Inspection on 04/07/06 for Sunnyside House

This inspection was carried out on 4th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 15 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 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 July 2006 10:00 Sunnyside House DS0000055006.V303211.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.V303211.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.V303211.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.V303211.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 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 Service User Guide are kept in the office. Sunnyside House DS0000055006.V303211.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 July 2006 and included a site visit to the home by two inspectors on 4th July. A pre-inspection questionnaire was provided prior to the visit. The registered manager was absent during the site visit, but the deputy manager and quality assurance manager were in attendance. People living at the home were spoken to and their care was observed. Discussions took place with four members of staff about the care they are providing. A range of records were examined including service user plans, staff files, health and safety records and quality assurance information. What the service does well: What has improved since the last inspection? What they could do better: Information about the services the home provides need to be accessible to people living at the home and their representatives. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 6 Discrepancies in the administration of medication need to be investigated. It is not sufficient to identify that an error has occurred without finding out the reason for this error. Action must then be taken to address this error. A decision needs to be made in a multi disciplinary forum whether the needs of one person can continue to be met by the home. Staffing levels need to be maintained to make sure that the needs of people living at the home are met and people are not put at risk of harm. The supervision of and support for staff needs to be improved to build up morale and promote positive communication. 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.V303211.R01.S.doc Version 5.2 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.V303211.R01.S.doc Version 5.2 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): 1, 2 and 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information about the home needs to be readily available providing access to people living at the home and their representatives. The changing needs of people living at the home are being monitored but the home is failing to take action or make decisions about whether they are able to continue to provide a service for people whose needs they can no longer meet. EVIDENCE: The Statement of Purpose and Service User Guide must be accessible to service users and visitors. There have been no new admissions to the home since the last inspection. There is one vacancy but no applications are being processed at present. The home has an admissions policy and procedure in place that would include a full assessment of the needs of the person wishing to live there. A requirement of previous inspections has been to put in place a crisis management plan for one service user whose needs are changing. A plan was examined which indicated to staff what they should do at times of crisis but there was no reference in this plan to what a crisis may be and what possible triggers the staff should look for. Discussions with managers, staff, and examination of records as well as observation of the service user indicate that Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 9 the health and wellbeing of this person have deteriorated dramatically over the past six months. Referrals to their doctor and a consultant psychiatrist have been made. A letter from a healthcare professional stated that their needs are not being met by the home and that a more specialist service is required. The managers have arranged two meetings with the placing authority to discuss this situation but both have been cancelled. A meeting must be rearranged as a matter of urgency. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 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): 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care planning in the home is satisfactory promoting the development of skills and independence. People living at the home are provided with support to make decisions about their lifestyles. Risk assessments encourage and support people living at the home to challenge and deal with the majority of problem areas in their lives. EVIDENCE: The care for three people living at the home was case tracked. This involved talking to them, reading their service user plans, discussing their care with staff and observing them during the visit. A range of care plans were in place that are reviewed annually. There was evidence that an annual review is held which may occasionally involve representation from the placing authority. Each care plan has a comments section for staff monitoring the progress or changes to identified needs but in many cases these were not being completed. One care plan indicated that staff had successfully used activity Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 11 sequencing to support a person to go to a garden centre. Discussions with the managers confirmed that they have identified this as a training need. There was no evidence that care plans are being monitored other than annually. Communication guidelines produced by a psychologist were reflected in the care plan and staff were observed following these during the site visit. Daily notes are kept for each person and these confirm their daily activities, appointments and meals provided. People living at the home were observed being supported to make decisions about their daily lives. One person who rarely goes out expressed a wish to go to the local pub and was supported to do this. They said they really enjoyed the outing. Any