Inspection on 04/01/07 for Sunnyside House

This inspection was carried out on 4th January 2007.

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 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 7 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 04/07/06

Sunnyside House 26/01/06

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 Lynne Bennett Key Unannounced Inspection 4th January 2007 13:30 Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 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) Mr Robert Theobald Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2006 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 that 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. Fee levels at the home range from £1,121 to £1,863. The Statement of Purpose and last inspection record are kept in the office. Each person living at the home has a personal copy of the Service User Guide. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. This inspection took place in January 2007 and included a site visit to the home on 4th and 5th January. The pharmacist inspector was present for part of the inspection. The registered manager and group manager attended for part of the inspection. All people living at the home were spoken to and time was spent observing their care. Three people returned comment cards. Comments were received from healthcare professionals. A range of records were examined including care plans, staff files, health and safety information and quality assurance audits. The pharmacist inspector looked at medicine stocks and storage arrangements, Medication Administration Record (MAR) charts and other records and procedures relating to medication. How medicines were given to some service users at lunchtime was observed and the manager, deputy manager and a team leader were spoken to. What the service does well: People are supported to be independent and make choices about their daily activities. One person said they wish to go to college to do catering and staff are helping them to achieve this. Another person said they enjoy washing the home’s vehicles for which they receive a payment. People said that they enjoy going shopping and to the pub and are helped to see their friends and family. People were observed helping themselves to snacks and making meals. Several people said they enjoyed the food. There is safe storage of medicines. The deputy manager has a good understanding of managing medicines safely in this home and has an overall responsibility for this area of care. She makes random checks and these are all recorded with any necessary follow up action. A quality assurance system is developing which involves people living at the home. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Each person living at the home must have a statement of terms and conditions providing them with information about the services they should receive. People living at the home must have regular access to dental check ups. Training updates for some staff about medicines are needed. Records of regular assessment of staff competence in handling medicines should be kept as evidence that properly trained staff administer medicines. All staff must receive training in the safeguarding of vulnerable adults from abuse. Increasing their knowledge may result in raising their awareness of what incidents need to be reported to the adult protection unit. Day to day maintenance of the home must be maintained. Information must be obtained about the employment history of new staff prior to appointment. The fire risk assessment must be reviewed and checks carried out on portable appliances. Please contact the provider for advice of actions taken in response to this Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 8 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.V326373.R01.S.doc Version 5.2 Page 9 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): 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People wishing to move into the home have access to information about the services they can expect to receive enabling them to make an informed choice about whether they would like to live there. Issuing people living at the home with a statement of terms and conditions will ensure that they are aware of the services which will be provided. EVIDENCE: The home presently has one vacancy. The registered manager described the process for referral which would be offered to people wishing to move into the home. The organisation has a comprehensive admissions policy and procedure which includes their own assessment process. One person has shown initial interest and had visited the home. An inter-disciplinary meeting has been held to discuss the changing needs of one person living at the home which came to the conclusion that the person will remain at the home. A considerable improvement was noted in their circumstances since the last inspection, staff confirming that their concerns had significantly reduced. The person was observed interacting positively with Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 10 staff and other people living at the home. Comments from the placing authority indicated that they are happy with the care being provided. People living at the home do not have a statement of terms and conditions in place. The group manager said that these would be put in place. These must comply with Regulation 5(1)(b) and (c) and follow the recommendations of Standard 5.2. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A person centred approach to care planning is being introduced which will enable people living at the home to express their wishes and aspirations. Any limitations on the rights of freedom or choice are negotiated with people living at the home, or their representatives, promoting their best interests. Risk assessments encourage and support people living at the home to challenge and deal with problem areas in their lives. EVIDENCE: Three people were case tracked as part of the inspection process. This involved observing the care they were receiving, talking to them and to staff about their care needs and looking at their rooms. The registered manager explained that having received training in person centred planning he and the staff team are in the process of implementing this Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 12 system at the home. An example of a PATH (Planning Alternative Tomorrows with Hope) was available which indicated the hopes and aspirations of a person living at the home using a mixture of text, symbol and picture. This will then be