Inspection on 28/09/05 for Sunnyside House

This inspection was carried out on 28th September 2005.

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 5 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 26/01/06

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 28th September 2005 10:00 Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 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.V255109.R02.S.doc Version 5.0 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.V255109.R02.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Sunnyside House Address Main Road Birdwood Glos GL19 3EA 01452 750491 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) Orchard End Limited To be Appointed Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th March 2005 Brief Description of the Service: Sunnyside provides accommodation and personal care to ten people who have learning disabilities and some 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.V255109.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over six hours and was supported by a second inspector, Lynne Bennett. There has been a change of manager since the last inspection. The acting manager and the deputy manager assisted with the visit. The atmosphere in the home was welcoming and friendly and residents seen on the day appeared relaxed, content and spoke positively of the care they receive in the home. A number of records were inspected and several staff were interviewed. What the service does well: What has improved since the last inspection? The opportunities for service users to access activities outside the home have increased. Staff are given guidance about the required standards of care early on in their introduction to the home. There are established links with the local Community Learning Disabilities Team, who provide the home with guidance and support on responding to behaviour challenges and in addition there is access to the services of the Company’s psychologist. The review of placement for one person has taken place following previous requirements and service users’ changing needs are being monitored and responded to. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 6 Polices on managing medication have been reviewed as required in the last inspection report. Staff are receiving regular formal supervision as necessary. 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.V255109.R02.S.doc Version 5.0 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.V255109.R02.S.doc Version 5.0 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): 2 and 3 Admission procedures are comprehensive and promote service user participation. EVIDENCE: Two service users left the home since the last inspection. The contracts for both service users were terminated by Orchard End Ltd, as their needs could no longer be met. The acting manager is looking at new admissions and has considered the difficulties in bringing a new person to the home where there is an established group of service users. The company has made the admission process more comprehensive. This includes thorough assessments, looking at how specialist needs will be met and extended trial period during which the frequent monitoring of the placement is undertaken. This should prevent the home from admitting anyone whose long term needs cannot be met. Following requirements made in the last report about re-assessment of one person’s needs, a placement review has taken place. The service user has been more settled and the staff team have been able to support the person as necessary. However, the person did experience significant problems last year when their mental health had deteriorated and their placement was in jeopardy. There were difficulties in accessing the necessary medical and psychiatric expertise, as the professionals were reluctant to accept responsibility. It is not clear whether these difficulties have been resolved and Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 9 the home is required to compile a contingency support plan which clearly states who will provide the necessary support at the point of crisis. There are other service users whose behaviours have caused concern to the staff team. Staff spoken with did not feel well equipped to understand and deal with more bizarre and strange behaviours which have become evident. The manager is looking at ways of providing better support and outside professionals have been approached. However, it is felt that staff need training in mental health needs to build on their existing skills and expertise. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 10 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): 6 and 9 Service users needs are reflected in individual plans and people are consulted about the support they receive and goals which they may have. Aspects of an independent lifestyle are promoted within a risk assessment framework. EVIDENCE: Records examined showed that comprehensive information is available about people’s assessed needs. A number of supporting records are kept, including guidelines on individual routines, daily observations and goal plans. There was evidence of key-worker consulting with the service users to ascertain their wants and obtain feedback. Staff spoken with were aware of the missing persons procedure and systems in place to activate emergency support. Missing person’s information is kept for all service users. Sample risk assessments have been forwarded to the Commission prior to the inspection and these are comprehensive. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 11 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): 12, 13, 14, 15 and 16 Service users benefit from increased opportunities for community presence and are supported to maintain family relationships and friendships. Service users may not always be supported to make choices in a way which respects their rights. EVIDENCE: Staff spoken with felt that there has been an increase in opportunities for service users to pursue their interests and to go out into the community. Timetable of attendance to local college was seen and this offered activities such as drama, computers and IT and gardening. Records examined provided evidence of trips into town, for meals out, pub nights and shopping. One service user has talked about being interested in horse riding at previous inspections. During this visit, the person said that they are still keen on this activity but have not been presented with an opportunity to access it. Such opportunities should be explored. The transport provided by the home now consists of two seven-seater vehicles. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 12 Links with relatives have been re-established for one person and staff said that this has had a positive impact on the service user. There are no locks on some bedrooms. The home should offer this option to any prospective service users and also review whether people who already live at Sunnyside would like to have a suitable lock on their door. A restriction has been implemented in the kitchen as a preventative measure and staff spoken with were aware of this. There was still evidence from discussions with staff and from records that service users’ requests for ‘treats’ are refused on occasion and this causes upset to the individuals. The manager is aware that some of the approaches used need to be reviewed to ensure people are supported to make positive choices without compromising individual’s autonomy and rights. Further training around these issues is recommended. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 13 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): 18 Emotional needs of the service users are being responded to with respect. Professional expertise is sought to ensure staff develop the right approach to dealing with difficult behaviours. EVIDENCE: Some service users have complex emotional needs and can present significant behaviour challenges. There was evidence from records and discussions with the manager that support has been sought from psychologists for a number of individuals as appropriate. One person has been supported by an assistant psychologist on weekly basis and this was felt to have benefited the service user. Guidance and recommendations made by any involved professionals will be included in personal files to promote better awareness for staff and look at good practice approaches to difficult situations. Staff spoken with said that particularly difficult behaviours and incidents are discussed amongst the team and strategies are then implemented to support the person and the staff. Previous requirements regarding the medication policy have been addressed. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 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): 22 and 23 There are good systems in place for supporting people to voice concerns and to protect service users from abuse. EVIDENCE: Service users in the home are supported to voice their concerns and to make a complaint. There are systems in place for recording all concerns and complaints from the service users. The residents spoken with said they would feel comfortable talking to the staff or the manager about any issues they may be unhappy about. A risk assessment has been implemented in recognition that a service user could make a serious allegation about staff. No allegations have been made at present, but the systems are already in place to ensure that the person will receive the necessary support. Staff have been instructed to monitor and record any concerns expressed by the service user to protect the person and themselves. The home has ensured that the Commission is notified of any events which may be detrimental to the service users and staff. The home has also kept the placing authorities and relatives informed of such events as necessary. A recommendation is made for the home to amend the paperwork regarding physical intervention to reflect the changes in personnel responsible for monitoring this practice. Examination of incident records provided evidence of possible racial connotations when conflict arises between service users. Discussion took place Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 15 about how this is being dealt with. The home manager felt there was no racial motivation in the incidents described, but advised that there will be close monitoring of any future incidents like this. The home has sought input from outside professionals in order to help the service users with anger management. Staff spoken with said that restrictive approaches are used rarely and only when there is a risk which cannot be managed safely through another approach. They said service users are helped to get control of their feelings and walk away from situations of conflict. They are then praised for this which reinforces this more positive response. The new manager has taken on board the recommendation made in the last report about monitoring which staff carry out physical interventions, so that their skills in this area can be appraised as necessary. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 16 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): 24 and 30 Service users live in a clean and comfortable environment which benefits from ongoing and planned programme of maintenance and improvement. EVIDENCE: The ground floor bathroom has been refurbished. Other plans to improve the environment in the home have been put on hold. The manager explained that this is due to the home carrying service users ‘ vacancies and that the improvements will now come out of next years budget. It was noted that the kitchen has started to look tired and staff confirmed that there are plans to refurbish this at the same time as other environmental works are carried out. One bedroom viewed was in very poor state, with broken furniture and poor décor. This has been as a result of the behaviours displayed by the person. The refurbishment of this area has already been scheduled and new furniture was due to be purchased. The systems for offering support to the service user when they are feeling upset have been reviewed and staff were aware of these. Another bedroom was seen; this was well furnished and provided space for personal belongings. The service user said they were liked spending time in their room listening to music. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 17 The home has employed a part-time housekeeper, who also has the responsibility for cleaning of communal areas. This has freed up care staff to support more community-based activities. A pool table has been purchased for the lounge. Service users are supported to do their laundry where appropriate. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 18 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): 32, 33 and 34 Better clarification of staff roles and responsibilities should enable the support to be delivered to the service users in a more co-ordinated way thus increasing the continuity of approach. EVIDENCE: Concerns were expressed by some staff that care plans and guidance for supporting service users is not being followed consistently. This creates divisions in the staff team and could result in people’s needs not being met. Staffing requirements for the home are being reviewed by the new manager. There are systems by which staff are allocated to support some individuals on day to day basis. This refers to the DMS role (designated support staff). It is not clear who needs this additional support, whether this corresponds to funding agreements and how it is being monitored. The manager was not aware of any service users being funded for one to one support at present. The home has been carrying two service user vacancies for several months and staffing levels have been adjusted in response to this. There are usually five (5) staff on duty during the day, although difficulties with cover can arise especially at weekends. Staffing levels can on occasion drop to 3-4 staff. The home manager advised the staffing levels have only dropped to 3 for one shift only since July 2005 due to an emergency. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 19 When there are five staff on shift, two generally cover the bungalow and three staff provide support in the main house. Staff spoken with felt that five staff were not sufficient to allow for flexibility in accessing community activities. The manager has approached the Group Manager with a proposal to increase staff ratio to six. There are systems in place for monitoring absenteeism. The manager should also monitor the impact staff shortages may have on the service users as this will provide evidence towards proposals to increase staffing. Communication systems within the home in particular between the staff teams are being improved through introduction of information sharing books and additional meetings. The staff still work in designated teams although a review of this is likely. A number of new staff have been employed in the home since the last inspection. Staff files were examined in order to assess the robustness of the recruitment process. CRB disclosures for new staff were not seen during this visit. Some shortfalls were identified as follows: 1. One file was missing a photo and evidence of ID. 2. The same file had an unexplained gap in the person’s employment record. 3. Another file dates of employment were given in years not months. This made it difficult to establish when the person had left their last employment. 4. One file did not contain the evidence of training and qualifications the person claimed to have completed. 5. Employment history on one file was incomplete, there was only one reference which was not dated and no written reasons were stated for leaving past employment in care. Standard 36 was not assessed in detail, but staff spoken with confirmed that they were receiving regular supervisions. The manager said that the aim is for all staff to receive formal supervision every two months. The Company has a comprehensive supervision policy in line with the National Minimum Standards. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 20 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 Presence of an experienced manager should benefit the service provided. EVIDENCE: The new manager has several years of experience in management positions and is in the process of applying to be registered with the Commission. The manager advised that since the start of his employment he has not implemented any major changes, but concentrated on building up his understanding of the service provided at Sunnyside, and on getting to know the residents and the staff team. There was evidence that the manager has acted promptly and professionally when responding to adverse events and has demonstrated a good understanding of protection principles. A number of issues have been identified by the manager for improvement and these include promoting better communication between staff, regular staff supervisions and greater involvement of service users in the running of the home. Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 2 x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 2 17 Standard No 31 32 33 34 35 36 Score X 2 2 2 X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Sunnyside House Score 3 X X X Standard No 37 38 39 40 41 42 43 Score 3 X X X X X X DS0000055006.V255109.R02.S.doc Version 5.0 Page 22 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 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. Ensure all staff are aware of care plans and support guidance and follow these as required. Ensure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. Ensure all necessary information is obtained for staff before they commence employment. Information found to be missing from staff files must be obtained as described in the text. Provide staff with training in mental health Timescale for action 31/12/05 2 3 YA32 YA33 12 (1)(5) 18(1) 31/12/05 31/12/05 4 YA34 17 and 19 31/12/05 5 YA3 18(1)(c) 31/03/06 Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 23 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 YA16 Good Practice Recommendations The home should offer to any prospective service users the option of having a lock on their bedroom door and their own key to maximise independence and privacy. The home should review whether people who already live at Sunnyside would like to have a lock and key for their bedroom doors. A recommendation is made for the home to amend the paperwork regarding physical intervention to reflect the changes in personnel responsible for monitoring this practice. Staff should receive further awareness training about service user empowerment to help them better respect people’s rights. The manager should monitor the impact of any staff shortages on service users. Explore opportunities for horse riding for the person who has expressed an interest in this activity. 2 YA23 3 4 5 YA16 YA33 YA14 Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 24 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. Extracts may not be used or reproduced without the express permission of CSCI Sunnyside House DS0000055006.V255109.R02.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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