided evidence that service users have opportunities for taking on roles and responsibilities to maintain the grounds around the home, look after the animals and birds. The manager advised that he has successfully discontinued the use of behaviour / consequence charts and has been advising staff on less restrictive Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 11 approaches. One example given was that service users are no longer offered ‘treats’. Instead, service users have access to snacks and drinks when they want. They are encouraged to have healthy options, but ultimately would be supported to make their own choices. There are well organised procedures for shopping, storing and preparing of food in the home. A number of staff have the responsibility for ensuring that the necessary food shopping is done regularly. There is a four weekly menu which is developed through discussion with the service users and incorporates people’s likes and dislikes. The menu is varied and provides ample fresh vegetables and healthy pudding options. Service users enjoy an occasional take away and this is incorporated into the menu plans. The inspector was able to sample the lunchtime meal which consisted of lamb chops, cabbage, roast potatoes and carrots. This was delicious and service users commented that they enjoyed it. It was also observed that alternatives to the main menu were offered to accommodate service users’ wishes and tastes. Service users are encouraged to help themselves to breakfast and there are flexible options for evening meals with a choice of sandwiches, salads, quiches and ploughman’s. Some easy to prepare meals are also available, so that service users can make these independently. The main meal is served at lunchtime. Service users are involved in meal preparation and clearing up. All food storage is well organised, rotated and replenished as necessary. Storage cupboards and fridges seen were very clean and well stoked. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 20 Service users health needs are well supported. Better monitoring of medication administration should ensure that service users are protected from potential errors. EVIDENCE: A number of service users were suffering with colds at the time of the visit. Staff were observed offering one person to see the doctor and demonstrated genuine concern for the service users’ wellbeing. One person said that they are continuing with their dental treatment, which has been ongoing for sometime. One person had an accident over a month ago and staff provided support for the person in hospital. The service user was accommodated in the ground floor room for the period of convalescence and at the time of the visit was fully recovered. The home has received input from the assistant psychologist with developing support and behaviour management plans for service users. A multidisciplinary approach has been used to review the support plans for one person to help them manage their anxieties and aggression. This resulted in a Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 13 new approach being introduced which is seen as less confrontational. The guidance for supporting the service user to manage their aggression gives staff a number of options before physical intervention is considered as a last resort. Medication administration records were examined and a number of discrepancies were found, where it was not clear if the prescribed medication has been administered or not. There were no records made to explain the gaps in signatures. There needs to be an effective system for monitoring administration of medicines to ensure any errors and discrepancies are picked up quickly and addressed as necessary. For one person a number of gaps in a row were attributed to the time the person had spent in hospital. Staff explained that hospital staff would not record on the home’s MAR sheet. This information should be recorded at the back of MAR sheet as an explanation. Other observations which should be addressed: a) List of staff competent to administer medication needs to be updated. This is because a number of staff on current list have left the home. b) Hand written amendments to instructions on MAR sheets need to be dated as well as signed. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: The Commission is not aware of any complaints about the home since the last inspection. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Not assessed. EVIDENCE: One service user showed the inspector their new bed which was assembled with support from staff. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36 The staff team may not be appropriately supported in carrying out their roles and developing their skills and competency and this may be compromising the quality of the care provided to the service users. EVIDENCE: There was evidence of regular staff meetings. These now take place in the bungalow, to ensure less impingement on service users space. Minutes from these meetings were examined. The meetings take place almost every month and there was evidence of discussion about care plans, policies and procedures and good practice approaches. Four staff files were examined. Some information was not available such as only one reference on one file and no evidence of induction. Staff files must contain all information relevant to the person’s employment. CRBs have been obtained and these were viewed for staff employed since the last inspection. The Organisation has a comprehensive procedure for formal supervision of all staff. At Sunnyside the team leaders have the responsibility for supervising care staff and the manager supervises the team leaders. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 17 Team leaders have received supervisory training to support them in this task. However, it was noted that there are significant shortfalls in the amount of formal supervision the staff receive. In the last inspection report the manager talked about providing at least a two monthly supervision for staff. Examination of records provided evidence that some staff have not received any formal supervision for a considerable amount of time. For example one staff member has been working in the home since 2002 and was last supervised over two years ago (17/01/04). No supervision date was evident for this staff member on the supervision matrix for 2005. File for another staff member provided evidence that there was a formal supervision meeting recently. However, prior to this, the person appears not to have received a formal supervision or appraisal since 2003 (6/11/03). A file for another member of staff showed that they have received supervision more regularly; with dates of meetings evident for June 2005, August 2005, December 2005 and a performance review in September 2005. A new staff member who started in September 2005 has received a supervision in December 2005. However, this appeared to be very brief and is not seen as being satisfactory for its purpose. The manager confirmed his awareness of the company policy regarding the need for more intense supervisory support for new staff, which should be incorporated into their induction. The home manager needs to determine the reasons for the identified shortfalls and address these as necessary. The manager advised that training in mental health issues is being planned. This requirement was made in the last report and at the time of this visit was still within agreed timescales. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42 On the whole the home is well run, providing person centred care. However, a number of shortfalls in procedures for supporting staff and in monitoring health and safety could potentially compromise the quality of the service and the well being of the service users. EVIDENCE: The home manager has applied for registration with the Commission and continues to demonstrate a good understanding of the requirements of his role. He has implemented a number of changes in order to re-focus the staff attitudes and enable the team to develop more inclusive and empowering approaches for the benefit of the service users (see examples under Standards 11- 17). This report identifies a number of shortcomings in the administrative procedures and systems for supporting and developing the staff team (see examples under Standards 31-36). Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 19 There is evidence that some of the delegated roles and responsibilities require better monitoring to ensure these are actually completed. The fire logbook was examined. The last alarm test was recorded to have been carried out on 14/01/06. There was only one alarm test carried out in August 2005 and in November 2005 with insufficient number of tests also evident in September and October 2005. These must be done weekly. The last emergency lighting test was done on 24/10/05. These must be done every month. Fire drills are recorded, with last one being done on 24/10/05 and one prior to that on 24/07/05. The manager advised that these are organised and carried out by a team leader, but was not sure whether this staff member has received the required training in this area. This should be established. It is also recommended that more detailed information is recorded following a fire drill as this is key to inform the evacuation procedures for the home and identify any critical factors which may compromise people’s safety in the event of a fire. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 20 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 X 2 X 3 2 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 2 35 2 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 X 16 X 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X 2 X X X X 2 X Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 21 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 YA3 Regulation 14 and 13(6) Requirement Compile a contingency care plan for a specific service user detailing how the necessary support will be accessed for the person at the point of crisis. (Timescale of 31/12/05 not met.) Implement an effective system for monitoring administration of medicines to ensure any errors and discrepancies are picked up quickly and addressed as necessary. Ensure all necessary information is obtained for staff before they commence employment. (Timescale of 31/12/05 not met) Information about employment of staff must be kept on relevant files and be available for inspection. 4 5 YA35 YA36 18(1)(c) 18(2) Provide staff with training in mental health. All staff employed in the home must receive regular supervision DS0000055006.V280208.R01.S.doc Timescale for action 31/03/06 2 YA20 13(2) 28/02/06 3 YA34 17 and 19 28/02/06 31/03/06 31/03/06 Sunnyside House Version 5.1 Page 22 in line with the Standard 36.4. 6 YA42 23 and 13 Ensure fire alarms and emergency lighting are tested regularly (at least once a week and once a month respectively). 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA20 Good Practice Recommendations List of staff competent to administer medication should be updated. Hand written amendments to instructions on MAR sheets should be dated as well as signed. 2 YA36 Quality of formal supervisions should be improved. New staff should receive more intensive supervisory support at least during the period of their induction. 3 YA42 The manager should establish whether staff member responsible for organising and executing fire drills has received the required training (if not this training should be provided). There should be better monitoring of roles and responsibilities delegated to support staff to ensure the required tasks are completed as necessary. Recording around fire drills and emergency evacuation should be improved. Sunnyside House DS0000055006.V280208.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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