translated into a person centred plan. The registered manager is hoping to schedule a PATH each month enabling each person to have a person centred plan in the next year. This is good practice. Each person has a main file which contains key assessments and care plans with copies of reviews from their placing authority. They also have support guidelines which provide copies of current care plans, risk assessments and reactive strategies. Some of these records are due for an annual review. The registered manager confirmed that these are scheduled for review in January. In addition to care plans, staff use a variety of monitoring forms providing information about weight, behaviour, activities and appointments. Daily communication books are also in use. The home has regular contact with members of the local Community Learning Disability Team who provide support in the management of people’s behaviours. Concerns were expressed by one healthcare professional that the home has not been implementing recommendations from their guidelines. Discussions with the registered manager and group manager confirmed that the home are implementing these recommendations. They acknowledge that the pace for change is slow as dictated by the ability and capacity of staff to implement these. Senior staff have just completed training in Applied Behavioural Analysis which they will cascade to staff. Records were available to verify that some of the recommendations have been put in place. Staff confirmed their understanding of some of the recommendations. For instance one procedure gives staff guidelines about interactions with a person who may become angry. To remember the method staff are given an acronym to remember the steps in the process. The registered manager said that the home would continue to work with the Community Learning Disability Team to implement their recommendations. This will be monitored at future inspections. There are some restrictions in place for some people living at the home. There was evidence of discussion in an inter-disciplinary forum and agreement by all present for restrictions on one person. These are in place in their best interests. People living at the home were observed being given the opportunity to make choices and decisions about activities of daily living. For instance one person wanted to purchase some new clothes and was given several options of when they could go and with whom. People were observed choosing when to have meals or snacks and how to spend their time. Staff assistance was available if needed. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 13 People are supported to manage their personal finances. Bank statements confirmed amounts are withdrawn at regular intervals and could be crossreferenced with financial records maintained in the home. Satisfactory systems are in place to monitor expenditure. The registered manager makes regular audits of the records. People were observed having access to their money when they needed it. Risk assessments are in place as developed by a psychologist employed by the organisation. Those examined were satisfactory although they are in need of review. The registered manager confirmed that these were due for review with the care plans. A risk assessment has been put in place for a person who has epilepsy meeting a requirement of the previous report. A missing person’s file is now in place for people at risk of leaving the home without staff supervision or becoming separated from staff whilst out in the community. Staff confirmed that they know where this file is kept. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 14 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 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home have access to a range of local community facilities and activities providing opportunities for them to be involved in their local community and lead active lifestyles. Staff enable people living at the home to participate in activities of daily living promoting independence and choice. Relationships with family and friends are developed and maintained with the help of staff. The variety of meals provided reflects the cultural backgrounds of people living at the home. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 15 EVIDENCE: People living at the home have individual activities schedules. Their daily diaries confirm whether or not they have chosen to take part in these. If a person chooses not to do an activity then this is noted in their diary. One person discussed their wish to go to college to do a catering course. Staff confirmed that they have approached the college to arrange this. Other people attend the local college on a regular basis. People were observed doing tasks around the home such as cleaning, washing vehicles and feeding the rabbits. They said they enjoy doing their jobs. The home gives them a small payment for the completion of such tasks. People living at the home said that they go to social clubs regularly where they get the opportunity to meet with friends. They were observed making arrangements with staff to keep in contact with friends and girlfriends using the internet, text messaging and meeting in local pubs. People are also supported to maintain contact with their family. One person is often taken to London. A record of contact with family and friends is kept in their files. People’s daily routines are very flexible. They decide when to get up and go to bed according to their daily commitments. People were observed choosing where to spend their time and with whom. People living in the bungalow spend time in the main house using the internet and preparing meals. They were also observed spending time in the bungalow listening to music or the radio. One person from the main house likes to watch the television in the lounge in the bungalow. Some people have put notices on their rooms to ask people to keep out of them. The registered manager confirmed that everyone has a key to their room although they do not all choose to use them. Some rooms were locked during the visits. People were observed helping around the home and gardens. Two people have pet rabbits which they are responsible for looking after. One person said they love looking after their rabbit. People were observed helping themselves to snacks, drinks and meals throughout the visits. Some people like to prepare their own meals and snacks and others have a meal prepared by staff. The main meals were freshly prepared for lunch time and over the two days offered people curry, beef in black bean sauce and fish and chips, with alternatives should they wish them. Meals reflect the cultural backgrounds of people living at the home providing a diverse range of choice. Fresh vegetables and fruit are available. People said Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 16 they enjoyed their meals. Menus are displayed in the kitchen and each individual’s choice of meal is recorded in their daily diary. The registered manager confirmed that the kitchen in the bungalow is due to for refurbishment enabling the people living there to prepare their own meals and snacks. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 17 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 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home receive personal support in the way they prefer and require which acknowledges their individual needs and cultural background. Improvements in record keeping for healthcare appointments will ensure that people’s healthcare needs are being monitored and met. There are safe arrangements for the handling of medicines which help to protect the health and well being of service users where medicine are used. Updating of some staff training about medicines is needed. EVIDENCE: Care plans identify the way in which people would like to be supported with their personal and healthcare needs. The majority of people living at the home are male. Care plans indicate a preference for support from female staff for females living at the home. Observations during the visits confirmed that staff ensure that this is made available. The staff team confirmed that there is always at least one female member of staff on each shift. People of Caribbean descent have access to specialist hairdressers and skin products. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 18 As mentioned concerns have been expressed by healthcare professionals from the local Community Learning Disability Team about the consistency and continuity of approach with several people living at the home. Their recommendations should be implemented. This will be monitored at future inspections. Healthcare appointments are recorded in the house diary and a record completed once the appointment is attended. Healthcare appointments on individual files are not being kept up to date. This was noted at the last inspection. This should be done so that staff can monitor when appointments are due. It appears that one person has not had a dentist appointment for over 12 months. The deputy manager said that an appointment would be arranged. The diary evidenced that some people are having access to dental appointments. A check must be made to assess whether all people living at the home are having regular dental appointments and ensuring that these are arranged. The progress of the health action plans that are being introduced was not monitored at this inspection. Pharmacist inspector – medication: There are correct arrangements for making records about the medicines used in the home. Checks showed that medicine records are kept properly and it is clear what medicines are given to service users. The quantities of medicines received are written on the charts so the home knows what medicines have come into stock. Where medicines remain at the end of the month and are carried forward on to the next chart this needs to be quite clear so that it does not look as though extra tablets have come into the home. There are protocols in place describing how to use those medicines prescribed ‘as required’. One protocol is needed for one person prescribed a liquid laxative ‘as required’. The pharmacy provides printed charts each month on which to record the medicines administered. Where staff have to make handwritten entries these are signed and checked. It is important to make sure the medicine is always fully defined – for example ‘paracetamol tablets 500mg’. Some doses of paracetamol were recorded as ‘2 x 1000mg’. Staff said that 2 x 500mg are given – a total of 1000mg. Arrangements for medicines when service users go away from the home were discussed. The original medicine administration charts must be kept in the home, as these are important legal records. The quantity of medicines sent out and subsequently returned should be recorded as part of the audit trail. A photocopy of the sheet could be used to send out if needed. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 19 The record book for medicines returned to the pharmacy was not available during the inspection (it was still at the pharmacy) so it was not possible to confirm the return of two medicines as part of the audit checks of these particular medicines. The deputy manager promised to send us a copy of this record when it is returned from the pharmacy. Service users have signed to consent to staff giving them their medicines. They either come to the office to take their medicines or medicines are put in a cup and staff take this to service users one at a time. This is a small home but care is still needed to have safe practices and be aware of the risks of having tablets in unlabelled containers. The medicine chart must only be signed when the medicine is actually swallowed. Checks were made on some of the medicines in stock and were correct apart from not being able to confirm on the return of two medicines to the pharmacy recently (see above). It is better if the date when medicine packs are first opened to use is written on the pack rather than the date received – this makes audit checks easier and clearer. There is a comprehensive medication policy kept with the medicine charts and so available to all staff. This was updated 1/12/05 with due for review 1/12/06. There is a list of staff who deal with medicines and examples of their signatures so it is possible to confirm who has signed medicine records. Staff said that training in medicines consists of attending training from the pharmacy about the medicine system used and in-house competence assessment. Some staff attended the pharmacy training in 2003. Records for in house assessments could not all be found. The deputy manager has a certificate of training (2005) from a local college for ‘Medicines – Principles of Administration and Handling’. Training about safe handling of medicines must be kept up to date. CSCI has published guidance about this on our website. There are recent information leaflets and a reference book available for staff and service users about the medicines that are used. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 20 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 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home feel confident to use the complaints procedure in the knowledge that their views are being listened to and acted upon. There are vulnerable adults procedures in place, although training for staff could be more robust to ensure the protection of people living at the home. EVIDENCE: Since the last inspection changes have been put in place to the complaints procedure. A new complaints form is being used by the home for the recording of complaints which indicates the outcome and action taken as a result of the concern or complaint. Further investigations were completed into the complaint highlighted at the last inspection to the satisfaction of the Commission. Changes were made to practice and guidelines have been put in place for staff as a result clearly explaining their responsibilities. Discussions with staff confirmed their understanding of these procedures. Since the last inspection seven complaints were received from people living at the home. Action taken was recorded in some instances but not all. It was possible to track a complaint made at a house meeting by a person living at the home through to completion of a complaint form and to its outcome. People said that they would complain to staff or the manager. This is a significant improvement. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 21 Since the last inspection there has been a considerable fall in the use of physical intervention and punitive measures in the home. Staff confirmed that physical intervention is rarely used, only as a last resort in favour of diversion and diffusion. Staff said that they attend training in MORE (Management of Response to Emotion) with annual refresher training being provided. This is major progress. Behaviour observation charts are maintained and confirmed that physical intervention is rarely used. The training database indicates that a significant number of staff have still to attend training in the protection of vulnerable adults. The registered manager confirmed he had attended enhanced training provided by the local adult protection unit. All staff must receive training in the safeguarding of vulnerable adults. Referrals to the adult protection unit have been made by other healthcare professionals and are monitored by placing authorities for out of county placements. Providing training to all staff may improve their understanding of when incidents should be referred to the unit. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 22 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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a homely and comfortable environment that needs considerable maintenance to conserve a good standard of accommodation. Infection control training will ensure staff have the necessary knowledge to prevent risks to the health of people living at the home. EVIDENCE: Sunnyside House consists of the main house, a bungalow and large grounds with a variety of sheds. The main house is due for redecoration and refurbishment. The kitchen has been renovated with a range of new fixtures and fittings and creating a safer environment in which to prepare and cook meals. The lounge is due to be redecorated and new carpets and suites provided. People living at the home confirmed that they are being involved in the choice of colour scheme. There are also plans to refurbish the kitchen in the bungalow. Ongoing problems with the decoration of a bedroom in the Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 23 bungalow are dealt with on a regular basis. Staff were observed supporting a person to choose paint to redecorate their room. There is a new maintenance system in place for reporting and dealing with day-to-day repairs. This has not gone smoothly but the registered manager was hopeful that any issues would be resolved. It is important that a reliable maintenance system is in place. The rooms of people being case tracked were examined and all communal areas and bathrooms. The following issues were identified: • The flooring in the hallway of the main house, bungalow and bathroom on the first floor is bubbling in places and is not sealed at the edges. This has been outstanding since the last inspection. The registered manager confirmed during the site visits that this would be dealt with in January 2007. There is a large hole in the ceiling of the entrance hall in the main house due to problems in the first floor bathroom. This needs to be resolved. Handles are missing on windows in the lounge in the bungalow. A shed in the garden is partially demolished. This needs to be made safe. • • • At the time of the visits the home was clean and tidy. Staff are due to attend infection control training in line with requirements from the last inspection. Personal protective equipment is provided. COSHH data sheets are in place and hazardous products are being stored securely. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A period of stability within the staff group has improved morale within the teams and is providing greater consistency and continuity of care to the people living at the home. The standard of vetting and recruitment practices has improved slightly but need to be more robust to protect people living at the home from harm. The staff team have access to regular training enabling them to acquire the knowledge and skills to meet the needs of people living at the home. Staff are benefiting from regular supervision which is improving communication and moral. EVIDENCE: The group manager commented that the staff team at Sunnyside has been stable for some time now and that they have a good absence record with minimal sickness. Moral appeared to have improved since the last inspection. Staff spoken with were positive about their roles and the support they receive Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 25 from each other. They have a good understanding of the care needs of the people they support. Staff confirmed that they complete the Learning Disability Award Framework prior to registering for NVQ Awards. Fifty per cent of staff either have or are working towards their awards. The home presently has one vacancy and shifts run with a minimum of 4 but usually 5 increasing to 6 at times. The deputy manager occasionally works as part of this shift pattern but is often supernumerary. Two new staff have been appointed since the last inspection. Induction is provided for new staff alongside completion of the Learning Disability Award Framework Induction programme. Their files confirmed that references are obtained prior to starting their employment. Checks are