restrictions are recorded in care plans and people living at the home have signed consent forms where appropriate. One person explained why they have no mirrors in their room. This was detailed in their care plan. Staff discussed their understanding of the reasons for this. Staff were observed dealing with personal finances during the site visit. Receipts are kept for all purchases. These were examined in full at the previous inspection and no concerns were noted. There is close working with the local Community Learning Disability Team who provide support to people living at the home and training to staff where needed. For instance a letter from a consultant psychiatrist and a follow up visit from a member of the team indicated that a risk assessment must be put in place for people with epilepsy. This has not yet been done. The deputy manager stated that a member of the team would be visiting the home to help staff to develop this. A Psychologist working for the organisation has completed risk assessments. Those examined were in date and identified hazards indicated in the care plans. A service user recently left the home during the night. This incident was discussed with the managers. A protocol was immediately put in place to provide staff with guidelines about their responsibilities, although this had not been dated or signed. (This was also reflected on other records in service users’ files. It is recommended that all records should be signed and dated). A missing person’s procedure on the service user’s file however was out of date, having been superseded by a new procedure. This was replaced during the inspection and staff asked to read the new procedure. The missing person’s file could not been easily found and information was out of date. This information needs to be reviewed and staff should know where to find this file. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 12 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): 12,13,15,16 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. Contact with family and friends is encouraged and supported. People living at the home are encouraged to maintain a healthy diet by giving them informed choice about the options available. EVIDENCE: Each person has a schedule of activities on their files. Daily diaries confirm whether or not these have been completed. Staff indicated that some people may refuse to participate in activities and this is then recorded. During the visit a group of people went to a local town for lunch and to sit by the river. People also attend a local college and social clubs. One person enjoys walks and visiting a garden centre. Another person said that they occasionally get bored when they do not have planned activities out of the home. One person Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 13 walked to the local pub on the day of the visit and others said they enjoy going to the pub. Aromatherapy is also provided regularly at the home. A number of animals and birds are kept at the home and people living there said that they help look after them. Daily diaries confirm visits to family and friends. One person said they are visiting friends and family in London. Others also keep in touch using the telephone. Contacts are listed in service user’s files. Daily routines are flexible. On the day of the visit several people chose to get up mid morning. Daily diaries and care plans confirm when people like to go to bed late. People were observed choosing where to spend their time and with whom. For those wishing to have company most people appeared to congregate in the dining room but others were observed in their rooms or in the large grounds. Menus are displayed in the kitchen and offer an alternative to the main meal. A selection of freshly produced food using fresh vegetables and meat is available as well as a selection of frozen food. Staff described how they monitor the diet of people considered to be of concern and how they encourage a healthy diet where possible. On the day of the visit people had sandwiches for lunch and a takeaway meal of fish and chips in the evening. A favourite of most people is the Sunday lunch. People were observed helping themselves to drinks and snacks throughout the day. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 14 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): 18,19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The way in which the people living at the home would like to be supported is clearly recorded providing staff with the information they need to meet their needs. People living at the home have access to a range of healthcare professionals. Improvements in record keeping would provide evidence of these appointments. There are serious concerns about the systems for the administration and control of medication. Improvements must be put in place to ensure that people living at the home are not put at risk. EVIDENCE: The way in which people wish to be supported with their personal and healthcare needs are identified in their care plans. There is one female living at the home and there was good evidence in the care plans of the ways in which she would like to be supported with her personal care. She confirmed that staff provide the help she requires. Discussion with staff verified their understanding of her needs. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 15 The managers confirmed that people living at the home have regular access to a range of healthcare appointments. This was confirmed by entries in daily diaries and by staff. Healthcare records are in place on individual files although these are not being kept up to date with current appointments. This should be done. Health action plans are being developed with people living at the home. This is to be commended. The deputy manager said that the home works closely with the local Community Learning Disability Team and the organisation’s psychologists. Records on files confirm regular visits to the home. Staff confirmed that they have access to visiting professionals when they visit. As mentioned the health and well being of one person is causing concern for staff and management. It was evident from records examined and discussions with staff that referrals have been made for medical and psychiatric investigations. At present there are no concerns about the physical health of this person. Further action needs to be taken as a matter of urgency to identify and support this person through this present crisis. Staff indicated that it could be due to bereavement earlier this year. (See also Standard 3). Observation of medication being administered during the visit was satisfactory. Since the last inspection the list has been updated of staff competent to administer medication. Staff confirmed that they attend training in the safe handling of medication, the monitored dosage system and also have an annual assessment with the organisation. Most of the handwritten entries on the medication administration charts are signed by the member of staff making the entry. One entry for a homely remedy had not been signed. It is recommended that another member of staff countersign these entries where possible. A system has been put in place to monitor discrepancies in the administration record in response to a requirement issued at the last inspection. An audit for June 2nd identified that there had been discrepancies in the levels of stock of medication for four people. It was not evident what action had been taken as a result of this audit. Medication administration records for the same period also indicated gaps in administration for one person. There was no audit trail to explain these gaps. A team leader said that usually where a medication is not signed for the team leader on the following shift would ascertain whether or not the medication had been given. A system needs to be put in place that not only audits medication administration but also provides evidence of the action taken. It is also suggested that handover includes feedback about medication administration for that shift identifying any refusals of medication or problems in administration. The registered manager is reminded that medication errors must be notified to the Commission under Regulation 37. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 16 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Major changes need to be implemented to the way in which complaints are investigated to ensure that people living at the home are safeguarded from possible abuse. EVIDENCE: The home has received six complaints over the past twelve months, four of these since the last inspection. Records of the four complaints were inspected. Of these three were straightforward and action taken was recorded. The fourth complaint involved a person who had earlier been involved in another incident involving three people living at the home and two members of staff. The Commission had been informed about this incident. The original complaint was dealt with and action taken as a result. A further investigation was necessary into the incident that had occurred previously. There were concerns that physical intervention had been used inappropriately causing bruising to this person. Interviews were conducted with staff and then a conclusion was reached upon this evidence. From reading through the statements there appear to be several issues in the staff statements that were not questioned or addressed: • • • Staff practice was not questioned or dealt with at the time of the incident other service users had to use physical intervention to prevent themselves being hurt – this was not explored further or commented on staff talk about keeping a door closed and keeping a person in their room – again this was not explored or investigated DS0000055006.V303211.R01.S.doc Version 5.2 Page 17 Sunnyside House • staff indicate that ‘arm locks’ were used – this needed further clarification. Discussions with managers confirmed that on the day of this incident the staffing level had fallen below the 5 people needed on shift to 4. (See also Standard 33) When the incident occurred staff had not been able to call the home for additional support because this would have left unsafe staffing levels at the home. This was not mentioned in the summary of the investigation. The conclusion indicated that ‘the use of physical intervention was appropriate and that injuries caused by other service users were unintentional whilst protecting themselves.’ There appeared to be no assessment of cause and effect or consideration of any practice issues that might have arisen as a result of this incident. The details of the incident infer that service users were put into a situation where they had to defend themselves from harm. There do not appear to be any changes to practice or guidance for staff to prevent this from happening again. This is not acceptable. These issues must be clarified and the outcome forwarded to the Commission. Discussions with management confirmed that as an organisation they are talking about how they could manage investigations more effectively and that one way would be to appoint a senior manager to consider the information gathered during an investigation. They also thought that it might be beneficial for a manager of another service to investigate incidents or complaints. The organisation is urged to do this. The organisation may also wish to revisit their complaints procedure in light of this. Staff confirmed that they are attending training in the protection of vulnerable adults from a variety of sources including completion of Learning Disability Award Framework, NVQ and from the adult protection team. Staff receive training in the use of diversion, de-escalation and distraction as well as the use of physical intervention. The use of physical intervention is recorded and the Commission receives notification under Regulation 37. Discussions with staff indicated that they reflect upon the use of physical intervention and try to minimise its use. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 18 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is homely and comfortably furnished. There is an ongoing maintenance programme in place to deal with day-to-day issues. Refurbishment of the kitchen is required to ensure that it provides a safe environment for people living at the home. Infection control measures need to be improved to ensure that the health of people living at the home is not put at risk. EVIDENCE: A walk around the environment of the main house and the bungalow confirmed that both are in need of some redecoration despite recent refurbishment in areas of the bungalow. 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 and the bungalow is bubbling in places and is not sealed at the edges. This will become a health and safety concern if not dealt with DS0000055006.V303211.R01.S.doc Version 5.2 Page 19 Sunnyside House • • • • • the kitchen in the main house is due for refurbishment – a door and a drawer are missing. An action plan needs to be forwarded to the Commission detailing timescales for refurbishment of this area and the laundry the bin in the kitchen has no lid there was a lack of soap and paper towels in many of the toilets and bathrooms the shower curtain in the shower in the bungalow needs cleaning or replacing checks must be carried out on the condition of pillows and duvets. Those that cannot be cleaned must be replaced. The deputy manager confirmed that lights in both properties are being replaced with integral light fittings. She was reminded that the light needs to be checked in bedrooms to ensure that sufficient light is provided. One of the bedrooms with a new light fitting appeared to be rather dark. At the time of the inspection the home was clean and tidy. Staff are supplied with personal protective equipment and attend training in infection control. A member of staff was noticed wearing the same apron and gloves throughout the course of the visit. This was discussed with the deputy manager who agreed to revisit infection control procedures with staff. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 20 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): 32,33,34, 35 and 36.. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff have access to a range of training providing them with the knowledge and skills to meet the needs of people at the home. Staffing levels need to be maintained to ensure the needs of people living at the home can be met. The levels of support and supervision of staff need to perform their jobs is affecting the quality of care provided in the home. EVIDENCE: Observations of staff during the visit confirmed that they are accessible and approachable. People living at the home said that they like staff. Staff have a mixture of skills, knowledge and experience, some having worked in the care field for a substantial period of time. Staff confirmed access to a NVQ programme and one person said they would be completing their award whilst another had just registered. Staff spoken with had a good understanding of the needs of the people they support. Rotas confirmed that 5 members of staff are scheduled to work each shift with 2 members of staff covering overnight. Staff indicated that as regularly as once a week this falls below 5 to 4 due to sickness when cover cannot be Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 21 found. The deputy manager confirmed this. Discussions centred on the availability of cover. Staff contact other homes in the group, off duty staff or staff working other shifts. The organisation formerly had a bank of relief staff and used agency staff to cover shifts. They must consider what contingency plans they will put in place to ensure that staffing levels do not fall below 5 on a regular basis. The registered manager is reminded that under Regulation 37 if staffing levels fall below the scheduled levels they must notify the Commission. It was also noted from staff files, that two of the people employed to work waking nights are under 21. Standard 33.10 states that ‘staff left in charge of the home are at least age 21’. The managers immediately took action to correct this. No new staff have been appointed to the home since the last inspection. The requirement in relation to recruitment and selection therefore stands until further appointments are made. The managers confirmed that a new induction programme is being introduced and that all staff will have access to this. A training matrix indicated what courses staff have attended and certificates confirmed their attendance. Staff confirmed they had access to training in mental health awareness although some commented this had been a very brief introduction. Some staff spoke positively about training that had been provided by the Community Learning Disability Team focussing on the needs of one person living at the home. Concerns in the past have focussed on the quality and availability of supervision sessions for staff. The deputy manager indicated that monthly supervision is aimed for but the schedule showed that there are inconsistencies in the frequency of supervision ranging from every two months to every three months. This needs to be monitored. The quality of supervision records is also inconsistent. Some people use the organisation’s pro forma for supervision but there was evidence that others do not. Staff indicated that they do not always get feedback about action taken on issues they have identified and if they do get feedback it is usually two or three months later at the next supervision. Management should aim to provide regular supervision for staff. Staff spoken with indicated that morale within the staff team is low and that they feel communication within the home is poor. Management confirmed that they are aware of these issues. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 22 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager needs to develop key managerial tasks and provide guidance to staff to ensure service users receive consistent quality of care. People living at the home need to feel confident that their views underpin the quality assurance system. Systems are in place checking that the home provides an environment which promotes the welfare and safety of people. EVIDENCE: At the time of the inspection the registered manager was absent from the home due to sickness. Since the last inspection the manager has been confirmed as the registered manager. Key management tasks such as investigating complaints, ensuring sufficient staff are on duty and providing satisfactory supervision of staff have been highlighted during this visit as requiring further action. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 23 The Quality Assurance Manager was present during the site visit. She confirmed that she completes unannounced Regulation 26 visits to the home and supplies copies to the Commission. She was informed about changes to the Regulations as from 1st July in relation to the need to produce an evaluation of the quality assurance systems in place for the home. Surveys of people living at the home were last completed in 2004 and these will need to be repeated to be included in this report. She confirmed that other departments within the organisation complete annual audits at the home and that she envisages that they will be part of an annual report. Health and safety monitoring systems are in place. The pre-inspection questionnaire confirmed that regular servicing and testing takes place. Records examined during the visit confirmed this. The registered manager must review the fire risk assessment to include reference to the frequency of fire equipment testing, fire drills and fire training. Fire alarm tests are not being carried out weekly which is the organisation’s suggested frequency. Good food hygiene practices were observed in the kitchen with cooked food temperatures being recorded and food labelled correctly in the fridges. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 1 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 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 1 X 2 X 2 X X 2 X Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 25 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 YA1 Regulation 4(2) 5(2) Requirement The registered person must ensure that copies of the Statement of Purpose and Service User Guide are available for inspection by service users and their representatives. Service users must have a copy of their service user guide. The registered person must 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. (Timescales of 31/12/05 and 31/03/06 not met.) 3. YA3 15(2) The registered person must ensure that a reassessment of need of the service user indicated in the standard is completed to verify whether the home can continue to meet their needs. The registered person must ensure that a risk assessment is completed for service users with epilepsy in relation to bathing and nighttime support. DS0000055006.V303211.R01.S.doc Timescale for action 30/09/06 2. YA3 14 and 13(6) 31/07/06 31/07/06 4. YA9 13(4)(c) 31/08/06 Sunnyside House Version 5.2 Page 26 5. YA9 17(2) 6. YA20 13(2) 7. 8. YA22 YA22 13(7) 22(8) 9. YA22 22(1)(3) 10. YA24 23(2) The registered person must ensure that the new missing person’s procedure must be accessible and brought to the attention of staff. The registered person must ensure that an effective system for monitoring administration of medicines is in place to audit any errors and discrepancies and address as necessary. Action taken must be recorded. (Timescale of 28/02/06 partially met) The registered person must ensure that physical restraint is not used inappropriately. The registered person must supply with Commission with a summary of the action taken as a result of issues outstanding from the investigation detailed in the standard. The registered person must review the complaints procedure and ensure that complaints are fully investigated and inform the person of action taken. The registered person must ensure that issues indicated in the standard are actioned. 31/07/06 31/07/06 31/07/06 31/07/06 31/07/06 31/08/06 11. YA30 12. YA33 An action plan must be forwarded to the Commission indicating timescales for the refurbishment of the kitchen and laundry. 18(1)(c)(i) The registered person must ensure that staff have access to infection control training and that the implementation of this is monitored in the home. 18(1)(a) The registered person must ensure that at all times suitably qualified, competent and experienced staff are working at the care home in appropriate numbers. DS0000055006.V303211.R01.S.doc 30/09/06 31/07/06 Sunnyside House Version 5.2 Page 27 13. YA34 17 and 19 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. 30/09/06 14. YA36 18(2) 15. YA39 24(1)(2) All staff employed in the home must receive regular supervision in line with the Standard 36.4. (Timescale of 31/03/06 partially met) A system for evaluating the quality assurance system must be put in place and a report produced which must be forwarded to the Commission. 30/09/06 31/12/06 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. 2. 3. 4. Refer to Standard YA6 YA9 YA9 YA20 Good Practice Recommendations Staff should receive training on the completion of the comments section on care plans. Records should be signed and dated. The missing person’s information should be reviewed and staff should be aware of the location of this file. Hand written amendments to instructions on MAR sheets should counter signed by another member of staff. Handovers should include feedback about the administration of medication for that shift. 5. YA22 A new system of investigating and managing complaints and investigations should be put in place. The complaints procedure should be reviewed in light of any changes that may be introduced. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 28 6. 7. YA24 YA36 The new light fittings need to supply sufficient light. Quality of formal supervisions should be improved. New staff should receive more intensive supervisory support at least during the period of their induction. Sunnyside House DS0000055006.V303211.R01.S.doc Version 5.2 Page 29 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.V303211.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!