also made to ensure the authenticity of references. Difficulties obtaining references for one person were referred to the Commission at the time and full records have been kept in the home. This is good practice. The registered manager must make sure that where there are gaps in the employment history these are recorded with the application form. He said he had queried the employment history at interview. He must also obtain the written reason for leaving former care positions wherever practicable. Two types of reference request are being used and one does not ask this question. Criminal Records Bureau checks were available for examination on the second day of the visit. Checks are also being redone for staff employed over three years. This is good practice. A training matrix was made available during the visit that confirms staff have access to a variety of training. Those spoken with said that all mandatory training is provided in addition to some training specific to the needs of people living at the home such as mental health awareness. Copies of certificates are kept on their files. Previous inspections have highlighted concerns about the quality and availability of supervision sessions. There was evidence that staff have received supervision sessions in October and November and that the organisation’s standard supervision form is being used. Each person has a supervision contract in place. Staff meetings are also being held regularly. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 26 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 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Since the last inspection there has been an improvement in key management tasks that has benefited both staff and people living at the home. The home’s quality assurance programme involves people living at the home in the review of services being provided. Further improvements to health and safety systems will enable the home to provide an environment that promotes the welfare and safety of people living there. EVIDENCE: The registered manager has considerable experience in the field of learning disability. He is maintaining his professional development completing training Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 27 in the protection of vulnerable adults and Applied Behaviour Analysis. Concerns about key management tasks identified at the last inspection such as investigating complaints, supervision of staff and maintaining staffing levels have been resolved and actioned satisfactorily. Staff indicated that he is accessible and has a hands on approach to his work. Since the last inspection a quality assurance audit has been completed involving people living at the home and other people involved in their care. The group manager confirmed that a development plan is being produced as a result of this audit and should be available in February. Regular unannounced visits take place to the home and copies of this report are forwarded to the Commission. Systems are in place for the monitoring of health and safety. Some key tasks are delegated to staff who have received the necessary training. During the visit it was noted that Portable Appliance Tests were overdue. These must be completed. Fire records confirmed that regular tests and servicing are completed. The fire risk assessment must be reviewed. Records confirm how often staff receive fire training. Records are in place to monitor food hygiene and good practice was noted during the visits. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 28 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 3 X X 2 X Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 29 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 YA5 Regulation 5(1)(b)(c) Requirement Timescale for action 30/04/07 2. YA19 3. YA23 The registered person shall produce a written guide to the care home which shall include – (b) the terms and conditions in respect of accommodation to be provided for service users including as to the amount and method of payment of fees (c) a standard form of contract for the provision of services and facilities by the registered provider to service users. 13(1)(b) The registered person shall make arrangements for service users to receive where necessary, treatment, advice and other services from any healthcare professional. This is with regard to regular check ups with a dentist. 18(1)(c)(i) The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they perform. This is with regard to DS0000055006.V326373.R01.S.doc 31/01/07 31/05/07 Sunnyside House Version 5.2 Page 30 4. YA24 23(2)(b) 5. YA30 18(1)(a) 6. YA34 17 and 19 training in the safeguarding of vulnerable adults. The registered person shall 31/05/07 having regard to the number and needs of the service users ensure that the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally. This is with regard to day to day maintenance and issues noted in the text. The registered person must 31/03/07 ensure that at all times suitably qualified, competent and experienced staff are working at the care home in appropriate numbers. This is with regard to infection control. (Timescale of 31/07/06 not met although this is being scheduled for later in the year). The registered person shall 31/03/07 ensure that subject to paragraphs (6)(8) and (9) he has obtained in respect of that person the information and documents specified in paragraphs 1 to 9 Schedule 2. With regard to a full employment history and the written reason for leaving former positions in care wherever practicable. (Timescales of 31/12/05 and 30/09/06 not met) The registered person shall ensure that all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. This is with regard to reviewing the fire risk assessment and ensuring that portable appliance tests are completed. 7. YA42 13(4) 31/03/07 Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 31 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. 3. 4. Refer to Standard YA18 YA19 YA20 YA20 Good Practice Recommendations Recommendations of the Community Learning Disability Team should be implemented as per their action plans. A record of healthcare appointments should be maintained. Update the training and assessments of staff competence in handling medicines and keep full records of this. Revise the arrangements for recording medicines during periods of leave away from the home as outlined in the report. Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Sunnyside House DS0000055006.V326373.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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